AHCCCS Medicaid Enterprise System (MES) Modernization:
Building a Better Experience for Our Partners and Communities

Since 2019, AHCCCS has been modernizing its systems to deliver better healthcare outcomes and improve how we collaborate with providers and partners.

Our goal is simple: make it easier, faster, and more secure to do business with AHCCCS.

This effort ensures that AHCCCS can adapt quickly and move forward to changing needs and continue providing high-quality care to Arizona communities.

What’s Changing?

• Modern Technology: Replacing outdated systems with secure, cloud-based platforms.
• Streamlined Processes: Reducing manual steps and improving accuracy.
• Better Data Access: Tools that help providers and partners get the information they need quickly.

Coming in 2026:

• Electronic Data Interchange (EDI): Behind-the-scenes upgrades for faster, more efficient data exchange—no changes to your current process.
• Program Integrity Tools: Enhanced fraud prevention and auditing for accurate payments and reduced delays.
• Customer Service System (CSS): A new one-stop portal for providers to update information, track requests, and communicate with AHCCCS.
• Cloud Migration: We’ve migrated our mainframe system to a secure Cloud platform for improved reliability and performance.

Program Integrity (Fraud, Waste & Abuse)

We are introducing new software to strengthen claims review and auditing. 

• Phase 1: Post-payment claims analysis and a tool to manage data, communications, and payments.
• Benefits: Advanced analytics, predictive modeling, and machine learning for more accurate leads, proper payments, and real-time dashboards for monitoring risk indicators, trends, and performance metrics.
• Phase 2: Pre-payment auditing for consistent review before claims are paid.  
• Benefits: Faster claim processing, improved accuracy, technology-assisted fraud detection. 
• Provider impact: Strong documentation and accurate billing will help avoid payment delays. 

Why It Matters to You:

• Faster claim processing
• Stronger data security (HIPAA & HITRUST compliant)
• Easier communication and request tracking
• Reduced administrative burden

For awareness, HR1, the recent budget reconciliation law introduces significant changes to Medicaid, including work requirements for certain adults and stricter eligibility verification. These provisions may create substantial operational and financial impacts for states and providers. AHCCCS is actively reviewing the legislation, and additional guidance will be provided regarding its implications for MES Modernization.

AHCCCS is committed to staying ahead of the curve! These modernization efforts ensure that we are running the most up-to-date, secure, and efficient systems to better serve the people and communities of Arizona. By investing in innovation today, we are building a stronger foundation for tomorrow, one that supports quality care, protects sensitive information, and makes it easier for members and providers to connect with us.

Stay Connected

We will share updates and training opportunities as new tools roll out. If you have any questions or comments about the MES Modernization Program, please submit them through this Public Feedback Form.

Together, we are building a stronger, more efficient system to serve Arizona’s communities!