MedicaidAdministrativeHigh impact
AHCCCS DFSM Claims Clues - IHS/638 Claim Audit Memo
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Dec 23, 2014
We identified it
Jun 17, 2026
Summary
AHCCCS Division of Fee for Service Management has identified common billing errors during recent audits of IHS/638 facilities, including improper pharmacy claims, vaccine billing, and unbundling issues. Billers must review current policies to ensure compliance and avoid audit findings.
Action Required
Immediately: Billing team must review and correct the following practices: 1) Stop submitting pharmacy claims to AHCCCS for Part D covered drugs, 2) Eliminate duplicate pharmacy claims for same date of service, 3) Review vaccine billing procedures for multiple vaccines per visit, 4) Stop billing All Inclusive Rate for non-covered services (adult dental, allergy, podiatry), 5) Correct unbundling of global delivery charges, 6) Use proper form types for radiologist reading claims, 7) Review same-day admit/discharge billing protocols. All staff must familiarize themselves with AHCCCS Medical Policy Manual, IHS/638 Provider Billing Manual, AHCCCS Telehealth Manual, and AHCCCS Behavioral Health Guide.