AHCCCS Claims Clues

2023

December 2023

• Checking Claim Status using the AHCCCS Online Provider Portal
• Behavioral Health Claims - Missing Documentation Denial Reason Codes
• H2016 and H0038 Same Day Billing Denial Edit L237.4
• Inpatient Psychiatric Facility (PT 71) Prior Authorization Submission Tips
• Important Billing Code Change: Place of Service Code 56 for BHRF PT (B8)
• Documentation Requirements for Behavioral Health Outpatient Claims
• New Denial Code AD281 Medical Documents Do Not Conform to AMPM Policy 940
• New 2024 American Dental Association Claim Form
• Community Health Workers and Community Health Representatives (CHW/CHR)
• Hysterectomy Consent and Acknowledgement Form
• Elective Sterilization Consent Form Requirement
• How to Check the Status of a Behavioral Health Claim and Documentation
• How to Create a Paper Work Numbers (PWK)
• Prior Authorization Lookup Tool
• Common Prior Authorization Submission Errors
• Prior Authorization Submission Tips - PT 02 Hospital – Outpatient Day Surgery
• Prior Authorization Tip: Outpatient Surgery – Physician Prior Authorization Request
• What Happens When The Prior Authorization Does Not Match The Service
• Selecting the Correct Claim Number To Submit a Replacement Claim
• Duplicate Prior Authorization Case Error Message
• How to Add a Provider Service Location in (APEP) Modification Tutorial
• 275 Transaction Insight Portal Batch Option Is Available - How to Sign Up!
• Transaction Insight Portal Reminders for Provider Types 77, 05 and IC

December 2023-Chiropractor Service Codes Update

November 2023

• AHCCCS Online Provider Portal Password Reset Requests
• Receive DFSM Email News Updates and Provider Training Notifications
• Important: Effective June, 9, 2023 Provider Moratorium
• Important Master Account Holder Changes
• AHCCCS Restricts Providers’ Ability to Bill on Behalf of Others
• Tribal Self-Insurance and Required Documentation
• 835 Electronic Remittance Advice Requests
• 275 Transaction Insight Portal Batch Option
• DFSM Prior Authorization Quick Training Guides
• Behavioral Health Claims-Missing Documentation Denial Reason Codes
• Provider Type 02 Hospital-Prior Authorization Submission Requirements
• Memo Release Date October 24, 2023: Fee for Service Prior Authorization Review Times
• Common Prior Authorization Submission Errors
• Reminder: Participating Provider Reporting Requirements Edit Denial Codes H482.1 and H482.7
• Prior Authorization Tips
• How to Add the Missing Event Information to an Existing PA
• How to Add the Missing Activity Information to an Existing PA

October 2023

• Linking Between AHCCCS Online Provider Portal and the Transaction Insight Portal
• Transaction Insight Portal Reminders for Provider Types 77, 05 and IC
• TIBCO and Attaching Documentation for BH Claims
• 275 Transaction Insight Portal Batch Option
• What Happens When the Prior Authorization Does Not Match the Service?
• Checking Claim Status using the AHCCCS Online Provider Portal
• Behavioral Health Claims-Missing Documentation Denial Reason Codes
• Inpatient Psychiatric Facility (Provider Type 71) Prior Authorization Submission Tips
• Rate Changes Effective 10/01/2023
• How to Add the Missing Event Information to an Existing PA
• How to Add the Missing Activity Information To An Existing PA
• Prior Authorization Tips
• Transaction Insight Portal (TIBCO) FAQs
• Claim Date Span Billing Requirement

September 2023

• Receive DFSM Email News Updates and Provider Training Notifications
• Reminder: Rate Changes Effective 10/01/2023
• Reminders: Participating Provider Reporting Provider Types 77, IC and 05
• Documentation Review for Behavioral Health Outpatient Claims
• Reminders: Important Effective June, 9, 2023 Provider Moratorium
• Reminder: Participating Provider Reporting Requirements Edit Denial Codes H482.1 and H482.7
• Reminders: 275 Transaction Insight Portal (TIBCO)
• Transaction Insight Portal (TIBCO) FAQS
• How to Check Receipt of Documentation Using the AHCCCS Online Provider Portal
• How to Add the Missing Event Information To An Existing PA
• How to Add the Missing Activity Information To An Existing PA
• Uploading Documentation To A Prior Authorization Request
• Prior Authorization Tips

