MedicaidCoverageHigh impact
AHCCCS DFSM Claims Clues - Respite Services AMPM 310B and 1250-D
Arizona Medicaid - AHCCCS·AZ · Psychiatry, Palliative Care, Family Medicine·Claims & Billing
Effective date
Mar 25, 2024
We identified it
Jun 17, 2026
Summary
AHCCCS clarified that Respite Services under AMPM 310B and 1250-D must provide relief to caregivers, not to the members themselves. Claims for respite services prescribed for member relaxation rather than caregiver relief will be denied reimbursement.
Action Required
Immediately: Billing team must review all pending and future Respite Services claims under AMPM 310B and 1250-D to ensure documentation shows services provide relief to caregivers, not members. Update billing system notes to flag respite claims for caregiver relief verification. Providers must revise respite service prescriptions to clearly indicate caregiver relief purpose. Claims without proper caregiver relief documentation will be denied reimbursement.