 |
ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AHCCCS; fee-for-service; claims
Purpose
Requires the Arizona Health Care Cost Containment System (AHCCCS) Division of Fee-For-Service Management (DFSM) to notify a person or entity of any administrative deficiencies in a claim within 72 hours and approve or deny the claim within 10 days if the deficiencies are corrected or there are no deficiencies.
Background
AHCCCS serves as Arizona's Medicaid agency, which offers qualifying Arizona residents access to healthcare programs. AHCCCS consists of contracts with contractors for the provision of hospitalization and medical care coverage to members. A contractor is a person or entity that has a prepaid capitated contract with AHCCCS to provide health care to members as prescribed, either directly or through subcontracts with providers (A.R.S. §§ 36-2901 and 36-2903).
The DFSM is a division within AHCCCS that serves as the health plan for fee-for-service Medicaid members and reimburses claims for other populations of individuals not enrolled with a contractor. The DFSM is responsible for the clinical, administrative and claims functions for the approximately 12 percent of AHCCCS membership under fee-for-service management, including: 1) American Indians and Alaska Natives enrolled in the American Indian health Program for outlined services; 2) members enrolled with the tribal regional behavioral health authorities for behavioral health care coordination services; 3) members enrolled with the tribal long-term care program; and 4) individuals in the Federal Emergency Service program (AHCCCS).
Fee-for-service means a method of payment by AHCCCS to a registered provider on an amount-per-service basis for a member not enrolled with a contractor (A.A.C. R9-22-101).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires the DFSM, within 72 hours after receiving a claim, to notify the person or entity that submitted the claim of all administrative deficiencies in the claim.
2. Requires AHCCCS, if the person or entity corrects all administrative deficiencies or if there are no administrative deficiencies in the claim, to either approve or deny the claim within 10 business days.
3. Becomes effective on the general effective date.
Prepared by Senate Research
February 9, 2026
MM/SDR/hk