Behavioral Health Interface
Monthly BHS Capitation Summary Report
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| Introduction |
The Monthly BHS Capitation Summary is created once
a month by AHCCCS. This file contains summary
data of AHCCCS eligible members included in the
monthly capitation calculation.
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| Schedules |
The following table
outlines schedules for the Monthly BHS Capitation
Summary Report process.
| Processing
requirement |
Schedule |
| Monthly
BHS Capitation Summary Report |
Run
on the third day before the 1st
of the next month as part of the Monthly
cycle and is available in the /AZ/BHS/PROD/OUT folder |
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| Media |
Monthly BHS Capitation
Summary Report file will be sent to the AHCCCS FTP
server.
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| Reporting |
This process produces the Monthly BHS Capitation
Summary reports of Title XIX, Title XIX with
Navajo Nation and Gila River, TXXI, Title XXI
with Navajo Nation and Gila River, HIFA II and
HIFA II with Navajo Nation and Gila River.
The reports created in this process will be
sent to the AHCCCS FTP server and will be
available for download and printed by ADHS.
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| Reference documents |
Monthly
BHS Capitation Summary Report
Monthly BHS Capitation Summary Report for Navajo
& Gila River Community
Monthly
BHS KidsCare Capitation Summary Report
Monthly BHS
KidsCare Capitation Summary Report for Navajo
& Gila River Community
Monthly
HIFA II BHS Capitation Summary Report
Monthly
HIFA II BHS Capitation Summary Report for Navajo
& Gila River Community
Monthly
Capitation Detail File
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Monthly
BHS Capitation Summary Report |
REPORT
ID: HP07M274-A ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
PAGE: 1
PROGRAM #: HP07L274 MONTHLY MENTAL HEALTH CAPITATION SUMMARY RUN:11/30/03
AS OF 12/01/03
01:29
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA ADULTS ADULTS NA GMH/ADULT GMH/ADULT
MEMBER COUNT 0-17 YRS 0-17 YRS 18 & OVER
18 & OVER TOTAL 18 & OVER 18 & OVER
__________________ ______________ ______________ ______________ ______________ ______________ ______________ ______________
TANF 6,713 719 3,608 454 11,494 3,608 454
SSI WITH MEDICARE 0 0 1,515 196 1,711 1,515 196
SSI W/O MEDICARE 446 51 1,953 253 2,703 1,953 253
SOBRA CHILDREN 3,737 642 390 46 4,815 390 46
SOBRA MOTHER 19 5 246 36 306 246 36
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY SUB-TOTAL 10,915 1,417 7,712 985 21,029 7,712 985
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $31.85 $31.85 $65.91 $65.91 $26.02 $26.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $347,642.75 $45,131.45 $508,297.92 $64,921.35 $965,993.47
-------------- -------------- -------------- -------------- -------------- -------------- --------------
GMS SUB-TOTAL $226,295.94 $200,666.24 $25,629.70
============== ============== ============== ============== ============== ============== ==============
SUB-TOTAL CAPITATION $1,192,289.41
FOR CATEGORICAL ============== ============== ============== ============== ============== ============== ==============
TANF EXP 106 23 1,552 272 1,953 1,552 272
SSI WITH MED EXP 0 0 213 95 308 213 95
SSI W/O MED EXP 0 0 9 1 10 9 1
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY SUB-TOTAL 106 23 1,774 368 2,271 1,774 368
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $31.85 $31.85 $65.91 $65.91 $26.02 $26.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $3,376.10 $732.55 $116,924.34 $24,254.88 $145,287.87
-------------- -------------- -------------- -------------- -------------- -------------- --------------
GMS SUB-TOTAL $55,734.84 $46,159.48 $9,575.36
============== ============== ============== ============== ============== ============== ==============
SUB-TOTAL CAPITATION $201,022.71
