Encounter Resources are intended for health plans and program contractors under the AHCCCS Acute Care and Arizona Long Term Care System (ALTCS) programs.
The following are included in Encounter Resources:
- Adjudication Resources
- Request for PMMIS Reference Table Update
- Encounter Override Request Spreadsheet Template
- Frequently Asked Questions (FAQs)
- Encounter Processing Schedules
Submission of encounter data to AHCCCS is a mandatory requirement established by the Centers for Medicare and Medicaid Services and is the responsibility of each contractor pursuant to its contract with AHCCCS.
Contractors may submit files as often as desired throughout the month. Multiple files may be submitted on the same day for validation and translation, after which each the encounter record is evaluated against a series of adjudication edits and audits on at least a monthly basis.
AHCCCS follows national industry standards and code sets as published by X12N, National Council for Prescription Drug Programs (NCPDP), and other data standard maintenance organizations.
For more information about current/future production and test schedules, select one of the following:
- Current Encounter Production (Updated 9/26/2023)
- Future Encounter Production
- Test Schedule For the test environment, the adjudication process begins every Thursday. Test files must be submitted by 5pm on Wednesday. Depending on the volume of test files submitted, test results are usually available anytime between Friday and Monday.
Encounter Unit staff is available Monday through Friday (excluding State holidays) to assist contractors in resolving encounter errors or to research specific encounter issues. Questions regarding the validator or TI should be submitted to the AHCCCSTIEncounters@azahcccs.gov e-mail address. All other encounter questions, including those concerning mainfame, should be sent to the AHCCCSEncounters@azahcccs.gov e-mail address.