APCD User Workgroup Webinar - January 28, 2014
Monthly APCD User
Workgroup Webinar
January 28, 2014
A
g
e
n
d
a
•
Release 2.0 and 2.1
•
Data Security / Privacy Updates to the
APCD/Case Mix Application
•
MassHealth/Medicare Data Update
•
Claims Versioning Update
•
SME Office Hours
R
e
l
e
a
s
e
2
.
0
H
i
g
h
l
i
g
h
t
s
•
Dates of service CY12 paid thru 6/30/13
•
Versioning for seven large carriers
•
Reassignment of multiple data elements to
different release levels (i.e. Level 2 or 3) to
ensure patient privacy
•
Updated data from prior years
•
MassHealth ISA Signed!
R
e
l
e
a
s
e
2
.
1
•
Expected release date Apr 30
th
•
More versioning
•
Master Patient Index
A
p
p
l
i
c
a
t
i
o
n
U
p
d
a
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e
s
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Non-Government
•
Fee Information
•
Type of Entity/Applicable Regulatory Process
•
Medicaid/Medicare Data
•
Data Security
•
Government
•
Project Summary
•
Medicaid/Medicare Data
•
Data Security
D
a
t
a
S
e
c
u
r
i
t
y
a
n
d
I
n
t
e
g
r
i
t
y
Changes on
both
Governmental Non-governmental applications:
•
New and legacy questions now grouped into ten (10) logical sections (Technical
safeguards, Administrative Safeguards, et al)
•
New questions:
•
Specific physical location where data will be housed
•
Data Privacy Training and Awareness
•
Encryption of copied data
•
Software Applications Accessing the Data
•
Audit log on system accessing data
•
Unique user accounts
•
Standard A/V at current version
•
Physical security features of room housing server holding data
D
a
t
a
S
e
c
u
r
i
t
y
a
n
d
I
n
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g
r
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t
y
Added questions unique to either application:
Governmental
•
Compliant with EO504 (state) or FISMA (federal)
•
Enterprise Information Security questions (for information security person)
Non-governmental
•
Cyber security awareness training in last 2 years
•
Breach of PHI or PII in last 7 years
•
Last risk assessment
•
Last audit
M
e
d
i
c
a
i
d
D
a
t
a
U
p
d
a
t
e
•
To request Medicaid data:
•
Check the box on the application
•
Provide support that work is “directly connected” to
the administration of Medicaid
•
MassHealth Review – “Directly Connected”
•
30-day goal for response
•
MassHealth may impose additional requirements
•
Default substance abuse filter is applied to all requests
M
e
d
i
c
a
r
e
D
a
t
a
U
p
d
a
t
e
•
To request Medicare data:
•
Only available to state agencies and/or entities
directed and partially funded by the state
•
Check the box on the application
•
Complete the Medicare data request form
(available on IRBNet)
•
Applicants must execute the Medicare Addendum
to CHIA’s Data Use Agreement (available on
IRBNet)
C
l
a
i
m
s
V
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o
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d
a
t
e
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Goal: Use the highest version claim lines to produce
accurate cost and utilization measures for each payer and
for the Commonwealth
•
Background: CHIA has standard versioning logic, based on
the APCD data submission guides:
1)
Applies cleaning logic
2)
Identifies duplicates, voids/back-outs, and
replacements/amendments
3)
Sets highest version flag
C
l
a
i
m
s
V
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r
s
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o
n
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a
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•
Hypothetical example of claims history:
C
l
a
i
m
s
V
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r
s
i
o
n
i
n
g
U
p
d
a
t
e
•
Since last summer, CHIA’s liaisons and QA analysts have
been working closely with selected carriers to
1)
Review if the CHIA standard logic apply and if any deviations
2)
Examine deviations and find agreeable solutions
3)
Implement and validate carrier-specific versioning logic
•
Highest Version Flag in Release 2.0:
0 – Not the highest version
1 – Highest version
9 – Not Versioned
C
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m
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V
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Medical claims versioned for the following seven carriers
(included in Release 2.0):
Blue Cross Blue Shield of Massachusetts
Boston Medical Center HealthNet Plan
ConnectiCare of Massachusetts, Inc.
Fallon Community Health
Harvard Pilgrim Health Care
Network Health
Tufts Health Plan
•
Future releases will include versioning for pharmacy and
dental claims and for other large carriers.
S
M
E
O
f
f
i
c
e
H
o
u
r
s
E
v
e
r
y
M
e
e
t
i
n
g
!
•
Our subject matter experts are available to answer your
technical questions about APCD and Case Mix data.
•
Please submit your questions in advance when possible
.
–
Examples:
•
“How stale is the data we would get from the Dental file?”
•
“Are mental health and substance abuse claims contained
within the APCD?
•
“Can you explain discharge dispositions as they relate to Case
Mix data?”
Q
u
e
s
t
i
o
n
s
?
