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.

2017

May 2017

  • BH PA Process Training notice
  • DFSM Training Schedule

April 2017

  • Article on TRBHAs and List of TRBHAs
  • DFSM Training Schedule
  • AHCCCS Contacts and links

February 2017

  • 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

January 2017

  • 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

December 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

November 2016

  • 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

October 2016

  • 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

September 2016

  • 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)

August 2016

  • 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

July 2016

  • KidsCare is Re-Instated Effective September 1, 2016
  • Prior Authorization Request Timeframes
  • Provider Registration Required for Licensed Board Certified Behavior Analysts (BCBA)

June 2016

  • 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

May 2016

  • 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

April 2016

  • 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?

March 2016

  • Hospital Presumptive Eligibility HPE
  • DFSM Claims Customer Service Tips
  • Are You Signed Up for Important Provider Notices?

February 2016

  • Provider Records Retention Requirements
  • Provider "Going Out of Business" Process
  • Claims Customer Service Tips - Using AHCCCS Online
  • Inpatient Outlier Review Process

January 2016

  • 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

November 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?

October 2015 Special Edition

  • Greater Arizona Integrated Care Update

September 2015

  • 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

August 2015

  • 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

July 2015

  • 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?

June 2015

  • 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?

May 2015

  • Fee For Service Provider Payment Changes
  • Still Submitting Paper Claims to AHCCCS FFS?
  • Provider Registration Changes for Provider Type 40 - Update

April 2015

  • Medically Unlikely Edits (MUEs)
  • Revised NEMT Trip Report and Instructions
  • Reminder: Paper Claim Submissions
  • Provider Registration Changes for Provider Type 40

March 2015

  • Coding Changes/Updates
  • FQHC / RHC

February 2015

  • Reminder: Claim Status - Pending
  • Reminder: Transition from ICD-9 to ICD-10 effective 10/1/2015
  • Coding Changes/Updates

January 2015

  • 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

December 2014

  • FQHC/RHC Changes Delayed
  • Coding Changes Effective 01/01/2015
  • NEMT Provider Reminder
  • New Provider Training Email Address
  • IHS/638 Claim Audit Memo

October 2014

  • Re-enrollments for NEMT & Group Billing Providers
  • FQHC AND RHC PAYMENT PROCESS CHANGE
  • PERM Audit Reminder

System Notice September 2014

  • No Claims Load Into System 9/24 - 9/30/14

August 2014

  • 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

July 2014

  • Billing Reminder
  • Did You Know...?
  • Timely Filing Denials
  • Claims Process Definitions
  • New Policy Changes for NEMT Providers
  • Reminder - ICD-10 Transition Delay

June 2014

  • 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

May Claims Clues Supplemental

  • AZ DOC Special Edition Notice

May 2014

  • 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

April 2014

  • Billing Reminders
  • Note from Provider Registration
  • PERM Cycle 3 Provider Education Webinar/Conference Calls

March 2014

  • Correction of February 2014 NEMT Article
  • Billing Reminders
  • NEMT Policy Changes Effective 4/1/2014
  • PERM Cycle 3 Arizona
  • PERM 2014 "Save The Date"

February 2014

  • OVER USE & MISUSE of 99285
  • Submitting Claim Documentation
  • NEMT (Provider Type 28) Policy Changes
  • PERM 2014 CYCLE
  • October 2013 NEMT Claim Audit

2013

December 2013

  • PERM 2014 CYCLE
  • NEMT TRIP REPORT REVISED
  • AHCCCS PROVIDER PARTICIPATION TO BE TERMINATED FOR INACTIVITY
  • MEDICARE LIABILITY

November 2013

  • NEMT TRIP REPORT REVISED
  • SEPTEMBER 2013 NEMT CLAIM AUDIT RESULTS
  • REMINDERS FROM THE Care Management Systems Unit’S PRIOR AUTHORIZATION UNIT
  • MEDICARE LIABILITY

October 2013

  • 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

August 2013

  • 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

July 2013

  • 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

June 2013

  • 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

May 2013

  • Changes coming for Non-Emergency Transport Claims
  • Reminders From the UM/CM's Prior Authorization Unit
  • Enhanced Rates for Primary Care Services

April 2013

  • 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

March 2013

  • 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

February 2013 - Supplemental

  • Primary Care Provider Enhanced Fee Attestation for AHCCCS Registered Providers

February 2013

  • 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

January 2013

  • Enhanced Payments to Primary Care Providers
  • Agency with Choice
  • Reminders from UM/CM Prior Authorization