Arizona Health Care Cost Containment System
Quality Management Performance Measures for the
Arizona Department of Economic Security
Division of Developmental Disabilities
Measurement Period Ending September 30, 2004
Prepared by the Division of Health Care Management
March 2006

Anthony D. Rodgers
Director, AHCCCS

TABLE OF CONTENTS
INTRODUCTION
Overview ....................................................................................................................
Methodology ..............................................................................................................
Data Sources and Quality ...........................................................................................
The Measures ..............................................................................................................
Performance Standards and Improvement .................................................................
Feedback ....................................................................................................................

1
1
1
2
2
2

RESULTS
Well-child Visits in the Third, Fourth, Fifth and Sixth Years of Life .........................
Adolescent Well-care Visits ........................................................................................
Annual Dental Visits ...................................................................................................

3
5
7

DISCUSSION
Overall Results ...........................................................................................................
Data Limitations ....................…….............................................................................
Quality Improvement Efforts ......................................................................................

9
9
9

REFERENCES
APPENDIX: METHODOLOGY AND TECHNICAL SPECIFICATIONS

10
i

INTRODUCTION
Methodology
AHCCCS used the Health Plan Employer
Data and Information Set (HEDIS®) as a
guide for collecting and reporting results of
these performance measures. Developed and
maintained by the National Committee for
Quality Assurance (NCQA), HEDIS is the
most widely used set of measures in the
managed care industry.

Overview
The Arizona Department of Economic
Security’s Division of Developmental
Disabilities (DDD) provides needed
supports to Arizona residents who are at risk
of having a developmental disability if
younger than 6 years or, if older, have a
diagnosis of epilepsy, cerebral palsy, mental
retardation or autism, which was made prior
to the age of 18 years. The Division also
provides services to Arizonans who have
substantial functional limitations in at least
three major areas, such as self-care, learning
and mobility.

One of the criteria for selecting members to
be included in the measures is that they be
continuously enrolled for a minimum period
of time. Thus, members included in the
results of each measure represent a portion
of DDD members enrolled with AHCCCS,
rather than the entire population.

Approximately 68 percent of clients served
by DDD also are covered under the Arizona
Long Term Care System (ALTCS), a
program of the Arizona Health Cost
Containment System (AHCCCS). In
addition to long-term care and supportive
services provided through DDD, these
members also receive primary and acute
medical services through subcontracts with
health plans.

This report includes results for the contract
year from October 1, 2003, through
September 30, 2004. Results are reported
overall for DDD and by Maricopa, Pima and
the combined rural counties. A change in a
rate from the previous measurement is
described as an increase or decrease only
when the Pearson chi-square test yields a
statistically significant value (p<.05).

Under its contract with DDD, AHCCCS has
established Performance Standards for
primary and preventive care provided to
children and adolescents. These standards
measure the extent to which DDD ensures
that these members receive necessary health
services and screenings, including well-child
visits and regular dental care. This document
reports DDD’s performance in three of these
measures.

Data Sources and Quality
AHCCCS uses a statewide, automated
managed care data system known as the
Prepaid Medical Management Information
System (PMMIS). Members included in the
denominator for each measure are selected
from the Recipient Subsystem of PMMIS.
Numerators, and therefore rates, for each
measure are based on AHCCCS encounter
data; i.e., records of medically necessary
services provided and the related claims
paid. The rates reported for DDD may be
significantly underreported because many of
its members also are covered by other
insurance, and DDD may not have access to
those encounters.

The results reported here should be viewed
as indicators of utilization of services, rather
than absolute rates for each service
measured. By analyzing trends over time,
AHCCCS and DDD can identify areas for
improvement and implement interventions
to increase access to, and use of, services.

1

goals for the Division for other measures,
based on the baseline rates reported here.

The Measures
AHCCCS has identified several Performance
Measures of clinical preventive services for
DDD, some of which were newly
incorporated into contract for the year ending
September 30, 2005. The measures include:
•
Well-child Visits in the First 15 Months
of Life
•
Well-child Visits in the Third, Fourth,
Fifth and Sixth Years of Life
•
Adolescent Well-care Visits
•
Dental Visits
•
Childhood Immunizations
•
Adolescent Immunizations (new measure
for which data has not yet been collected)

AHCCCS will continue to provide technical
assistance, such as identifying new
interventions or enhancements to existing
efforts, to help DDD and other Contractors
improve their performance. For example,
AHCCCS is leading a collaborative effort that
includes all Acute-care Contractors and DDD,
as well as some community agencies and
provider associations, to improve well-child
visits among children 3 through 6 years of
age. The data reported here also may be used
in
developing
future
Performance
Improvement Projects by AHCCCS or
individual Contractors.