August 2023

• Important: Effective June, 9, 2023 Provider Moratorium
• Important: Behavioral Health Billing Codes Documentation Requirements
• DFSM New Training Tutorials!
• Required Documentation For Outpatient Behavioral Health Claims
• Documentation Review for Behavioral Health Outpatient Claims
• Important: AHCCCS Changes Enrollment Procedures for the American Indian Health Program (AIHP)
• Participating Provider Reporting Requirements Edit Denial Codes H482.1 and H482.7
• Provider Type 02 Hospital - Prior Authorization Submission Reminders
• AHCCCS Online Provider Portal Password Reset Requests
• AHCCCS Online Provider Portal Registering Under the Group Billing Provider (01) NPI
• How to Register Your Group Billing Account On the AHCCCS Online Portal
• How to Verify if the Service Provider is linked to the Group Billing Provider
• Important Master Account Holder Changes

July 2023

• Required Documentation For Outpatient Behavioral Health Claims
• AHCCCS Audio Only Telehealth Changes Modifier FQ
• Transaction Insight Portal (TIBCO) File Size and Types
• Reminder: Non-Emergency Medical Transport Diagnosis Codes
• New and Revalidating Behavioral Health Providers Subject to High-Risk Screening
• Behavioral Health Services Billing and Coding H2016 and H0038 Same Day Billing Denial Edit L237.4
• Provider Type 02 Hospital - Prior Authorization Submission Reminders
• AHCCCS Restricts Providers’ Ability to Bill on Behalf of Others
• Psychiatric Hospital Provider Type 71 Prior Authorization Diagnosis Code Mismatch
• Reminder: Non-Emergency Medical Transportation (NEMT) Policy Change for Local Community Based Support Programs
• Prior Authorization Tips For Provider Type 71 Psychiatric Hospital
• Claim Date Span Billing Requirement
• Electronic Visit Verification (EVV) Edit Tips Edit Denial Code: L227.1 Claim Line Failed For Unmatched Units, Field is Missing

July 2023 - Outpatient Behavioral Health Billing Update

• Required Documentation For Outpatient Behavioral Health Claims

June 2023

• Multi-Systemic Therapy (MST)
• CR Modifier and DR Condition Code Covid-19 Emergency Related
• Medical Coding Resources - Code Coverage Changes
• Community Health Workers and Community Health Representatives (CHW/CHR)
• Transaction Insight Portal for Outpatient Behavioral Health Providers How to Attach Documentation for Specific BH Service Codes
• Prior Authorization Tips For Provider Type 71 Psychiatric Hospital
• Diabetes Self-Management Training (DSMT)
• Dental Tooth Code Number Assignment
• Prior Authorization Guidelines
• Principal Diagnosis versus Admitting Diagnosis Codes UB-04
• All Patient Refined Diagnosis Related Groups (APR-DRG) Classification System DRG Ungroupable Denials
• Filing a Reconsideration for APR-DRG Payments
• Reminder: Billing Vaccines for Children (VFC)
• Reminder: Missing AHCCCS 835 and Paper Remittance Advice
• Claim Date Span Billing Requirement

May 2023

• Alternate Care Site (ASC) Flexibility Ending for Indian Health Service (IHS) and Tribally Owned/Operated (638) Facilities
• Reminder: Claim Date Span Billing Requirement
• Attendant Care Provider Type 40 Non-Emergency Medical Transportation Services
• Selecting the Correct Event Type for Medical and Behavioral Health Admissions
• Common Prior Authorization Submission Errors
• Prior Authorization Tips
• When is a Faxed Prior Authorization Request Acceptable
• Verifying if a Service Requires a Prior Authorization
• Prior Authorization Submission Tips
• PA Tip: Outpatient Surgery – Physician Prior Authorization Request
• PA Tip: BHRF (Provider Type B8) Prior Authorization Request
• BHRF Criteria for Continued Stay
• Inpatient Psychiatric Facility (Provider Type 71) Prior Authorization Submission Tips
• Uploading Documentation To A Prior Authorization Request
• How to Add the Missing Event Information To An Existing PA
• How to Add the Missing Activity Information To An Existing PA
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit

