AHCCCS; fee-for-service; claims

Plain English Breakdown

The official source material does not provide information on what happens if problems with a claim are not corrected within the specified time frame.

AHCCCS Fee-for-Service Claims Review

This bill requires AHCCCS to notify people about issues with their claims and decide whether to approve or deny those claims within specific time frames.

What This Bill Does

• Requires the AHCCCS Division of Fee-For-Service Management (DFSM) to inform a person or entity if there are administrative deficiencies in their claim within three days.
• If all problems with the claim are fixed, AHCCCS must decide whether to approve or deny the claim within ten business days.

Who It Names or Affects

• People who submit claims to AHCCCS for healthcare services.
• AHCCCS, which manages Medicaid programs in Arizona.

Terms To Know

Claim

A request made by a person or entity for payment from AHCCCS for healthcare services provided.

Administrative deficiencies

Problems with the paperwork or information submitted in a claim that need to be fixed before it can be reviewed further.

Limits and Unknowns

• The bill does not specify what happens if problems are not corrected within the time frame.
• There is insufficient data to evaluate whether the estimated costs for additional staff positions are reasonable.

Official Summary Text

SB1346 - 572R - Senate Fact Sheet

Assigned to
HHS�������������������������������������������������������������������������������������������������������������������� FOR
COMMITTEE

ARIZONA STATE SENATE

Fifty-Seventh
Legislature, Second Regular Session

REVISED

FACT SHEET FOR
s.b. 1346

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
).

The Joint Legislative Budget Committee
states that AHCCCS estimates S.B. 1346 would increase state General Fund costs
by $579,400 and total fund costs by $2,200,000 annually, beginning in FY 2027,
to cover 19 additional FTE positions. JLBC
notes that there is
insufficient data to evaluate the reasonableness of the specific estimates (
JLBC
fiscal note
).

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.

Revisions

�

Updates the fiscal impact statement.

Prepared by
Senate Research

March 26, 2026

MM/SDR/hk

Current Bill Text

SB1346 - 572R - S Ver

Senate Engrossed

AHCCCS;
fee-for-service; claims

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SENATE BILL 1346

AN
ACT

Amending title 36, chapter 29, article 1,
Arizona Revised Statutes, by adding section 36-2903.18; relating to the arizona
health care cost containment system.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it
enacted by the Legislature of the State of Arizona:

Section 1. Title 36, chapter 29, article 1,
Arizona Revised Statutes, is amended by adding section 36-2903.18, to read:

START_STATUTE
36-2903.18.

Claims review time frame; fee-for-service; administrative
deficiencies

Within seventy-two hours after receiving a
claim, the system's division of fee-for-service management shall notify the
person or entity that submitted the claim of all administrative deficiencies in
the claim, if any.� If the person or entity corrects all administrative
deficiencies in the claim or if there were no administrative deficiencies in
the claim, the administration shall either approve or deny the claim within ten
business days.
END_STATUTE