This is the first time AHCCCS has collected
data for Well-child Visits in the First 15
Months of Life, Well-child Visits in the
Third, Fourth, Fifth and Sixth Years of Life,
and Adolescent Well-care Visits for DDD.
Only one member met the continuous
enrollment criteria for Well-child Visits in the
First 15 Months of Life, so a rate could not be
calculated for that measure. DDD’s results for
the immunization measures will be reported
separately.

Feedback
For questions or comments about this report,
please contact:
Rochelle Tigner, Quality Improvement
Manager
Division of Health Care Management
Clinical Quality Management, MD 6700
701 E. Jefferson St.
Phoenix, AZ 85034
rochelle.tigner@azahcccs.gov

Results of the other measures include:
•
Well-child Visits in the Third, Fourth,
Fifth and Sixth Years of Life – the
baseline rate for this measure was 42.3
percent.
•
Adolescent Well-care Visits – the
baseline rate for this measure was 31.4
percent.
•
Annual Dental Visits – DDD’s rate for
this measure was 39.3 percent, a relative
increase of 20.2 percent from the previous
period.
Performance Standards and Improvement
AHCCCS has established performance
standards for annual dental visits for DDD,
and will establish minimum standards and

2

Well-child Visits in the Third, Fourth, Fifth and Sixth Years of Life

range goal (known as a Benchmark) that
DDD achieve a rate of 80 percent or higher
for this measure.

Children who are healthy are better able to
achieve their potential to become happy,
productive adults.1,2 Like all children, those
with special health care needs require
preventive health care services. In addition
to early intervention services and therapies to
help support optimal development, children
with disabilities should have well-child
checkups at regular intervals to monitor and
improve their health through:
•
comprehensive physical examinations,
•
nutritional
and
behavioral
health
assessments,
•
appropriate immunizations according to
age and health history,
•
laboratory tests, including tuberculosis
screening appropriate to age and risk, and
testing for anemia,
•
appropriate vision, hearing and speech
assessments,
•
oral health screening to identify potential
dental problems and referral for treatment
if indicated, and
•
parental health education and anticipatory
guidance.

Results
DDD’s overall rate for this measure was 42.3
percent. By county, the rate was highest in
the combined rural counties, at 49.5 percent,
compared with Pima and Maricopa counties,
at 46.6 percent and 39.9 percent,
respectively (Table 1).

100%
80%
60%
Maricopa

40%
Pima

20%
0%

Description
AHCCCS measured the percentage of
children who:
•
were 3, 4, 5, or 6 years old as of
September 30, 2004,
•
were continuously enrolled with DDD
during the measurement period (one
break in enrollment, not exceeding 31
days, was allowed), and
•
had at least one well-child visit during
the measurement period.
Performance Goals
This measurement established a baseline rate
for DDD for well-child visits 3 through 6
years old. AHCCCS will use this rate to
develop a Minimum Performance Standard
and Goal for DDD. AHCCCS set a long-

3

Rural

Table 1
Arizona Health Care Cost Containment System
WELL-CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS OF LIFE, BY COUNTY
Members Enrolled with the DES Division of Developmental Disabilities (DDD)
Measurement Period: October 1, 2003, through September 30, 2004

County
Maricopa County
Pima County
Rural Counties
Total

Number

Percent

Number

with One or

with One or

of Members

More Visits

More visits

1,732

691

39.9%

337

157

46.6%

392

194

49.5%

2,461

1,042

42.3%

4

Adolescent Well-care Visits
achieve a rate of 50 percent or higher for this
measure.

The impact or severity of disability often
increases with age. Recent research indicates
that the prevalence of chronic emotional,
behavioral and developmental problems is
greatest among adolescents 12 to 17 years
old, as well as among children living in
poverty and males.3

Results
DDD’s overall rate for this measure was 31.4
percent. The rate for 11- to 15-year-olds was
31.5 percent and the rate for 16- to 20-yearolds was 30.8 percent.

