ARIZONA STATE SENATE
Phoenix, Arizona
AHCCCS; claims
Purpose
Makes several changes to the
time frames for claims payments under the Arizona Health Care Cost Containment
System (AHCCCS), and changes the reporting date for the annual AHCCCS report on
immunization rates.
Background
Laws 1999, Chapter 313
revised the AHCCCS statutes relating to time frames for claims payments. Specifically, time frames for initial
fee-for-service claims were reduced from 9 months to 6 months after the date of
service; and the period of time health plans and providers have for submitting
reinsurance claims to the AHCCCS administration changed from 9 months after the
close of the contract year to 12 months after the date of service.
A.R.S. §36-2904 (H) allows
AHCCCS health plans to require providers to submit initial claims within 6
months after the date of service and clean claims within 12 months after the
date of service. Due to the 1999 change
to the time frame requirements regarding reinsurance claims, a health plan may
be precluded from submitting a reinsurance claim to the AHCCCS administration
if a provider takes the full 12 months to submit a clean claim. S.B. 1141 resolves these conflicting time
frame requirements by allowing health plans to submit reinsurance claims within
the time period specified in the contract.
S.B. 1141 also ensures providers have 12 months to submit clean
fee-for-service claims with the AHCCCS administration for cases in which the
patient was not eligible for AHCCCS when services were delivered.
There is no cost to the
state general fund relating to the provisions of this measure.
Provisions
1. Allows AHCCCS and health plans to pay for claims submitted within six months of the date eligibility is posted. (Currently, AHCCCS and health plans are only authorized to pay claims submitted within six months of the date of service.)
2. Allows AHCCCS and health plans to pay for clean claims submitted within 12 months of the date eligibility is posted. (Currently, AHCCCS and health plans are only authorized to pay clean claims submitted within 12 months of the date of service.)
3. Replaces the requirement of health plans to submit reinsurance claims to the AHCCCS administration within 12 months after the date of service to the time period specified in the contract.
4. Increases, from 35 to 60 days, the amount of time a health plan may submit a claim for reinsurance or deferred liability if the claim is the subject of an administrative grievance or appeal proceeding.
5. Authorizes the AHCCCS administration and health plans to specify a shorter time frame for claims payments in their contracts.
6. Defines “submitted.”
7. Changes, from January 30 to April 1, the reporting date for the annual AHCCCS report on immunization rates for children through age two.
8. Makes conforming and technical changes.
9. Provides for a general effective date.
Prepared by Senate Staff
January 26, 2001