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MEASURES & PERFORMANCE MEASUREMENT


TIP Measure Detail Guides

These measure-specific guides were developed to assist TI-participating Providers with understanding of the measures and TI performance measurement. They include measure definitions, why it matters, what TI measures, member population assessed, attribution methods, qualifying billing codes, and performance targets. Accommodations made to allow telehealth visits and Collaborative Care Model services to qualify are specified in the guides, where applicable.



Health Plan Measure Guides

The following guides provide the measure definitions and denominator- and/or numerator-qualifying billing codes. Providers do not need to be contracted with the plan to access these resources. For telehealth and Collaborative Care Model accommodations made for TI performance measurement, see the TIP Measure Detail Guides (above). For more information on HEDIS measures or to get your own license, visit the NCQA website and store.

Care 1st
Mercy Care
United Healthcare


HEDIS Value Sets & Codes

Value sets and codes used in HEDIS 2020 (Measurement Year 2019) measure calculations are available at no cost. Download the 2019 Quality Rating System (QRS) HEDIS Value Set Directory from the NCQA store.



Provider Types/Specialties

These documents define the AHCCCS Provider Types and Specialties that qualify as PCP and Mental Health Provider for measures and attribution.



Provider Identification Method

The Provider Identification Method and Attribution Methods directly affect which members each Provider is held accountable for. This section explains the Provider Identification Method. Attribution Methods are detailed in the TIP Measure Detail Guides linked above.

Read the summary below or, for detailed explanation and examples, watch the Provider Identification Methodology video (slides).

Year 4
  • Attribution was done at the level of billing provider ID, with results summed to the TIN level.
  • Members from non-TI sites that used a TI-participating billing ID were included.
  • This led to non-TI members being included in TI denominators during attribution.

Years 5 & 6
  • Attribution is done at the level of billing and servicing provider ID.
  • This adds more granularity to the data analysis and a greater ability to exclude members seen at non-TI sites.
  • This change may impact attributed members (denominator) as well as measure compliance (numerator).
  • The revised methodology was accounted for in setting the Year 5 targets.


Collaborative Care Model Inclusion

Psychiatric Collaborative Care Model (CoCM) is an approach to behavioral health integration recognized by CMS.

Recognition in TI Program

An AHCCCS Committee in consultation with CHiR established how the CoCM services (i.e., codes 99492, 99493 and 99494) are recognized in the TI Program.

  • PCP measure evaluation (i.e., 7/30-day follow up after hospitalization for mental illness measures): Collaborative codes will count as a qualified visit for numerator for all servicing provider types (licensed and non-licensed).
  • PCP attribution: CoCM codes will not be included among E&M codes or other qualifying visit in PCP attribution process.
  • BH measure evaluation & attribution (i.e., 7/30-day follow up after hospitalization for mental illness measures): In post-discharge period, CoCM codes will count as a qualified visit for numerator for all servicing provider types (licensed and non-licensed). In period prior to hospitalization (i.e., 90 days prior), CoCM codes will qualify the BH provider in denominator for all servicing provider types (licensed and non-licensed).
  • TIP does not recognize the newest HCPCS code G2214 as a qualifying follow-up after hospitalization service, as G2214 is not an AHCCCS reimbursable code in any TI program year.

Billing Guidance

To maximize CoCM services for FUH compliance, the following may be useful in guiding how your organization bills for these services. This guidance was developed and validated by subject matter experts in CoCM billing and coding from AHCCCS and other organizations. It does not conflict with CoCM billing guidelines from CMS.

  • Providers may submit only one CoCM claim per member per calendar month.
  • All CoCM services factored into a claim must have been provided in the calendar month.
  • The date of service on the submitted CoCM claim must be within the calendar month in which the services were provided. The coding guidelines do not otherwise dictate which date in the month must be listed. Therefore, the date of service can be the date of the first service, the date of a subsequent service that month, and the last day of the month are all allowed.
  • The CoCM claim date of service, in relation to the most recent hospital discharge date, determines how many days passed between hospital discharge and the provided follow up service.

TIP Providers who deliver CoCM services

To view a list of TIP providers that deliver CoCM services, see TI-participating Providers who deliver CoCM services.



