MES Modernization Update

As shared previously, the AHCCCS MES Modernization Program is focused on updating technology and improving how we work so we can better support our members and Arizona communities.

Modernization means:

• Replacing outdated systems
• Streamlining processes
• Strengthening our foundation for future growth
• Making data easier to use

These upgrades help AHCCCS respond more quickly and effectively to members’ and providers’ needs. If you have any questions not answered in the newsletter, please use the feedback form.

In our last update, we introduced you to the technology development cycle and projected timeline AHCCCS is applying to our MES Modernization projects. Below are recent updates:

Electronic Data Interchange (EDI) - Test phase

AHCCCS is actively working on an EDI modernization initiative to upgrade our translator expected to be in use March 2026. This upgrade is currently in the final testing phase with AHCCCS staff and external partners who currently used EDI. The transition should be seamless for trading partners, with no changes to the transaction submission process.

Upcoming Improvements to AHCCCS Systems - New Tools to Strengthen Program Integrity

AHCCCS is enhancing several systems which prevent and detect fraud, waste, and abuse within Medicaid services. The Office of Inspector General (OIG) and the Division of Fee for Service Management (DFSM) are launching a new Program Integrity platform that replaces older technology and brings multiple tools into one streamlined system.

Two major components will be introduced:

• OIG: FWA Finder® and Case Manager – Launching March 31, 2026
• DFSM: Claim Manager System – Launching June 28, 2026

These updates will offer a more modern system for AHCCCS staff and give AHCCCS better tools to communicate with providers and protect program integrity. More information about what to expect during launch will be shared as the dates get closer.

Customer Service System (CSS) - Testing phase

Starting in April 2026, Providers, Applicants/ Members, and Health Plans will have a new and streamlined way to engage with AHCCCS through the new Customer Service System (CSS) available on the AHCCCS Solutions Center. This modernized system is designed to make it easier to request assistance and track the status of your inquiries.

Today's requests may require a phone call or email, but in the future, you can submit these requests, such as claims, billing, and others, directly through the AHCCCS Solutions Center.

These efforts reflect our commitment to modernization through secure, cloud-based solutions that simplify processes and enhance transparency.

H.R. 1 - Design phase

The agency has formed an Executive Steering Committee, Working Steering Committee, and Work Groups for key bill sections. The following work groups and the bill sections of H.R. 1 that they are working on are listed below (the work group titles and bill section titles are a short summary used by AHCCCS):

• Rural Health Transformation: Bill Section 71401 – Rural Health Transformation
• Community Engagement: Bill Section 71119 – Community Engagement
• Provider-Eligibility & Finance: Bill Sections 71120 – Cost-Sharing for Expansion Adults, 71113 – Prohibited Entities, 71112 – Modifying Retroactive Coverage, & 71110 – Emergency Medicaid FMAP
• Eligibility & Enrollment: Bill Sections 71107 – 6-month redetermination, 71109 – Alien Medicaid Eligibility, & 71103 – Enrollee Address Verification
• Finance: Bill Sections 71116 – State Directed Payments & 71115 – Provider Tax Change
• Payment Reduction for Erroneous Payments: Bill Section 71106 - Payment Reduction for Erroneous Payments

PMMIS/Mainframe Refactor - Testing phase

While the PMMIS/Mainframe testing in the new Azure cloud environment started this month in a very limited capacity with AHCCCS technical staff.

Stay Connected!

We will share updates and training opportunities as new tools roll out. If you have any questions or comments about the MES Modernization Program, please submit them here or type the link in your browser: https://forms.office.com/r/HpAnSQvXdK

Together, we are building a stronger, more efficient system to serve Arizona’s communities!