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BH Inpatient Payment Responsibility
Comment Period Closed
Friday November 11, 2014
The Administration is proposing a rulemaking to clarify an issue that has been identified
through the administrative hearing process regarding contractor responsibility for covering
inpatient hospital services when both medical and behavioral health services are provided
during the same hospital stay. The proposed rule will clarify the reimbursement methodology.
The Administration is proposing to clarify through rule, its existing policy that the RBHA is
responsible for all inpatient hospital services if the principle diagnosis on the hospital
claim is a behavioral health diagnosis. Those claims will be paid in accordance with a per
diem fee schedule developed by ADHS and approved by AHCCCS. Hospital claims that do not have a
behavioral health diagnosis as the principle diagnosis will be paid by the acute care contractor
using the DRG payment methodology. This proposed amendment will benefit hospitals by clarifying
to whom claims should be submitted and the amount of reimbursement that the hospital can expect.
The Administration intends to initiate and implement this clarification as soon as possible to
reduce billing disputes between hospitals and health plans and to reduce unnecessary
administrative hearings arising from those disputes.
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