Target Setting - How were the performance targets determined?

An AHCCCS Committee in consultation with CHiR established the tiers and targets. The committee considered National Medicaid Performance, AHCCCS Historical Performance, TIP Historical Performance, AHCCCS Minimum Performance Standards (MPS), and previous TI Fiscal Year performances to determine TI tiers and targets. The identity of the TI participants was blinded. Tiers and targets may differ across AOCs for the same measure. These differences accommodate variation in attribution methodologies. For your organization’s specific targets, please see your dashboard or the email received from the AHCCCS TI team.

PCP, BH & Hospital AOCs

  • Two to four tiers are established for all measures. To qualify for the performance incentive, Organizations must improve from tier in baseline year to next higher tier in measurement year (top tier to maintain).
    • Organizations in the lowest tier in the baseline year must meet or exceed the above target for the measurement year to qualify for the performance incentive.
    • Organizations in a middle tier in the baseline year must meet or exceed the above target for the measurement year to qualify for the performance incentive. For example, for TI Year 5, Adult PCP and Adult BH organizations between 56% and 70% on the SSD measure in the baseline year must meet or exceed 70% to qualify for the performance incentive.
    • Organizations in the highest tier, the tier above the high target, in the baseline year must stay above the high target for the measurement year to qualify for the performance incentive.

Justice AOC

  • A single target was established for each measure. To qualify for the performance incentive, Organizations must improve from their performance level in the baseline year to meet or exceed one of the two options below, whichever is lowest:
    • The target established for the measure, OR
    • 10%-points above the Organization’s performance in the baseline year.
  • If an Organization’s baseline performance is above the target, they must maintain performance above the target in the measurement year in order to qualify for the performance incentive.
  • Examples of this logic:
    • The AOD measure has a target of 78%.
    • Provider A has a performance of 69% in the baseline year, which is less than 10%-points below the target. To qualify for the performance incentive, the Organization must improve to equal to or greater than the 78% target in the measurement year.
    • Provider B has a performance of 60% in the baseline year, which is more than 10%-points below the target. To qualify for the performance incentive, the Organization must improve to equal to or greater than 70% (10%-points above baseline) in the measurement year.
    • Provider C has a performance of 85% in the baseline year, which is above the target. To qualify for the performance incentive, the Organization must maintain performance equal to or greater than the 78% target in the measurement year.



Justice Referral Lists

Read below or watch the Justice Referral Lists: How to Prepare video (slides)

Monthly Referral Lists Due to CHiR on the 15th of Each Month (Starting 11/15/2020)

  • Include members released from incarceration and referred to a TI-Justice Clinic, as well as members referred to a TI-Justice Clinic via Diversion Programs (e.g. drug court)
  • Include all TIP-Justice referrals made during the previous month (first day of previous month through last day of previous month)
    • For example, file due 12/15/2020 to include TI-Justice referrals 11/1/2020 – 11/30/2020
  • Each referral in the Referral List should include:
    • File Source: Organization sending the referral list
    • AHCCCS ID: A# for individual referred to a TI-Justice Clinic
    • Referral Date: Date member was referred to the TIP Justice Clinic (For the ReferralDate column, use the "3/14/2012" date format in Excel)
    • Referral Source: Organization/ Entity that referred the member, and
    • Referral To: TI-Justice Organization that the member was referred to
  • Use this template file with columns for each of the data elements required

File Naming Conventions

  • Use the following conventions for the file name: ReferralList_[OrgName]_[YYYYMM].xlsx
    • [OrgName]: Name of your organization - Use the values allowable in the "FileSource" field (e.g. AzCH, BUFC, Care1st, CHA, etc.)
    • [YYYYMM]: Month and year of the most recent referrals in the file - If the file includes referrals made through September 30th 2020, then this value would be 202009
    • Example: ReferralList_AzCH_202009.xlsx

Additional Preparation Notes

  • Title the sheet containing the referrals as "ReferralList"
  • Use the column names as they are shown in the template file - do not reorder or rename the columns
  • Do not include extra notes or data outside of the columns in the template file
  • Please submit via SFTP by the 15th of the month



CONTACT US: TIPQIC@asu.edu
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