Due to the large shift of GMH/SU membership to the ACC contractors effective 10/01/18 for integrated care, this provider notification serves as a reminder to all providers/facilities registered as
Provider Type 02
that under the ACC contract all physical health and behavioral health inpatient stays will be considered under APR-DRG payment methodology only. Prior to 10/01/18, the primary diagnosis of the claim was considered and behavioral health claims were processed by the RBHA and paid at a per diem rate.
Mercy RBHA will continue to consider the primary diagnosis. Inpatient behavioral health stays will be processed using the per diem methodology, while physical health stays will be processed under APR-DRG.
As currently outlined in the AHCCCS APR-DRG manual, only Mercy RBHA reimburses per diem for behavioral health; Mercy Care Complete Care reimburses APR-DRG. It’s important to understand that under the APR-DRG methodology, the date of discharge dictates which ACC contractor is responsible for payment; the plan the member is enrolled with at the time of discharge is responsible for the entire stay. The APR-DRG rate applied is also based on the discharge date; if the stay falls during a rate change for the facility the rate on discharge is applied. This is unlike per diem, where the admit date is used and claims can be split for enrollment changes. For further information, please refer to the AHCCCS Fee for Service Provider Manual for more information:
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our
Mercy Care website.
Thanks for all you do!
