MedicaidCoverageMedium impact
AHCCCS DFSM Claims Clues - October 2013 - Special Edition
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Jan 1, 2014
We identified it
Jun 17, 2026
Summary
Beginning January 1, 2014, AHCCCS (Arizona Medicaid) will expand coverage to include services provided up to three months prior to application date if the patient was eligible during those months. Providers must bill AHCCCS directly for prior quarter services and refund patients for any payments received during approved prior quarter periods.
Action Required
By January 1, 2014: Billing team must establish process to identify AHCCCS patients with prior quarter coverage eligibility. When notified of prior quarter approval: 1) Promptly refund patients for any payments made during approved prior quarter periods, 2) Submit claims to AHCCCS Administration (not managed care contractors) using 837 transaction, online portal, or paper forms, 3) Accept AHCCCS payment as payment in full. Front desk staff must track patient notifications of prior quarter eligibility. Failure to refund patients will result in investigation by AHCCCS Office of Inspector General.