AHCCCS Technical Interface Guidelines (TIG)

 

Health Plan Interface - Monthly Enrollment Notification Process


 

Introduction

Monthly Enrollment Notification files identify the total active population for each Health Plan as of the first of the next month. The Monthly Enrollment Notification file is used to reconcile the Health Plan's member file against that of AHCCCS. In order for this reconciliation to be successful, it is important that all daily transmission files, including the last daily, be processed prior to the monthly reconciliation.

There are no Monthly Capitation Notification files. Capitation is transmitted to Health Plans weekly in HIPAA 820 TCS.

 

Schedules

  • Monthly Enrollment Notification occurs three days before the first of the next month for each Health Plan under contract with AHCCCS. For a thirty-one day month, the Monthly Notification file is run after the 'Last Daily' Enrollment Notification file on the twenty-ninth day of the month. The ‘Last Daily' and Monthly Enrollment Notification processing schedules are published in advance of each monthly cycle and is available from AHCCCS web site.
  • Month End File Availability Notice

 

Media

Monthly Enrollment Notification file is available on the AHCCCS communications server.

Monthly Enrollment Notification is produced in 834 data file format only.

 

Testing

Monthly Enrollment Notification and Monthly Capitation Notification file 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

 

Notes

Monthly Enrollment Notification data, once delivered to the Health Plan, is considered legal notification of the Health Plan's responsibility for provision of care to AHCCCS members.

Monthly Enrollment Notification files are retained on the AHCCCS computer server for one month.