AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Mass Adjustment Process

• Introduction
• Schedules
• Media
• Testing
• Reference Documents

Introduction

The Mass Adjustment process is used as a tool for administrative adjustment of contracted rates. Previously paid amounts are recouped, and then repaid at the new rate. From the Health Plans' perspective, the mass adjustment resembles the Daily Enrollment Notification process in that it is transaction driven. The mass adjustment transmission file (HIPAA 820) is identical to that produced using the Daily Enrollment Notification process.

Schedules

• Mass Adjustment Processing is normally scheduled after the completion of the daily roster process as needed. Health Plans are notified of the adjustment in writing prior to processing.
• HIPAA 820 TCS files are downloaded to the AHCCCS Communications Server and available for extraction by the Health Plan by 11:59 p.m. on a weekly basis.

Media

The Weekly Capitation Notification file (HIPAA 820) is available on the AHCCCS communications server.

Testing

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

• HIPAA 820 Companion Document