MA APCD Case Mix User Workgroup Webinar Overview
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November 25, 2014
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I.
Announcements
II.
Release 3.0 Features
III.
Common Application Issues / Questions
IV.
Rx Versioning
V.
Questions from Current APCD Users
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Archive of questions and answers from this
Workgroup has been posted to the MA
APCD website
•
Link:
http://www.mass.gov/chia/researcher/hcf-
data-resources/apcd/acessing-the-
apcd/data-release-committee-and-apcd-
workgroup-
meetings.html#Technical_Workgroup
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CHIA’s overhauled website is expected to go
live within a few weeks
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Some links to the MA APCD and Case Mix
pages may change
•
December Workgroup Webinar will include a
tour of the new MA APCD and Case Mix
pages
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Data through 2013 (incurred through June 2014)
•
MEID updates retroactive to 2009 data
•
More Versioning
MC –14 of the Top 16 Payers [well over 90% of total MC claims]
PC – For MassHealth, BCBSMA, Tufts and Harvard Pilgrim
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Data element changes:
New elements
Shifts from Level 2 to Level 3 and vice versa
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Question
:
When can I apply for 2013 APCD data?
Answer
:
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Release 3.0 application materials are
expected to be ready in December 2014
•
Will be announced at this workgroup and via
eblast
[NOTE: 2013 Case Mix data is available now]
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Question
:
Can I keep the encrypted hard drive on which
the MA APCD data is delivered?
Answer
:
•
No. This drive must be returned to us.
•
You should plan to keep a copy of the data
on some other encrypted storage device.
•
NOTE: Case Mix CDs do not need to be
returned to CHIA
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The versioning process identifies duplicates,
voids, adjustments and replacements.
•
Differs from APCD medical claims versioning.
•
Some carriers refer to this process as ‘squishing’
the data.
•
The critical data elements for versioning are:
•
Organization ID
•
Carrier Specific Unique Member ID
•
Date Prescription Filled
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New Prescription or Refill
•
Script Number
•
Drug Code
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Pharmacy Number
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Currency data elements.
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Does the MA APCD contain claims
from Ambulance Services?
Yes, the MA APCD contains claims from over
8,300 different public and private ground
ambulance services nationwide and from over 120 different air and water ambulance
services
which can be identified using MC037.
MC037
MC037
Site of Service on NSF/CMS Form 1500
Site of Service on NSF/CMS Form 1500
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QUESTION
•
Can you tell me more about the sensitivity / specificity
of the Enterprise ID in the MA APCD?
ANSWER
•
Release 3.0 will include Enterprise IDs for 5 years of
data as opposed to 2 years of data in Release 2.1
•
The incorporation of the added 3 years of
demographic information will enhance confidence
levels of specific MEIDs
QUESTION
•
What MA percent of covered lives or number of
covered lives is accounted for in the data? What
percent of MA payers / employers have opted-in?
ANSWER
•
The MA APCD does not include Workers’
Compensation, Veteran’s Affairs, Tricare, Federal-
Employee Health Benefit Plan, or Private Insurers with
under 1,000 beneficiaries
•
Some of the beneficiaries utilizing these plans have
dual-eligibility in the carriers are included in the MA
APCD
•
Interviews with carriers have indicated that the MA
APCD receives data from the majority of self insured
employers
•
Our analysis of the Master Patient entity identifiers to
census estimates show that over 85% of the Under Age
65 Massachusetts residents are represented in the MA
APCD
QUESTION
•
Would we be correct in classifying Indemnity
insurance as private insurance? (for purposes of our
analysis, our general insurance categories are
Private, Medicare, Medicaid, VA, Other, and
Uninsured)
ANSWER
•
Correct.
QUESTION
•
We weren’t able to find a full listing of Site of Service codes. We found
a partial list, but some values in the data are not in it, and we are not
sure what they map to. Is there a complete code mapping for this
variable that could be shared with us?
ANSWER
•
For a complete list of site of service codes, see page 21:
http://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Downloads/clm104c26.pdf
•
For values not on the look up table, such as some single digit
numbers, these values are missing a leading zero padding. Therefore
‘3’ could be mapping to ‘03’. It is not a field like MC032 (Provider
Taxonomy) that, as speculated, has carrier specific look-up values.
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12/11 – Data Privacy Committee Meeting
•
12/18 – Data Release Committee Meeting
[a week early]
•
12/23 – MA APCD / Case Mix User
Workgroup Webinar
Q
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t
i
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n
s
?
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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
)
Detailed information about the Monthly MA APCD Case Mix User Workgroup Webinar held on November 25, 2014. Topics covered include Release 3.0 features, common application issues, Rx versioning, questions from current APCD users, announcements, question archive, updates on the new CHIA website, and important data elements related to Versioning process.