FOR CAT LINKED EXP ============== ============== ============== ============== ============== ============== ==============
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Monthly BHS Capitation Summary for Navajo Nation
and Gila River Report |
REPORT
ID: HP07M274-B ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM PAGE: 1
PROGRAM #: HP07L274 MONTHLY MENTAL HEALTH CAPITATION SUMMARY RUN:11/30/03
FOR NAVAJO NATION & GILA RIVER COMMUNITY
AS OF 12/01/03 01:45
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA
ADULTS ADULTS NA GMH/ADULT GMH/ADULT
MEMBER COUNT 0-17 YRS 0-17 YRS 18 & OVER 18 & OVER TOTAL 18 & OVER 18 & OVER
__________________ ______________ ______________ ______________ ______________ ______________ ______________ ______________
TANF 6,571 0 3,535 0 10,106 3,535 0
SSI WITH MEDICARE
0 0 1,507 0 1,507 1,507 0
SSI W/O MEDICARE 431 0 1,939 0 2,370 1,939 0
SOBRA CHILDREN
3,643 0 381 0 4,024 381 0
SOBRA MOTHER 17 0 241 0 258 241 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY SUB-TOTAL 10,662 0 7,603 0 18,265 7,603 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $31.85 $31.85 $65.91 $65.91 $26.02 $26.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $339,584.70 $.00 $501,113.73 $.00 $840,698.43
-------------- -------------- -------------- -------------- -------------- -------------- --------------
GMS SUB-TOTAL $197,830.06 $197,830.06 $.00
============== ============== ============== ============== ============== ============== ==============
SUB-TOTAL CAPITATION $1,038,528.49
FOR CATEGORICAL ============== ============== ============== ============== ============== ============== ==============
TANF EXP 105 0 1,516 0 1,621 1,516 0
SSI WITH MED EXP 0 0 209 0 209 209 0
SSI W/O MED EXP 0 0 9
0 9 9 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY SUB-TOTAL 105 0 1,734 0 1,839 1,734 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $31.85 $31.85 $65.91 $65.91 $26.02 $26.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $3,344.25 $.00 $114,287.94 $.00 $117,632.19
-------------- -------------- -------------- -------------- -------------- -------------- --------------
GMS SUB-TOTAL $45,118.68 $45,118.68 $.00
============== ============== ============== ============== ============== ============== ==============
SUB-TOTAL CAPITATION $162,750.87
FOR CAT LINKED EXP ============== ============== ============== ============== ============== ============== ==============
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Monthly BHS KidsCare Capitation Summary Report |
REPORT
ID: HP07M274-C ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM PAGE: 1
PROGRAM #: HP07L274 MONTHLY MEN. HLTH. KIDSCARE CAP. SUMMARY RUN:11/30/03
AS OF 12/01/03 01:54
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA ADULTS ADULTS
MEMBER COUNT 0-17 YRS 0-17 YRS 18 18 TOTAL
__________________ ______________ ______________ ______________ ______________ ______________
KIDSCARE 656 133 27 9 825
-------------- -------------- -------------- -------------- --------------
COUNTY
TOTAL 656 133 27 9 825
-------------- -------------- -------------- -------------- --------------
CAPITATION RATE $13.34 $13.34 $26.54 $26.54
-------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $8,751.04 $1,774.22 $716.58 $238.86 $11,480.70
-------------- -------------- -------------- -------------- --------------
TOTAL CAPITATION $11,480.70
============== ============== ============== ============== ==============
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Monthly BHS KidsCare Capitation Summary for Navajo
Nation and Gila River Report |
REPORT
ID: HP07M274-D ARIZONA
HEALTH CARE COST CONTAINMENT SYSTEM PAGE: 1
PROGRAM #: HP07L274 MONTHLY MEN. HLTH. KIDSCARE CAP. SUMMARY RUN:11/30/03
FOR
NAVAJO NATION & GILA RIVER COMMUNITY
AS OF 12/01/03 01:59
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA ADULTS ADULTS
MEMBER COUNT 0-17 YRS 0-17 YRS 18 18 TOTAL
__________________ ______________ ______________ ______________ ______________ ______________
KIDSCARE 643 0 27 0 670
