DDD Virtual Lunch and Learn

Sleep in Autism

10/21/2026

Noon-1:00 pm

The Division of Developmental Disabilities (DDD) Behavioral Health Administration invites behavioral health providers, qualified vendors and DDD employees to its next Virtual Lunch and Learn session.

Presenter: Dr. Haley Masterson, board-certified pediatric neurologist and Cortica medical site director

This session will explore common sleep challenges in autistic children; potential causes of sleep disruptions and evidence-based strategies that may help improve sleep and family well-being.



Space is limited. Register in advance and learn more about upcoming DDD behavioral health training opportunities on the Arizona Department of Economic Security website.

FWA 101 Video Now Available

Learn the basics of fraud, waste and abuse

Need a quick refresher on Fraud, Waste and Abuse (FWA)? Watch our new FWA 101 video, now available on YouTube. This short training explains the differences between fraud, waste and abuse, why prevention matters, and how to recognize and report potential concerns. Whether you are new to Medicaid or looking to strengthen your compliance knowledge, this video offers practical information to support program integrity and responsible stewardship of health care resources.



Watch the video

AHCCCS Updates Covered Behavioral Health Services Guide (CBHSG)

Review the October 1,2026 changes to the CHBSG. Changes include new billing guidance, codes and service clarifications.

• B2 Matrix
• Disallow Table
• New Disallow Table Summary Document
• Covered Behavioral Health Services Guide (CBHSG)



Preparing for Changes to Gender Dysphoria Treatment Coverage



Effective Oct. 13, 2026, a new CMS final rule prohibits the use of federal Medicaid funds for certain sex-rejecting procedures (SRPs) for children under age 18 and federal CHIP funds for individuals under age 19. CMS is allowing a transition period of up to six months for eligible members already receiving hormone therapy for gender dysphoria as of Oct. 13, 2026. Mental health treatment for gender dysphoria remains covered. AHCCCS encourages providers to identify affected members and begin the tapering process or begin obtaining medications through the manufacturer patient assistance programs (PAP). RxAssist.org is a website where you can find most manufacturers’ PAP forms or you can go directly to the manufacturer’s website which should have directions for their PAP process.

Reminder: Complete Your Required Primary Provider Onboarding Requirements

Watch the video and submit your attestation

If you have not yet completed the required Primary provider’s Onboarding training, now is the time to do so. The training video reviews key information to help providers understand Mercy Care requirements and expectations.

After viewing the video, be sure to complete and submit the required attestation. Completing both the training and attestation helps ensure compliance with provider participation requirements and confirms that you have reviewed the onboarding information.

Medicaid Billing Provider Tax ID Edit for Encounters

• Excludes Mercy Care Advantage
• 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 specifically on screen PR045.

Note: Not having the correction could cause set up issues and subsequent payment delays for providers.  See example (red arrows) below:

2026 Provider Language Service Satisfaction Survey

We value your feedback and would like to learn about your experience using Mercy Care language services. Your responses will help us identify opportunities for improvement and strengthen our language service offerings and vendor management practices to better meet your business needs. The survey takes only a few minutes to complete, and all responses are 100% anonymous.



Thank you in advance for taking the time to share your experience and help us improve our services.

Referrals to Non-Contracted Providers: What Providers Need to Know

Referrals do not automatically require coverage of out-of-network services.

Contracted providers should work with Mercy Care before referring members to non-contracted providers. A referral alone does not guarantee coverage or payment for out-of-network services. Coverage decisions are based on network availability, prior authorization requirements, plan benefits and applicable regulatory guidelines. If a medically necessary service is not available within the network, Mercy Care may arrange authorized out-of-network care in accordance with plan requirements. Providers are encouraged to follow established referral and authorization processes and ensure appropriate documentation when coordinating member care.

Billing Preventive and Sick Visits Correctly

Follow CPT and AHCCCS guidelines when services occur during the same visit.

Mercy Care reminds providers that a sick visit may be billed on the same date as a preventive visit when a significant, separately identifiable medical issue requires additional evaluation and management (E/M) services. Trivial or insignificant findings that do not require additional work should not be billed separately. For Medicare members, qualifying E/M services must be reported separately with Modifier 25 when medically necessary. Review CPT guidelines and AHCCCS AMPM Policy 430 for additional requirements.

• Codes 10/07/2026

• Valid OPFS Procedure Modifiers (RF121); F (RF122) and (RF132) 10/07/2026

• End Date 10/06/2026

• Procedure Codes & Descriptions (RF110) 10/06/2026

• Correct Coding (RF128) 10.01.2026

• Procedure AHCCCS Coverage (RF123) 10/01/2026

• Procedure Prior Authorization (RF124) 10/01/2026

• Revenue Codes-To-Procedure Codes (RF773) 10/01/2026

• Revenue Codes-To-Procedure Codes (RF773) 09/28/2026

• Codes 09/28/2026