Technical Consortium

Centralized data management has been shifted to ISD under Data Analytics and Operations, while Technical Coordination and Encounter Units maintain service levels to MCOs. Hiring cap reductions may lead to delays in processing overrides. New H2O program effective 10/1/24, with specifications in progress. SFTP upgrade postponed. System changes include new fields in DEX file for dental information, service provider NPI restrictions, and unique population file updates.

• Data Management
• Technical Consortium
• System Changes
• H2O Program
• Security Upgrade

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Presentation Transcript

1. Technical Consortium May 21, 2024

2. Welcome Data Management and Oversight Moved to ISD Under Data Analytics and Operations Technical Coordination and Encounter Units still function and serve the MCOs same as before Hiring Cap Down staff on Encounters Team May result in delays in override processing and technical assistance 2

3. H2O New H2O Program Effective 10/1/24 New H2O Program Administrator Award by 7/1/24 Technical Specifications are currently being worked on Anticipating having the technical specifications by 7/1/24 3

4. SFTP Upgrade Need to ensure user id s have a new password for switch over of new platform Implementation postponed Will communicate once implementation determined 4

5. Recent and Upcoming System Changes DEX File to contain Dental Information Three new fields in previous filler section Area of Oral Decay, Dental Tooth Code and Surface Group Codes Communication with updated DEX file layout was sent 4/30/24. Implementation date of 7/18/24. Will first appear on August 2024 DEX File. 5

6. Recent and Upcoming System Changes Cont. H051 Enhancement Service Provider NPI Can t be in Note Field 9XXXX HCPC Codes Can t have all 9 s in Note Field There are a few codes that may be exceptions to this. Will provide guidance once confirmed. 6

7. Recent and Upcoming System Changes Cont. A625 Enhancement T1015 Edit that requires CRS or former CRS Add LTC Program Contractors to bypass this logic Currently a soft edit 7

8. Recent and Upcoming System Changes Cont. Unique Population File Added Exception Code 25 (Transplant) Started appearing on March 2024 Unique Population File 8

9. Recent and Upcoming System Changes Cont. Z293 and Z294 Set to Hard Edit Effective 2/1/24 Z293 - Chiropractic Service Limits Z294 - Diabetes Self Management 9

10. 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

11. EDI Vendor AHCCCS is changing EDI Vendors Implementing End of October 2024 No changes to uploading EDI Files on SFTP 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 11

12. Future System Enhancements Ethnicity on 834 Updates to VFC Edits as discussed in the MCO Encounter Meetings Z628 and DAP MES Modernization LTC DSNP Alignment 12

13. MCO Encounter Meetings Will schedule for June/July 13

14. Future Agenda Topics 14

15. Questions? 15

16. Thank You. 16