AHCCCS Technical Interface Guidelines (TIG)

Recipient Interface


Eligibility Verification System (EVS)

Introduction - The automated EVS at Arizona Health Care Cost Containment System (AHCCCS) is a process to provide member eligibility verification services to AHCCCS providers. This is accomplished through a contract with an outside vendor who provides terminals in the providers' offices and data communication access statewide through a common entry point into the AHCCCS production member data. Providers can obtain specific eligibility and enrollment data without having to call the AHCCCS Communications Section.

Schedules - EVS is available 24 hours a day, and is limited only by downtime scheduled at the ADOA-DC mainframe and the recycling of AHCCCS' production CICS region. These downtimes are normally scheduled from 4:00 a.m. to 4:15 a.m. daily, from midnight Friday to 7:00 a.m. Saturday, and from midnight Saturday to 7:00 a.m. Sunday.

Media - EVS is accessed via point-of-sale terminals, or via modem on IBM compatible PCs with a modem. The vendor will sell or lease this equipment, which includes the necessary software, or will sell the software only to run on existing equipment.

Reporting - An automated audit trail and a paper printout are available for record keeping and research.

Testing - The vendor is responsible for all marketing, installation, training, and testing of the EVS system. AHCCCS is not actively involved in any of these activities; however, AHCCCS does support and monitor progress of these activities.

Interactive Voice Response (IVR) System

Introduction - The automated IVR system at Arizona Health Care Cost Containment System (AHCCCS) is a process that provides recipient eligibility verification services to AHCCCS providers. Providers can obtain specific eligibility, enrollment, Medicare and other third party data without using the AHCCCS Communications Center.

Schedules - IVR is available 24 hours a day, and is limited only by downtime scheduled at the ADOA-DC mainframe and the recycling of AHCCCS' production CICS region. These downtimes are normally scheduled from 4:00 a.m. to 4:15 a.m. daily, from midnight Friday to 7:00 a.m. Saturday, and from midnight Saturday to 7:00 a.m. Sunday.

Media - IVR is accessed via any touch-tone phone. A local number and a 1-800 toll-free number are available to all contracted providers.

Reporting - AHCCCS has automated paper trails to aid in problem diagnosis. Some areas in the state are offered the option of receiving faxed copies of the verification information to be used for record keeping, or as an audit trail.

Testing - AHCCCS is responsible for all marketing, training, and testing of the IVR system.

WEB Based Verification System

Introduction - The WEB Based Verification at Arizona Health Care Cost Containment System (AHCCCS) is an internet-based process to provide member eligibility verification of services to AHCCCS registered Providers. Providers can obtain specific eligibility, enrollment, Medicare, other Third Party Liability and claims data without using the AHCCCS Communication Center, EVS or IVR.

Schedules - The WEB Based Verification is available 24 hours a day, and is limited only by downtime scheduled at the ADOA-DC mainframe and the recycling of AHCCCS' production CICS region. These downtimes are normally scheduled from 4:00 a.m. to 4:15 a.m. daily, from midnight Friday to 7:00 a.m. Saturday, and from midnight Saturday to 7:00 a.m. Sunday.

Media - The WEB Based Verification is accessed via the internet. Registration is required. The application can accessed from the AHCCCS Online website.

Reporting - Summary reports are produced to reflect the number of new accounts created, eligibility inquiries, and claim inquiries made during the month.

Testing - AHCCCS is responsible for all marketing, training, and testing of the WEB Based Verification process.