operations update o contract amendments o ahcccs provider claims survey 1 reaching across arizona to...

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OPERATIONS UPDATE

oContract AmendmentsoAHCCCS Provider Claims Survey

Reaching across Arizona to provide comprehensive quality health care for those in need

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Upcoming Contract Amendments


Anticipated Effective Date Amendment Line of Business

April 1, 2015

FQHC/RHC PPS Rates All

Supplemental Rebates (language) All

Incontinence Briefs Rates Long Term Care (EPD & DDD)

Physical Health/Behavioral Health Rates ADHS/DBHS & Acute

April 13, 2015 Rural Hospital

Acute • Health Choice • UFC • UHCCP

(?) May 1, 2015 Risk Adjustment Acute

June 1, 2015 Health Insurer Fee (the sequel) All (Except for CMDP)

July 1, 2015 Renewals DDD & CMDP

January 1, 2015 April 1, 2015 July 1, 2015 Nursing Facility Quarterly Amendment ALTCS EPD

TBD 3% Provider Rate Adjustment All

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Provider Claims Survey


• Survey was developed using web-based provider of survey solutions, Survey Monkey

• Survey for Acute Care, CRS, and ALTCS EPD

• Made available on the web 10/16/2014 – 12/04/2014

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Survey Questions• How satisfied are you with this Health Plan’s

processing of your initial claims?

• How satisfied are you with this Health Plan’s resolution of your claims issues?

• How satisfied are you with this Health Plan’s timeliness of resolution of your claims issues?

• How satisfied are you with this Health Plan’s Claims Customer Service Department?

• How satisfied are you with this Health Plan’s Provider Services Staff?


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How Health Plans Compare


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• Most satisfaction o Health plan performance

with processing of initial claims, Claims Customer Service, and Provider Services Staff.

• Most dissatisfaction o Health plan performance

with resolution of claims issues and timeliness of resolution of claims issues.

• Comments• 728 total comments across all

health plans. o Provider satisfaction - 18.3%o Provider dissatisfaction -

81.7% o Dissatisfied responses

indicate a desire for health plan improvement in the efficiency and processes for resolution of claims issues, particularly related to timeliness of resolution and subsequent payment.

Overall Findings


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Follow-up Actions & Expectations• Contractors

o Discuss the survey results at their Quarterly Health Plan Update meeting with the Director.

o Include, at a minimum, an overview of the results, strengths and challenges, and a planned course of action to address needed improvements.

• AHCCCSo Survey Report posted to the AHCCCS web 02/2015

o Follow up survey early 2016

o Follow up survey early 2016


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OPERATIONS UPDATE - ALTCS

oAMPM 1240 PolicyoHCBS Rule


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OPERATIONS UPDATE - ALTCS

oAMPM 1240 Policy Update Contractor and Provider Notification

Provider Compliance SB 1241


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OPERATIONS UPDATE -ALTCS


o HCBS Rule Workgroup Workgroup is meeting regularly Completed assessment of residential

settings; beginning assessment of non residential settings

Adult Day Health and Day Treatment Programs Supportive Employment Programs

Member and Provider Survey ALTCS Advisory Council is developing the survey

questions

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Questions?


operations update o contract amendments o ahcccs provider claims survey 1 reaching across arizona to...

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