AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Monthly Rate Code Summary Process

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

Introduction

The Monthly Rate Code Summary provides a report for the Health Plan of the total dollar amounts by contract type, rate code, and county. The Monthly Rate Code Summary provides a view of the capitation paid for each rate code for the prospective month's capitation. The Monthly Rate Code Summary can also be used to reconcile against the Weekly HIPAA 820 TCS.

Schedules

• Monthly Rate Code Summary files are created and available on the AHCCCS Communications server at approximately the same time as the Monthly Enrollment Notification file File is named ccyymm.SUM and is available in the plan’s folder under AZ/hpmnemonic/PROD/OUT

Media

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

Testing

Monthly 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

• Monthly Rate Code Summary File Layout

Notes

Monthly Rate Code Summary files are retained on the AHCCCS computer server for one month.