May 2023 - Transaction Insight Portal for Outpatient Behavioral Health Providers

• How to Attach Documentation for Specific BH Service Codes

May 2023 - Clarification of Billing Requirements for Behavioral Health Outpatient Claims

• H0004 (Behavioral Health Counseling and Therapy)
• H0038 (Self-Help/Peer Services)
• H2011 (Crisis Intervention Service)
• H2014 (Skills Training and Development)
• H2015 (Comprehensive Community Support Services)
• H2017 (Psychosocial Rehabilitation Services)
• H0025 (Behavioral Health Prevention Education Service)
• H2027 (Psychoeducational Service)
• S5150 (Unskilled Respite Care, Not Hospice)
• T1016 (Case Management)
• T1019 (Personal Care Services)
• H0034 (Medication Training and Support)

May 2023 - Special Edition

• Service Ticket Request For Electronic Remittance Advice (ERA) 835 Setup
• If you are missing your ERA/835 Remits

April 2023

• Alternate Care Site (ASC) Flexibility Ending for Indian Health Service (IHS) and Tribally Owned/Operated (638) Facilities
• Denial Edit - L013.5 Claim Service Requires Prior Authorization, PA Not Found
• Claim Edit Review Tips
• Common Prior Authorization Submission Errors
• Effective 10/14/2022 Covered Dental Services at an IHS/638 Facility Are Unlimited
• Additional Reimbursements of the Pharmacy All Inclusive Rate (AIR) for the Administration of COVID-19 and Influenza Immunizations are Ending
• BHRF Criteria for Continued Stay
• Selecting the Correct Event Type for Medical and Behavioral Health Admissions
• Reminders Transaction Insight Portal
• Prior Authorization Tips
• Verifying if a Service Requires a Prior Authorization
• Reminder: Referring/Ordering Provider Requirement
• AHCCCS FFS New Vendor Notification Medicaid Travel Services Provider
• Easy Access to Provider Training Presentations via Constant Contact
• Denial Edit AD962 Referring/Ordering Provider NPI Is Not Listed
• Tribal Self-Insurance and Required Documentation
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit

March 2023

• Claim Date Span Billing Requirement
• Claim Denials Information
• AHCCCS FFS New Vendor Notification Medicaid Travel Services Provider
• APEP Reminder –Service Addresses Can Be Updated Directly in APEP
• Prior Authorization Reminders
• Reminder: Common PA Submission Errors
• AHCCCS FFS New Vendor Notification Medicaid Travel Services Provider
• Attendant Care Provider Type 40 Non-Emergency Medical Transportation Services
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit

February 2023

• AHCCCS FFS New Vendor Notification Medicaid Travel Services Provider
• Attendant Care Provider Type 40 Non-Emergency Medical Transportation Services
• Who Can Become an American Indian Medical Home (AIMH)
• Prior Authorization Reminders
• Effective 10/14/2022 Covered Dental Services at an IHS/638 Facility Are Unlimited
• REMINDER: NEMT Pick Up and Drop Off Address
• EVV Update on Hard Claims Edits
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit

January 2023

• Effective 10/14/2022 Covered Dental Services at an IHS/638 Facility Are Unlimited
• Reminder: Provider Participation Reporting Requirements
• Diabetes Self-Management Training
• Claim Denials Information
• EVV Update on Hard Claims Edits
• Payment Error Rate Measurement (PERM) Audit
• How To Determine if a Prior Authorization Is Required
• Reminder: Common PA Submission Errors
• What is Payment Error Rate Measurement (PERM) Audit
• APEP Reminder –Service Addresses Can Be Updated Directly in APEP
• Prior Authorization Reminders
• REMINDER: NEMT Pick Up and Drop Off Address
• Reminder: Common PA Submission Errors
• Provider Self-Service Tips AHCCCS Online Provider Portal
• Pended Prior Authorization Request Information

