AHCCCS Update Meeting – Systems Update May 2014. Cost Sharing (Copays) Addition modifications under evaluation and planned for 10/1/2014: o Populations

AHCCCS Update Meeting – Systems UpdateMay 2014

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Cost Sharing (Copays)• Addition modifications under evaluation and

planned for 10/1/2014:o Populations currently subject to mandatory and optional

(nominal) copaymentso Populations exempt from copaymentso Amounts for applicable copaymentso And services for which copayment apply are planned o Will begin to share details in upcoming Technical

Consortiums

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

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Data Exchange/Blind Spotso AHCCCS will manage an ongoing exchange of

encounter and claims data to Contractors in order to eliminate “blind spots” for services provided to a member shared by multiple programs (In compliance with Federal privacy regulations); Contractors should use this information to develop short- and long-term strategies to improve care coordination

o Ongoing – provide at least quarterly; First 1/4ly report for January – March 2014 was run and distributed in April


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Data Exchange/Blind Spots (cont.) Planned additions to the Data Exchange include

the integration of - Medicare Paid Claims Data (Part D; D-SNP; Medicare FFS) – In progress


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DRG’s• On schedule for 10/1/2014 Implementation (based

upon Dates of Discharge) • Technical Workgroup Formed for this project;

Meeting on a regular/as needed basis; Meeting materials available at http://www.azahcccs.gov/commercial/EDIresources/EDITechnicalWorkgroups.aspx

• 3 Key Forms of Project Documentation – o AHCCCS Policy Document – Final Distributedo AHCCCS Rule – Revisions based on Comments in Progresso AHCCCS DRG Calculator – Final Distributed


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

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

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DRG’s (cont.)• Finalized all Policy decisions and shared with all

Contractors as a component of the DRG Technical Workgroup

• Testing 3M APR-DRG software• Contractors will be provided with and will be

required to successfully execute a defined set of test scenarios

• Contractor monthly project Milestone Reporting began in February, 2014; Status Summary developed for internal tracking and publication to the web


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DRG’s (cont.)• Current DRG Project Milestones:

o Complete Requirements and Design - Completed - March 2014

o Complete Coding – In Progress - May 2014o Internal Testing Begins - May 2014o Internal Testing Ends - July 2014o External Testing Begins (all Contractors/providers/ATR) -

June 2014o System Implementation - September 2014o External Testing Ends (No earlier than) - September 2014


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ICD-10• The AHCCCS ICD10 Project was impacted by

Federal Legislation; direction from CMS as to timeframes and implementation requirements specifies a delay in implementation to 10/1/2015

• No impact to APR-DRG project timeframes


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ICD-10 (cont.)• Communication to Contractors – “It is AHCCCS’s

intent, as previously communicated, to continue to pursue finalization of our ICD10 system changes and to utilize the delay to expand the External Testing window afforded to our Trading Partners. We will also be soliciting feedback from each of our Contractors over the next few weeks as to your ability to or barriers from being able to follow the aforementioned approach to project timelines. Please do not stop work on your current timelines related to ICD10 project without first discussing revisions to your timelines with us.”


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ICD-10 (cont.)• “Revised” AHCCCS ICD10 Project Milestones

o Complete Requirements and Design – ReferenceCompleted

o Begin Coding – ReferenceCompleted

o Complete Requirements and Design – All other Completed

o Internal Testing Begins – ReferenceCompleted

o Begin Coding – All other System Areas In Progress

o Freeze Begins.....o System Implementation – Reference

Completedo Initial Reference Table Loads Completed


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ICD-10 (cont.)• Internal Testing Begins – System Areas In Progress• Other than Reference• Internal Testing Ends – All System Areas September 2014• External Testing Begins (all Contractors/providers/ATR)

(see detail)o 837 Submissions – Claims/Encounters January

2014o Claims/Encounters Editing and Results Reporting March

2014o Reports June

2014o ICD9/DRG Integrated End to End June

2014o ICD10/DRG Integrated End to End TBDReaching across Arizona to provide comprehensive

quality health care for those in need

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ICD-10 (cont.)• System Implementation (with 10/1/2015 effective dates) – All

Systems September 2014 • Freeze Ends.....• External Testing Ends No earlier than September 2015

ICD10 Effective Date - October1 2015 (OP Dates of Services or IP Dates of Discharge)


