MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - March 2013
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
We identified it
Jun 17, 2026
Summary
AHCCCS (Arizona Medicaid) requires all claims to list the correct rendering provider who actually provided the care. Billing with another provider's ID number is prohibited except in approved locum tenens situations, and hospitals/clinics cannot bill using facility NPI numbers for physician/mid-level practitioner services.
Action Required
Immediately: Billing team must ensure all AHCCCS claims list the actual rendering provider who provided care. Stop billing with substitute provider ID numbers except for approved locum tenens arrangements. Physicians and mid-level practitioners must use their individual NPI numbers, not facility NPI numbers. Review current billing practices to identify violations as audits may result in claim denials, recoupments, or penalties.