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AHCCCS DFSM Claims Clues - February 2014
Arizona Medicaid - AHCCCS·AZ · Emergency Medicine·Claims & Billing
Effective date
Apr 1, 2014
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) is cracking down on overuse of emergency department code 99285, requiring comprehensive documentation and threatening OIG referrals for improper billing. Additionally, new requirements for NEMT providers include tribal business licenses for reservation services and vehicle signage, both effective April 1, 2014.
Action Required
Immediately: Review all 99285 emergency department claims to ensure comprehensive history, comprehensive examination, and high complexity medical decision making are documented. Stop billing 99285 for routine conditions like constipation, earaches, and colds. By April 1, 2014: NEMT providers must obtain tribal business licenses before transporting patients on reservations and display company signage on vehicles. By February 1, 2014: Use only the revised NEMT trip report form that includes recipient date of birth. Failure to comply will result in claim denials and potential OIG investigation.