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Daily Enrollment Notifications identify:
Enrollment Notifications occur through the HIPAA
834 Transaction Code Set.
for enrollments will be calculated on a per diem
will be paid through the end of the processing
capitation will be paid on a monthly basis (See
Monthly Enrollment Notification Process).
payments and recoupments as a result of Daily
Enrollment Notification process are transmitted to
the Health Plan on the HIPAA 820 Transaction Code
notifications are produced in data file format. Health Plans, or their services bureaus, must dial in to the
Arizona Health Care Cost Containment System
(AHCCCS) computer system and download the data
file for batch processing.
Enrollment Notification and Capitation
Notification file transmissions must be tested in
coordination with the AHCCCSA ISD operations staff
prior to production implementation of a new Health
Plan or change in service bureau, or as a result
of changes. Typical testing of file transmissions takes approximately one
week and must be completed prior to implementation
of any new processing arrangement.
notification and capitation notification data,
once delivered to the Health Plan, is considered
legal notification of the Health Plan's
responsibility for provision of care to AHCCCS
attention should be given to the daily process
immediately preceding the monthly processing, as
well as to the daily processing run on the last
two days of the month. The daily process which runs prior to the monthly is referred
to as the 'last daily' and will contain all
rate code changes which are effective for the next
month, as well as any new enrollment, and a
majority of the dis-enrollments effective at the
end of the month. It is important that this last
daily be processed by the Health Plans before
attempting to run the monthly reconciliation
process (See Monthly Enrollment Notification
The two daily processes that run after the
monthly process are different from 'regular'
daily process in that they will pay capitation, or
recoup capitation into the next month. This is because the monthly, which normally
pays prospective capitation, has already run.