MedicaidAdministrativeMedium impact
AHCCCS DFSM Claims Clues - February 2017
Arizona Medicaid - AHCCCS·AZ · Nephrology, Emergency Medicine·Claims & Billing
Effective date
Jan 1, 2017
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) updated guidance on overpayment handling, prior authorization processes, and claims documentation requirements. Key changes include using web portal for PA requests instead of faxing, new ESRD procedure codes effective 01/01/17, and specific documentation requirements for different claim types.
Action Required
Immediately: Update ESRD procedure billing to use new CPT codes effective 01/01/17. Switch to AHCCCS Web Portal for prior authorization submissions instead of faxing. Update billing team training on documentation requirements - ensure H&P, physician notes, labs, and imaging are submitted with initial claims. Verify member eligibility online before submitting claims to prevent denials. Do not send checks for overpayments - submit claim adjustments through the system instead.