AHCCCS Update Meeting – Systems Update March 2015.

AHCCCS Update Meeting – Systems UpdateMarch 2015

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Topics:• Encounter Claims Data Exchange/Blind Spots Updates• APR-DRG Project Wrap-up• ICD10 Project Updates• FQHC/RHC Project Updates• PCP Rate Parity Project Updates• AHCCCS CRN Expansion Project (999 Lines) Updates• Greater AZ SMI Integration Updates• GMH/SA Duals Integration Updates• Other Updates – Next Technical Consortium

Reaching across Arizona to provide comprehensive quality health care for those in need

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Encounter/Claims Data Exchange/Blind Spots Planned additions to the Data Exchange:• Integration of - Medicare Paid Claims Data Part

D• (also looking at feedback to CMS on gaps in the data

provided) - in progress• Inclusion of Member Behavioral Health

Category and a supplemental file of revenue code data – in progress

• Will be looking for additional Contractor feedback on possible data element additions, etc…

• Reminder Quarterly data extracts are based on Claims and Encounters adjudicated within the reporting ¼


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APR-DRG’s• Implemented 10/1/2014 (based upon Dates of

Discharge)• Limited issues noted to date • Technical Workgroup meeting materials and

related documentation continue to be available at http://www.azahcccs.gov/commercial/EDIresources/EDITechnicalWorkgroups.aspx

• 3 Key Forms of Project Documentation – o AHCCCS Policy Document (updated Track Changes

version currently posted)o AHCCCS Ruleo AHCCCS DRG Calculator


http://www.azahcccs.gov/commercial/EDIresources/EDITechnicalWorkgroups.aspx


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ICD-10• Testing with Trading Partners began in January of

2014 and will continue through September of 2015• ICD10 Effective Date - October1 2015 (OP Dates of

Services or IP Dates of Discharge)• AHCCCS will be supplying a limited set of required

Testing Scenarios that all Contractors must successfully complete prior to implementation – development of these scenarios is in progress


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FQHC/RHC Project• FQHC/RHC Payment Alignment

o AHCCCs and Contractor’s will pay FQHC/RHC provider specific PPS rates for each “visit” for dates of service 4/1/2015 forward

o Technical workgroups – material posted to the Technical workgroup webpage http://www.azahcccs.gov/commercial/EDIresources/EDITechnicalWorkgroups.aspx

• FQHC/RHC Billing Rules (FFS Billing Manual Chapter) final draft released on 3/12 for final review





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PCP Rate Parity Adjudication Dates Run Date Comments

August - December 2013 Completed

Slimmed Down Report; void/replacement impacts

Jan - March 2014 CompletedSlimmed Down Report; void/replacement impacts

April - June 2014 CompletedSlimmed Down Report; void/replacement impacts

July - Sept 2014 Completed Modified Slimmed Down Report*October 2014 Completed Intent is fully-corrected Report**November 2014 Completed Intent is fully-corrected ReportDecember 2014 Completed Intent is fully-corrected ReportJan - March 2015 April 2015 Intent is fully-corrected Report


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PCP Rate Parity (cont.)• Contractor Error Reports in sample or full may be

made available to plans as requested

• In the event that a provider is subsequently “decertified” for enhanced payments as result of required audits or other changes to providers: o Contractors will be required to reprocess all impacted

claims for recoupment of enhanced payment amounts and replace encounters for the reprocessed claims

o Contractors will be required to refund payments to AHCCCS for any reduced claim payments


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PCP Rate Parity (cont.)• The first of the required audits of eligible providers

is currently nearing completion pending receipt of a few identified outstanding records and final assessment of provider

• A detailed workgroup was held with all Contractors to review:o The audit process and related provider outreacho Outcomes of the audit and related artifactso Impacted providers o Next steps to be taken by AHCCCS and required of

Contractorso The process for Contractor handling of potential provider

disputes


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PCP Rate Parity (cont.)• While AHCCCS is responsible for determining

qualified practitioners for enhanced payments, and decertifying them when necessary, the obligation is on the Contractor to understand the reason for recoupments as well as the accuracy of the recoupment amounts


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AHCCCS CRN Expansion Project (999 Lines)• AHCCCS 999 UB Lines HIPAA compliance changes

proposed to begin mid to late 2015 and implement in 2016

• Will fully remediate the PMMIS system to expand the CRN by 1 additional digit for all form types; i.e.… AHCCCS CRN’s will go from 14 digits to 15 digits in length

• Will impact and require testing with Contractors and Trading Partners everywhere the AHCCCS CRN is used or reported


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Greater AZ SMI Integration• ADHS/BHS awarded two contracts one for southern

AZ GSA’s (Cenpatico Integrated Care) and one for northern AZ GSA’s (Health Choice Integrated Care) to serve as Integrated Contractors (providing both behavioral and physical health services to SMI members) and the RBHA for all other members in these GSA’s

• AHCCCS required systems changes are in progress this implementation 10/1/2015


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GMH/SA Duals Integration• AHCCCS will identify Medicare/Medicaid dual

eligible General Mental Health (GMH)/Substance Abuse (SA) members and will assign their AHCCCS Health Plan to provide both their behavioral health services

• AHCCCS required systems changes are in progress for the 10/1/15 implementation


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Questions?


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Thank You.


AHCCCS Update Meeting – Systems Update March 2015.

Documents

Transcript of AHCCCS Update Meeting – Systems Update March 2015.