Many children and adolescents with
developmental disabilities have comorbid
physical conditions, such as asthma, cerebral
palsy and diabetes. They also suffer from
emotional and behavioral problems, and
adolescents in particular are more likely to
need mental health services than younger
children with special health care needs.4
Adolescent well-care visits enable providers
to focus on a range of physical and mental
health needs of these members, so that they
may experience the best possible health.

Total rates by county were: 33.1 percent in
the combined rural counties, 32.4 percent in
Pima County, and 30.4 percent in Maricopa
County (Table 2).

100%
80%
60%
Maricopa

Description
This indicator measured the percentage of
members who:
•
were ages 11 through 20 years as of
September 30, 2004,
•
were continuously enrolled with DDD
during the measurement period (one
break in enrollment, not exceeding 31
days, was allowed), and
•
had at least one well-care visit during the
measurement period.

40%
Pima

20%
0%

Results are reported overall and separately
for two age groups, 11 through 15 years and
16 years and older.
Performance Goals
This measurement established a baseline rate
for DDD for adolescent well-care visits.
AHCCCS will use this rate to develop a
Minimum Performance Standard and Goal for
the Contractor. AHCCCS set a long-range
goal (known as a Benchmark) that DDD

5

Rural

Table 2
Arizona Health Care Cost Containment System
ADOLESCENT WELL-CARE VISITS, BY COUNTY
Members Enrolled with the DES Division of Developmental Disabilities (DDD)
Measurement Period: October 1, 2003, through September 30, 2004
Visits within a One-year Period
Number

Percent

Age

Number

with One or

with One or

County

Group

of Members

More Visits

More Visits

Maricopa County

11-15

1,486

456

30.7%

16-20

397

116

29.2%

Pima County

Rural Counties

Total

Total

1,883

572

30.4%

11-15

426

140

32.9%

16-20

118

36

30.5%

Total

544

176

32.4%

11-15

551

180

32.7%

16-20

176

61

34.7%

Total

727

241

33.1%

11-15

2,463

776

31.5%

16-20

691

213

30.8%

Total

3,154

989

31.4%

6

Annual Dental Visits
Oral health is inseparable from overall
health, and problems of the teeth and gums
can affect a child’s ability to learn and
function.5,6

Performance Goals
AHCCCS has adopted a Minimum
Performance Standard that DDD achieve a
rate of at least 35 percent for this indicator. If
it has already achieved this rate, DDD should
strive for a Goal of 37 percent.

In general, people with developmental
disabilities have poorer oral health and oral
hygiene than those without such disabilities.
Data indicate that people who have mental
retardation have more untreated caries and a
higher prevalence of gingivitis and other
periodontal diseases than the general
population. Medications, malocclusion,
multiple disabilities, and poor oral hygiene
combine to increase the risk of dental
disease in people with developmental
disabilities.7

Results
A rate for annual dental visits for DDD has
been previously measured. The overall rate
for CYE 2004 was 39.3 percent, an increase
over the previous rate of 32.7 (p<.001).
By county, the rate was highest in the
combined rural counties, at 42.9 percent.
Rates in Pima and Maricopa counties were
38.5 percent and 38.3 percent, respectively
(Table 3).

Brushing, flossing and other oral health
practices can reduce the risk of developing
diseases of the teeth and gums. These tasks
are more difficult for people with
developmental
disabilities
and
their
caregivers. Regular professional dental care,
such as the application of topical fluorides
and dental sealants, as well as treatment
services, can reduce tooth decay and other
oral diseases.

100%
80%
60%
Maricopa

40%
Pima

20%

Description
AHCCCS measured the percentage of
children who:
•
were ages 3 through 20 years as of
September 30, 2004,
•
were continuously enrolled with DDD
during the measurement period (one
break in enrollment, not exceeding 31
days, was allowed), and
•
had at least one dental visit during the
measurement period.