-------------- -------------- -------------- -------------- --------------
COUNTY
TOTAL 643 0 27 0 670
-------------- -------------- -------------- -------------- --------------
CAPITATION RATE $13.34 $13.34 $26.54 $26.54
-------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $8,577.62 $.00 $716.58
$.00 $9,294.20
-------------- -------------- -------------- -------------- --------------
TOTAL CAPITATION $9,294.20
============== ============== ============== ============== ==============
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Monthly BHS HIFA II Capitation Summary Report |
REPORT
ID: HP07M274-E ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM PAGE: 1
PROGRAM #: HP07L274 MONTHLY HIFA II SUMMARY
RUN:11/30/03
AS OF 12/01/03 02:00
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA ADULTS ADULTS
NA
GMH/ADULT GMH/ADULT
MEMBER COUNT 0-17 YRS 0-17 YRS 18 & OVER 18 & OVER TOTAL 18 & OVER 18 & OVER
__________________ ______________ ______________ ______________ ______________ ______________ ______________ ______________
HIFA II 0 0 179 34 213 179 34
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY TOTAL 0 0 179 34 213 179 34
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $0.00 $0.00 $27.13 $27.13 $11.02 $11.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $.00 $.00 $4,856.27 $922.42 $5,778.69 $1,972.58 $374.68
-------------- -------------- -------------- -------------- -------------- -------------- --------------
$2,347.26 $1,972.58 $374.68
============== ============== ============== ============== ============== ============== ==============
TOTAL CAPITATION $8,125.95
============== ============== ============== ============== ============== ============== ==============
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Monthly BHS HIFA II Capitation Summary for Navajo
Nation and Gila River Report |
REPORT
ID: HP07M274-F
ARIZONA HEALTH CARE COST CONTAINMENT
SYSTEM PAGE: 1
PROGRAM #: HP07L274 MONTHLY HIFA II SUMMARY RUN:11/30/03
FOR
NAVAJO NATION & GILA RIVER COMMUNITY
AS OF 12/01/03 02:01
PLAN: 079999 DHS BEHAVIORAL HEALTH
COUNTY: 01 APACHE
NA CHILDREN CHILDREN NA ADULTS ADULTS NA GMH/ADULT GMH/ADULT
MEMBER COUNT 0-17 YRS 0-17 YRS 18 & OVER 18 & OVER TOTAL 18 & OVER 18 & OVER
__________________ ______________ ______________ ______________ ______________ ______________ ______________ ______________
HIFA II 0 0 173 0 173 173 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
COUNTY TOTAL 0 0 173 0 173 173 0
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION RATE $0.00 $0.00 $27.13 $27.13 $11.02 $11.02
-------------- -------------- -------------- -------------- -------------- -------------- --------------
CAPITATION PAYMENT $.00 $.00 $4,693.49 $.00 $4,693.49 $1,906.46 $.00
-------------- -------------- -------------- -------------- -------------- -------------- --------------
$1,906.46 $1,906.46 $.00
============== ============== ============== ============== ============== ============== ==============
TOTAL CAPITATION $6,599.95
============== ============== ============== ============== ============== ============== ==============
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Monthly
BHS Capitation Detail File
| FIELD
NAME |
TYPE |
SIZE |
REMARKS |
| HP-ID |
X |
6 |
HEALTH PLAN ID |
| CTRT-TYP |
X |
1 |
CONTRACT TYPE |
| CTY-SER-AREA-CD |
X |
2 |
COUNTY CODE |
| AHCCCS-ID |
X |
9 |
AHCCCS ID |
| RP-NAME |
X |
34 |
NAME |
| ELG-KEY-CD |
X |
3 |
ELIGIBILITY KEY
CODE |
| RP-ZIP |
X |
9 |
ZIP CODE |
| RP-SEX |
X |
1 |
GENDER |
| RP-DAT-OF-BIR |
X |
8 |
DATE OF BIRTH (CCYYMMDD) |
| PMT-DAT |
X |
8 |
PAYMENT DATE (CCYYMMDD) |
| ACT-TYP |
X |
1 |
NATIVE AMERICAN (Y OR N) |
| CASE-ID |
X |
9 |
CASE ID |
| ACUTE-HP-ID |
X |
6 |
ACUTE MEDICAL HP
ID |
| TRIBE-CD |
X |
2 |
RACE |
| MH-CATEGORY |
X |
1 |
BHS CATEGORY |
| ACUTE-RATE-CD |
X |
4 |
ACUTE MEDICAL
RATE CODE |
| LANGUAGE |
X |
1 |
LANGUAGE |
| FILLER |
X |
15 |
FILLER |
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