Massachusetts All-Payer Claims Database Updates
Stay informed about the latest updates and deadlines related to the Massachusetts All-Payer Claims Database, including technical assistance group meetings, intake processes, payer data reporting, and DOI reporting requirements for healthcare plans in Massachusetts. Get insights into important timelines, membership sign-off dates, and more.
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Presentation Transcript
Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) June 13, 2017
Agenda APCD Version 6.0 TME, APM, RP Update DOI Reporting Update Annual Premiums Data Request and Enrollment Trends Updates Housekeeping Items Wrap Up
Intake APCD Version 6.0 MA APCD Intake Process Intake 6.0 Timeline Proposals Shared/Discussed with Carriers December 2016/January 2017 New sftp testing January 2017 Draft Submission Guides published January 2017 Guides Reviewed at Technical Advisory Group January 2017 Carrier Comment Period January 2017 New sftp Pilot April 2017 Administrative Bulletin and Guides Adopted February 2017 Development/Testing February/June 2017 Carrier Testing new guides and new transmission process July 2017 MA APCD Intake Version 6 Production August 2017
Payer Data Reporting: TME, APM, RP Deadlines Deadline Data File Due CY 2015 Final APM Friday, June 2, 2017 CY 2016 Preliminary APM Supplemental Filing: CY 2014, 2015, 2016 Prescription Drug Rebates Friday, June 30, 2017 CY 2016 Hospital RP CY 2016 Other Provider RP Friday, July 14, 2017 CY 2015 Physician Group RP 4
DOI Reporting Q1 2017 Membership signoff due 7/14 Feedback on initial Utilization reports due 7/17 During upcoming bi-weekly calls, CHIA staff available to answer questions
DOI Reporting - continued Continue to report as you have been for this field as it is used in DOI reporting for Merged Market membership. Non-grandfathered individual and small group plans underwritten and filed in the Commonwealth of Massachusetts are subject to risk adjustment. Large group plans, self-insured plans, and plans underwritten and filed in states other than Massachusetts are not subject to risk adjustment. Report RACP status as of the 15th of the month. EXAMPLE: 1 = Yes, the Member was enrolled in RACP as of the 15th of the month. Description Yes No Mock Provided for Simulation Purposes Only Risk Adjustme nt Covered Plan (RACP) Looku p table Integ er Member Enrolled in RACP Indicator M E1 26 100 % A 0 Flag Int(1) All Value 1 2 3
CHIA Reporting Updates: Annual Premiums Data Request and Enrollment Trends Ashley Storms | Analytic Reporting Manager Lauren Almquist | Manager of Analytics June 13, 2017
Annual Premiums Data Request
Annual Premiums Data Request Update Data review is underway. We appreciate your partnership in responding promptly to follow-up questions sent by CHIA and Oliver Wyman. Once known, 3R* transfer amounts for 2016 should be filled in on the data submission workbooks. Final workbooks including all 3R amounts should be submitted to Dianna Welch by July 17, 2017. CHIA will send a follow up email in early July to remind payers of this submission deadline. *Risk adjustment, risk corridors, reinsurance
Annual Premiums Data Request Timeline May 2017 Jun. 2017 Jul. 2017 Aug. 2017 Sept. 2017 Initial submissions due CHIA requests updated 3R amounts 3R addendum submissions due Reporting
Enrollment Trends Update CHIA shared MA APCD-sourced enrollment counts for payer review earlier this month. These enrollment counts are based on payers March 2017 Member Eligibility (ME) submissions and do not reflect any additional supplemental data. Some data in the workbooks was provided for informational purposes only (i.e. Medicaid product types ); please see the Notes for Payers section on the Main Data Review tab for more specific information on how to focus review. CHIA plans to source enrollment counts for Medicaid product types from the MassHealth enhanced eligibility file, rather than payers ME files. Please contact us with any comments or concerns about this data by June 30th 2017. Feedback received after this date may not be incorporated into the upcoming report.
Enrollment Trends Timeline Apr. 2017 May 2017 Jun. 2017 Jul. 2017 Aug. 2017 Payers submit March 2017 MA APCD files Supplemental enrollment reports due (select payers) MA APCD enrollment counts sent to payers for review Reporting
Contact Information For Annual Premiums technical questions and data submission: Contact Dianna Welch at dianna.welch@oliverwyman.com For Annual Premiums reporting and general questions: Contactyour CHIA liaison and Ashley Storms at ashley.storms@state.ma.us For Enrollment Trends questions: Contact your CHIA liaison and Lauren Almquist at lauren.almquist@state.ma.us
Housekeeping Items Member Month Tracker reports: February/March 2017 signoff due 6/24 April 2017 last report requiring signoff May 2017 final report no signoff required Linkage between Eligibility and Claims files needs to be fixed before V6. V6 submission guides go into effect in August for July 2017 data and any resubmissions back to October 2013.
Next Meetings July 11, 2017 @ 2:00 pm August 8, 2017 @ 2:00 pm
