Tip: Identifying Arkansas PASSE claims

0047

16256, 16244, 60217, 99MCD1, 17096

Feb 12, 2020

Apr 12, 2022 Mar 16, 2023 Apr 7, 2025

Included in March 2023 data tips email. Included in the April 2025 data tips email

Updated PASSE data identification methodology

The Provider-led Arkansas Shared Savings Entity (PASSE) – a new model of organized care created by Arkansas Act 775 – addresses the total health care needs of Medicaid beneficiaries who have behavioral health (BH) disorders or intellectual developmental disabilities (IDD). The purpose of the model is to improve the health of those who need intensive levels of specialized care, link providers of physical health care with specialty BH and IDD providers and coordinate care for all community-based services.

PASSE third party administrators (TPA) submit claims for the services provided to qualifying Arkansas Medicaid beneficiaries.  Arkansas Medicaid also submits these claims as part of the Arkansas Medicaid data provided to the Arkansas APCD. The Arkansas Medicaid claims should NOT be used.  They do not contain usable data for these services.

Updated:

Use field ME001_CAT = ‘PASSE’ to find members enrolled in PASSE plans using this methdology:

1.  Arkansas Total Care enrollees and associated claims can be identified using submitting entity code (ME001, MC001, PC001)  = 16256. 

2.  Empower enrollees and associated claims can be identified using entity code (ME001, MC001, PC001, DC001)  = 16244

3. Summit enrollees and associated claims are included with data received from Anthem.  These data can be identified within the Anthem data by using entity code (ME001, MC001, PC001, DC001)  = 60217 combined with Insurance type code (ME003, MC003, PC003, DC003) = MCD. NOTE, when selecting member records, include Market Category (ME030) = GPL.

4. Caresource enrollees and associated claims can be identified using entity code (ME001, MC001, PC001, DC001)  = 17096

Fulfilled data requests will not contain the Arkansas Medicaid PASS claims data.  Arkansas Medicaid PASS claims are available upon request.

PASSE

Medicaid Expansion

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