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Episodes of Care

An Episode of Care (EOC) is the bundle of Arkansas Medicaid-covered health care services provided to perform a specific procedure or treat an ailment/condition for a given length of time. EOCs are based on data from two main sources: 1) paid claims processed per standard Medicaid fee-for-service reimbursements, and 2) data submitted through AHIN (Advanced Health Information Network), a Provider Portal utilized when key data are not available through claims.
 
For each EOC, providers submit claims and will continue to be reimbursed per established fee schedules. A Principal Accountable Provider (PAP) is identified for each EOC through claims data. PAPs are defined as providers who have the greatest potential to influence treatment decisions, cost, and quality of care within each type of EOC. PAPs share in savings or excess costs of an EOC determined by the average cost per valid EOC and performance on quality/outcome measures as compared to peers.
 
An EOC’s performance period is twelve-months in duration.  Quarterly reports are published for each PAP and EOC throughout the performance period culminating in the fourth and final quarterly report upon which financial incentives are determined.
 
An Episodes of Care’s Principal Accountable Provider Report will be one of three different types of quarterly reports (the report cover of each document will indicate the report type):
 
Historical Performance Report – An informational report for newly launched EOCs which provides a twelve-month historical perspective prior to the publication of an actual Performance Period Report.
 
Performance Period Report – A quarterly report detailing the information upon which a PAP’s clinical quality and cost performance are based.  The fourth and final quarterly report is frequently referred to as the “payment” report upon which financial incentives are determined.
 
Reconciliation Report – A report published one year after an EOC’s fourth and final Performance Period Report.  The Reconciliation Report will adjust clinical quality and cost information based on data submitted after the close of a performance period.

Click here for a PAP Report Glossary
Click here for a PAP Report Guide

Additional information and provider support is available by contacting AHCPII Help Desk at 501.301.8311 or arkpii@dxc.com.

Below is a list of EOCs currently in production. The performance period and the “payment” report dates for each EOC are list below:

Episode of CarePerformance PeriodFinal Performance Period Report
Medical
AsthmaJUL 1 - JUN 30OCT 31
Chronic Obstructive Pulmonary Disease (COPD)JAN 1 - DEC 31APR 30
Heart Failure (HF)JAN 1 - DEC 31APR 30
Upper Respiratory Infection (URI)OCT 1 - SEP 30JAN 31
Procedural/Surgical
Cholecystectomy (CHOLE)OCT 1 - SEP 30JAN 31
Colonoscopy (COLON)OCT 1 - SEP 30APR 30
Coronary Artery Bypass Graft (CABG)APR 1 - MAR 31JUL 31
PerinatalOCT 1 - SEP 30JAN 31
Tonsillectomy (TONSIL)OCT 1 - SEP 30APR 30
Total Joint Replacement (TJR)JAN 1 - DEC 31APR 30
Behavioral Health
Attention Deficit Hyperactivity Disorder (ADHD)JAN 1 - DEC 31APR 30
Oppositional Defiant Disorder (ODD)APR 1 - MAR 31JAN 31