AHCCCS Update Meeting – Systems Update September 2015

AHCCCS Update Meeting – Systems UpdateSeptember 2015

2

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

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

3

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


4

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


5

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


6

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”


7

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


8

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


9

PCP Rate Parity


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

10

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


11

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


12

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


13

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


14

Questions?


15

Thank You.


Documents

AHCCCS Update Meeting – Systems Update September 2015