Technical Interface
Guidelines
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Recipient Interface
Overview
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| Introduction |
This chapter includes general information
on the Eligibility Verification System (EVS), the Interactive Voice
Response (IVR) system, and the WEB Based Verification. |
| In this section |
This section covers the following topics:
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Eligibility Verification System (EVS)
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| Introduction |
The
automated EVS at Arizona Health Care Cost
Containment System (AHCCCS) is a process to
provide member eligibility verification services
to AHCCCS providers.
This is accomplished through a contract
with an outside vendor who provides terminals in
the providers' offices and data communication
access statewide through a common entry point into
the AHCCCS production member data.
Providers can obtain specific eligibility
and enrollment data without having to call the
AHCCCS Communications Section
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| Schedules |
EVS
is available 24 hours a day, and is limited only
by downtime scheduled at the ADOA-DC mainframe and
the recycling of AHCCCS' production CICS region.
These downtimes are normally scheduled from
4:00 a.m. to 4:15 a.m. daily, from midnight Friday
to 7:00 a.m. Saturday, and from midnight Saturday
to 7:00 a.m. Sunday.
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| Media |
EVS
is accessed via point-of-sale terminals, or via
modem on IBM compatible PCs with a modem.
The vendor will sell or lease this
equipment, which includes the necessary software,
or will sell the software only to run on existing
equipment.
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| Reporting |
An
automated audit trail and a paper printout are
available for record keeping and research.
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| Testing |
The
vendor is responsible for all marketing,
installation, training, and testing of the EVS
system. AHCCCS
is not actively involved in any of these
activities; however, AHCCCS does support and
monitor progress of these activities.
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| Back To Top |
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Interactive Voice Response (IVR) System
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| Introduction |
The
automated IVR system at Arizona Health Care Cost
Containment System (AHCCCS) is a process that
provides recipient eligibility verification
services to AHCCCS providers.
Providers can obtain specific eligibility,
enrollment, Medicare and other third party data
without using the AHCCCS Communications Center.
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| Schedules |
IVR
is available 24 hours a day, and is limited only
by downtime scheduled at the ADOA-DC mainframe and
the recycling of AHCCCS' production CICS region.
These downtimes are normally scheduled from
4:00 a.m. to 4:15 a.m. daily, from midnight Friday
to 7:00 a.m. Saturday, and from midnight Saturday
to 7:00 a.m. Sunday.
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| Media |
IVR
is accessed via any touch-tone phone.
A local number and a 1-800 toll-free number
are available to all contracted providers.
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| Reporting |
AHCCCS
has automated paper trails to aid in problem
diagnosis. Some
areas in the state are offered the option of
receiving faxed copies of the verification
information to be used for record keeping, or as
an audit trail.
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| Testing |
AHCCCS is responsible
for all marketing, training, and testing of the
IVR system.
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Back To Top
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WEB Based Verification
System
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| Introduction |
The
WEB Based Verification at Arizona Health Care Cost
Containment System (AHCCCS) is an internet-based
process to provide member eligibility verification
of services to AHCCCS registered Providers.
Providers can obtain specific eligibility,
enrollment, Medicare, other Third Party Liability and
claims data without using the AHCCCS Communication
Center, EVS or IVR
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| Schedules |
The
WEB Based Verification is available 24 hours a
day, and is limited only by downtime scheduled at
the ADOA-DC mainframe and the recycling of
AHCCCS' production CICS region.
These downtimes are normally scheduled from
4:00 a.m. to 4:15 a.m. daily, from midnight Friday
to 7:00 a.m. Saturday, and from midnight Saturday
to 7:00 a.m. Sunday.
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| Media |
The
WEB Based Verification is accessed via the
internet. Registration is required.
The application can accessed from the
AHCCCS Home Page (www.ahcccs.state.az.us).
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| Reporting |
Summary
reports are produced to reflect the number of new
accounts created, eligibility inquiries, and claim
inquiries made during the month. |
| Testing |
AHCCCS
is responsible for all marketing, training, and
testing of the WEB Based Verification process.
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