Arizona Heal!h  Care  Cost Conlaimnenl System

December  II, 2014

James Stover
Chief Executive Officer University Family Care Maricopa Health Plan
270 I  East Elvira Road
Tucson, AZ  85756

Janice K. Brewer, Go'lernor
Thomas  J. Betlach, Director

SUBJECT:   Final Results of Sanctionable Pended Encounters  June 2014

Dear Mr. Stover:

This attached  information will provide the final aged pended encounter  sanctions for the quarter ending June 2014    According to the Contract,  University Family Care and Maricopa Health Plan is required  to resolve all pended encounters within 120 calendar days of the proces ing date.  If this requirement is not met, the Contractor  is subject to sanctions.

The  exception  to  the  above  is  when  the  pended  encounter  is  due  to  an  Arizona  Health  Care  Cost Containment   System  (AHCCCS)   error.    AHCCCS  error  is  defined  as  a  pended  encounter,  which AHCCCS   acknowledges   to  be  the  result  of  its  own  error,  and  requires  a  change  to  the  system programming,  an update to the database  reference table, or further  research  by AHCCCS.   Contractors must notifY AHCCCS, in writing that the resolution of a pended encounter depends on AHCCCS instead of  the  Contractor.     Pended  encounters   do  not  quality  as  AHCCCS  error  if  AHCCCS  reviews   the Contractor's  notification   and   asks  the   Contractor   to   research   the   issue   and   provide   additional substantiating  documentation, or if AHCCCS disagrees with the Contractor's claims of AHCCCS error.

AHCCCS distributed the preliminary sanction results, including a summary of encounters excluded from sanctions  as AHCCCS  error  on September  25, 2014.   The Contractor  was  provided an opportunity  to review the preliminary results, and challenge those encounters believed to be sanctioned in error.  The Contractor's mitigation was considered,  and when appropriate,  the mitigated  encounters  were removed from the final sanctionable encounters.

The preliminary  sanctionable  number of pended encounters  for June 2014 for UFC was 5 and the final sanction number pended encounters for this quarter is 0.   The preliminary sanctionable number of pended encounters  for June 2014 for Maricopa  was 5 and the final sanction  number  pended encounters for this quarter is 0.  The final sanction dollar amount is $0 for UFC and the final sanction dollar amount is $0 for Maricopa.

801 East Jefferson.  Phoenix, ?-Z 85034 ·PO Box 25520, Phoenix. AZ 85002 • 602-417-4000  • www.azahcccs.gov

Mr. Stover
December  11, 2014
Page 2

If  you  have  any  questions  regarding your  pended   encounter sanctions,  please  contact   Gina  Aker  at
Gina.Akerrwazahcccs.gov, (602) 417-4016.

Contracts & Purchasing, Administrator
Division of Business  and Finance
Mail  Drop #5700

cc: 		Shelli  Silver Lori Petre Devra  Navas Nancy  Neroni Aker, Gina
Virginia  Rountree Alvarez, Diana DAR File
Jami.snyder@uahealth.com