AHCCCS Technical Interface Guidelines (TIG) - Behavioral Health Interface

Introduction

SMI Determinations are entered into a secure web-based portal by the third-party SMI vendor for processing. This portal is maintained and administered by Arizona Health Care Cost Containment System (AHCCCS).

Schedules

SMI Portal – there are four daily reports created Monday through Friday out of the SMI Portal.

Media

The four files created are:

  • Open-SMI_SED-Pended-NonElig-Report_YYYYMMDD_XXXXXX.DAT
  • Open-SMI_SED-Pended-Elig-Report_YYYYMMDD_XXXXXX.DAT
  • SMI_SED-Determination-Outcome-Elig-Report_YYYYMMDD_XXXXXX.DAT
  • SMI_SED-Determination-Outcome-NonElig-Report_YYYYMMDD_XXXXXX.DAT

Testing

The SMI Portal must be tested in coordination with the AHCCCSA ISD operations staff prior to production implementation of a new contractor or change in service bureau, or as a result of changes. Typical testing takes approximately one week and must be completed prior to implementation of any new processing arrangement.

Reference Documents

SMI Portal User Manual

Introduction

The Department of Corrections provides (on weekdays) BHS with a list of recently incarcerated people. This flat report is a list of all clients who are (or have been) enrolled at each RBHA and matched by name, gender, and DOB.

Schedules

Weekly once on Monday @12.30pm

Media

The Weekly Updates of DOC Members will be sent to the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is ADCLINKxx.yyyymmdd.txt (xx is rbha id)

Testing

Weekly Updates of DOC Member 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

Link to BHS TIG Information File Layouts.Weekly Updates of DOC Members

Introduction

Report includes the encounters where quantity dispensed is 10 times more than the day’s supply value.

Schedules

2nd Working Friday of the Month

Media

The NCPDP Encounter Inflated Quantity Report file will be sent to /XXX/PROD/OUT/ on the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is h74enc_disp_YYYYMMDD_XX.txt. The file is a pipe-delimited file (each field is separated by pipe( ‘|’)).

Testing

NCPDP Encounter Inflated Quantity Report 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

Link to BHS TIG Information File Layouts.NCPDP Encounter Inflated Quantity Report

Introduction

Reports includes encounters where DOS is greater than the Date of death.

Schedules

2nd Working Friday of the Month

Media

The Encounter DOD Report file will be sent to /XXX/PROD/OUT/ on the AHCCCS SFTP server, /XXX/PROD/OUT where XXX is the RBHA folder. The file name is h74enc_dod_YYYYMMDD_XX.txt. The file is a pipe-delimited file (each field is separated by pipe( ‘|’)).

Testing

Encounter DOD Report 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

Link to BHS TIG Information File Layouts.Encounter DOD Report