MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - Integration Special Edition
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Oct 1, 2018
We identified it
Jun 17, 2026
Summary
AHCCCS is integrating physical and behavioral health services under single health plans effective October 1, 2018. Most AHCCCS members will transition from separate health plans to unified coverage under AHCCCS Complete Care (ACC) or American Indian Health Program (AIHP).
Action Required
By October 1, 2018: Billing team must verify each AHCCCS member's new enrollment status before submitting claims, as members are transitioning from dual health plans to single integrated plans. Update workflows to check member eligibility online to determine correct claim submission destination (ACC plan, AIHP via DFSM, or TRBHA). For AIHP members, look for new behavioral health designation '98 AMERICAN INDIAN HLTH PLAN AIHP' in eligibility system. Claims sent to incorrect plan due to enrollment changes will be rejected.