0%

7

Rural

Table 3
Arizona Health Care Cost Containment System
ANNUAL DENTAL VISITS, BY COUNTY
Members Enrolled with the DES Division of Developmental Disabilities (DDD)
Measurement Period: October 1, 2003, through September 30, 2004

County
Maricopa County
Pima County
Rural Counties
Total

Number

Percent

Number of

with Dental

with Dental

Change from

Statistical

Members

Visits

Visits

Previous Period

Significance

5,327

2,039

38.3%

13.32%

p<.001

4,290

1,449

33.8%

1,283

494

38.5%

-0.38%

p=.942

1,066

412

38.6%
71.83%

p<.001

20.22%

p<.001

1,697

728

42.9%

1,458

364

25.0%

8,307

3,261

39.3%

6,814

2,225

32.7%

Relative %

Shaded rows are totals and percentages for the previous measurement period.

8

DISCUSSION
develop curriculum for dental students on
treating
people
with
developmental
disabilities. In addition, DDD has contracted
with the dental school to provide care to
individuals enrolled with the Division; this
service is expected to begin in 2006. DDD
also has collaborated with the Arizona Dental
Association to train dentists in treating
children with special health care needs.

Overall Results
DDD exceeded the goal set by AHCCCS for
annual dental visits by children and
adolescents. AHCCCS will use the results of
the other two measures – well-child visits in
the third, fourth, fifth and sixth years of life
and adolescent well-care visits – to establish
performance standards for the Division.
It is noteworthy that DDD showed
significant improvement in the measure of
annual dental visits. Parents of children with
special health care needs, including those
with developmental disabilities, have
reported that the health care service needed
but most often not received was dental care.4
Providing dental services to people with
developmental disabilities is challenging for
oral health professionals: reduced cognitive
abilities, behavior problems, mobility issues,
uncontrolled body movements, cardiac
disorders, seizures, and hearing and vision
loss can interfere with care.8

The Division also utilizes Support
Coordinators, who function in a case
management
role
and
facilitate
communication and the coordination of
services. The Division has provided training
to Support Coordinators to help ensure that
children and adolescents receive necessary
well-child and preventive services. It plans to
continue these trainings in CYE 2006.
Since nearly all of DDD’s members receive
primary and preventive health care services
through subcontracted health plans, the
Division should continue to monitor and
ensure that these health plans improve rates of
preventive services among the DDD-enrolled
population.

Quality Improvement Efforts
DDD and other Contractors have been
participating in an AHCCCS-mandated
Performance Improvement Project to
increase the proportion of children who have
an annual dental visit. In CYE 2003, all
Contractors implemented activities to
improve this rate. The Division reports that
it is continuing to work with its
subcontracted health plans to strengthen
outreach to families and caregivers of
members enrolled with DDD, and to
improve efforts to obtain data on dental
services received by members using their
private insurance coverage.

Data Limitations
As previously described, rates for each
measure are based on AHCCCS encounter
data. Data submitted by Contractors is
processed monthly, with approximately 600
edits, which examine the accuracy of
encounter data. If errors are found, the
encounter is “pended.” Contractors must
correct pended encounters in order to
finalize them. Numerator data for these
measures include only finalized encounters.
Therefore, services may have been provided
through AHCCCS Contractors, but if the
associated encounters have not been
submitted or finalized – or if services were
paid for through private insurance – the data
reported here will not reflect those services.

In order to continue improving the rate of
annual dental visits by children and
adolescents enrolled with DDD, the Division
also has been working with the Arizona
School of Dentistry and Oral Health to

9

References
1

U.S. Department of Health and Human Services.
Healthy People 2000 objectives. Washington, D.C.:
U.S. Government Printing Office, November 1990.
2
Arizona School Readiness Board. Early Childhood
Health Screening Fact Sheet. Available at:
http://www.azgovernor.gov/cyf/school_readiness/
index_school_readiness.html
3
Centers for Disease Control and Prevention. Health
care and well being of children with chronic
emotional, behavioral and developmental problems –
United States, 2001. MMWR. 2005; 54(39):985-989.
Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5
439a3.htm. Accessed Oct. 6, 2005.
4
U.S. Department of Health and Human Services,
Health Resources and Services Administration,
Maternal and Child Health Bureau. The National
Survey of Children with Special Health Care Needs
Chartbook 2001. Rockville, Maryland: U.S.
Department of Health and Human Services, 2004.
Available at: http://mchb.hrsa.gov/chscn/index.htm.
Accessed Mar. 1, 2006.
5
U.S. Department of Health and Human Services.
Oral health in America: A report of the surgeon
general. Rockville, MD: Department of Health and
Human Services, National Institutes of Health,
National Institute of Dental and Craniofacial
Research, September 2000.
6
Arizona Department of Health Services. Arizona
Oral Health Update. Phoenix, AZ: Arizona
Department of Health Services, Office of Oral
Health, May 2000
7
Health Resources and Services Administration. Oral
Health for Children and Adolescents with Special
Health Care Needs: Challenges and Opportunities.
2005. Available at:
http://www.ask.hrsa.gov/detail.cfm?PubID=MCH001
56. Accessed March 1, 2006.
8
National Institute of Dental and Craniofacial
Research. Continuing Education: Practical Oral Care
for People with Developmental Disabilities.
Available at:
http://www.nidcr.nih.gov/HealthInformation/Disease
sAndConditions/DevelopmentalDisabilitiesAndOral
Health/ContinuingEducation.htm. Accessed March 1,
2006.

