AHCCCS Claims Clues
Claims Clues is a newsletter produced periodically by the AHCCCS Claims Department for Fee-For-Service (FFS) providers. It provides information about the following:
- Changes to the program
- System changes and updates
- Billing policies and requirements
Additional information can be found in the Encounter Keys newsletter.
2019
- Pharmacy Services for AIHP Members
- Remittance Advice FAQs
- Billing the Global OB When Delivery Occurs at a Different Facility
- General Reminders
- Paper Claim Reminders
- Member Eligibility – How to Check if a Member is Designated SMI
- Are Contracts Needed for FFS Members? (No)
- Covered Behavioral Health Services Guide Transition – Important Updates
- The American Indian Health Program (AIHP) – An integration topic.
- Behavioral Health - An integration topic.
- Billing Considerations – An integration topic.
This edition of Claims Clues is dedicated to providing providers with information about Integration, which begins on 10/01/2018. It contains enrollment and billing information.
- The Future of Integrated Healthcare
- 10/1/18 Enrollment Changes for Members
- The American Indian Health Program
- Behavioral Health
- This article includes a screenshot detailing what a member's eligibility screen will look like, after 10/01/2018, if they are receiving behavioral health services through AIHP.
- Billing Considerations for:
- AIHP/AIHP-enrolled members,
- AIHP/TRBHA-enrolled members, and
- AHCCCS Complete Care (ACC) enrolled members.
- CRS Updates
- Provider Training Information
- ACC Training will be held by our Provider Training division and dates and sign-up information is included.
- Answers to the following questions:
- Are contracts needed to provide services to FFS members?
- How can I submit a claim for a FFS member?
- How can I submit a PA request for a FFS member?
2018
- Covered Behavioral Health Service Guide Transition - Important Update
- Behavioral Health Residential Facility (BHRF) Notice
- What is the difference between AIHP and IHS?
- Reminder for NEMT Providers (Registration Process of Employees)
- Direct Care Worker Agency Monitoring
- Training dates for January:
- Wednesday, January 16th
- Wednesday, January 23rd
- NEMT Reminders and Unloaded Mileage
- Privacy Rules and Continuity of Care
- Claims - How to Register as a Provider and Receive Payment for Services Rendered
- Provider Registration
- Enrolling in AHCCCS Online
- Electronic Remittance Advice (ERA/835) Setup
- Claim Submission
- Documentation Submission & Enrolling for the Transaction Insight Portal
- Payments
- Field 43 and Reporting the Medicaid Drug Rebate Data (NDC Number)
- CMS 1500 Claim Form Updates
- Updates/Clarifications on Fields 24I, 24J, 33a, and 33b
- Reminder that Fee-For-Service providers do not need to contract with AHCCCS AIHP, Tribal ALTCS, or a TRBHA to continue providing Medicaid Title XIX/XXI services to FFS members. A provider simply must be an AHCCCS registered provider. Contracts are not needed.
- Emergency Dental Services
- Request for Electronic Remittance Advice (ERA) or 835 Transaction Setup (FAQs)
- Integration Billing Information
- NEMT AHCCCS Daily Trip Report Reminders
- Pharmacy Services for AIHP Members
- Direct Care Worker Agencies
- Reminder Regarding the FFS & IHS/Tribal Provider Billing Manual Usage
- Fee-for-Service Authorization Reminders
- Crisis Services
- Crisis Hotline Phone Numbers
- Global OB Billing for IHS/638 Facilities
- October Provider Training
- Crisis Services
- AHCCCS Online Claim Disputes
- Billing Reminders for the CMS 1500 and UB-04 Claim Forms
- Paper Claim Reminders
- Acronyms
- Where to Go if You Have ACC Questions
This edition of Claims Clues is dedicated to providing providers with information about Integration, which begins on 10/01/2018. It contains enrollment and billing information.
- The Future of Integrated Healthcare
- 10/1/18 Enrollment Changes for Members
- The American Indian Health Program
- Behavioral Health
- This article includes a screenshot detailing what a member's eligibility screen will look like, after 10/01/2018, if they are receiving behavioral health services through AIHP.
- Billing Considerations for:
- AIHP/AIHP-enrolled members,
- AIHP/TRBHA-enrolled members, and
- AHCCCS Complete Care (ACC) enrolled members.
- CRS Updates
- Provider Training Information
- ACC Training will be held by our Provider Training division and dates and sign-up information is included.
- Answers to the following questions:
- Are contracts needed to provide services to FFS members?
- How can I submit a claim for a FFS member?
- How can I submit a PA request for a FFS member?
- Open House Announcement
- Direct Care Workers
- Billing Manual Purpose Reminder
- Fee for Service Authorization Reminders
- 1500 Paper Claim Forms (Box 21) ICD-10 Diagnosis Reminder
- Integration
- Ground Ambulance
- Provider Education Dates
- Non-Emergency Medical Transportation Updates
- New: Open House
- What is Integration and Who is Affected?
