MedicaidPrior AuthHigh impact
AHCCCS DFSM Claims Clues - May 2016
Arizona Medicaid - AHCCCS·AZ · Dentistry, Psychiatry·Claims & Billing
Effective date
Jul 1, 2016
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) has implemented three key changes: all genetic testing now requires prior authorization, TRBHA behavioral health authorization requests must be submitted directly to AHCCCS starting July 1, 2016, and dental services under deep sedation/general anesthesia will transition from prior authorization to retrospective review starting August 1, 2016.
Action Required
By July 1, 2016: Behavioral health providers must redirect all TRBHA authorization requests to AHCCCS DFSM via fax at 602-364-4697 using the FFS Authorization Request form as coversheet. By August 1, 2016: Dental providers must stop requesting prior authorization for deep sedation/general anesthesia services and instead submit claims electronically with required documentation (treatment plan, radiographs, substantiation of necessity). Ordering physicians must obtain prior authorization for all genetic testing before laboratory claims submission - failure to do so will result in claim denials.