2022

December 2022

• Effective 10/14/2022 Covered Dental Services at an IHS/638 Facility Are Unlimited
• Diabetes Self-Management Training
• Public Health Emergency
• Provider Participation Modifier Deadline Extended Until January 1, 2023
• Missing Remittance Requests
• Reminder: Electronic Visit Verification
• Reminder: Common PA Submission Errors
• Reminder: Paper Claim Submission Errors
• Reminder: Billing Per Diem Codes
• 835/Electronic Remittance Advice (ERA)
• AHCCCS To Start 10-Month Process to Disenroll Non-Compliant Providers

November 2022

• Effective 10/14/2022 Covered Dental Services at an IHS/638 Facility Are Unlimited
• Payment Error Rate Measurement (PERM) Audit
• Important Updates
• What is Payment Error Rate Measurement (PERM) Audit
• Missing Remittance Requests
• Serious Mental Illness (SMI) Changes Effective 10/1/2022
• Reminders: Behavioral Health Residential Facility (BHRF) Admission
• Important Update: Provider Participation Reporting Requirements Deadline Has Been Extended Until January 1, 2023

October 2022

• Serious Mental Illness (SMI) Changes Effective 10/1/2022
• Behavioral Health Residential Facility Policy 320-V Update
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit
• Important Update: Provider Participation Reporting Requirements Deadline Has Been Extended Until January 1, 2023
• APEP Reminder - Service Addresses Can Be Updated Directly in APEP
• Quick Reference Guide - What Services Require A FFS Prior Authorization
• Missing Remittance Requests
• Provider Self-Service Tips AHCCCS Online Provider Portal

September 2022

• Serious Mental Illness (SMI) Changes Effective 10/1/2022
• 835/Electronic Remittance Advice (ERA)
• Reminders: Behavioral Health Residential Facility (BHRF) Admission
• Payment Error Rate Measurement (PERM) Audit
• What is Payment Error Rate Measurement (PERM) Audit
• Participating Provider Reporting Requirements Effective 10/1/2022
• Provider Denial Resolution Guide
• APEP FAQs
• Reminders: Fee-for-Service Prior Authorizations
• Reminder: Transaction Insight Portal- Important Information for Users

July/August 2022

• Serious Mental Illness (SMI) Changes Effective 10/1/2022
• Payment Error Measurement (PERM) Audit
• Participating Provider Reporting Requirements Effective 10/1/2022
• Provider Denial Resolution Guide
• Tips: Behavioral Health Prior Authorization
• Tips: BHRF Prior Authorization Reminders
• DD-THP Tribal Health Program Prior Authorization Forms
• Update: AHCCCS Prior Authorization and Concurrent Review Standards during the COVID-19 Emergency for Fee-for-Service Providers
• AHCCCS Provider Enrollment Portal (APEP)
• Review of Documentation Signature Requirements
• Reminder: Non-Emergency Medical Transportation (NEMT) Policy Change for Local Community Based Support
• Reminder: Transaction Insight Portal-Important Information for Users Reporting the Date of Service
• Reminders: Important Billing Information for Paper Claims Submissions

March 2022

• DD Tribal Health Plan (THP)
• Office of the Inspector General (OIG) Provider Participation Agreement
• Participating Provider Reporting Requirements
• Payment Error Rate Measurement (PERM) Audit
• Transaction Insight Portal-Important Information for Users Reporting the Date of Service and Provider Address Fields
• Transaction Insight Portal-PWK Using the AHCCCS 12 Digit Claim Reference Number (CRN)
• Important Billing Information for Providers-Common Billing Errors on Paper Claim Submissions
• Transportation Requests

January/February 2022

• Payment Error Rate Measurement(PERM) Audit
• CMS Extension of “Four Walls” Grace Period for IHS and Tribal 638 Facilities
• First Quarter Provider Training Schedule Posted
• General Requirements for the Submission of Paper Claim Forms
• Transportation Requests
• Transportation Passes/Bus Passes
• AHCCCS Prior Authorization and Concurrent Review Standards during the COVID-19 Emergency for Fee-for-Service Programs
• Tribal ALTCS Digital Tool
• COVID-19
• Transaction Insight Portal – Important Information for Users Who Select Non-Person Entity
• Electronic Visit Verification (EVV)
• AIHP Transportation Request Process

