MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - March 2016
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Mar 1, 2016
We identified it
Jun 17, 2026
Summary
AHCCCS has implemented Hospital Presumptive Eligibility (HPE) allowing qualified hospitals to temporarily enroll eligible persons for full Medicaid benefits using health plan ID 000675. All HPE claims must be submitted to AHCCCS Fee-for-Service with medical records attached, as claims without medical records will be automatically denied.
Action Required
Immediately: Billing team must verify patient eligibility online and identify HPE patients by health plan ID 000675. Submit all HPE claims to AHCCCS Fee-for-Service with complete medical records attached. Update billing workflows to ensure medical records accompany every HPE claim submission, as claims without medical records will be denied as unclean. For Federal Emergency Services claims, ensure CMS 1500 Box 24C contains 'Y' or 'X' and UB-04 forms have Admit Type '1' for emergency services.