As of March 22, 2013, the Bidders’
Library will no longer be maintained. Refer to the corresponding section of the AHCCCS
website for updates to
the
AHCCCS Contractor Guides & Manuals.
AHCCCS has established an RSS (Really Simple Syndication) feed as a courtesy to
notify interested parties that information has been added to the Acute/CRS RFP Information
page. Due to the numerous browsers and RSS Readers available for use, AHCCCS cannot
guarantee whether, and to what extent, the RSS feed information will be viewed by
the subscriber. Therefore, the RSS feed may not reliably provide the subscriber
with RFP and Bidders' Library updates. In order to ensure that subscribers have
access to all information pertaining to the RFP and Bidders' Library, it is
the responsibility of the subscriber/interested party to regularly visit the AHCCCS
Website, Acute/CRS RFP Information page.
The Bidders’ Library is a site to assist Offerors with information and resources
regarding the Acute/CRS RFP. The information in the Bidders’ Library is not intended
to be comprehensive. It is the responsibility of the Offeror to obtain and review
all pertinent information relating to the Acute/CRS RFP.
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Solicitation Amendments |
Solicitation Amendments |
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Solicitation
Amendment #1 Q & A
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[PDF posted 11/27/12, 267KB]
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Signed Solicitation Amendment Signature Page
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[PDF posted 11/27/12, 39KB]
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Solicitation Amendment #2 Q & A |
[PDF posted 12/19/12, 433KB]
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Signed Solicitation Amendment Signature Page |
[PDF posted 12/20/12, 77KB]
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Solicitation Amendment #3 Q & A
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[PDF posted 01/04/13, 111KB]
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Signed Solicitation Amendment Signature Page
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[PDF posted 01/04/13, 79KB]
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Solicitation Amendment #4 with Signature Page
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[PDF posted 01/10/13, 194KB]
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Solicitation Amendment #5 with Signature Page
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[PDF posted 01/24/13, 104KB]
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Sections
A, B and C:
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Solicitation Page, Capitation Rates and Definitions
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Solicitation Page, Capitation Rates and Definitions
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[PDF, 173KB]
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Section D:
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Program Requirements
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D1 Acute Care Program Requirements
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[PDF, 650KB]
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D2 CRS Program Requirements
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[PDF, 645KB]
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Section E:
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Contract Terms and Conditions
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E1 Acute Care Program Contract Terms and Conditions
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[PDF, 141KB]
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E2 CRS Program Contract Terms and Conditions
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[PDF, 140KB]
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Section F:
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Attachments
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Attachment A1 Enrollee Grievance System Standards
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[PDF, 49KB]
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Attachment A2 Provider Claims Dispute Standards
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[PDF, 27KB]
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Attachment B1 Acute Care Program Contractors’
Chart of Deliverables
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[PDF, 99KB]
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Attachment B2 CRS Program Contractor’s Chart of
Deliverables
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[PDF, 90KB]
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Section G:
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Representations and Certifications of Offeror
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Representations and Certifications
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[WORD, 94KB]
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Disclosure Information Templates
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[EXCEL, 39KB]
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Section H:
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Instructions to Offerors
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Instructions to Offerors
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[PDF, 195KB]
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Section I:
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Exhibits
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Exhibit A Offeror's Checklist
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[PDF, 45KB]
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Exhibit B Minimum Subcontract Provisions
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[PDF, 106KB]
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Exhibit C Attestation Form
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[PDF, 58KB]
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Exhibit D Medicare Requirements
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[PDF, 61KB]
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Notification of Overdue Certifications
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[PDF posted 01/29/13, 18KB]
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AHCCCS members who are also enrolled in Medicare are referred to as dual eligible.
In an effort to improve care coordination for AHCCCS dual eligible members, AHCCCS
will require all Acute plans to be organizations that manage and provide Medicare
benefits to dual eligible members in all GSAs they hold a contract. Contractors
will be required to meet the Medicare requirement either through the CMS Capitated
Financial Alignment Demonstration or as Medicare Advantage Dual Eligible Special
Needs Plans (D-SNPs) if AHCCCS does not finalize a Demonstration contract with CMS.
Below is further information and resources.
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AHCCCS Duals
Page
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[WEB PAGE]
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Acute/CRS RFP Medicare Major Decisions
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[PDF, 16KB]
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CMS Memo Notice of Intent to Apply (NOIA) Information
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[PDF, 143KB]
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AHCCCS Policy Contracting with Special Needs Plans
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[PDF, 62KB]
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Acute Duals Enrollment by County
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[PDF posted 12/06/12, 12KB]
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CMS Capitated Financial Alignment Demonstration Information
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[WEB PAGE]
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The Financial Alignment Demonstration seeks to better serve people who are enrolled
in both Medicare and Medicaid by testing a person-centered, integrated care model
that provides a more easily navigable and seamless path to all Medicare and Medicaid
services. Expected outcomes include: improved beneficiary experience of care, fewer
avoidable hospitalizations and emergency room visits, and greater independence in
the community and at home for seniors and people with disabilities.
