A:izo,o Health  Care  Cost Containment System

December 11, 2014

Trista Loops
Interim Plan Administrator
Health Net Arizona
1230 West Washington Street
Suite 401
Tempe, AZ 85281

Janice  K. Brewer, Governor
Thomas  J. Betlach, Director

SUBJECT:  Final Results of Sanctionable Pended Encounters June 2014

Dear Ms. Loops:

This attached information  will provide the final aged pended encounter  sanctions for the quarter ending June 2014.  According to the Contract, Health Net is required to 1esolve all pended encounters within 120 calendar days ofthe 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  25 and  the final  sanction  number  pended  encounters  for this quarter  is 25.   The final sanction dollar amount is $130.

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 8503.1 ·PO Box 25520, Phoenix. AZ 85002 • 602-417-4000  • vJww azahcccs.go•;

Ms. Loops
December 11, 2014
Page 2

Enclosed is a summary of the final sanction results.  Please retrieve your pended encounter sanction information  from  AHCCCS'  FTP server.   The path is sftp.state.medicaid.us\NET\OTHER\ and the file names are:

•	NET June 2014 Final Sanctions.txt
•	NET June 2014 Final Error Summary.pdf
•	NET June 2014 Final Age Category.pdf

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.

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
Susan.a.gilkey@healthnet.com