2021

October 2021

• CMS Extension of “Four Walls” Grace Period for IHS and Tribal Providers
• AIHP Transportation Request Process
• Transportation Requests
• Transportation Passes/Bus Passes
• Electronic Visit Verification (EVV)
• Emergency Triage, Treat and Transport (ET3)
• COVID-19 Information
• Tribal ALTCS Digital Toolbox
• Transaction Insight Portal – Important Information for Users Who Select Non-Person Entity
• Prior Authorization Updates and Reminders

September 2021

• Emergency Triage, Treat and Transport (ET3)
• Medical Review Documentation Requirements
• Documentation Requirements and the Transaction Insight Portal
• Transaction Insight Portal - Important Information for Users Who Select Non-Person Entity
• COVID-19 Prior Authorization and Concurrent Review Standards During the Publich Health Emergency for Fee-for-Service Programs
• APEP FAQs
• Prior Authorization Updates and Reminders
• APEP Updates - Service Addresses May Now Be Updated Directly in APEP
• ROPA: Referring, Ordering, Prescribing, Attending (ROPA) Providers Required to Register with AHCCCS
• Tribal ALTCS Digital Toolbox

August 2021

• APEP Updates – Service Addresses May Now Be Updated Directly in APEP
• APEP FAQs
• IHS & 638 Tribal Facility / Pharmacy Authorization Form for Submission to OptumRx
• Transaction Insight Portal - Important Information for Users Who Select Non-Person Entity
• ROPA
• Fee for Service Authorization Reminders
• Quality Management (QM) Housekeeping Tips
• NEMT Daily Trip Report Instructions

July 2021

• Transaction Insight Portal – Important Information for Users Who Select Non-Person Entity
• Court Ordered Treatment FAQ Update
• DFSM Provider Training Team’s Third Quarter Schedule Posted
• APEP
• APEP and Adding Service Locations
• BHRF Notifications
• Medicare EOB
• ROPA
• Quality Management Housekeeping Tips
• AHCCCS Prior Authorization (PA) and Concurrent Review (CR) Standards during COVID-19 for Fee-for-Service Health Programs
• Behavioral Health Residential Facility (BHRF) Notification
• Behavioral Health Residential Facility (BHRF) – Per Diem Rate Information

May/June 2021

• ROPA
• Recoupment (Applies to All Providers)
• Fee For Service Prior Authorization
• Non-Emergency Medical Transportation (NEMT) Daily Trip Report Instructions
• NEMT Resources
• NEMT – Transportation of Family Members is Not Permitted
• General Reminders for All Providers
• Attendant Care Non-Emergency Medical Transportation & Special Considerations
• Use of the AHCCCS Online Provider Portal – Why NOT Sharing Your User ID and Login Information is VERY Important
• Upcoming APEP Training Sessions
• What is the AHCCCS Provider Enrollment Portal (APEP)?
• APEP and Adding Service Locations
• Payment Error Measurement (PERM) Audit Information for Providers
• Telehealth Resources
• Telehealth Services and IHS/638 Providers
• Second Quarter Training Schedule Posted
• COVID-19 Information on the AHCCCS Website & Billing for Services
• COVID-19 Billing for Services

March/April 2021

• Upcoming APEP training sessions
• Medicare EOB
• Quality Management (QM) Housekeeping Tips
• Preferred Provider Lists
• Vaccination Memos
• 2021 All Inclusive Rate
• Payment Error Measurement Audit Information for Providers
• Telehealth
• Electronic Visit Verification (EVV)
• Second Quarter Training Schedule Posted
• COVID-19 Billing for Services
• COVID-19 Information
• COVID_19 FAQs
• The U.S. Department of Health and Human Services (HHS) Releases COVID-19 Care and Vaccine Access Fact Sheets
• AHCCCS Prior Authorization (PA) and Concurrent Review (CR) Standards during COVID-19 Emergency for Fee-for-Service Health Programs
• AHCCCS Provider Enrollment Portal (APEP)