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Arizona's Demonstration Proposal
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[PDF, 830KB]
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July
08, 2011 - State Medicaid
Director Letter |
[PDF posted 11/14/12, 214KB]
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January 25, 2012 - CMS Guidance |
[PDF posted 11/14/12, 323KB]
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March 29, 2012 - CMS Guidance |
[PDF posted 11/14/12, 807KB]
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CMS - 2013 Capitated Financial Alignment
Demonstration Application |
[PDF posted 11/14/12, 1MB]
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Joint Rate Setting Process Under the
Capitated Financial Alignment Initiative |
[PDF posted 11/14/12, 300KB]
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CMS Medicare Advantage Special Needs Plan
Information
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[CMS link posted 11/14/12]
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Dual Eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII)
and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the
opportunity of enhanced benefits by
combining those available through Medicare and Medicaid. |
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CMS - 2013 Medicare Advantage Application
Information |
[CMS link posted 11/14/12]
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Medicare Managed Care Manuals |
[CMS link posted 11/14/12]
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Medicare Managed Care Manual - Chapter 16B:
Special Needs Plans |
[CMS PDF link posted 11/14/12]
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AMPM
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Policy 310-B - Behavioral Health Services
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[PDF, 439KB]
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Policy 310-V - Prescription Medication/Pharmacy Services
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[PDF, 329KB]
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Policy 330 - Covered Conditions and Services for the Children's
Rehabilitative Services (CRS) Program
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[PDF, 655KB]
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Policy 400 - Medical Policy for Maternal and
Child Health -
Chapter Overview
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[PDF, 3MB]
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Policy 520 - Member Transitions
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[PDF, 466KB]
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Policy 540 - Other Care Coordination Issues
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[PDF, 472KB]
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Policy 560 - CRS Care Coordination and Service Plan (SP)
Management
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[PDF, 197KB]
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Policy 900 - Quality Management and Performance
Improvement Program - Chapter Overview
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[PDF, 442KB]
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ACOM
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Note:
Clean versions of the Draft Policies have been posted below replacing previously posted redline versions.
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New Policy, Chapter 300 - Auto-Assignment Algorithm |
[PDF posted 11/20/12, 159KB]
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New Policy, Chapter 300 - Acute Program Payment Reform
Initiative
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[PDF to be posted 04/01/13, 01/10/13]
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New Policy, 302-I - Prior Period Coverage Reconciliation
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PDF posted 11/16/12, 177KB]
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New Policy, 302-I - Prior Period Coverage Reconciliation -
Attachment A
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[PDF posted 11/16/12, 17KB]
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Policy 304 - Premium Tax Reporting
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[PDF posted 11/16/12, 157KB]
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Policy 304 - Premium Tax Reporting
- Attachment A
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[PDF posted 11/16/12, 29KB]
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Policy 305 - Performance Bond and Equity Per Member
Requirements
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[PDF posted 11/16/12, 162KB]
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Policy 306 - Performance Bond
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[PDF posted 11/16/12, 346KB]
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Policy 311 - Acute Program Tiered Prospective Reconciliation
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[PDF posted 11/16/12, 184KB]
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Policy 311 - Acute Program Tiered Prospective Reconciliation
-
Attachment A
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[PDF posted 11/16/12, 25KB]
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Policy 312 - CRS Program Tiered Reconciliation
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[PDF posted 11/16/12, 181KB]
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Policy 312 - CRS Program Tiered Reconciliation -
Attachment A
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[PDF posted 11/16/12, 21KB]
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New Policy, Chapter 400 - Acute Network Standards
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[PDF posted 11/16/12, 429KB]
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New Policy, Chapter 400 - Coordination of Benefits/Third Party
Liability
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[PDF updated 01/10/13, 185KB]
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New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting
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[PDF posted 11/16/12, 185KB]
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New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting - Attachment A
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[PDF posted 11/16/12, 17KB]
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Policy 404 - Member Information
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[PDF updated 02/07/13, 715KB]
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Policy 412 - Claims Reprocessing
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[PDF posted 11/16/12, 210KB]
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Policy 415 – Provider Network Development and Management
Plan
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[PDF posted 11/16/12, 667KB]
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Policy 417 - Appointment Availability Monitoring and Reporting
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[PDF posted 11/16/12, 316KB]
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Policy 426 - Eligibility Reviews for CRS Applicants and
Referrals
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[PDF updated 02/07/13, 215KB]
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Policy 427 - CRS Contractor No-Show
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[PDF posted 11/16/12, 78KB]
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Policy 433 - Member Identification Cards
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[PDF posted 11/16/12, 178KB]
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Section A:
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Data Supplement Instructions and Overview
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[PDF, 18KB]
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Section B:
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Program and Fee Schedule Changes
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Program and Fee Schedule Changes
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[PDF posted 11/07/12,
2.7MB.]
