May 2013 Purpose amp 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 ID: 1040809
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1. Claims/Encounters Data ExchangesMay 2013
2. Purpose & Types of Data ExchangeAHCCCS 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 programsIn compliance with Federal privacy regulationsContractors should use this information to develop short- and long-term strategies to improve care coordinationHistorical – provide up to 3 years of dataOngoing – provide at least quarterly
3. Historical Data ExchangeWho does this apply to?New SMI Integrated ContractorNew CRS Integrated ContractorNew Acute ContractorIncumbent Contractors New to a GSAALTCS Contractors for CRS Eligibles
4. Historical Data Exchange, cont.What Data will be provided? SMI Integrated ContractorFFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor, DDD and CMDP EncountersCRS Contractor, for each type of coverageFFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor, BHS, DDD and CMDP Encounters
5. Historical Data Exchange, cont.Incumbent Contractor New to a GSA or New Acute ContractorFFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; Any other FFS Claims; Acute Contractor and BHS EncountersALTCS Contractor for CRS eligiblesFFS Claims from I.H.S and 638 Providers; CRS Contractor EncountersA draft format for the data exchange has been provided to Contractor technical staff for comment and we are in the process of updating now
6. Ongoing Data ExchangeWho does this apply to?Acute ContractorsSMI Integrated RBHA and BHS for each RBHACMDPDDDCRS Contractor, for each type of coverage
7. Ongoing Data Exchange, cont.What Data will be provided? Acute ContractorsFFS 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 ProvidersBHSFFS Claims from I.H.S and 638 Providers; Acute Contractor, DDD and CMDP EncountersCMDP and DDDFFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA Providers; BHS Encounters; CRS Partially Integrated – BH and CRS Only Encounters
8. Ongoing Data Exchange, cont.CRS Contractor, for each type of coverage Fully Integrated: FFS Claims from I.H.S and 638 ProvidersCRS Partially Integrated - Acute: FFS Claims from I.H.S and 638 Providers; FFS Claims from TRBHA ProvidersCRS Partially Integrated - BH: FFS Claims from I.H.S and 638 Providers; DDD and CMDP EncountersCRS 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
9. 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 nowPlanned Future Data ExchangeMedicare Paid Claims Data – Targeted for early 2014