Technical Consortium Updates and Important Notices
Stay informed about recent developments in the technical consortium, including staff changes, encounter edits, EDI vendor updates, and alignment requirements for EPD and DSNP plans effective in 2025.
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Presentation Transcript
Technical Consortium November 13, 2024
Welcome Hiring Cap Down staff on Encounters Team May result in delays in override processing and technical assistance 2
H2O Member Exception Codes on Unique Population File HE H2O Eligible Member RA H2O Rental Assistance Member (6 month limit) Provider Types HA Statewide Housing Administrator (ABC Housing 212129) ES Enhanced Shelter Provider HO H2O Provider H2O Program Administrator (211880) 3
H2O Cont. Encounter Edits P606 H2O FFS Only Any encounters with the provider type HA, ES or HO Any encounters with the H2O Program Administrator (211880) This edit is a denial Utilization H2O Claims Utilization will be on the Dex (Blind Spot) File. 4
EDI Vendor AHCCCS is changing EDI Vendors Implemented 11/8/24 AHCCCS will now enforce TR3 edits for inbound 837 files Transaction Insight Correction Process will not be immediately available at implementation Correction process will be developed after implementation Until implemented, will need to correct and resubmit EDI files through SFTP Health Plan EDI Training 11/18/24 at 8 am 5
EPD DSNP Alignment Effective 1/1/25 CMS regulation requires the member s EPD Medicaid Plan be aligned with their DSNP Plan if possible. EPD enrollment will now look at the member s DSNP (MHMO record in PMMIS) to see if there is an aligned DSNP plan and if so, enroll accordingly. If AHCCCS receives a DSNP plan change from CMS on an EPD member, AHCCCS will re-evaluate enrollment and if the DSNP plan aligns with another plan in the member s GSA, then the member s plan will be changed accordingly. 6
EPD DSNP Alignment Cont. AHCCCS will be working on a new annual enrollment letter for members that are in an aligned DSNP. Members that are currently unaligned will all be re-evaluated effective 1/1/25 and if they align to another plan in their GSA, the enrollment will update accordingly. 7
Recent and Upcoming System Changes H051 Enhancement (dates of service after 7/18/24) Service Provider NPI Can t be in Note Field 9XXXX HCPC Codes Can t have all 9 s in Note Field HCPC Codes 97151 97156 are exceptions and are eligible to be overridden until system change for these exceptions can be implemented. 8
Recent and Upcoming System Changes Cont. Dex Tooth History Added dental fields to the monthly Dex file. Implemented 7/18/24 9
Recent and Upcoming System Changes Cont. DAP Effective 10/1/24 DAP Flows sent to the plans 4/26/24 Automating DAP programming on AHCCCS side 10
Recent and Upcoming System Changes Cont. New Certified Doula Provider Type Effective 10/1/24 Provider Type DU No registered Certified Doulas as of today 11
Recent and Upcoming System Changes Cont. A905 Edit Update Implementing 11/21 Bypass this edit when the member has Medicare or Third Party Insurance 12
Recent and Upcoming System Changes Cont. U262 Edit Update Implementing 12/19 Check for days from members date of death and bypass U262 for up to 4 hours per day of direct skilled nursing services when the services are within 7 days of members date of death. 13
Future System Enhancements Ethnicity on 834 Updates to VFC Edits as discussed in the MCO Encounter Meetings Z628 and DAP MES Modernization CAA ROPA (FFS) 14
Questions? 16
Thank You. 17