- Integration Billing Information
- Policies Rescinded
- Linking between AHCCCS Online and the Transaction Insight Portal
- Medical Documentation Reminders
- What is Integration and Who is Affected?
- PERM Audit - Where do you stand?
- Behavioral Health Prior Authorization Requests
- Online Prior Authorization (PA) Submission Requirements for FFS Providers Effective 07/01/2018
- Federal Emergency Service Plan (FESP) Member Prior Authorization Requirements
- Medical Authorization Reminders
- The Updated AHCCCS Daily Trip Report is Now Available
- 638 FQHCs
- Participants in the Targeted Investments Program
- Behavioral Health Prior Authorization Requests
- Online Prior Authorization (PA) Submission Requirements for FFS Providers Effective 7/1/18
- Federal Emergency Service Plan (FESP) Member Prior Authorization Requirements
- FAQ Round Up (Case Management & FQHCs; Group Therapy & FQHCS; and American Indian Medical Homes that are also an FQHC or a 638 FQHC)
- 638 FQHCs
- General Requirements for the Submission of Paper Claim Forms
- All Inclusive Rate (AIR) Provider Billing Manual Updates
- Coding Updates for Modifiers JG and TB
- AMPM 320-N - Prior Authorization Requests for Direct
- Acting Antiviral Medication Treatment for AHCCCS Members
- Age 18 Years and Older
- Occupational Therapy
- Demographic Transition Communication
- Transportation Reminders
- Medical Authorization Reminders
- Fee-For-Service Authorization Reminders
- Transportation
- Medical Authorization
- Home Health Services
- Family Planning
- Orthotics and Prosthetics
- Use of Social Determinants of Health Codes for Member Outcomes
- Billing 59 Modifier
- Inpatient Outlier Review Process
- PERM Audit: Where Do You Stand?
- Online Prior Authorization Submission–New Document Attachment Feature
2017
- Home Infusion
- Non-Physician Billing of Vaccinations & Emergency Injections
- Combatting the Opioid Use Disorder Crisis with Medication Assisted Treatment (MAT)
- Online Prior Authorization Submission–New Document Attachment Feature
- Podiatric Services
- DFSM Billing Tips
- Home Health Services
- Notification to Applicants of the Targeted Investments Program
- Dental Benefits
- Billing - 59 Modifier
- Home Health Services
- Home Health Services - Face to Face Requirements
- DFSM Billing Tips
- Targeted Investments Program
- DFSM Billing Tips
- Online PA - New Document Attachment Feature
- AMPM Policy 310H
- Fee For Service NEMT Authorization Update June 2017
- FFS Behavioral Health NEMT Updates and Reminders
- FFS Billing Specialty NF & HCBS Rate Increase Effective 1-1-17
- AHCCCS Targeted Investment Program
- Federal Emergency Services Program (FESP)
- Paper Claims Submission Font Issue
- BH PA Process Training notice
- DFSM Training Schedule
- Article on TRBHAs and List of TRBHAs
- DFSM Training Schedule
- AHCCCS Contacts and links
- Overpayments
- Fee-For-Service (FFS) Prior Authorization Information and Reminders
- DFSM Training Schedule
- UPDATE: AHCCCS - Constant Contacts replaces ListServ
- Claim Reminders
- UB Medical Review - Suggested Documentation
- AHCCCS Contacts, Links and Resources
- Reminder: AHCCCS will be closed February 20, 2017 (Monday) to observe President’s Day
- Fee-For-Service (FFS) Prior Authorization Reminder
- Behavioral Health NEMT Updates and Reminders
- DFSM Training Schedule
- AHCCCS Contacts and links
2016
- Reminder: AHCCCS will be closed January 2, 2017 (Monday) to observe New Year’s Day.
- Non-Emergency Medical Transportation (NEMT)
- DFSM Training schedule
- AHCCCS Contacts and links
- Week of December 12, 2016 Fee-For-Service Payments and Remits Will Be Delayed One Day
- Reminder: AHCCCS will be closed December 26, 2016 (Monday) to observe Christmas Day.
