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| Introduction |
Monthly
Enrollment Notification files identify the total
active population for each Health Plan as of the
first of the next month. The Monthly Enrollment Notification file is
used to reconcile the Health Plan's member file
against that of AHCCCS. In order for this reconciliation to be
successful, it is important that all daily
transmission files, including the last daily, be
processed prior to the monthly reconciliation.
There are no Monthly
Capitation Notification files.
Capitation is transmitted to Health Plans
weekly in HIPAA 820 TCS.
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| Schedules |
The following table
outlines schedules for the Monthly Enrollment
Notification process.
Processing
requirement |
Schedule |
| Monthly Enrollment Notification |
occurs three days before the first of the next
month for each Health Plan under
contract with AHCCCS.
For a thirty-one day month, the
Monthly Notification file is run after
the ‘Last Daily' Enrollment
Notification file on the twenty-ninth
day of the month. The ‘Last Daily'
and Monthly Enrollment
Notification processing schedules are
published in advance of each monthly
cycle and is available from AHCCCS web
site. |
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| Media |
Monthly
Enrollment Notification file is available on the
AHCCCS communications server.
Monthly Enrollment Notification is produced in 834 data
file format only.
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| Testing |
Monthly Enrollment Notification and Monthly
Capitation Notification file transmissions must be
tested in coordination with the AHCCCS ISD
operations staff prior to production
implementation of a new Health Plan, change in
service bureau, or as a result of roster changes.
Typical testing of file transmissions takes
approximately one week and must be completed prior
to implementation of any new processing
arrangement.
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| Reference
documents |
HIPAA
834 Companion Document
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| Notes |
Monthly
Enrollment Notification data, once delivered to
the Health Plan, is considered legal notification
of the Health Plan's responsibility for
provision of care to AHCCCS members.
Monthly Enrollment Notification files are
retained on the AHCCCS computer server for one
month.
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