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“Reaching across Arizona to provide comprehensive quality health care for those in need” Claims/Encounters Data Exchanges May 2013.

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Presentation on theme: "“Reaching across Arizona to provide comprehensive quality health care for those in need” Claims/Encounters Data Exchanges May 2013."— Presentation transcript:

1 “Reaching across Arizona to provide comprehensive quality health care for those in need” Claims/Encounters Data Exchanges May 2013

2 “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

3 “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

4 “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

5 “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

6 “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

7 “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

8 “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

9 “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


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