- Non-Emergency Medical Transportation (NEMT)
- DFSM Training schedule
- AHCCCS Contacts and links
- Genetic Testing Prior Authorization – Correction
- Reinstatement: Coverage of Podiatry Services Performed by a Licensed Podiatrist
- Reinstatement : ALTCS Dental
- Third Party Liability (TPL)
- Non-Emergency Medical Transportation (NEMT)
- AHCCCS Contacts and Links
- Reminder: AHCCCS will be closed Monday, October 10, 2016
- Long Acting Reversible Contraceptive (LARC)
- Reinstatement: Coverage of Podiatry Services Performed by a Licensed Podiatrist
- ALTCS Dental Benefit
- Referrals for NEMT Trips Beyond "nearest facility"
- Dental Review Process for Deep Sedation/General Anesthesia
- Prior Authorization Request Timeframes
- Provider Registration Required for Licensed Board Certified Behavior Analysts (BCBA)
- New Provider Type: Free-Standing Emergency Departments (FrEDs)
- Proposed Reinstatement: ALTCS Dental Benefit
- Reinstated: Coverage of Podiatry Services Performed by a Licensed Podiatrist
- KidsCare is Reinstated Effective September 1, 2016
- Reminder: Tribal Regional Behavioral Health Authority Provider Notification
- Paper Claim Submission Issues
- KidsCare is Re-Instated Effective September 1, 2016
- Prior Authorization Request Timeframes
- Provider Registration Required for Licensed Board Certified Behavior Analysts (BCBA)
- UM/CM Unit Name Change to CMSU Effective 7/1/2016
- Provider Registration Required for Licensed Board Certified Behavior Analysts (BCBA)
- Provider Records Retention Requirements
- Provider "Going Out of Business" Process
- Genetic Testing Requires Prior Authorization
- Tribal Regional Behavioral Health Authority Provider Notification
- Dental Review Process Change for Deep Sedation/General Anesthesia
- Claims Customer Service Tips
- Tribal Regional Behavioral Health Authority Provider Notification
- Dental Review Process Change For Deep Sedation/General Anesthesia
- APR-DRG On Interim Claims
- Submitting Medical Records For An EDI Claim
- When Your Claim Is Denied For Medical Documentation
- NEMT Providers - Provider Registration Records Update
- AHCCCS Provider Participation Terminated For Inactivity
- DFSM Claims Customer Service Reminders
- Are You Signed Up for Important Provider Notices?
- Hospital Presumptive Eligibility HPE
- DFSM Claims Customer Service Tips
- Are You Signed Up for Important Provider Notices?
- Provider Records Retention Requirements
- Provider "Going Out of Business" Process
- Claims Customer Service Tips - Using AHCCCS Online
- Inpatient Outlier Review Process
- Attention Providers: Claim Submission System Downtime
- AHCCCS Webpage Has a New Look!!
- When Other Coverage is Primary
- NEMT Providers: Provider Registration Records Update
- Referrals for NEMT Trips Beyond "nearest facility" for AIHP
- Behavioral Health Fee Schedule
- Reminder: FREE Online Services for AHCCCS Providers
2015
- NEMT Coverage & Limitations
- Prior Authorization Submission
- Continuous Glucose Monitoring (CGM)
- Home Infusion of Inotropic Medications
- Provider Training Email Address
- Mandated Hospice Rate Changes Effective 01/01/2016
- Fee-For-Service Claims Payment Questions?
- Greater Arizona Integrated Care Update
- Reminder: Transition from ICD-9 to ICD-10 on 10/01/2015
- ICD-10 Diagnosis Code on ADA Form - Correction
- ICD-10 Implementation and Prior Authorization Changes
- Reminder: Claims Received 9/28/15 and 9/29/15
- Delayed: Changes to AHCCCS Covered Behavioral Health Services
- Dental Service Requirements for IHS and Tribal 638 Providers
- Reminder: Transition from ICD-9 to ICD-10 on 10/01/2015
- Adult Orthotic Benefit Change Effective 8/1/2015
- Significant Changes to AHCCCS Covered Behavioral Health Services
- Visiting the AHCCCS Administration Office?
- Claims Submitted 9/28/15 and 9/29/15
- Coding/POS Updates
- NEMT Trip Report Issues
- Reminder: Revised Trip Report & Instructions
- Billing FQHC/RHC Claims with a Primary Payer - Correction
- Reminder: FREE Online Services for AHCCCS Providers
- Are You Signed Up for Important Provider Notices?
- Reminder: Fee for Service (FFS) Provider Payment Changes
- Digital X-rays
- Billing FQHC/RHC Claims with a Primary Payor
- Still Submitting Paper Claims to AHCCCS FFS?
- Fee For Service Provider Payment Changes
- Still Submitting Paper Claims to AHCCCS FFS?