10

APPENDIX
Technical Specifications
for the Measurement Period from October 1, 2003, through September 30, 2004

I.

WELL-CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS
OF LIFE

Recipient Subsystem Requirements
•
Members must have been 3 through 6 years old as of September 30 of the measurement period.
•
Members must have been continuously enrolled during the measurement period and on
September 30 of the measurement period.
•
Members must have been enrolled with DES/DDD for the entire measurement period
(enrollment was selected only for contract types ‘A,’ ‘B,’ or ‘N’).
•
Prior Period Coverage (PPC) was not considered part of continuous enrollment and was treated
as a break in acute enrollment.
•
A member with one single enrollment gap, not exceeding 31 days, was considered to have
continuous enrollment and was included in the population; however, the gap could not occur at
the beginning or the end of the continuous enrollment period.
•
Change of county service area without any gap of enrollment was not considered a break in
enrollment. In these cases, the member was assigned to the last county of residence.
•
Any member enrolled with the following Contractors was excluded:
000850 - State Emergency Services
000960 - Family Planning Services
008690 - Temporary Fee-For-Service
010182 - Pima LTC, Residual
888886 - Fee-For-Service LTC, residual
•

000950 - Federal Emergency Services
003335 - Permanent Fee-For-Service
010174 - Maricopa LTC, Residual
999998 - Indian Health Services
079873 - DHS

Members with rate codes 45XX were excluded.

Note:
A data file containing the information for each member was created and used to identify services
received.
Encounter Subsystem Requirements
Utilizing data from the Recipient Subsystem:
•
All encounters selected (Form 1500 and UB 82/92) for the eligible population were based on the
service selection criteria listed below.
•
Encounters were included if the begin-date of service fell within the measurement period.
•
Encounters from the Arizona Department of Health Services (ADHS)/Children’s Rehabilitative
Services (CRS) and ADHS/Behavioral Health Services (BHS) were excluded from the
numerator. Children receiving services through CRS or BHS who also were enrolled with DDD
were included in the denominator.
•
All services for the member were reported under the member’s last county of residence in the
measurement period.
•
The selected encounters were sorted by member primary ID.

i

Service Selection Criteria
CPT-4 Codes Preventive Medicine Services (UB82/92 or HCFA 1500)
99382
New patient (ages 1 - 4 years)
99383
New patient (ages 5 – 11 years)
99392
Established patient (ages 1 - 4 years)
99393
Established patient (ages 5 – 11 years)
OR
CPT-4 Codes Evaluation and Management (UB82/92 or HCFA 1500)
99201 - 99205
New Patient
99211 - 99215
Established patient
In conjunction with ICD-9 Diagnosis codes
V20.2
Routine infant or child health check
V70.0
General medical examination (routine)
V70.3-V70.9 General medical examination
and
Not in conjunction with Category of Service
03
Respiratory Therapy
06
Physical Therapy
07
Speech/Hearing Therapy
11
Dental
12
Pathology & Laboratory
13
Radiology
15
Durable Medical Equipment & Supplies
30
Home Health Nurse Service
31
Non-emergency Transportation
40
Medical Supplies
Deviations from HEDIS 2004 Codes to Identify Well-child Visits
•
AHCCCS requires that certain CPT-4 codes be used in conjunction with ICD-9 revenue
codes and/or not in conjunction with certain category of service codes in order to ensure that
well-child services were provided.

ii

II.

