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Systems Update

Systems Update. May 2012. HIPAA 5010. Project Status Key Considerations/Timeline for 7/1/2012 Next Steps. Project Status. Wrapping up all 5010 changes per the previously stated timeline Key Milestones for 7/1/2012 full compliance:

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Systems Update

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  1. Systems Update May 2012

  2. HIPAA 5010 • Project Status • Key Considerations/Timeline for 7/1/2012 • Next Steps

  3. Project Status • Wrapping up all 5010 changes per the previously stated timeline • Key Milestones for 7/1/2012 full compliance: • 11/1/2011 – Programming re-started and Freeze Period began • 1/2012 – Coding completes, start internal testing • 3/2012 – Begin UAT (external testing) • 6/2012 – Complete UAT • 7/1/2012 – Implementation in Production and Freeze Period ends

  4. Key Considerations/Timeline for 7/1/2012 • To accommodate necessary changes to the PMMIS databases the 2nd Encounter cycle for June will be cancelled and PMMIS will not be available during this conversion process beginning 6/30 up to a late as 7/4. • Last day that plans may submit 4010 and NCPDP non PAH format encounters for AHCCCS processing is 6/7/2012 (before 6:00pm) • If 4010 format encounters are received after 6/7/2012 they will be rejected upfront in validation

  5. Key Considerations/Timeline for 7/1/2012, cont. • Contractors must also complete all TI corrections to 4010 format encounters prior to 6/7/2012 • All Contractors are encouraged to complete their 5010 and NCPDP Encounter testing as soon as possible

  6. Next Steps • Post implementation support 30 to 60 days after 7/1 • Publish final Companion Documents for all Transactions

  7. ICD10 • Proposed CMS Implementation Date Change • Revised AHCCCS Project Timeline • AHCCCS Project Approach • CMS Site Visit • Next Steps

  8. Proposed CMS Implementation Date Change • “The Department of Health and Human Services (HHS) announced a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the International Classification of Diseases, 10th Edition diagnosis and   procedure codes (ICD-10).” • Comments to proposed Rule due by May 17th • Should be published by September 2012 if approved

  9. Revised AHCCCS Project Timeline • Assuming a 10/1/2014 effective date AHCCCS has revised our project milestones as follows:

  10. Revised AHCCCS Project Timeline, cont. • Complete Final Review of System Impacts July 2012 • Complete Document/Operational Impacts July 2012 • Finalize Operational Documentation Changes October 2012 And Policy Remediation • Complete Requirements and Design – Reference November 2012 • Complete Requirements and Design – All other January 2013 System Areas • PMMIS Code Freeze Begins…. February 2013 • Freeze Begins..... • System Implementation – Reference March 2013 • Initial Reference Table Loads April 2013 • External Testing BeginsSeptember 2013 • System Implementation – All other System September 2013 • Areas • PMMIS Freeze Ends..... • External Testing EndsSeptember 2014 • ICD10 Effective Date October 2014

  11. AHCCCS Project Approach • Native processing including review and remediation of impacted policies and processes • Use of GEMS as a points for reference/validation only

  12. CMS Site Visit • The CMS team responsible for ICD10 will be onsite in Arizona to conduct a half day Management level overview of interested parties • Information as to the specific date/time/location and how to RSVP will be posted on the AHCCCS webpage

  13. Next Steps • Finalize System Impacts • Finalize Documentation, Policy and Process impacts • Begin review and remediation of above impacts • Conduct Internal Training • Complete the detailed project planning • Inventory published GEMS and other related ICD10 documentation • Establish parameters for and initiate Contractor milestone reporting

  14. Other Projects • Pharmacy Data – Professional and Facility Form Type • Focused Encounter Pends and Denials Review • Recent Implementations – NEMT Copays; 340B Pharmacy Payments

  15. Pharmacy Data – Professional and Facility Form Type • Captured as reported effective 7/1/2012 with the implementation of 5010 changes • Specific rule tables outlining reporting requirements are in progress and will be implemented along with related encounter and claims editing for 10/1/2012 • http://www.azahcccs.gov/commercial/pharmacyupdates.aspx

  16. Focused Encounter Pends and Denials Review • We have identified a number of opportunities to clarify and or revise current encounter edit logic and related processes • The revisions and clarifications will be prioritized for completion between October 2012 and March 2013 • Specific details as to the impacted edits and proposed changes will be communicated as they are finalized

  17. Recent Implementations – NEMT Copays; 340B Pharmacy Payments • Non-Emergency Transportation Copays (NEMT) - http://www.azahcccs.gov/commercial/providerbilling/copayments.aspx • 340B Pharmacy Payments – http://www.azahcccs.gov/commercial/pharmacyupdates.aspx

  18. Technical Consortium Meetings • Looking at scheduling for late July, early August watch webpage for more information on date/time/location and how to RSVP

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