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March 13, 2012

Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) meeting with Health Care Payers. March 13, 2012. Objectives for today’s meeting. Welcome and Introductions APCD Implementation Updates Data Release Claim Versioning Data File Linkage

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March 13, 2012

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  1. Massachusetts All-Payer Claims Database:Technical Assistance Group (TAG) meeting with Health Care Payers March 13, 2012

  2. Objectives for today’s meeting • Welcome and Introductions • APCD Implementation Updates • Data Release • Claim Versioning • Data File Linkage • Technical Support – Payer Specific Questions • Open Discussion

  3. Data Release • Schedule: Late June/Early Summer • Files: Data from the six APCD file types (medical, dental, pharmacy claims, member eligibility, provider, and product) • Public Use - de-identified member and utilization data elements and excludes payer identifiers • Restricted Use – has additional release requirements; release only those restricted data elements that are necessary to accomplish the applicant's intended use

  4. Data Release cont’d • Process: • Application Required • Public Comment Period • Data Release Committee (DRC) - Broad stakeholder representation, including “health care plans, providers, and consumers” • Data Release Criteria – public interest, applicant is qualified to undertake the study, data is required for the study, patient privacy will be protected

  5. Data Release cont’d • For more information: • Health Care Claims Data Release Regulation (114.5 CMR 22.00) can be found at: • http://www.mass.gov/eohhs/researcher/physical-health/health-care-delivery/hcf-data-resources/apcd/user-resources.html • APCD Workgroup on Data Release Process (2/28/12) PowerPoint can be found at: • http://www.mass.gov/eohhs/researcher/physical-health/health-care-delivery/hcf-data-resources/apcd/

  6. Claim Versioning • Claim versioning will be triggered by use of the Claim Line Type field. Versioning is indicated by using the claim line type code, in combination with the payer claim control number, line counter, and version number fields. • Other elements such as charges, paid amount, CPT and units may be used to validate the correct Void or Back Out

  7. Claim Versioning cont’d • Dental Claim • DC059 – Claim Line type • DC004 - Payer claim control number • DC005 - Line counter • DC005A - Version number. • Medical Claim • MC138 – Claim Line type • MC004 - Payer claim control number • MC005 - Line counter • MC005A - Version number. • Pharmacy Claim • PC110 – Claim Line type = V • PC004 - Payer claim control number • PC005 - Line counter • PC005A - Version number.

  8. Claim Versioning cont’d • Examples: • Single Line Claim

  9. Claim Versioning cont’d • Multi Line Claim

  10. Claim Versioning cont’d • Former Claim Number (MC139, DC060, PC111) • Use approved by DHCFP

  11. Future Agenda Item: Data File Linkage • Product (PR) to Eligibility (ME) Matching • Eligibility (ME) to Claims (MC, DC, PC) Matching • Provider (PV) to Claims (MC, DC, PC) Matching

  12. APCD Cross-File Relationships 11

  13. APCD Resources for Payers Updated APCD Website - www.mass.gov/dhcfp/apcd

  14. APCD Resources for Payers Updated USER RESOURCES section -

  15. APCD Technical Assistance Group (TAG) meeting with Payers • Monthly meeting to provide technical assistance and provide updates on recent APCD developments • Payers are encouraged to send at least one designee to participate in the discussion • 2nd Tuesday of each month @ 2pm EST • Link to webinar registration for meetings through 2012 https://www3.gotomeeting.com/register/941044990

  16. Q&A with Health Care Payers • Questions emailed to APCD Liaisons • Questions emailed to DHCFP (dhcfp.apcd@state.ma.us) • Open discussion

  17. For more information: • Send questions and feedback to dhcfp.apcd@state.ma.us • For more information, including important updates and events, please visit: www.mass.gov/dhcfp/apcd 16

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