Claims/Encounters Data Exchanges
Arizona Health Care Cost Containment System (AHCCCS) manages data exchange to improve care coordination and eliminate blind spots in services provided to members. Historical and ongoing data exchanges benefit various contractors to enhance comprehensive health care delivery in Arizona.
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Presentation Transcript
Claims/Encounters Data Exchanges May 2013 Reaching across Arizona to provide comprehensive quality health care for those in need
Purpose & Types of Data Exchange AHCCCS will manage exchange of encounter and claims data to Contractors in order to eliminate blind spots for services provided to a member shared by multiple programs In compliance with Federal privacy regulations Contractors should use this information to develop short- and long-term strategies to improve care coordination Historical provide up to 3 years of data Ongoing provide at least quarterly Reaching across Arizona to provide comprehensive quality health care for those in need
Historical Data Exchange Who does this apply to? New SMI Integrated Contractor New CRS Integrated Contractor New Acute Contractor Incumbent Contractors New to a GSA ALTCS Contractors for CRS Eligibles Reaching across Arizona to provide comprehensive quality health care for those in need
Historical Data Exchange, cont. What Data will be provided? SMI Integrated Contractor FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor, DDD and CMDP Encounters CRS Contractor, for each type of coverage FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor, BHS, DDD and CMDP Encounters Reaching across Arizona to provide comprehensive quality health care for those in need
Historical Data Exchange, cont. Incumbent Contractor New to a GSA or New Acute Contractor FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor and BHS Encounters ALTCS Contractor for CRS eligibles FFS Claims from I.H.S and 638 Providers; CRS Contractor Encounters A draft format for the data exchange has been provided to Contractor technical staff for comment and we are in the process of updating now Reaching across Arizona to provide comprehensive quality health care for those in need
Ongoing Data Exchange Who does this apply to? Acute Contractors SMI Integrated RBHA and BHS for each RBHA CMDP DDD CRS Contractor, for each type of coverage Reaching across Arizona to provide comprehensive quality health care for those in need
Ongoing Data Exchange, cont. What Data will be provided? Acute Contractors FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; BHS Encounters SMI Integrated Contractor (via BHS) FFS Claims from I.H.S and 638 Providers BHS FFS Claims from I.H.S and 638 Providers; Acute Contractor, DDD and CMDP Encounters CMDP and DDD FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; BHS Encounters; CRS Partially Integrated BH and CRS Only Encounters Reaching across Arizona to provide comprehensive quality health care for those in need
Ongoing Data Exchange, cont. CRS Contractor, for each type of coverage Fully Integrated: FFS Claims from I.H.S and 638 Providers CRS Partially Integrated - Acute: FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers CRS Partially Integrated - BH: FFS Claims from I.H.S and 638 Providers; DDD and CMDP Encounters CRS Only: FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; FFS Claims from Tribal Contractor Providers; Any other FFS Claims; BHS, CMDP and DDD Encounters Reaching across Arizona to provide comprehensive quality health care for those in need
Ongoing Data Exchange, cont. A draft format for the data exchange has been provided to Contractor technical staff for comment and we are in the process of updating now Planned Future Data Exchange Medicare Paid Claims Data Targeted for early 2014 Reaching across Arizona to provide comprehensive quality health care for those in need
