MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - April 2015
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
We identified it
Jun 17, 2026
Summary
AHCCCS implemented Medically Unlikely Edits (MUEs) that will deny entire claim lines when units of service exceed maximum allowable limits for specific procedures. Claims exceeding MUE limits will be denied with edit code L207 and must be rebilled with correct units.
Action Required
Immediately: Billing team must monitor claim denials for edit code L207 indicating MUE violations. When L207 denials occur, review the units of service billed and rebill claims with appropriate UOS counts that don't exceed MUE limits. Update billing procedures to verify reasonable unit counts before claim submission to avoid denials.