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ICD-10 (cont.) Status Summary developed for publication to the

web based on ongoing Contractor Milestone Reporting and Tracking


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FQHC/RHC• FQHC/RHC Payment Alignment

o Contractor’s will need to pay FQHC/RHC unique PPS rates for each “visit” (separate service not with same discipline)

• Timeline o October 1, 2014 implementationo Provider registration letter and spreadsheet (In progress,

due by 8/15/14)o Testing window for Contractors and providers (late July

2014 – early August 2014)


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FQHC/RHC (cont.)• AHCCCS Proposal for FQHC/RHC

Processing o AHCCCS will establish a unique provider type for FQHCs

and a unique provider type for RHCs; Provider types 29 and C2

o AHCCCS is requesting that all FQHCs and RHCs register and obtain a unique AHCCCS Provider ID under these applicable provider types

o To facilitate this registration and AHCCCS claims processing, AHCCCS is requesting that FQHCs or RHCs have a unique NPI (not already associated with any other active AHCCCS Provider ID) to be on file and utilized for related claims submissions

o AHCCCS will provide a streamlined approach for provider registration


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FQHC/RHC (cont.)o FQHC and RHC claims will identify the unique NPI of the

FQHC or RHC as the service/rendering providero FQHCs and RHCs can be reimbursed on same day for

each “unique” visit, (.e. a separate service not within same discipline (e.g. dental and medical)); no change from the current process

o FQHCs and RHCs will bill AHCCCS and its Contractors for each “unique” visit utilizing appropriate CPT Evaluation and Management codes and including all related services for the visit utilizing a 1500 claim format (standard practice for most facilities)

o FQHCs and RHCs will be paid an all inclusive "visit" rate per visit that will serve a full reimbursement for the individual visit regardless of other related services for the visit Reaching across Arizona to provide comprehensive

quality health care for those in need

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FQHC/RHC (cont.)o Visit payments will be paid associated with the billed E&M

“visit” codes and any other related services will be valued at $0.00

o AHCCCS will implement a unique Provider specific fee schedule (equivalent to the PPS rate) for each FQHC and RHC where visit E&M codes will reflect the appropriate per visit rate effective for the date of service and in which all other related service codes will reflect a rate of $0.00 (due to bundling under the per visit rate as noted above)

o Current FQHC Pharmacy (340B) billing will remain as is under the Pharmacy provider type, etc... and will not be impacted by this change


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FQHC/RHC (cont.) AHCCCS will continue to have a quarterly payment and

reconciliation process but the amounts that are part of the quarterly payments will be updated to reflect that fact that Contractors will be paying considerably more to avoid recoupments as part of the reconciliation


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PCP Rate Parity• AHCCCS will make quarterly cost-settlement

payments to the Contractor based upon adjudicated/approved PCP Rate Parity encounter data

• Contractors will be required to refund payments to AHCCCS for any reduced claim payments in the event that a provider is subsequently “decertified” for enhanced payments as result of subsequent audits or other changes to providers


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PCP Rate Parity (cont.)• “Catch-up” cost-settlement report for qualified

encounters adjudicated/approved between 8/1/2013 and 12/31/2013 a well as the first 1/4ly report for the January through March time period were run and distributed to Contractors; late last week an issue was noted with the reporting and re-runs of both reports for redistribution to Contractors is in progress


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Security Audit• Reminder - First audit due no later than June 1,

2014; any issues or concerns with this timeframe please let us know ASAP

• Minor clarifications made to published policy in response to additional Contractor feedback made and distributed in January

• Timeframe for our internal review not yet determined but will be communicated shortly


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AHCCCS >99 Encounter Lines• AHCCCS 999 UB Lines HIPAA compliance changes

proposed for mid 2015• Will fully remediate the PMMIS system to expand

the CRN by 1 additional digit• Will impact and require testing with Contractors• Detailed timelines in development


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RBHA Encounter Data• Beginning in January of this year AHCCCS began

directly processing RBHA (including the Integrated RHBA) encounters for both TXIX/TXXI and State Only populations/services

• Includes processes to capture and support State Only member records in PMMIS

• ADHS/BHS receives copies of process related reporting


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Other• Next Technical Consortium scheduling

in progress for sometime in June• Technical Workgroup focused on TPL

data and related processes scheduled for Tuesday, June 10th; Will include participants from HMS


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Questions?


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Thank You.


Documents

AHCCCS Update Meeting – Systems Update May 2014. Cost Sharing (Copays) Addition modifications under evaluation and planned for 10/1/2014: o Populations