SMI Determinations are entered into a secure web-based portal by the third-party SMI vendor for processing. This portal is maintained and administered by Arizona Health Care Cost Containment System (AHCCCS).
SMI Portal – there are four daily reports created Monday through Friday out of the SMI Portal.
The four files created are:
The SMI Portal must be tested in coordination with the AHCCCSA ISD operations staff prior to production implementation of a new contractor or change in service bureau, or as a result of changes. Typical testing takes approximately one week and must be completed prior to implementation of any new processing arrangement.
The Department of Corrections provides (on weekdays) BHS with a list of recently incarcerated people. This flat report is a list of all clients who are (or have been) enrolled at each RBHA and matched by name, gender, and DOB.
Weekly once on Monday @12.30pm
The Weekly Updates of DOC Members will be sent to the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is ADCLINKxx.yyyymmdd.txt (xx is rbha id)
Weekly Updates of DOC Member file transmissions must be tested in coordination with the AHCCCSA 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 transmission takes approximately one week and must be completed prior to implementation of any new processing arrangement.
Report includes the encounters where quantity dispensed is 10 times more than the day’s supply value.
2nd Working Friday of the Month
The NCPDP Encounter Inflated Quantity Report file will be sent to /XXX/PROD/OUT/ on the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is h74enc_disp_YYYYMMDD_XX.txt. The file is a pipe-delimited file (each field is separated by pipe( ‘|’)).
NCPDP Encounter Inflated Quantity Report file transmissions must be tested in coordination with the AHCCCSA 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 transmission takes approximately one week and must be completed prior to implementation of any new processing arrangement.
Reports includes encounters where DOS is greater than the Date of death.
2nd Working Friday of the Month
The Encounter DOD Report file will be sent to /XXX/PROD/OUT/ on the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is h74enc_dod_YYYYMMDD_XX.txt. The file is a pipe-delimited file (each field is separated by pipe( ‘|’)).
Encounter DOD Report file transmissions must be tested in coordination with the AHCCCSA 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 transmission takes approximately one week and must be completed prior to implementation of any new processing arrangement.
