C-26-08-011-0-17 AMENDMENT TO IGA WITH ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM.PDF

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AHCCCS - Attachment A 
Administrative Annual Cost Estimates for 
Maricopa County Corrections 100% State IGA SFY24 - Agreement C-26-08-011-0-17 
Claims 
Estimated total number of claims: 
Physician & Emergency Transport/Hospital 
DFSM Cost per Claim 
DMPS Provider Enrollment Cost per Claim 
ISD Cost per Claim 
Concurrent Review 
Estimated cost per case 
Estimated number of HSAG reviews 
Claims Processing costs: 
DFSM 
DMPS Provider Enrollment 
ISD 
State Accounting System Charges @ $0.2336/claim 
Total Claims Processing Costs 
Direct DFSM Labor for MDOC 100% State Claims Processing 
Direct ISD Labor for MDOC 100% State Claims Processing 
Concurrent Review Estimated costs: 
Cost for 4 reviews 
Administrative Costs (see detail) 
DBF Paper Processing Personnel costs 
Postage @ $.0861/claim 
Data Center Charges@ $.8103/claim 
OOD @ $.3700/claim 
OGC @ $.1026/claim 
HRD @ $.0314/claim 
TIBCO@ $.1416/claim 
Indirect at 10% 
Total Administrative Costs 
DMPS Eligibility Costs 
Application Processing Costs - DMPS 
Estimated Total Annual Costs for Program 
Cost per Claim 
Electronic 
92% 
20,400 
2 $ 
0.82 
2 $ 
0.18 
2 $ 
2.00 
6 
7 
8 
10 
Average Cost 
$ 
134.35 
4 
$16,697.40 
$3,707.97 
$40,849.67 
$4,766.26 
$66,021.30 
1 Actual number of daims may be higher. Number indudes, original, recoupment and adjustment claims. 
2 Cost based on actual expenditures and actual number of claims processed 
3 Average rate per contract. Actual costs will be a strict pass-through based on price negotiated on contract. 
4 Actual number may be higher or lower depending on MDOC 100% State program requirements. 
5 Based on estimates of DFSM staff time required to process the claims. 
6 Estimate based on 80 hours at a rate of $175 per hour. Will only be billed for actual hours incurred. 
7 Based on estimates of DBF staff time required to monitor funding activity and process payments. 
8 Postage based on average cost per claim times number of claims. 
9 Data Center charges calculated based on average costs 
10 DMPS Eligibility charges calculated at $105/determination. Estimated O annual applications/determinations. 
Paper 
Total Fund 
8% 
100% 
1,800 
22,200 
$ 
0.95 
$ 
0.18 
$ 
2.00 
$1,702.56 
$18,399.96 
$327.17 
$4,035.14 
$3,604.38 
$44,454.05 
$355.40 
$5,121.66 
$5,989.51 
$72,010.81 
117,629.82 
$14,000.00 
$537.39 
$ 
11,356.73 
$1,911.97 
$17,988.27 
$8,215.03 
$2,278.47 
$695.98 
$3,145.49 
$4,559.19 
$ 
50,151.13 
$0.00 
$254,329.16 
$11.43 
AHCCCS DBF 10/30/2023 
3:11 PM 
C:\Users\AMCota\Documents\lGAs\lnmate Hospitalization\SFY Rates Updates\YH08-0073\SFY24\MDOC 100% State SFY 2024 Rate