Encounter Manuals and Documents
AHCCCS Administration follows national industry standards
and code sets as published by X12N, NCPDP, and other data
standard maintenance organizations. The 837 and NCPDP
Implementation Guides, AHCCCS Companion Documents, the
Encounter Manual and the FTP provider/reference files
provide information regarding encounter reporting to comply
with CMS’ terms and conditions, and ensure the completeness,
accuracy and timeliness of encounter data. Contractors
utilizing these resources will be successful in reporting
encounter data to AHCCCS Administration.
Encounter Manual
The Encounter Manual is a reference guide for Contractors
outlining how to submit and correct encounter data to the
Arizona Health Care Cost Containment System Administration
(AHCCCSA). The manual contains chapters addressing encounter
submission, file specifications, pended encounter correction
requirements, and other encounter-related subjects.
837 Encounter Transaction Companion Document
This document provides information related to electronic
submission of 837 Encounter Transaction to AHCCCS by
contractors. Three distinct encounter transaction formats
are documented: 837 Professional (837P); 837 Dental (837D);
and 837 Institutional (837I). For each of these formats,
this document assists contractors in preparing an 837 file
that meets the business rules of AHCCCS.
277
Unsolicited Encounter Status Transaction Document
This document provides information about the 277 Health Care
Payer Unsolicited Claim Status Transactions that is specific
to AHCCCS and AHCCCS trading partners. AHCCCS uses the
unsolicited version of the 277 Transaction to inform
contractors of the statuses of encounters that have been
adjudicated by AHCCCS. For this transaction, the document
describes the data sent electronically to AHCCCS contractors
in response to encounter submissions.
NCPDP v5.1 Encounter Transaction Companion Document
This document provides information related to electronic
submission of NCPDP Pharmacy Encounter Transaction to AHCCCS
by contractors. This document assists contractors in
preparing an NCPDP v5.1 file that meets the business rules
of AHCCCS. Contractors submitting a version other than v5.1
should contact the Encounter Unit for additional information
or assistance.
Data Validation Technical Document
CMS requires AHCCCSA to submit progress reports on the
encounter data collection process. The effectiveness of
AHCCCSA’s encounter collection actions are based on the
results of encounter data validation studies. This document
provides Contractors with the methodology and statistical
formulae used in Encounter Data Validation.
HIPAA
Crosswalks and Meetings Minutes
This section contains code crosswalks and Arizona HIPAA
Medicaid Consortium meeting minutes and examples. This
information provides additional assistance to contractors
beyond the Transaction Implementation Guides and Companion
Documents.
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