•
General questions about the APCD:
(
CHIA-APCD@state.ma.us
)
•
Questions related to APCD applications:
(
apcd.data@state.ma.us
)
•
Questions related to Casemix:
(
casemix.data@state.ma.us
)
C
a
l
e
n
d
a
r
•
2/11 – Monthly TAG Meeting with Payers
•
2/25 – February APCD User Workgroup Webinar
•
2/27 – Data Release Committee Meeting
Monthly APCD User Workgroup Webinar held on January 28, 2014, covering Release 2.0 and 2.1 data security and privacy updates, MassHealth/Medicare data updates, versioning, application updates, and data security enhancements for governmental and non-governmental entities.
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Presentation Transcript
Monthly APCD User Workgroup Webinar January 28, 2014
Agenda Release 2.0 and 2.1 Data Security / Privacy Updates to the APCD/Case Mix Application MassHealth/Medicare Data Update Claims Versioning Update SME Office Hours
Release 2.0 Highlights Dates of service CY12 paid thru 6/30/13 Versioning for seven large carriers Reassignment of multiple data elements to different release levels (i.e. Level 2 or 3) to ensure patient privacy Updated data from prior years MassHealth ISA Signed!
Release 2.1 Expected release date Apr 30th More versioning Master Patient Index
Application Updates Non-Government Fee Information Type of Entity/Applicable Regulatory Process Medicaid/Medicare Data Data Security Government Project Summary Medicaid/Medicare Data Data Security
Data Security and Integrity Changes on both Governmental Non-governmental applications: New and legacy questions now grouped into ten (10) logical sections (Technical safeguards, Administrative Safeguards, et al) New questions: Specific physical location where data will be housed Data Privacy Training and Awareness Encryption of copied data Software Applications Accessing the Data Audit log on system accessing data Unique user accounts Standard A/V at current version Physical security features of room housing server holding data
Data Security and Integrity Added questions unique to either application: Governmental Compliant with EO504 (state) or FISMA (federal) Enterprise Information Security questions (for information security person) Non-governmental Cyber security awareness training in last 2 years Breach of PHI or PII in last 7 years Last risk assessment Last audit
Medicaid Data Update To request Medicaid data: Check the box on the application Provide support that work is directly connected to the administration of Medicaid MassHealth Review Directly Connected 30-day goal for response MassHealth may impose additional requirements Default substance abuse filter is applied to all requests
Medicare Data Update To request Medicare data: Only available to state agencies and/or entities directed and partially funded by the state Check the box on the application Complete the Medicare data request form (available on IRBNet) Applicants must execute the Medicare Addendum to CHIA s Data Use Agreement (available on IRBNet)
Claims Versioning Update Goal: Use the highest version claim lines to produce accurate cost and utilization measures for each payer and for the Commonwealth Background: CHIA has standard versioning logic, based on the APCD data submission guides: 1) Applies cleaning logic 2) Identifies duplicates, voids/back-outs, and replacements/amendments 3) Sets highest version flag
Claims Versioning Update Hypothetical example of claims history: Payer Claim Control Number Version Number Claim Line Type Claim Status Procedure Code Charge Amount Paid Amount Date of Service From Line Counter MZ110228E5331 1 0 O 1 99401 $ 50.00 $ 25.00 2/17/2011 MZ110228E5331 1 1 B 22 99401 $ 50.00 $ (25.00) 2/17/2011 MZ110228E5331 1 2 A 1 99401 $ 50.00 $ 30.00 2/17/2011
Claims Versioning Update Since last summer, CHIA s liaisons and QA analysts have been working closely with selected carriers to 1) Review if the CHIA standard logic apply and if any deviations 2) Examine deviations and find agreeable solutions 3) Implement and validate carrier-specific versioning logic Highest Version Flag in Release 2.0: 0 Not the highest version 1 Highest version 9 Not Versioned
Claims Versioning Update Medical claims versioned for the following seven carriers (included in Release 2.0): Blue Cross Blue Shield of Massachusetts Boston Medical Center HealthNet Plan ConnectiCare of Massachusetts, Inc. Fallon Community Health Harvard Pilgrim Health Care Network Health Tufts Health Plan Future releases will include versioning for pharmacy and dental claims and for other large carriers.
SME Office Hours Every Meeting! Our subject matter experts are available to answer your technical questions about APCD and Case Mix data. Please submit your questions in advance when possible. Examples: How stale is the data we would get from the Dental file? Are mental health and substance abuse claims contained within the APCD? Can you explain discharge dispositions as they relate to Case Mix data?
Questions? General questions about the APCD: (CHIA-APCD@state.ma.us) Questions related to APCD applications: (apcd.data@state.ma.us) Questions related to Casemix: (casemix.data@state.ma.us)
Calendar 2/11 Monthly TAG Meeting with Payers 2/25 February APCD User Workgroup Webinar 2/27 Data Release Committee Meeting
