Division of Fee for Service Management (DFSM)

We are the third largest health plan in the AHCCCS program. DFSM is the fee for service health plan responsible for the clinical, administrative and claims functions of the Fee For Service Population (FFS) of more than 250,000 members.

This includes American Indians enrolled in the AHCCCS Fee for Service Program (AIHP) for acute care and Tribal long term care programs, and individuals in the Federal Emergency Service Population (FES). DFSM pays fee for service provider claims, prior authorizes medical services, provides ongoing training, completes clinical claims reviews, provides customer services to FFS providers, and completes care coordination activities for the FFS population.

DFSM also acts as the Third Party Administrator for various other state entities, such as the Division of Behavioral Health Service for claims related to Tribal Regional Behavioral Health, Arizona Department of Corrections, along with the (counties) correctional systems, and school-based services.