Division of Fee for Service Management (DFSM)
The Division of Fee for Service Management is the third largest health plan in the AHCCCS program, responsible for the clinical, administrative, and claims functions of the Fee-for-Service (FFS) population of nearly 300,000 members.
This includes American Indians and Alaskan Natives enrolled in the American Indian Health Program (AIHP), members enrolled with the Tribal Regional Behavioral Health Authorities (TRBHAs), Tribal Arizona Long Term Care Services (ALTCS), and individuals in the Federal Emergency Service Program (FESP). DFSM pays FFS provider claims, issues prior authorization for certain medical and behavioral health services, provides ongoing training, completes clinical claims reviews, provides customer service to FFS providers, and completes care management activities for the FFS population.
DFSM acts as the Third Party Administrator for the School Based Claimingprogram, the Maricopa County Department of Corrections, and various other counties’ correction systems. AHCCCS uses a Pharmacy Benefit Manager to manage the FFS pharmacy benefit.