- Provider Registration Changes for Provider Type 40 - Update
- Medically Unlikely Edits (MUEs)
- Revised NEMT Trip Report and Instructions
- Reminder: Paper Claim Submissions
- Provider Registration Changes for Provider Type 40
- Coding Changes/Updates
- FQHC / RHC
- Reminder: Claim Status - Pending
- Reminder: Transition from ICD-9 to ICD-10 effective 10/1/2015
- Coding Changes/Updates
- Correction - Coding Changes Effective 01/01/2015
- Correction - Provider Training Email Address
- Claims Status - Pending
- Recipient Signature on NEMT Trip Report
- Reminder - FQHC/RHC Payment Process Change Delayed
2014
- FQHC/RHC Changes Delayed
- Coding Changes Effective 01/01/2015
- NEMT Provider Reminder
- New Provider Training Email Address
- IHS/638 Claim Audit Memo
- Re-enrollments for NEMT & Group Billing Providers
- FQHC AND RHC PAYMENT PROCESS CHANGE
- PERM Audit Reminder
- No Claims Load Into System 9/24 - 9/30/14
- Billing Reminder
- Did You Know...?
- When AHCCCS Requests Medical Documentation
- 2 Policy Changes for NEMT Providers
- REMINDER: Transition from ICD-9 to ICD-10 code sets delayed until 10/1/2015
- Billing Reminder
- Did You Know...?
- Timely Filing Denials
- Claims Process Definitions
- New Policy Changes for NEMT Providers
- Reminder - ICD-10 Transition Delay
- NEMT Policy - Tribal Business Licenses Required
- 2014 1st Quarter NEMT Quality Audits
- Reminder - Transition to ICD-10 Delayed
- Reminder - New ADA 2012 Version
- PERM 2014 Cycle "Save the Date" Webinars
- AZ DOC Special Edition Notice
- Billing Reminder
- UB04 Date Discrepancies
- NOTICE: Transition from ICD-9 to ICD-10 delayed until 10/1/2015
- New ADA form 2012 Version
- PERM 2014 Cycle CMS Provider Education
- Monthly NEMT Quality Audits
- Billing Reminders
- Note from Provider Registration
- PERM Cycle 3 Provider Education Webinar/Conference Calls
- Correction of February 2014 NEMT Article
- Billing Reminders
- NEMT Policy Changes Effective 4/1/2014
- PERM Cycle 3 Arizona
- PERM 2014 "Save The Date"
- OVER USE & MISUSE of 99285
- Submitting Claim Documentation
- NEMT (Provider Type 28) Policy Changes
- PERM 2014 CYCLE
- October 2013 NEMT Claim Audit
2013
- PERM 2014 CYCLE
- NEMT TRIP REPORT REVISED
- AHCCCS PROVIDER PARTICIPATION TO BE TERMINATED FOR INACTIVITY
- MEDICARE LIABILITY
- NEMT TRIP REPORT REVISED
- SEPTEMBER 2013 NEMT CLAIM AUDIT RESULTS
- REMINDERS FROM THE Care Management Systems Unit’S PRIOR AUTHORIZATION UNIT
- MEDICARE LIABILITY
- PAYMENT ERROR RATE MEASUREMENT (PERM)
- PRIOR QUARTER COVERAGE ELIGIBILITY
- REMINDERS FROM THE Care Management Systems Unit’S PRIOR AUTHORIZATION UNIT
October 2013 - Special Edition
- Prior Quarter Coverage Eligibility
- AHCCCS Fee for Service Non-Emergency Medical Transportation (NEMT) Changes
- CMS Approved Supplemental Waiver Payments for Option 1 & Option 2 Ends 12/31/13
- PERM Audit - Where do you stand?
- Reporting Vaccine Administration Codes with E/M Codes
- Important Arizona Department of Corrections (ADOC) Information
- General Reminders From the UM/CM's Prior Authorization Unit
- 2013 FFS Provider Training Schedule
- Payment Error Rate Measurement (PERM) 2014
- Reporting Vaccine Administration Codes with E/M Codes
- Important Arizona Department of Corrections (ADOC) Information
- Changes coming for Non-Emergency Transport Claims
- Reminders From the UM/CM's Prior Authorization Unit
- Enhanced Rates for Primary Care Services
- Changes coming for Non-Emergency Transport Claims
- Reminders From the UM/CM's Prior Authorization Unit
- Enhanced Rates for Primary Care Services
- Enhanced Rates for Primary Care Services
- General Care Management Systems Unit Reminders
- AHCCCS' Tribal Health Care Coordinator
- Update on Govenor Brewer's Medicaid Restoration Plan
- Information from The Office of The Inspector General
- Correction to January 2013 Article
- A Bit of Claims Trivia
- Reminders From the UM/CM's Prior Authorization Unit
- Primary Care Provider Enhanced Fee Attestation for AHCCCS Registered Providers
- Information from The Office of The Inspector General
- Claims Tips and Reminders
- PERM 2012 Errors
- Vaccine Administration Reporting Changes - Including the VFC Program
- New Requirements for Submission of Claims for Vaccine Administration - FAQ's
- General Reminders from the Care Management Systems Unit's PA Unit
- Enhanced Payments to Primary Care Providers
- Agency with Choice
- Reminders from UM/CM Prior Authorization