DRAFT DSH Methodology beginning 2008
There are many changes to AHCCCS and hospital requirements in the new
DSH methodology. Draft documents of our proposed methodology and the
Private Facility Information Sheet (PFIS) that will be required from
Arizona hospitals are attached. We expect we may need to make a few
minor changes to the documents, but they are very close to the final
version that we anticipate CMS will approve.
There are two major changes that will take some significant effort on the part of the hospitals to compile: The amount of inpatient charity charges for the State Plan Year 2006 (October 1, 2005 to September 30, 2006) and information regarding the uninsured for the same period of time. The uninsured information will include the number of inpatient days and the ancillary charges for inpatient and outpatient services provided to uninsured individuals.
One additional change that is worth noting is that AHCCCS will be establishing a cutoff date for hospitals to report the information required by the PFIS. If hospitals have not provided the requested information by the cutoff date, the hospital will be ineligible for DSH payments. We plan on discussing what a reasonable cutoff date would be during the webinars.
As this new methodology will be required for processing 2008 DSH payments, it is important that you familiarize yourself with the documents prior to the meeting. Please ensure representation at one of these meetings, and bring any and all questions.
Please note that, as this process has taken longer than expected, hospitals should plan on receiving the 2008 DSH payment in the third calendar quarter (July – September 2008).
Newborn Notification Training
Deficit Reduction Act - Policy and Training
This training is provided by the AHCCCS,
Office of Program Integrity.
Medicare Modernization Act (MMA) of 2003
These training materials are
specifically for Health Plans, Regional
Behavioral Health Authorities, and Program
Contractors.
National Provider Identification (NPI) Documents
Our NPI page contains links to documents related use of the National Provider Identification (NPI) number including the NPI Fact Sheet [PDF] and NPI Provider Type [PDF] documents.
Tamper Resistant Prescription Pad Guidance
This
bulletin
[PDF] provides guidance related to the federal mandate requiring
prescribers and pharmacies to use tamper resistant pads when writing or
filling prescriptions for certain Medicaid members. This federal mandate
becomes effective on: April 1, 2008.
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MOST COMMONLY USED LINKS FOR HEALTH PLANS & PROVIDERS
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AHCCCS Fee-For-Service Formulary for Providers [PDF, 126Kb]
Baby Arizona
If you are a physician interested in becoming a
participating Baby Arizona provider.
Check Eligibility/Enrollment, Enter Claims, and Review Claim Status Online
All registered AHCCCS Providers are eligible
to create an account and use this service to check
eligibility/enrollment, enter claims, and check
claim status online.
Newborn
Notification
All registered AHCCCS Health Plans and Hospitals
are eligible to use the online Newborn
Notification process to notify AHCCCS when a baby
is born to an AHCCCS member.
Technical
Interface
Links to Computer Operations Schedules,
File Layouts, and the to Technical Interface
Guidelines.
Got A Question About Claims?
Send us an email
You can now
e-mail
the AHCCCS Claims Department if you have
a question or comment about our
fee-for-service claims policies and
procedures.
Provider
Registration
To enroll in the
Arizona Medicaid Program as a provider of
services. Reinsurance
This page contains information for health
plans and program contractors concerning
reinsurance under the AHCCCS acute care and
ALTCS long term care programs.
HIPAA
Crosswalks
In addition to the standardization of
electronic transactions mandated by HIPAA
effective October 16, the law also mandates
standardization of codes by eliminating all
local codes. For AHCCCS, this means the
"W," "Y," "Z,"
and IHS-specific codes (00090 - 00099) will
be replaced by standard HCPCS codes. These
crosswalks show the standard codes which
will replace AHCCCS' local codes.
Claim Disputes
AHCCCS Providers of health care services may
file a claim dispute to challenge payments or
denials of claims. If you have a claim dispute
for a member enrolled in a health plan you
must file your written dispute with the health
plan.
For disputes involving a FFS
member the written dispute must be filed with
AHCCCS OLA. All claim disputes must comply
with the requirements of A.R.S.
36-2903.01.B.4.
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