January/February 2021

• 2021 All Inclusive Rate Update
• First Quarter Provider Training Schedule Posted
• Vaccination Memos for Providers
• COVID-19 Information

2020

November/December 2020

• ROPA Update – Extension of Timelines
• Sandata EVV System Users – Preparation for the Welcome Kit Release
• Non-Emergency Medical Transportation Updates and Reminders
• Documentation Requirements on the Transaction Insight Portal (TI)
• Claim Tips Corner – Claim Submission Errors on CMS 1500 Claim Forms
• Online Prior Authorization Reminders
• IHS 638 Nursing Facility and Skilled Nursing Facilities AIR Updates
• COVID-19 Information
• COVID-19 Modifier Use
• Provider Location within the United States
• Long Acting Reversible Contraceptives (LARC)
• Behavioral Health Matrix Reminder
• Vaccination Billing Information for IHS & Tribal Providers

October 2020

• EMS Providers and Flu Shots
• AHCCCS Reimbursement Options for EMS Agencies Administering Flu Vaccine
• Flu Vaccine Administration for Members 3-18 Years of Age
• Electronic Visit Verification Information
• Provider Location within the United States
• COVID-19 Information
• COVID-19 Modifier Use
• Referring, Ordering, Prescribing and Attending (ROPA) Providers
• IHS 638 Nursing Facility and Skilled Nursing Facilities AIR Updates
• Long Acting Reversible Contraceptives (LARC)
• Claim Tips Corner – Claim Submission Errors on CMS 1500 Claim Forms
• Documentation Requirements and the Transaction Insight (TI) Portal
• Behavioral Health Matrix Reminder
• AHCCCS Prior Authorization (PA) and Concurrent Review (CR) Standards during COVID-19 Emergency Fee-for-Service Health Programs
• Behavioral Health Transportation Responses (Questions and Answers)

September 2020

• Flu Vaccine Administration for Members 3-18 Years of Age
• Documentation Requirements and the Transaction Insight Portal (TI)
• Referring, Ordering, Prescribing and Attending (ROPA) Provider Notification “Don’t Be the Weak Link in the Chain!”
• Electronic Visit Verification (EVV) Reminders and Training Information
  • Please note EVV announcements are only applicable to providers subject to EVV requirements. For additional information on EVV please visit the AHCCCS EVV web page.
• COVID-19 Information
• COVID-19 FAQs
• COVID-19 “CR” Modifier Use
• IHS 638 Nursing Facility and Skilled Nursing Facilities AIR Updates
• Claim Dispute Process – Office of Administrative Legal Services (OALS)
• AHCCCS Announces Provider Enrollment Portal (APEP) Launch
• Telehealth Reminders
• Behavioral Health Facilities Providing Personal Care Services
• Behavioral Health Residential Facility (BHRF) – Prior Authorization Documentation Requests
• Behavioral Health Residential Facility (BHRF) Trainings
• AHCCCS Prior Authorization (PA) and Concurrent Review (CR) Standards during COVID-19 Emergency for Fee-for-Service Health Programs
• Provider Training Schedule Fourth Quarter 2020

July/August 2020

• COVID-19 - FAQs and CR Modifier Use
• Long Acting Reversible Contraceptives (LARC)
• Telehealth Materials on the AHCCCS Website
• The "Four Walls" Provision and IHS & 638 Providers
• Billing for Telehealth and Telephonic Services as an IHS/638 Provider
• AHCCCS Provider Enrollment Portal (APEP) Information - Launch Date of August 31, 2020
• AHCCCS Prior Authorization (PA) and Concurrent Review Standards during COVID-19 Emergency for Fee-for-Service (FFS) Health Programs
• Behavioral Health Services Matrix
• Claim Dispute Process - Office of Administrative Legal Services (OALS)
• Referring, Ordering, Prescribing, and Attending (ROPA) Providers Flier - Register by January 1, 2021

