AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Manual Payment Process

• Introduction
• Schedules
• Media
• Testing
• Reference Documents

Introduction

The Manual Payment process is used as a tool for manual adjustments to capitation records. Manual payments are utilized to create a payment or recoupment override to manually process records that would not be processed systematically.

From the Health Plan perspective the Manual Payment Process will be incorporated into the Weekly Capitation Notification (HIPAA 820) processes.

Schedules

• Manual Payment Update on-line entry during the day.
• Manual Payment Roster are downloaded to the AHCCCS Communications Server and available for extraction by the Health Plan by 11:59 p.m.
• 820 TCS files

Media

The Daily Manual Payment Roster and Weekly Capitation Notification file (HIPAA 820) are available on the AHCCCS communications server.

Testing

Daily Manual Payment Roster and Weekly Capitation Notification transmissions must be tested in coordination with AHCCCS 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.

Reference Documents

• Manual Payment Roster File Layout
• HIPAA 820 Companion Document