AHCCCS Update Meeting – Systems Update March 2015

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

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

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 aspx aspx 3 Key Forms of Project Documentation – o AHCCCS Policy Document (updated Track Changes version currently posted) o AHCCCS Rule o AHCCCS DRG Calculator 4 Reaching across Arizona to provide comprehensive quality health care for those in need

ICD-10 Testing with Trading Partners began in January of 2014 and will continue through September of 2015 ICD10 Effective Date - October (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 5 Reaching across Arizona to provide comprehensive quality health care for those in need

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 Workgroups.aspx Workgroups.aspx FQHC/RHC Billing Rules (FFS Billing Manual Chapter) final draft released on 3/12 for final review 6 Reaching across Arizona to provide comprehensive quality health care for those in need

PCP Rate Parity Adjudication DatesRun DateComments August - December 2013Completed Slimmed Down Report; void/replacement impacts Jan - March 2014Completed Slimmed Down Report; void/replacement impacts April - June 2014Completed Slimmed Down Report; void/replacement impacts July - Sept 2014CompletedModified Slimmed Down Report* October 2014CompletedIntent is fully-corrected Report** November 2014CompletedIntent is fully-corrected Report December 2014CompletedIntent is fully-corrected Report Jan - March 2015April 2015Intent is fully-corrected Report 7 Reaching across Arizona to provide comprehensive quality health care for those in need

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

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 outreach o Outcomes of the audit and related artifacts o Impacted providers o Next steps to be taken by AHCCCS and required of Contractors o The process for Contractor handling of potential provider disputes 9 Reaching across Arizona to provide comprehensive quality health care for those in need

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

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

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

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

Questions? 14 Reaching across Arizona to provide comprehensive quality health care for those in need

Thank You. 15 Reaching across Arizona to provide comprehensive quality health care for those in need