Tip: Identifying Arkansas PASSE claims

0047

16256, 16244, 60217, 99MCD1, 17096

Feb 12, 2020

Apr 12, 2022 Mar 16, 2023

Included in March 2023 data tips email.

Arkansas PASSE data receipt began in 2019 and will be available for data requests beginning in June, 2020.  Three submitters provide these data: 16256 - Arkansas Total Care; 16244 - Empower; and 60217 - Summit (submitted through Anthem). 

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.

To identify PASSE claims, Arkansas Medicaid now provides a supplemental file containing all PASSE claim numbers.  These are joined to the Arkansas Medicaid claims. When a match occurs, the PASSE flag is set on medical (MC841), pharmacy (PC841), or dental (DC841) claims.

Going forward, fulfilled data requests will not contain the Arkansas Medicaid PASS claims data.  Arkansas Medicaid PASS claims are available upon request.

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Previous workaround prior to Arkansas Medicaid supplemental data:

To segment data for these passes, use the following methodology:

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.

PASSE

Medicaid Expansion

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