ADOLESCENT WELL-CARE VISITS

Recipient Subsystem Requirements
•
Members selected must have been 11 through 20 years old as of September 30 of the
measurement period.
•
Members must have been continuously enrolled during the measurement period and on
September 30 of the measurement period.
•
Members must have been enrolled with DES/DDD for the entire measurement period
(enrollment was selected only for contract types ‘A,’ ‘B,’ or ‘N’).
•
Prior Period Coverage (PPC) was not considered part of continuous enrollment and was treated
as a break in acute enrollment.
•
A member with one single enrollment gap, not exceeding 31 days, was considered to have
continuous enrollment and was included in the population; however, the gap could not occur at
the beginning or the end of the continuous enrollment period.
•
Change of county service area without any gap of enrollment was not considered a break in
enrollment. In these cases, the member was assigned to the last county of residence.
•
Any member enrolled with the following Contractors was excluded:
000850 - State Emergency Services
000960 - Family Planning Services
008690 - Temporary Fee-For-Service
010182 - Pima LTC, Residual
888886 - Fee-For-Service LTC, residual
•

000950 - Federal Emergency Services
003335 - Permanent Fee-For-Service
010174 - Maricopa LTC, Residual
999998 - Indian Health Services
079873 - DHS

Members with rate codes 45XX were excluded.

Note:
A data file containing the information for each member was created and used to identify services
received.
Encounter Subsystem Requirements
Utilizing data from the Recipient Subsystem:
•
All encounters selected (Form 1500 and UB 82/92) for the eligible population were based on the
service selection criteria listed below.
•
Encounters were included if the begin-date of service fell within the measurement period.
•
Encounters from the Arizona Department of Health Services (ADHS)/Children’s Rehabilitative
Services (CRS) and ADHS/Behavioral Health Services (BHS) were excluded from the
numerator. Children receiving services through CRS or BHS who also were enrolled with DDD
were included in the denominator.
•
All services for the member were reported under the member’s last county of residence in the
measurement period.
•
The selected encounters were sorted by member primary ID.

iii

Service Selection Criteria
CPT-4 Codes Preventive Medicine Services (UB82/92 or HCFA 1500)
99383
New patient (ages 5 – 11 years)
99384
New patient (ages 12 - 17 years)
99385
New patient (ages 18 - 39 years)
99393
Established patient (ages 5 – 11 years)
99394
Established patient (ages 12 - 17 years)
99395
Established patient (ages 18 - 39 years)
OR
CPT-4 Codes Evaluation and Management (UB82/92 or HCFA 1500)
99201 - 99205
New Patient
99211 - 99215
Established patient
In conjunction with ICD-9 Diagnosis codes:
V20.2
Routine infant or child health check
V70.0
General medical examination (routine)
V70.3 - V70.9
General medical examination
and
Not in conjunction with Category of Service:
03 Respiratory Therapy
06 Physical Therapy
07 Speech/Hearing Therapy
11 Dental
12 Pathology & Laboratory
13 Radiology
15 Durable Medical Equipment & Supplies
30 Home Health Nurse Service
31 Non-emergency Transportation
40 Medical Supplies
Deviations from HEDIS 2004 Codes to Identify Well-child Visits
•
AHCCCS requires that certain CPT-4 codes be used in conjunction with ICD-9 revenue
codes and/or not in conjunction with certain category of service codes in order to ensure that wellcare services were provided.

iv

III.

ANNUAL DENTAL VISITS

Recipient Subsystem Requirements
•
Members must have been 3 through 20 years old as of September 30 of the measurement
period.
•
Members must have been continuously enrolled during the measurement period and on
September 30 of the measurement period.
•
Members must have been enrolled with DES/DDD for the entire measurement period
(enrollment was selected only for contract types ‘A,’ ‘B,’ or ‘N’).
•
Prior Period Coverage (PPC) was not considered part of continuous enrollment and was treated
as a break in acute enrollment.
•
A member with one single enrollment gap, not exceeding 31 days, was considered to have
continuous enrollment and was included in the population; however, the gap could not occur at
the beginning or the end of the continuous enrollment period.
•
Change of county service area without any gap of enrollment was not considered a break in
enrollment. In these cases, the member was assigned to the last county of residence.
•
Any member enrolled with the following Contractors was excluded:
000850 - State Emergency Services
000960 - Family Planning Services
008690 - Temporary Fee-For-Service
010182 - Pima LTC, Residual
888886 - Fee-For-Service LTC, residual
•

000950 - Federal Emergency Services
003335 - Permanent Fee-For-Service
010174 - Maricopa LTC, Residual
999998 - Indian Health Services
079873 - DHS

Members with rate codes 45XX were excluded.

