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Frequently Asked Questions

If your questions are not answered below or elsewhere on the site, please contact us at TIPQIC@asu.edu. Go to the TI Onboarding page and download the Onboarding Checklist.

Getting Started

1. I'm new to the AHCCCS Targeted Investments Program (TIP). Where do I start?

A: Welcome! Please go to the TI Onboarding page and download the Onboarding Checklist.
2. What organizations participate in the AHCCCS TI Program?

A: Find lists of the TI Program participants on the AHCCCS website here. The lists will be updated periodically to reflect changes.

QICs

1. What are the QIC attendance requirements?

A: Find information about the QICs on the QIC Meetings & CEU page and subpages accessed from there. For QIC attendance requirements, please refer to the Year 6 QIC subpages that are relevant to your organization: Y6 Pediatric QIC page, Y6 Adult QIC page, Y6 Justice QIC page.
To get credit for attending a virtual QIC session, each person must register individually and log in to the webinar individually. If you attend a virtual QIC with more than one representative from your organization on one computer, both (or more) representatives must each log into the webinar separately to assure both (all) are counted as attending.
2. If my organization participates in two TI programs, do I need to attend both QICs?

A: Yes, if a TI organization participates in multiple TI programs, then they must attend the QIC sessions for each program and are expected to meet the attendance expectations for each QIC.
3. How many representatives from my organization need to attend each QIC?

A: See the Y6 Required QIC Representation list for the number of representatives who must attend the Adult QIC and Peds QIC from your organization.

Data Dashboards

1. What level of detail will we be able to see within the QIC data dashboard?

A: For each measure, the dashboard shows a 12-month moving window of performance over 12 months. In doing so, you can see how your organization’s performance on each measure trends over 12 consecutive months. The dashboard also shows your organization’s Year 4 target. Protected health information (PHI) is not displayed on the dashboard.
2. Will the dashboard specify the members included in the numerator and denominator for each measure calculation?

A: The dashboard shows the number of members in the denominator for your organization's data. Protected health information (PHI) is not be displayed on the dashboard.
3. How does the data account for churn?

A: Please see the PCP Attribution Methodology.
4. Will there be a baseline panel? Who will be included in this?

A: Baseline performance was evaluated for each organization using FY 2019 performance period and the attribution methods.
5. How far in advance of our monthly QIC will the data be available?

A: We aim to update the dashboard at the end of each month pending receipt of new claims.
6. Will we be able to remove non-TI-participating sites from TIN trends and target setting?

A: Site-level data is not available before October 2019.
7. What is the claims lag?

A: It is variable based on when encounters are submitted to the MCO and the MCO submits to AHCCCS. Performance displayed on the dashboard are based on adjudicated claims. The performance for a 12-month performance period reflects services provided in that 12-month window.
8. Why do our previously reported denominators (or performance) change when the dashboard is updated?
A: Changes can be caused by addition of, removal of, or revision to one or more of the following:
- Adjudicated claims
- Member eligibility
- Outcome of the attribution process
  
  Each member's attribution is re-evaluated for all report periods prior to updating the dashboard
- Provider IDs or Group Billing IDs
- Allowed billing codes
  
  E.g., inclusion of Collaborative Care Model codes for follow-up after hospitalization (FUH) measures

9. How do I interpret the denominator counts for the Follow Up After Hospitalization (FUH) measures?

A: For the hospitalization measures, the reported denominator for a given month is the number of hospitalization events that occurred in the last 12 months for AHCCCS members attributed to the organization. Members who are hospitalized more than once (with sufficient time lag) are counted multiple times in the denominator.

10. Why do our denominators for Follow up After Hospitalization (FUH) measures gradually increase between performance periods ending October 2018 to September 2019?

A: Members enrolled in RBHA plans are not included in performance assessment, while members in ACC plans are included. Beginning October 1, 2018, a large number of members moved from RBHA to ACC plans. The FUH measures require members to be enrolled from the date of discharge through 30 days after discharge. All of these members would have had qualifying enrollment as of October 30, 2018, but only a small fraction of them would have had a qualifying hospitalization event in that period. The number of qualifying hospitalizations increases linearly as more months of data are taken into account, and levels off one year later (September 2019) because the data are evaluated on a 12-month basis.

11. Why does our denominator for the Diabetes Screening (SSD) measure have a noticable increase at performance period ending August 2019?

A: Members enrolled in RBHA plans are not included in performance assessment, while member in ACC places are included. Beginning October 1, 2018, a large number of members moved from RBHA to ACC plans. The minimum enrollment requirement for the Diabetes Screening measure is 10.5 months, so these members becoame eligible for this measure in August 2019. Of these newly eligible members, those who qualify for the measure denominator are included in the denominator in August 2019.

Attribution & Assignments

1. What is the attribution model used for PCP?

A: Please see the PCP Attribution Methodology.
2. What is the attribution model used for BH?

A: Please see the BH Attribution Method.
3. How are dual payer/ non-billed (or paid) claims considered?

A: Encounters must be submitted to Medicaid and adjudicated to count towards the TI Program measures. Even if a submitted and adjudicated claim is not paid by the Medicaid health plan, it will count towards the measures. Therefore, for dual payer patients, if TI Participant submits claims to both Medicare and Medicaid, then the TI Participant receives credit for TI Program measures even when Medicare pays the full claim.
4. How does assignment work for FQHCs?

