Encounter keys

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Volume 4 Issue 5 February, 1999
TAPES & TRANSMITTALS PENDING ENCOUNTERS
Pick Up Tapes
Promptly!
he Encounter Opertions Unit
requests that whenever we call
Plans regarding the pick up of tapes,
that pick-up is within 24 hours. Tapes
that are called on, need to be collected
expeditiously.
$$$$$
Error Code
C040 – Days
Supply Is Invalid!
hile researching pended Universal Drug Forms
(C) submitted by the Health Plans and Program
Contractors, the Encounter Operations Unit found that in
the remarks column of the Encounter Reporting Users
Manual the information states that Numeric value or
“PRN” (PRN needed as required) are applicable. The
information in the paragraph has been modified. This
information should now read “Numeric Value Only”.
This change should be made to your Tape Specifications
for the Universal Drug Form C – New Day Encounter
Tape Record Layout which is found in (Chapter 5-29) of
the manual.
Please Note: If you are using an NDC code that has
been submitted by the provider and it is not available on
the AHCCCS database, please submit documentation to
the Encounter Operations Unit. This documentation
should include the page from the Red or Blue Book
detailing the NDC code.
If you have any questions regarding the
submission of documentation, please
contact your Technical Assistant.
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Correcting A
Diagnosis Code!
hen a Plan or Program Contractor
is correcting a diagnosis code they
should reenter the complete diagnosis
code. We have learned that many Plans
are only keying in the 4th or 5th digit on
the diagnosis code.
$$$$$
Edit Codes and
Descriptions Are On
Their Way!
list of encounter edit codes and descriptions by
form type will soon be distributed to all Health Plans and
Program Contractors. The list will include all error
codes, active and inactive. The Encounter Operations
Unit is distributing this list so Plans have a clearer
knowledge of our editing system. This information will
be distributed to all Health Plans and Program
Contractors by the end of March.
“The only gift is a portion of thyself.”
Ralph Waldo Emerson
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“Is not this the true romantic feeling – not to
desire to escape life, but to prevent life from
escaping you?”
Thomas Wolfe
2 Encounter Keys
Note: The following information is from the AHCCCS
CLAIMS CLUES – FEBRUARY, 1999. If you have not
read or received a copy of the current Claims Clues,
contact Lois Golden at (602) 417-4140. Brent Ratterree
has requested that we add this information to the
Encounter Keys.
Plans Must Pay 90%
of Clean Claims
Within 30 Days!
ffective for claims received on and after October
1, 1998, AHCCCS Health Plans and Program
Contractors must pay 90 percent of clean claims within
30 days of receipt unless otherwise specified in the
contract with a provider.
Health Plans and Program Contractors also must pay 99
percent of clean claims within 90 days of receipt and 100
percent of valid clean claims within 12 months of the
date of receipt unless the contract with a provider states
otherwise.
The payment requirements are in accordance with the
federal law and will be incorporated into the Arizona
Administrative Code (R8-22-705).
$$$$$
Data Set Name (DSN)
Can Change At
Anytime!
ecently, our Information Systems Department has
discovered that the reason Health Plans and Program
Contractors could not read their Provider and
Reference Tape was because the DSN had been changed. This
change occurred because of a tape number segment
redistribution.
Note: The DSN can change periodically. It is your
responsibility to read the information and load it accordingly.
Dilemmas!!
he dilemmas for the month of February
researched by the Encounter Operations Unit are
listed below. These error codes will not be sanctioned.
Edit
Code Description
H470 Date of Service is Prior to Date of Birth
P227 COS Assignment Not Found For Service Code
T030 ICU With Nursery Not A Logical Split
aaaaa
ENCOUNTER OPERATIONS UNIT EDITORIAL
STAFF: Deborah Burrell, Peggy Brown, Sandra
Jeademann, Lois Golden
LAYOUT AND DESIGN: Deborah Burrell and
Gustavo Morón, Jr.
Direct Correspondence to: AHCCCS Encounter
Operations Unit, P.O. Box 25520, Phoenix, Arizona
85002-5520, Mail Drop 8500
Fax: 602-417-
4725, Phone: 602-
417-4487
“Hatred paralyzes life; love releases it.
Hatred confuses life; love harmonizes it.
Hatred darkens life; love illumines it.”
Martin Luther King, Jr.
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