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Presentation Transcript
Monthly MA APCD / Case Mix User Workgroup Webinar November 25, 2014
Agenda I. II. Release 3.0 Features III. Common Application Issues / Questions IV. Rx Versioning V. Questions from Current APCD Users Announcements
Question Archive Posted Archive of questions and answers from this Workgroup has been posted to the MA APCD website Link: http://www.mass.gov/chia/researcher/hcf- data-resources/apcd/acessing-the- apcd/data-release-committee-and-apcd- workgroup- meetings.html#Technical_Workgroup
New CHIA Website CHIA s overhauled website is expected to go live within a few weeks Some links to the MA APCD and Case Mix pages may change December Workgroup Webinar will include a tour of the new MA APCD and Case Mix pages
Release 3.0 Features Data through 2013 (incurred through June 2014) MEID updates retroactive to 2009 data More Versioning MC 14 of the Top 16 Payers [well over 90% of total MC claims] PC For MassHealth, BCBSMA, Tufts and Harvard Pilgrim Data element changes: New elements Shifts from Level 2 to Level 3 and vice versa
Common Application Questions Question: When can I apply for 2013 APCD data? Answer: Release 3.0 application materials are expected to be ready in December 2014 Will be announced at this workgroup and via eblast [NOTE: 2013 Case Mix data is available now]
Common Application Questions Question: Can I keep the encrypted hard drive on which the MA APCD data is delivered? Answer: No. This drive must be returned to us. You should plan to keep a copy of the data on some other encrypted storage device. NOTE: Case Mix CDs do not need to be returned to CHIA
Rx Versioning The versioning process identifies duplicates, voids, adjustments and replacements. Differs from APCD medical claims versioning. Some carriers refer to this process as squishing the data. The critical data elements for versioning are: Organization ID Carrier Specific Unique Member ID Date Prescription Filled New Prescription or Refill Script Number Drug Code Pharmacy Number Currency data elements.
Rx Versioning APCD Release 3.0 Pharmacy Data Impact of Versioning 20 18 16 Line Count (in millions) 14 12 10 Squish 8 Original 6 4 2 0 2011 2012 2013 2011 2012 2013 2011 2012 2013 2012 2013 MassHealth BCBS HPHC Tufts* Payers *Commercial claims only
Does the MA APCD contain claims from Ambulance Services? Yes, the MA APCD contains claims from over 8,300 different public and private ground ambulance services nationwide and from over 120 different air and water ambulance services which can be identified using MC037. MC037 Site of Service on NSF/CMS Form 1500 Code Ambulance Type Description 41 Ground Ambulance (Trucks, Vans, Segways, Buses) Land vehicles specifically equipped and staffed for lifesaving and/or transporting the sick or injured. 42 Air Ambulance (Helicopter and fixed- wing Jet Aircraft), Water Ambulance (Rescue Boats, Stillwater Launches, and Ship Hospitals) . Water vehicles specifically equipped and staffed for lifesaving and/or transporting the sick or injured.
Questions from MA APCD Users QUESTION Can you tell me more about the sensitivity / specificity of the Enterprise ID in the MA APCD? ANSWER Release 3.0 will include Enterprise IDs for 5 years of data as opposed to 2 years of data in Release 2.1 The incorporation of the added 3 years of demographic information will enhance confidence levels of specific MEIDs
QUESTION What MA percent of covered lives or number of covered lives is accounted for in the data? What percent of MA payers / employers have opted-in? ANSWER The MA APCD does not include Workers Compensation, Veteran s Affairs, Tricare, Federal- Employee Health Benefit Plan, or Private Insurers with under 1,000 beneficiaries Some of the beneficiaries utilizing these plans have dual-eligibility in the carriers are included in the MA APCD Interviews with carriers have indicated that the MA APCD receives data from the majority of self insured employers Our analysis of the Master Patient entity identifiers to census estimates show that over 85% of the Under Age 65 Massachusetts residents are represented in the MA APCD
QUESTION Would we be correct in classifying Indemnity insurance as private insurance? (for purposes of our analysis, our general insurance categories are Private, Medicare, Medicaid, VA, Other, and Uninsured) ANSWER Correct.
QUESTION We weren t able to find a full listing of Site of Service codes. We found a partial list, but some values in the data are not in it, and we are not sure what they map to. Is there a complete code mapping for this variable that could be shared with us? ANSWER For a complete list of site of service codes, see page 21: http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/clm104c26.pdf For values not on the look up table, such as some single digit numbers, these values are missing a leading zero padding. Therefore 3 could be mapping to 03 . It is not a field like MC032 (Provider Taxonomy) that, as speculated, has carrier specific look-up values.
Upcoming Schedule 12/11 Data Privacy Committee Meeting 12/18 Data Release Committee Meeting [a week early] 12/23 MA APCD / Case Mix User Workgroup Webinar
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)