A: FQHCs are not eligible to participate in the TI Program.
5. Does attribution include temporary (fill-in) physicians?

A: Please see the PCP Attribution Methodology.
6. Does PCP attribution include non-physician specialties?

A: Yes. Please see the PCP Attribution Methodology.
7. How do we account for members seeking services from different providers?

A: For PCP measures, the member is attributed to a PCP provider as described in the PCP Attribution method. For BH measures, a member or hospitalization can be attributed to more than one provider as described in the BH Attribution method.
8. There are a large number of members assigned to my panel that get care from other practices. To whom are these patients attributed?

A: Please see the PCP Attribution Methodology.
9. Why do we have members in our Adult BH denominator for the Diabetes Screening (SSD) measure when we do not provide diabetes screenings at our locations?

A:Members who meet the SSD denominator criteria are attributed to the BH providers with whom the member had a visit with a diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder during the measurement year. It does not require the provider to conduct the diabetes screening themselves. This performance measure reflects coordination of care for high-risk individuals. If a practice does not provide diabetes screening services, this measures your ability to refer/ follow-up with the member to ensure screening is completed.
10. Our organization is a Direct Support Provider (DSP), but another Health Home (HH) or Qualified Service Provider (QSP) is responsible for post-hospitalization follow up appointments for many of our members. Is our organization responsible for these members in TI performance measurement?

A: Yes, for TI performance measurement you will held responsible for all members served under your participating provider IDs. DSP/QSP/HH designation is not factored into TI attribution. Aligned with the care coordination objectives of the TI Program, you are encouraged to coordinate with the QSP to ensure that follow up takes place. TI attribution methods may differ from health plan attribution methods. For details on TI attribution methods, see Measure Evaluation & Attribution Methods.
11. How do I see if our PCP providers are enrolled in AHCCCS with a qualifying PCP Provider Type and Specialty?

A: The AHCCCS Provider Enrollment Portal (APEP) is the main database where providers can view their AHCCCS Provider Type and Specialties. If your organization has not already participated in the APEP re-registration process, please do so by going to the website linked here: https://www.azahcccs.gov/PlansProviders/APEP/Access.html.
Please note, you can also contact the Provider Assistance at (602) 417-7670 (select Option 5) for questions or if you encounter any difficulties during the process.
12. How do I see if our BH providers are enrolled in AHCCCS with a qualifying Mental Health Provider Type and Specialty?

A: The AHCCCS Provider Enrollment Portal (APEP) is the main database where providers can view their AHCCCS Provider Type and Specialties. If your organization has not already participated in the APEP re-registration process, please do so by going to the website linked here: https://www.azahcccs.gov/PlansProviders/APEP/Access.html.
Please note, you can also contact the Provider Assistance at (602) 417-7670 (select Option 5) for questions or if you encounter any difficulties during the process.

Measures

1. Will Day 0 be counted?

A: No, day 0 is not counted. This is a CMS/NCQA decision and AHCCCS is aligning with the national standards.
2. What are the measure targets?

A: Measure tiers and targets are displayed within the dashboard and on this site -- See the PCP, BH & Hospital page and the Justice page for their respective targets.
3. Do the 7-/30-day BH core measures require scheduling of appointments or that the patient kept the appointment?

A: The patient must keep the appointment to be included in the numerator.
4. How will TI Program respond to COVID-19?

A: We understand the implications that COVID-19 may be having on your practice. Given the uncertainty on how long it will last, we will continue to monitor and adjust as the data leads us and as the situation becomes clearer.
5. What antipsychotic medications trigger the Diabetes Screening measure?

A: A list of the antipsychoic medications that trigger the Diabetes Screening (SSD) measure is available on the NCQA website. A link to the NCQA website and instructions are posted on the HEDIS Resources page of the TIPQIC.org website.
6. Do telehealth visits count in calulation of the measure performance?

A: We are reviewing the AHCCCS Temporary Telephonic Code Set as well as NCQA guidance for 2020.
7. NCQA released HEDIS Measurement Year 2020 specifications in July 2020. Will the TI Program be adopting these updated HEDIS Measurement Year 2020 specifications?

A: No. We will be using HEDIS Measurement Year 2019 guidelines for TI Year 4 performance evaluation. Please see HEDIS Resources for measure details.
8. If a member has two inpatient hospitalizations for mental illness or intentional self-harm within 30 days, are both hospitalizations in the denominator for the FUH measure?

A: No, if the member has a readmission or direct transfer to an acute facility within 30 days of the discharge date and primary diagnosis is again mental illness or intentional self-harm, then only the second discharge date qualifies for the denominator. The first discharge is essentially excluded.
9. If a non-licensed provider is the servicing provider on claim with a Collaborative Care Model (CoCM) code (i.e., 99492, 99493, 99494), will this count towards the 7/30 day FUH measure?

A:Yes. An approved CoCM claim counts as a follow-up to hospitalization. Please consult your Health Plan for assistance with billing these codes. Please see additional CoCM guidance on the TIPQIC website here.

Continuing Education (CE)

1. How can I earn CE credit?

A: CE credit can be earned by attending any of the virtual QIC sessions and completing an evaluation survey made available following each session. Please see our CE page for more detail on the type and number of credits that can be earned.

Other

1. What TI-participating Providers deliver Collaborative Care Model (CoCM) services?

A: To view a list of TIP providers that deliver CoCM services, see TIP Providers who deliver CoCM services.