Massachusetts All-Payer Claims Database Technical Assistance Group Insights
Discover key details from the Massachusetts All-Payer Claims Database Technical Assistance Group meeting on March 10, 2020, covering agenda items, updated submission guides, and data element modifications for 2020. Gain insights into enrollment trends, DOI reporting, and essential data elements. Stay informed on the latest updates in healthcare data reporting and analysis.
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. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
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.
E N D
Presentation Transcript
Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) March 10, 2020
Agenda MA APCD Enrollment Trends DOI Reporting Questions
MA APCD Intake CHIA updates to submission guides for 2020: ME131 TME Global Budget/Payment Indicator: updated Element Submission Guideline MC023 Discharge Status: updated Condition MC039 Admitting Diagnosis: updated Element Submission Guideline MC062 Charge Amount: updated Condition
MA APCD Intake Data Element Name Date Modifi ed Fil e C ol El mt Type Description Format / Length Ca t Type Description Element Submission Guideline Condition % Required when Submitter is identified as a TME / RP Submitter. Report whether the member s primary care provider group s contract was assigned under a global budget/payment contract. EXAMPLE: 1 = Yes, the member s primary care provider group s contract was assigned under a global/budget/payment contract. Description Yes No TME Global Budget/P ayment Indicator TME Global Budget/Pay ment Indicator 1 1 4 M E1 31 Assigned Submitters only. Integ er 100 % ME 2/2020 Int[1] A2 Value 1 2
MA APCD Intake Data Element Name Date Modifie d Fil e C ol Elm t Type Description Format / Length Element Submission Guideline Conditio n Type Description % Cat Required when MC094 = 002 and MC069 is populate d. May be present without MC069 populate d when MC094 = 002 and MC023 = 30 Externa l Code Source 14 - Numeri c External Code Source 14 - Discharge Status Report the appropriate Discharge Status Code of the patient as defined by External Code Source Inpatient Discharge Status Code M C MC 023 Discharg e Status 24 2/2020 char[2] 98% A1
MA APCD Intake Data Element Name Date Modifie d Fil e C ol Elm t Type Description Format / Length Element Submission Guideline Conditio n Type Description % Cat Required when MC094 = 002 and MC036 = 11, 18, 21, 28, 41, 65, 66, 84, 86, or 89 External Codes Source 8 - International Classification of Diseases Report the diagnostic code assigned by provider that supported admission into the inpatient setting. Do not code decimal point. Admittin g Diagnosi s Externa l Code Source 8 - Text Admitting Diagnosis Code M C MC 039 varchar[ 7] 40 2/2020 98% A1
MA APCD Intake Data Element Name Date Modifie d Fil e C ol Elm t Type Description Format / Length Element Submission Guideline Conditio n Type Description % Cat Report the charge amount for this claim line. 0 dollar charges allowed only when the procedure code indicates a Category II procedure code vs. a service code. When reporting Total Charges for facilities for the entire claim use 001 (the generally accepted Total Charge Revenue Code) in MC054 (Revenue Code). Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All MC062 must be greater than zero when MC0130 is not 6. Amount of provider charges for the claim line varcha r[10] M C MC 062 Charge Amount 63 11/8/12 Integer Currency 99% A0
Enrollment Trends Update Enrollment Trends, sourced from September 2019 MA APCD Member Eligibility data, is scheduled to be released in March 11, 2020. The next Enrollment Trends report with data through March 2020 is currently scheduled to be published in August 2020. We will be sending requests for Supplemental enrollment data to selected payers in early April. Supplemental enrollment reporting is requested where populations cannot be accurately sourced from the MA APCD. Payers will receive aggregate MA APCD Member Eligibility data for review in early June. For questions on Enrollment Trends: Contact your CHIA liaison and Lauren Almquist at lauren.almquist@state.ma.us
Enrollment Trends Timeline Apr. 2020 May 2020 Jun. 2020 Jul. 2020 Aug. 2020 Payers submit March 2020 MA APCD files Supplemental enrollment reports due (select payers) MA APCD enrollment counts sent to payers for review Reporting
DOI Reporting Q4 2019 HMO Membership signoff is due by April 6th. CY2019 Annual Membership reports will be sent to payers this week. Claims/Utilization reports: First production run using data through September 2019 sent to payers on 12/23. Signoff was due by 2/6. CHIA working with DOI/Oliver Wyman and payers to reconcile differences.
Next Meetings April 14, 2020 @ 2:00 pm May 12, 2020 @ 2:00 pm