June 2020

• COVID-19 & FAQs
• Telehealth
• Contact Information
• The "Four Walls" Provision and IHS & 638 Providers
• Billing for Telehealth and Telephonic Services as an IHS/638 Provider
• AHCCCS Announces Provider Enrollment Portal (APEP) Launch Date Change - August 31st, 2020
• Electronic Visit Verification (EVV) Update
• Claims - How to Register as a Provider and Receive Payment for Services Rendered
• Prior Authorization and Concurrent Updates
• Tribal Relations Corner
• Upcoming AHCCCS Special Tribal Consultation Meetings
• Providers Can Be Reimbursed for COVID-19 Testing and Treatment for Uninsured Arizonans Through Federal HRSA Web Portal
• AHCCCS Policies Open for Tribal Consultation as of 5/21/2020
• Upcoming Training Schedule - June 2020

April/May 2020

• COVID-19
• COVID-19 FAQs
• Telehealth
• Contacts
• EVV
• APEP Updates
• American Indian Medical Home (AIMH)
• Claims Disputes Process - OALS
• Federal Emergency Services Recipients
• Medicare Savings Programs - FFS
• 2020 All Inclusive Rate (AIR) Updates

March 2020

• Long Active Reversible Contraceptives (LARC)
• Arizona Court Care Website – Involuntary Treatment or “Civil Treatment” Process
• Behavioral Health Residential Facility (BHRF) Notification for Codes H0031 an H2019
• General Requirements for the Submission of Paper Claim Forms
• Tribal ALTCS Web Page
• Billing Reminders for the CMS 1500 and UB-04 Claim Forms
• AHCCCS Provider Enrollment Portal (APEP) to Launch June 1st, 2020
• New Standards and Reporting Requirements for Opioid Treatment Programs
• Electronic Visit Verification (EVV)
• Provider Training Web Page
• Federal Emergency Service Recipients
• Upcoming Provider Trainings

January/February 2020

• Tribal ALTCS Web Page
• AHCCCS Provider Enrollment Portal (APEP) Updates- Launching on June 1st, 2020
• Electronic Visit Verification (EVV) Updates
• Covered Behavioral Health Services Guide (CBHSG) Transition Reminder
• Telehealth Services Reminder
• New Standards and Reporting Requirements for Opioid Treatment Programs
• Provider Training Web Page
• Upcoming Provider Training Sessions

2019

November/December 2019

• Tribal ALTCS Web Page - NEW!
• AHCCCS Provider Enrollment Portal (APEP) to Launch June 1st, 2020 - Launch Date Changed!
• Telehealth Services - Important Update
• APR-DRG Payment Policy Update
• Covered Behavioral Health Services Guide - Important Update
• Behavioral Health Facilities Provider Personal Care Services
• Behavioral Health Residential Facility - Prior Authorization Documentation Requests
• Transaction Insight Portal (TI)
• Claims Status Inquiries using the AHCCCS Online Provider Portal and via the Claims Customer Service Phone Line
• Claim Submission - Medicare/Third Party Liability
• AHCCCS Complete Care (ACC) Health Plan Contact Information
• A0998 Article - Billing Manual Update

October 2019

• AHCCCS Provider Enrollment Portal (APEP) to Launch in 2020
• Vaccine Administration and Point of Sale System Billing to Optum
• Electronic Prescribing of Controlled Substances (EPCS) - Memo Regarding State of Arizona House Bill 2075, Dated October 23rd, 2019
• Arizona Controlled Substances Prescription Monitoring Program
• House Bill 2075 Reminders with Additional Resource Information
• AHCCCS Fee for Service Drug List & T(RBHA) Drug List Effective 10/01/2019
• APR-DRG Payment Policy Update
• Covered Behavioral Health Services Guide – Important Update
• Telehealth Services – Important Update
• Behavioral Health Facilities Providing Personal Care Services
• Non-Emergency Medical Transportation Daily Trip Report Reminders
• Naturopathic Physicians

September 2019

• ***Additional Trainings Added for 3rd Quarter
• Assistant Surgeon Modifier (AS) and Modifier AS Notification
• Multi-Specialty Interdisciplinary Clinic Update (MSIC)
• Provider Enrollment Updates
• Master PDF Documents of the Fee-for-Service and IHS/Tribal Provider Billing Manuals to Replace ZIP Files
• Telehealth Policy Updates
• BHRFs Providing Personal Care Services

