Division of Fee for Service Management (DFSM)

DFSM is the third largest health plan in the AHCCCS program. DFSM is responsible for the clinical, administrative, and claims functions of FFS population of more than 245,000 members.

This includes American Indians and Alaskan Natives enrolled in the American Indian Health Program (AIHP) for acute care, members enrolled with the Tribal Regional Behavioral Health Authorities (TRBHA) for behavioral health services, Tribal Arizona Long Term Care Services (ALTCS) and individuals in the Federal Emergency Service Program (FESP). DFSM pays FFS provider claims, prior authorizes certain medical and behavioral health services, provides ongoing training, completes clinical claims reviews, provides customer services to FFS providers, and completes care coordination activities for the FFS population.

DFSM acts as the Third Party Administrator (TPA) for the School Based Claiming (SBC) program, the Maricopa County Department of Corrections (DOC), and various other counties’ correction system. AHCCCS uses the services of a Pharmacy Benefit Manager (PBM) to manage the Fee for Service pharmacy benefit.