AHCCCS Transparency

In an effort to promote transparency and support the State’s Transparency website, Arizona Open Books, AHCCCS is providing additional information on direct payments made for medical and health related services in Arizona’s Medicaid and Children's Health Insurance Program (CHIP) programs.

GENERAL DISCLAIMER:

The AHCCCS expenditure/financial information provided on this website comes from a variety of sources that may or may not tie to one another due to timing differences between the Pre-Paid Medicaid Management Information System (PMMIS) transaction posting dates and the Arizona Financial Information System (AFIS) payment posting dates.  The footnotes on each page include valuable information on the source of the data provided.

Primary sources of AHCCCS financial data include:

  1. AFIS - the State of Arizona’s official financial information system. This information is based on the statewide accounting structure (based on appropriation line items, fund numbers, organization levels, etc). Also, AFIS payments are generally posted at a summary level with the payment detail residing in PMMIS.
  2. The Centers for Medicare and Medicaid Services (CMS) - 64 and - 21 Quarterly Financial reports - the Agency’s official federal funds claim for each quarter. These reports are based on CMS reporting categories, which summarize payments in pre-defined, broad categories such as “Medicaid Health Insurance Payments: Managed Care Organizations (MCO)”. Additionally, the CMS reports can include adjustments to prior year expenditures that may or may not impact the current year in AFIS, therefore, differences will exist.
  3. PMMIS - AHCCCS’ primary source of detailed financial information. PMMIS is a grouping of subsystems which includes: Finance, Claims, Encounters, Reinsurance, Recipient, Health Plan, and others. PMMIS information can be date-of-payment (DOP) basis only, date-of-service (DOS) basis only, or in some cases the information can be accessed either way, this frequently leads to timing differences. Information in PMMIS is always based on a full day, month, quarter or year; however, the actual posting to AFIS may cross into a different accounting period, yet another cause of timing differences. Encounter data provided by the health plans may lag several months depending on form type and contractor. Health plans from time-to-time suffer system problems of their own which can increase the lag times and potentially skew the data.

The majority of the information provided on this website comes from PMMIS extracts in the AHCCCS data warehouse.  Based on the subsystem that the data is derived from, the data will likely not tie to other sources for the reasons described above.

DATA

The AHCCCS program makes the majority of payments initially to health plans or managed care organizations (see "Health Plan Payments" below). Additional information includes payment amounts by various provider types at the provider level. Additional provider types will be added over time so continue to check this page.

 

Adobe Acrobat Reader is required to view PDF files. This is a free program available from the Adobe web site. Follow the download directions on the Adobe web site to get your copy of Adobe Acrobat Reader.