August 2019

• APR-DRG Policy
• Provider Enrollment Updates (Automated Online Provider Enrollment System to Launch in 2020)
• Master PDF Documents of the Fee-for-Service and IHS/Tribal Provider Billing Manuals to Replace ZIP Files
• Retroactive Coverage (also called Prior Quarter Coverage)
• Adult Immunization Coverage
• Behavioral Health Residential Facilities Notification
• Direct Care Worker Agency Monitoring
• Four Walls Requirement
• Training Schedule for the 3rd Quarter

July 2019

• AHCCCS Adult Immunization Coverage at County Health Departments
• Retroactive Coverage (also called Prior Quarter Coverage)
• Retroactive Coverage
• Direct Care Worker Agency Monitoring
• Behavioral Health Residential Facility (BHRF) Per Diem Rate Information
• Covered Behavioral Health Services Guide - Important Notice
• Training Schedule for 3rd Quarter

June 2019

• Provider Welcome Letter
• Provider Office Check List
• Retroactive Coverage
• Behavioral Health Residential Facility (BHRF) Notification
• Behavioral Health Residential Facility (BHRF) Per Diem Rate Information
• Transition of Covered Behavioral Health Services Guide
• 3D Mammograms
• Upcoming Trainings

May 2019

• Covered Behavioral Health Services Guide - Important Update
• Automated Online Provider Enrollment System to Launch in 2019
• Training Opportunities (Technical Assistance Webinar; BHRF PA Submission Training; General Direct Care Agency Worker; One-on-Ones; Claims and Disputes)
• Electronic Visit Verification Differential Adjusted Payment Notice (DUE 05/20/2019)
• Request for Electronic Remittance Advice (ERA) or 835 Transaction Setup (FAQs)
• Accessing Behavioral Health Services in Schools
• BHRF Notification
• 3D Mammograms

April 2019

• BHRF Notification/Update
• Covered Behavioral Health Services Guide - Important Update
• OALS Claims Dispute Process
• Notice of Non-Discrimination
• Provider Registration (Enrollment) Updates
• Accessing Behavioral Health Services in Schools
• Coordination of Care
• What is the AIMH?

March 2019

• Care Coordination: FFS Programs
• Notice of Non-Discrimination
• Addressing the Increase of Syphilis in Arizona
• BHRF Notification
• *Updated April 2019
• Covered Behavioral Health Services Guide – Important Update
• Pharmacy Updates

February 2019

• CBHSG Updates
• BHRF Notification
• QMB Only, QMB Dual, and Non-QMB Dual Member Copays
• What Does a Tribal ALTCS Membership Card Look Like?

January 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.

Integration Special Edition

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

December 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.

November 2018

• 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 2018

• 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

Integration Special Edition

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?

September 2018

• 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

August 2018

• Provider Education Dates
• Non-Emergency Medical Transportation Updates
• New: Open House
• What is Integration and Who is Affected?
• Integration Billing Information
• Policies Rescinded

July 2018

• 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?

June 2018

• 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

May 2018

• 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)

April 2018

• 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

March 2018

• 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

February 2018

• 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

January 2018

• Billing 59 Modifier
• Inpatient Outlier Review Process
• PERM Audit: Where Do You Stand?
• Online Prior Authorization Submission–New Document Attachment Feature

2017

December 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

November 2017

• Podiatric Services
• DFSM Billing Tips
• Home Health Services
• Notification to Applicants of the Targeted Investments Program

October 2017

• Dental Benefits
• Billing - 59 Modifier
• Home Health Services

September 2017

• Home Health Services - Face to Face Requirements
• DFSM Billing Tips

August 2017

• Targeted Investments Program
• DFSM Billing Tips
• Online PA - New Document Attachment Feature
• AMPM Policy 310H

July 2017

• 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

June 2017

• Federal Emergency Services Program (FESP)
• Paper Claims Submission Font Issue

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