ahcccs update meeting – systems update september 2015
TRANSCRIPT
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AHCCCS Update Meeting – Systems UpdateSeptember 2015
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Topics:• ICD10 Project Wrap-up/Reminders• Greater AZ SMI Integration Wrap-up/Reminders• GMH/SA Duals Integration Wrap-up/Reminders• FQHC/RHC Project Updates – Open
Issues/Challenges• PCP Rate Parity Project Updates• AHCCCS CRN Expansion Project (999 Lines)
Updates
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ICD10 Project Wrap-up/Reminders• ICD10 Effective Date - October1 2015 (OP Dates of
Services or IP Dates of Discharge); no exceptions• Testing with Trading Partners began in January of
2014 and will continue through September of 2015 (or ongoing as needed)
• We have received a high volume of questions from providers as well as requests for testing in the last 30 days
• AHCCCS supplied a limited set of required Testing Scenarios that all Contractors had to successfully complete prior to implementation
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ICD10 Project Wrap-up/Reminders, cont.• AHCCCS will be running a standard set of
monitoring reports post 10/1/2015 for Claims and Encounters to assess and make early identification of any areas of issue
• If fully implemented MCO Milestone reporting will cease after the 10/15 reporting for this project
• Beginning 10/1/15 MCO’s will be asked to supply a limited set of every other week updates on key areas, more information to be distributed this week
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Greater AZ SMI Integration Wrap-up/Reminders• ADHS/BHS awarded two contracts one for southern
AZ GSA’s (Cenpatico Integrated Care - Health Plan ID 010725; Site Codes 39 & 79) and one for northern AZ GSA’s (Health Choice Integrated Care – Health Plan ID 010700; Site Codes 38 & 78) 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 and conversion programs to support this implementation will be in place for 10/1/2015
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Greater AZ SMI Integration Wrap-up/Reminders, cont.• Walkthrough of AHCCCS Implementation/Go Live
Plan scheduled for next week with each Contractors Key Contacts
• Clarification of Opt-Out o Allowed only with cause; initiated by membero Specific reasons for opt out with be tracked and
reported to CMSo Opt Out only impacts “Enrollment Rules”;
member will remain with a SMI BH Category, but will not be enrolled in an Integrated RHBA and will instead follow regular Non-Integrated “Enrollment Rules”
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GMH/SA Duals Integration Wrap-up/Reminders• Medicare/Medicaid dual eligible General Mental
Health (GMH)/Substance Abuse (SA) members will be assign their enrolled AHCCCS Health Plan to provide both their physical and behavioral health services (New BH site codes – 50, 51, 52, 53, 54, 55, 56 & 57)
• AHCCCS required systems changes and conversion programs to support this implementation will be in place for 10/1/2015
• Walkthrough of AHCCCS Implementation/Go Live Plan scheduled for next week with each Contractors Key Contacts
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FQHC/RHC Project Updates – Open Issues/Challenges• FQHC/RHC Payment Alignment policy and
processes put in place for dates of service 4/1/15 and after to pay FQHC/RHC provider specific PPS rates for each “visit”
• With this implementation challenges were identified related to MIHS; updates/changes in progress to support MIHS specific needs ASAP by AHCCCS and all Contractors
• Recently an concern regarding requirements related to the Participating Practitioner was posed by Dental Quest; meeting this week to assess
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PCP Rate Parity
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Adjudication Dates Run Date
August - December 2013 Completed
January - March 2014 Completed
April - June 2014 Completed
July - September 2014 * Completed
October 2014 Completed
November 2014 Completed
December 2014 Completed
January - March 2015 Completed
April – June 2015 (includes July 2014 –June 2015 Void/Replace) Distributed July 21, 2015
April – June 2015 (includes July 2014 –June 2015 Void/Replace) - Rerun Distributed August 28, 2015
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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
• Future cost settlements will include only dates of service on and after 10/1/13 other than by specific exception
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AHCCCS CRN Expansion Project (999 Lines)• AHCCCS 999 UB Lines HIPAA compliance changes• Targeted for a March 2016 Implementation • Fully remediated 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
• Impacts all processes, reporting, PMMIS screens, etc… that utilize CRN’s from the implementation date forward
• Will impact and require testing with Contractors and Trading Partners
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AHCCCS CRN Expansion Project (999 Lines), cont.• Testing to begin ASAP after 10/1/15 and CRN
expansion will be reflected in the AHCCCS PMMIS Test System after this week
• Technical Workgroup to be schedule to review specific project details and areas of impact ASAP
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Questions?
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Thank You.
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