AHCCCS Technical Interface Guidelines (TIG) - Program Contractor Interface

Introduction

The ALTCS Placement Extract is created to give health plans information in regards to an ALTCS member’s current placement.

Schedules

The ALTCS Placement Extract is produced on a monthly basis and are normally created on the 15th of the month.

Media

The ALTCS Placement Extract is placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The file names are YYMMDD.B.PLC.

Testing

ALTCS Placement Extract 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.

Reference Documents (File Layout)

ALTCS Placement Extract

Introduction

This process systematically generates copies of PAS reports at Maricopa County and Pima County Program Contractor sites. The PAS is a record of an ALTC member's pre-admission medical screening. The Program Contractor case managers will use an initial PAS report as a guide in determining an appropriate Case Management Plan for the member. The case manager will use the reassessment PAS as a guide to modify the existing Case Management Plan.

Schedules

Maricopa County receives the PAS reports as a formatted report file. The process utilizes host-to-host file transmission via a dedicated line between Maricopa County and the ADOA-DC mainframe. Pima County has an ITT dot matrix printer defined as a systems printer to the ADOA-DC mainframe. The reports print on this printer. Pima County is linked to ADOA-DC by the SNA protocol supported by an IBM 3270 controller, modem and a dedicated communications line.

Reporting

The following reports are generated via this process:

• E/PD PAS Report Contains detailed information of the applicant's PAS. Maricopa County receives the reports in a formatted report file. Pima County's reports print on a printer at their site.
• E/PD No PAS Transmitted Report This report indicates to the Program Contractor that no initial assessments or reassessments occurred on the current processing day. Maricopa County receives this report in a sequential print file. Pima County's reports print on a printer at their site.

Media

• Batch Process runs daily after 6:00 p.m.. The process selects all pre-admission screening records processed in the online system prior to 6:00 p.m. on the current day.

Testing

Prior to production implementation, Program Contractor interfaces must successfully complete the following testing stages:

• Stage 1 Systems Testing as documented in a formal test plan, performed by the Program Contractor technical staff and ISD ALTCS staff.
• Stage 2 User Acceptance Testing performed by Division of Member Services staff.

Introduction

Case management data is a record of the Long Term Care member's cost- effectiveness study, case managers, placement history, case manager review dates, Community First Choice, and all title XIX services authorized for and provided to the member, including third party services. This includes any institution to which room and board is paid. The maintenance of this data is possible through online screens in the ALTC system and through a batch process called the Program Contractor case management interface. The batch process receives and sends data via host-to-host file transmissions.

Schedules

The contract between AHCCCS and the Program Contractors requires Program Contractors submit the case management data no less than twice per calendar month. AHCCCS will accept the interface input file from the Program Contractor anytime the ADOA-DC mainframe is available. The system is available 24 hours per day, seven days a week, except for scheduled system downtimes. Processing of the file occurs at night during a regularly scheduled time period. File processing time varies depending on the number of records processed.

Media

The Program Contractor case management interface accepts a 500 byte sequential file formatted in EBCDIC code. The data is sent in chronological order for each recipient. The data is ordered by CES, placement, review, community first choice and demographic records. The Program Contractor must establish a dedicated data communication link between their system and the PMMIS external server.

Testing

Case Management Interface 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.

Reference Documents (File Layout)

PCI Tech

Introduction

SOC Monthly Extracts are created to give health plans information in regards to an ALTCS member’s current and historical share of cost. There are two files created in this process. One file gives the member’s share of cost per month for the current contract year and the other gives the member’s share of cost per month in the previous contract year.

Schedules

SOC Monthly Extracts are produced on a monthly basis and are normally created on the 1st of the month.

Media

The SOC Monthly Extracts are placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The file names are SOC-CY-PCXXXXX.TXT (previous contract year) and SOC-MONTHLY-PCXXXXXX.TXT (current contract year) where XXXXXX is the health plan id.

Testing

SOC Monthly Extract 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.

Reference Documents (File Layout)

SOC Monthly Extract

Introduction

The ALTCS Discontinuance Report is a report used to inform MCO’s of ALTCS members who lost their eligibility and will be discontinued at the end of the month.

Schedules

ALTCS Discontinuance Report is a report that is produced on a daily basis.

Media

The ALTCS Discontinuance Report is placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The file name is HPXXXXX_Discontinuance_YYYYMMDD.XLS where XXXXXX is the health plan id.

Testing

ALTCS Discontinuance report 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.

Reference Documents (File Layout)

ALTCS Discontinuance Report

Introduction

The ALTCS Transitional Report is used to inform the MCO of members transitioned into and out of ALTCS transitional program.

Schedules

ALTCS Transitional Report is produced on a daily basis.

Media

The ALTCS Transitional Report is placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The file name is HPXXXXX_Transitional_YYYYMMDD.XLS where XXXXXX is the health plan id.

Testing

ALTCS Transitional report 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

Reference Documents (File Layout)

Encounter ALTCS Transition Report

Introduction

The ALTCS HCBS SOC Report is used to identify members who are in an HCBS setting and have a Share of Cost greater than $0.

Schedules

ALTCS HCBS SOC Report is produced on a monthly basis.

Media

The ALTCS HCBS SOC Report is placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The file name is HPXXXXX_HCBS_SOC_YYYYMMDD.XLS where XXXXXX is the health plan id.

Testing

ALTCS HCBS SOC report 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.

Reference Documents (File Layout)

Encounter ALTCS HCBS Report

Introduction

The PAS Extract is used to inform the MCO of the detailed information used in the PAS assessment or PAS reassessment completed by AHCCCS.

Schedules

PAS Extract is produced on a daily basis.

Media

The PAS Extract is placed on the AHCCCS FTP server in the plan’s folder under AZ/hpmnemonic/PROD/OUT. The report name is CountyName_YYMMDD_HHMM.pdf.

Testing

PAS Extract 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.

Reference Documents (File Layout)

PAS Extract