Note:
A data file containing the information for each member was created and used to identify services
received.
Encounter Subsystem Requirements
Utilizing data from the Recipient Subsystem:
•
All encounters selected (Form 1500 and UB 82/92) for the eligible population were based on the
service selection criteria listed below.
•
Encounters were included if the begin-date of service fell within the measurement period.
•
Encounters from the Arizona Department of Health Services (ADHS)/Children’s Rehabilitative
Services (CRS) and ADHS/Behavioral Health Services (BHS) were excluded from the
numerator. Children receiving services through CRS or BHS who also were enrolled with DDD
were included in the denominator.
•
All services for the member were reported under the member’s last county of residence in the
measurement period.
•
The selected encounters were sorted by member primary ID.

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Service Selection Criteria
Preventive Services
For services reported on Form “D” (Dental) use the following logic
Procedure class code = 70 or 71 or
Procedure code range = D0100 – D0999 or D1000 – D1999
For services reported on any other form
CPT-4 codes (UB82/92 or HCFA 1500)
70300 - 70320 Radiological exams (partial, complete, single, unilateral, bilateral)
70350
Cephalogram, Orthodontic
70355
Orthopantogram
OR
Procedure Class Codes
70
Diagnostic
D0100-D0999
71
Preventive
D1000-D1999
OR
ICD-9-CM Procedure Code (UB 82/92)
87.11 Full mouth X-Ray of Teeth
87.12 Other dental X-Ray
89.31 Dental examination
OR
ICD-9 Diagnostic Code (UB 82/92)
V72.2 Dental examination
In conjunction with Revenue Code
510
Clinic
512
Dental Clinic
515
Pediatric Clinic
519
Other Clinic
or
HCPCS Code (UB82/92 or HCFA 1500)
D1310 Nutritional counseling for the control of dental disease
OR
ICD-9 Diagnostic Code (HCFA 1500)
V72.2 Dental examination
In conjunction with Provider Type

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07
54

Dentist
Dental Hygienist
or

In conjunction with Provider Specialty Type
800
Dentist – General
801
Dentist – Orthodonture
802
Dentist – Endodontist
803
Dentist - Oral Pathologist
804
Dentist – Pedodontist
805
Dentist – Prosthodontist
806
Dentist – Periodontist
807
Dentist - Public Health
808
Dentist - Oral Surgeon
809
Dentist – Anesthesiologist
Treatment Services
For services reported on Form “D” (Dental) use the following logic
Procedure class codes = 72 through 79 or
Procedure range = D2000 – D9999
For services reported on any other form
Procedure Class Codes
72
Restorative
73
Endodontics
74
Periodontics
75
Prosthodontics
76
Implant Services
76
Fixed Prosthodontics
77
Oral Surgery
78
Orthodontics
79
Adjunctive General Services

D2000-D2999
D3000-D3999
D4000-D4999
D5000-D5999
D6000-D6199
D6200-D6999
D7000-D7999
D8000-D8999
D9000-D9999

OR
ICD-9 Procedure Code (UB 82/92)
23.xx Removal and restoration of teeth
24.xx Other operations on teeth, gums, and alveoli
93.55 Dental wiring
96.54 Dental scaling, polishing and debridement
97.22 Replacement of dental packing
97.33 Removal of dental wiring
97.34 Removal of dental packing
97.35 Removal of dental prosthesis
99.97 Fitting of denture

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Deviations from HEDIS 2004 Codes to Identify Annual Dental Visits
•
Procedure classification codes for dental services were used to select services in lieu of
individual CPT codes when possible.
•
AHCCCS uses HCPCS/CDT-3 code ranges D0100 – D0999 and D1000 – D1999; HEDIS
uses code ranges D0120 – D0999 and D1110 – D1550
•
HEDIS uses ICD-9-CM procedure codes 23, 24, 93.55, 96.54, 97.22, 97.33-97.35, and
99.97; AHCCCS does not select services based on these specific codes.
AHCCCS uses ICD-9 diagnostic code V72.2 (dental examination) to select services;
HEDIS does not use this code.

viii