MedicaidBilling CodesMedium impact
AHCCCS DFSM Claims Clues - July 2013
Arizona Medicaid - AHCCCS·AZ · Family Medicine, Internal Medicine, Pediatrics +1 more·Claims & Billing
Effective date
Jun 14, 2013
We identified it
Jun 17, 2026
Summary
AHCCCS has ended its contract with Arizona Department of Corrections (ADOC) as TPA, with all claims from June 14, 2013 onwards being forwarded to ADOC for processing. The policy also clarifies that vaccine administration codes should not be billed with E/M codes like 99211 unless there's a significant, separately identifiable service warranting modifier 25.
Action Required
Immediately: Stop billing E/M codes (especially 99211) with vaccine administration codes unless there is significant, separately identifiable evaluation and management service. When both are billed, add modifier 25 to the E/M code and ensure medical records document the medical necessity and extent of the separate E/M service. For any FY 2012 claims involving ADOC patients, submit to: Arizona Department of Corrections, 1601 West Jefferson MC 320, Phoenix, Arizona 85007, Attention: Prior Year Claims Department.