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NEWS -- AHCCCS will delay implementation of the planned 01/01/2015 payment
process change described and discussed below. Select members and staff of the Arizona Alliance for
Community Health Centers and several AHCCCS MCOs requested that AHCCCS push back the implementation date
in order to allow additional time for systems testing and clarification of other pre-implementation
details. AHCCCS intends to implement this change no sooner than 03/01/2015. Please monitor this page
for up-to-date news.
Effective no sooner than 03/01/2015, AHCCCS and its contracted Managed Care Organizations (MCOs) will
begin paying the all-inclusive per visit PPS rate on a per claim basis, replacing the current
method of reimbursing claims by the capped fee-for-service fee schedule and annually reconciling to
the PPS rate. The method for calculating the all-inclusive per visit PPS rates will not change.
AHCCCS will continue to perform annual reimbursement reconciliations. Additionally, AHCCCS
anticipates that quarterly supplemental payments will continue, though in amounts appropriate to the
expectation that the MCOs will, in most cases, be paying the PPS rate. MCOs may continue to establish
sub-capitated reimbursement arrangements.
All questions related to FQHC/RHC reimbursements should be directed to Victoria Burns
at (602) 417-4049 or by email at
AHCCCS has established a provider type for FQHCs and FQHC Look-Alikes (C2) and a provider type for RHCs
(29). AHCCCS is requiring that all FQHCs, FQHC-LAs, and RHCs re-register under the applicable provider
types, and obtain a unique NPI, not already associated with another active AHCCCS provider ID, for each
clinic covered by the CMS FQHC, FQHC-LA, or RHC designation. The new NPIs will be used for claim submissions
beginning with dates of service on and after January 1, 2015. All provider registration forms must be
submitted by November 1, 2014.
A new NPI can be obtained here:
For questions related to provider registration, please contact Veronica Valenzuela at (602) 417-7516
or by email at Veronica.Valenzuela@azahcccs.gov.
A face-to-face encounter with a licensed AHCCCS-registered practitioner during which an AHCCCS-covered ambulatory
service is provided when that service is not incident to another service. Multiple encounters with more than one
practitioner within the same discipline, i.e., dental, physical, behavioral health, or with the same
practitioner and which take place on the same day and at a single location, constitute a single visit unless the
patient, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment.
In this circumstance, the subsequent encounter is considered a separate visit. A service which is provided
incident to another service, whether or not on the same day or at the same location, is considered to be part of
the visit and is not reimbursed separately.
Beginning 01/01/2015, all FQHC, FQHC-LA, and RHC visits must be billed using the Form 1500 or the ADA form. For
purposes of reimbursing visits beginning 01/01/2015, AHCCCS has adopted the five 'G' procedure codes recently
established by CMS for medical and behavioral health services. These procedure codes should be reported on
Form 1500 claims. Claims submitted on the ADA form for dental services will continue to use CDT codes. Claims
must include all appropriate procedure codes describing the services rendered in addition to the visit code.
A visit will be identified by, and reimbursement for the visit will be associated with, the 'G' code or the
key 'D' code; all other services reported on the claim will be bundled into the visit and valued at $0.00.
The five codes that will identify a visit on Form 1500 are:
The five codes that will identify a visit on the ADA form are:
Further billing instructions will soon be provided in the
AHCCCS Fee-For-Service Provider Manual.
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