Medicaid Billing Provider Tax ID Edit for Encounters

Date: 08/05/25

AHCCCS Encounter Edits

Focused on Billing Provider’s Tax ID & AHCCCS ID

Effective 7/24/2025, AHCCCS implemented two encounter edits to ensure the billing provider’s Tax ID is valid within the AHCCCS system and the rendering provider’s AHCCCS ID is correctly associated with the billing provider’s AHCCCS ID.  The edits will apply to CMS-1500, UB-04 and Dental claims.

These edits are triggered when a health plan submits the claim data to AHCCCS via the encounter process and AHCCCS identifies missing or invalid information. The edits will be “soft” edits for approximately six months. During the soft edit period, health plans will review the error report made available by AHCCCS to confirm the edits are triggering accurately. Following this initial period, AHCCCS intends to convert them to “hard” edits. At that point, if one of the edits is triggered, the health plan will be required to deny the associated claim until you’ve resolved the issue(s) within the AHCCCS system.

We very much want to avoid future claim denials!  Please review your information on file with AHCCCS via the AHCCCS Provider Enrollment Portal (APEP) https://www.azahcccs.gov/PlansProviders/APEP/ProviderEnrollment.html as soon as possible to confirm it’s up to date and accurate.

For example, if you have never added the billing association in APEP or if changes are needed, you’ll add/update the billing association within the rendering provider’s APEP profile and submit to AHCCCS for review and approval.

If you have questions, please contact your Provider Engagement Account Manager. If you need your Provider Engagement Account Manager’s contact information, please email AzCHProviderEngagement@azcompletehealth.com.