Arizona Hea!lh  Cme  Cost Containment Syslem

December  11, 2014

Mike Uchrin
Chief Executive Officer
Health Choice Arizona

h

410 North 441    Street

JaniceK. Brewer, Governor
Thomas  J. Betlach, Director

Suite 900
Phoenix, AZ  85008

SUBJECT:   Final Results of Sanctionable Pended Encounters June 2014

Dear Mr. Uchrin:

This attached information will provide the final aged pended encounter sanctions for the quarter ending June 2014.  According to the Contract, Health Choice Arizona is required to resolve all pended encounters within 120 calendar days of the processing 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  qualify  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 was 48 and the final sanction number pended encounters for this quarter is (0) zero.  The final sanction dollar amount is $0.00.

Even if sanctions are waived, the Contractor is liable for addressing all pended encounters (except those errors  which  have  been identified  as due  to  AHCCCS  error or as  being  under  review  by AHCCCS). When error codes are identified as an AHCCCS  error and are corrected,  or are identified as being under AHCCCS  review  and then  released,  the Contractor  is responsible  for  addressing  any  remaining  error codes and will be afforded a new 120 day clock for resolution.   However,  the true age for these pended encounters will continue to appear on the Aging Reports.

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

Mr. Uchrin
December 9, 2014
Page 2

Per the terms of the Contract, sanctions are not the Administration's  exclusive  remedy.  In particular and without  limiting possible future actions, if any legal action is brought against the Administration  as the result of your non-compliance with the Contract, the Administration will seek compensation from you for any damages arising from such legal action including but not limited to the Administration's cost of representation  as well as the cost of any attorneys' fees and costs payable to the party bringing the action.

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

pP-
Michael Veit
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
nlarson@iasishealthcare.com