Encounter Submissions. All Encounter records except pharmacy transactions must be submitted and determined acceptable by the Department on or before the last calendar day of the third month after the payment/adjudication calendar month in which the PCO paid/adjudicated the Claim. Pharmacy transactions must be submitted and approved in PROMISeTM within 30 days following the adjudication date. Encounter records sent to the Department are considered acceptable when they pass all Department edits. Encounter records that deny or suspend due to Department edits are returned to the PCO and must be corrected. Denied Encounter records must be resubmitted as a “new” Encounter record if appropriate and within the timeframe referenced above. Suspended Encounter records must be corrected and resubmitted as an adjustment within the timeframe referenced above. Corrections and resubmissions must pass all edits before they are accepted by the Department. Failure of subcontractors to submit Encounter Data timely shall not excuse the PCO’s noncompliance.
Encounter Submissions. Encounters must be submitted in the format prescribed by AHCCCS. Encounter data must be provided to AHCCCS as outlined in the HIPAA Transaction Companion Guides, Trading Partner Agreements and the AHCCCS Encounter Manual. Professional, Institutional and Dental Encounters not involving services eligible for Federal Drug Rebate processing should be received by AHCCCS no later than 240 days after the end of the month in which the service was rendered, or the effective date of the enrollment with the Contractor, whichever date is later. Pharmacy related encounter data and other encounters involving services eligible for Federal Drug Rebate processing must be provided to AHCCCS no later than 30 days after the end of the quarter in which the pharmaceutical item was dispensed. A Contractor shall prepare, review, verify, certify, and submit, encounters for consideration to AHCCCS. Upon submission, the Contractor must provide attestation that the services listed were actually rendered. The Contractor may be assessed sanctions for noncompliance with encounter submission completeness, accuracy and timeliness requirements.