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Section C:
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Data Book Information
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Data Book Introduction
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[PDF, 39KB]
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Data Book Layout/File Description
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[PDF posted 11/16/12, 141KB]
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Details of Updated CRS Data Book Files
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[PDF posted 11/29/12, 141KB]
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Data Book Files
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[Acute Care Bid Files posted via EFT
11/16/12, CRS Bid Files updated via EFT 11/29/12]
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Rate Setting Document
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[PDF posted 12/14/12, 228KB]
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Supplemental Data Book Reports
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[PDF updated 12/20/12, 117KB]
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| Note: A new posting date will be noted whenever this document has been updated.
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Section D:
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Service Matrix/Selection Criteria for Data Book
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Introduction
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[PDF, 20KB]
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Acute Care/CRS Service Matrix
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[PDF updated 12/14/12, 40KB]
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Behavioral Health Services Service Matrix
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[PDF, 35KB]
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Crosswalk Acute Care Service Matrix to
Capitation Bid Template
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[PDF posted 12/14/12, 185KB]
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Section E:
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AHCCCS Category of Service, Form Types,
Provider Type List of Codes and Descriptions
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Introduction
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[PDF, 10KB]
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AHCCCS Categories of Service Codes
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[PDF, 23KB]
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Definition of Form Types
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[PDF, 15KB]
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AHCCCS Provider Types
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[PDF, 30KB]
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Section F:
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Bid Submission Information
Note: See RFP Section H, Instructions to Offerors, Paragraph
16.C. Capitation
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Bid Template Overview
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[PDF posted 11/19/12, 345KB] |
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Capitation Bid Templates
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[EFT posted 11/19/12]
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Acute Care Medical Component Ranges
and CRS Rates
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[PDF posted 12/14/12, 192KB]
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Section G:
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Crosswalk from Service Matrix to Financial Statements
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Introduction
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[PDF, 14KB]
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Crosswalk Acute Care/CRS-Service Matrix
to Financial Statements
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[PDF, 27KB]
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Crosswalk BHS Service Matrix to Financial
Statements
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[PDF, 25KB]
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Section H:
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Enrollment Information
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Introduction
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[PDF, 24KB]
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H-1 Enrollment by County by Contractor
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[EFT]
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H-2 Report Acute Care Enrollment Activity
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[EFT]
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H-3 Enrollment by Month
(Historical and Projected)
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[EFT]
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H-4 AHCCCS Members Count By Zip Code
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[EFT]
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Section I:
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Risk Adjustment Information
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Introduction |
[PDF posted 11/13/12, 77KB]
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CYE 09 Risk Adjustment Whitepaper
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[PDF posted 11/13/12, 1MB]
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CYE 10 through CYE13 Risk Adjustment
Methodologies
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[PDF posted 11/13/12, 102KB]
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Proposed CYE 14 and CYE 15 Risk
Adjustment Methodologies
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[PDF posted 11/13/12, 77KB]
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Risk Factors
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[PDF posted 11/13/12, 13KB]
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Diagnosis Percentages by Form Type
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[PDF posted 11/13/12, 25KB]
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Section J:
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Financial Information for Prospective Members
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Introduction
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[PDF, 19KB]
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Acute Care Financial Information
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[EFT]
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CRS Financial Information
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[EFT]
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Section K:
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Capitation Rates
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Capitation Rates
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[Web Page]
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Section L:
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Birth to Member Month Analysis
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Introduction
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[PDF, 17KB]
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Birth to Member Month Analysis
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[EFT]
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Section M:
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Reinsurance Information
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Introduction
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[PDF, 21KB]
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Reinsurance Payments
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[PDF, 40KB]
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Reinsurance Offsets
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[PDF, 23KB]
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Section N:
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Hospital Rate Overview
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Introduction
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[PDF, 9KB] (contains link)
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Outlier Cost Thresholds
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[PDF posted 12/18/12, 179KB]
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Section O:
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Contractor Audited Financial Statements
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Introduction
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[PDF, 13KB] (contains link)
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Section C:
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Data Book Files
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[Acute Care Bid Files updated via EFT 12/20/12, CRS Bid Files
updated via EFT 12/20/12, 12/21/12]
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Section F:
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Capitation Bid Templates
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[Posted 11/19/12 via EFT.]
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Section H:
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H-1 Enrollment by County by Contractor
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H-2 Report Acute Care Enrollment Activity
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[EFT]
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H-3 Enrollment by Month (Historical and Projected)
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[EFT]
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H-4 AHCCCS Members Count By Zip Code
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[EFT]
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Section J:
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Acute Care Financial Information
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[EFT]
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CRS Financial Information
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[EFT]
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Section L:
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Birth to Member Month Analysis
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[EFT]
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Questions about Solicitations, Contracts & Purchasing should be directed to Meggan Harley: