MES Modernization Update

The AHCCCS MES Modernization Program is transforming agency systems and enhancing operations to better meet the needs of Arizona residents and strengthen local communities. This modernization effort focuses on upgrading outdated technology, streamlining everyday processes, creating a solid platform for future advancements, and improving access to and usability of important data.

As you can see from our updated timeline below, we have many system updates going live in the next few months.

Electronic Data Interchange (EDI)

AHCCCS is also preparing to implement the new EDI translator on March 1, 2026. This is a behind the scenes upgrade for faster and more efficient data exchange. The new translator has been thoroughly tested internally and externally with trading partners, including health plans and clearing houses. It is expected that this change will be seamless to our trading partners, with no changes to their transaction submission process.

Should you encounter any issues, please report following your process below:

Health plans: Existing process will be followed. MCO will email the AHCCCS health plan coordinator with the EDI issue.

For Providers and Clearing houses:

Follow the process below to engage the EDI team for any EDI related issues/questions.

Open Government Service Portal - Government Service
Select “IT Issue?” under Help at the bottom of the page.
Select ‘EDI’ from the category dropdown

Program Integrity (PI)

Our Program Integrity (PI) modernization efforts include several important upgrades.

The Case Manager provides improved visibility into case status and houses all case information on a single platform. AHCCCS previously had two independent case management systems that could no longer keep up with the high demand and output of investigations and audits. Leadership will benefit from expanded reporting capabilities and more detailed dashboards. FWA Finder and Case Manager systems remain on schedule for their March 31, 2026, go live date, with Service Now following close behind for an April 2026 go live date.

The FWA Finder® will allow staff to automate triaging of fraud, waste and abuse referrals while escalating quality of care concerns to the appropriate divisions. Anonymous referrals from staff and the public will continue to be accepted.

AHCCCS is improving how Fee-for-Service (FFS) claim denial reasons are communicated to providers. Based on provider feedback and with support from external partners, AHCCCS has identified opportunities to clarify and enhance denial reason codes and messaging within the claims process. New and updated denial reasons will be tested and incorporated into the Denial Resolution Guide ahead of the Alivia Prepay system launch.

Customer Service System (CSS)

Another part of our modernization efforts is the launch of the Customer Service System (CSS) through the AHCCCS Solutions Center, powered by ServiceNow.

AHCCCS has launched a project to modernize the Fee-for-Service (FFS) prior authorization portal, workflows, and overall user experience. The project is currently focused on assessing existing functionality, identifying areas for improvement, and defining enhancements needed to better support providers and staff.

We are also streamlining how clinical and operational service requests are submitted and managed. These improvements will support better tracking and prioritization of requests, including the ability to distinguish urgent needs from routine inquiries. The enhanced process will also help identify trends in provider questions, inform targeted training opportunities, and support continuous improvements to workflows, resolution timelines, and overall service delivery.

As we introduce this advanced platform to streamline how requests are submitted and managed, it is important to emphasize that the heart of our service remains with our dedicated AHCCCS teams. Although this state-of-the-art platform uses modern technology and enhanced forms to improve efficiency, every inquiry will continue to be carefully reviewed, evaluated, and responded to by real people. Our staff remains fully engaged throughout the process, ensuring personalized attention and support. The updated platform is designed to support our teams by improving work management and response times, allowing us to continue delivering exceptional, human-centered customer service.

Mainframe/PMMIS transition

Internal technical testing continues on the new database which is replacing our legacy mainframe system with the first testing phase to be completed this month.

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 through the Public Feedback Form.