Updates on Massachusetts All-Payer Claims Database - September 2022

Slide Note

Stay informed about the latest developments regarding Massachusetts All-Payer Claims Database, including enrollment trends, data submission guidelines, and upcoming reporting cycles. Learn about the changes in submission guide for Medical, Pharmacy, and Provider files, as well as the updates on Member Gender values. Stay ahead of deadlines and contact your CHIA liaison for any questions or assistance.

jaz_bra Follow

Uploaded on Dec 15, 2024 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript

Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) September 13, 2022

Agenda MA APCD Enrollment Trends Aggregate Reporting DOI Reporting Questions

MA APCD Intake All APCD submissions through July 2022 were due by August 31st. This includes any re-submissions. Please work with your liaison in submitting any overdue files and alert them if you expect any further delays. CHIA is revisiting Medical Claim versioning methods with select payers. We ll reach out when we have examples to share with each company.

MA APCD Intake 2022 APCD submission guide changes are now incorporated in the Medical, Pharmacy and Provider files. Production files with the submission guide changes started with July 2022 data. There is no change to the version field in the header record it remains 2019 .

MA APCD Intake CHIA is updating Member Gender (ME013, MC012, PC012, DC012) to allow for more options in the lookup table based on the USCDI code set. We are targeting October 2022 data (due in November) to have these new values in place. Report member gender as reported on enrollment form in alpha format. Used to create Unique Member ID. EXAMPLE: F = Female Description Membe r Gender Lookup Table - Text ME01 3 8/16/2 2 Member's Gender 100 % ME 13 tlkpGender char[1] All A0 Code F Female M Male A Transgender Male/Trans Man Transgender Female/Trans Woman Genderqueer/gender nonconforming: neither exclusively male nor female Non-binary B G N O Other U Unknown C Choose not to answer

Enrollment Trends Update The Enrollment Trends report with data through March 2022 was published on the CHIA website on August 31st, 2022. The next Enrollment Trends reporting cycle will be based on data through September 2022 and is scheduled to be published in February 2023. CHIA will be sending out requests for Supplemental data to certain payers in early October 2022. For questions on Enrollment Trends: Contact your CHIA liaison.

Enrollment Trends Timeline Oct 2022 Nov 2022 Dec 2022 Jan 2023 Feb 2023 Payers submit Sept 2022 MA APCD files Supplemental enrollment reports due (select payers) MA APCD enrollment counts sent to payers for review Reporting

Aggregate Data Submission Deadlines Data Submission Due Date Submission Method TME-APM Wednesday, September 14th CHIA Submissions Platform Prescription Drug Rebates Wednesday, September 14th CHIA Submissions Platform Premiums Wednesday, September 14th Email to CHIAData@gormanactuarial.com Thursday, September 1st Email to CHIAData@gormanactuarial.com Completed MLR Forms 8

Aggregate Data Submissions FAQ Where can I find the data specifications and templates? On CHIA s website - TME-APM, Rx Rebates, Premiums. Where should I direct questions regarding these data submissions? For questions about TME-APM and Rx Rebates, email Lauren Coakley (Lauren.Coakley@chiamass.gov) For questions about Premiums, email (CHIAData@gormanactuarial.com) 9 9/12/22

Aggregate Data Submissions FAQ (cont) How can I request an extension for these data submissions? Please email Lauren Coakley (Lauren.Coakley@chiamass.gov) with any extension requests. My organization has a new contract with Beth Israel Lahey, does CHIA have an orgID for this Parent Provider Group? Yes, please use orgID 16665 10 9/12/22

DOI Reporting Q2 2022 HMO Membership were sent 8/25. Signoff is due 10/10. Claims/Utilization: Reports using data through March 2022 were sent 8/26. Signoff is due 10/25. We continue to meet with select payers to reconcile differences in certain report categories.