AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Daily Rate Code Summary Process

• Introduction
• Schedules
• Media
• Testing
• Reference Documents
• Notes

Introduction

The Daily Capitation Notification process (HIPAA 820) also creates the Daily Rate Code Summary. The Rate Code Summary provides a formatted report file for the Health Plan of the total dollar amounts by contract type, rate code, and county. The Daily Rate Code Summary provides a view of the amounts paid for each rate code of the next prospective month's capitation. The Daily Rate Code Summary can also be used to reconcile against the Daily HIPAA 820 TCS.

Schedules

• Daily Rate Code Summary files are created and available on the AHCCCS Communications server at approximately the same time as the Daily Capitation Notification file (HIPAA 820). File is named yymmdd.DRC and is available in the plan’s folder under AZ/hp mnemonic/PROD/OUT

Media

Daily Rate Code Summary is available on the AHCCCS FTP server.

Testing

Daily Rate Code Summary 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.

Reference Documents

• Daily Rate Code Summary File Layout

Notes

Daily Rate Code Summary file is created as a formatted report, not a data file.