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Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) March 5, 2013

Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) March 5, 2013. AGENDA. General Updates TME Update MA Health Connector Risk Assessment Administrative Bulletin Variance Process Volume Reports. TME Update. TME Update.

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Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) March 5, 2013

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  1. Massachusetts All-Payer Claims Database:Technical Assistance Group (TAG) March 5, 2013

  2. AGENDA General Updates • TME Update • MA Health Connector Risk Assessment • Administrative Bulletin • Variance Process • Volume Reports

  3. TME Update

  4. TME Update • The APCD monthly submissions will not require the reporting of the Non-Claims Payment information (PV065 – PV070) or the Health Status Adjustment Tool information (ME124 – ME130) • Two APCD data fields will be re-purposed to allow the collection of: • Attributed PCP Provider ID (Included when Payment Type is Global and there is no assigned PCP Provider.) • TME OrgID for the Physician Group of the Member’s PCP on eligibility • Implement quarterly TME reporting and collect this data through a new APCD file. The information collected will be based on date of service as is the current TME practice.

  5. MA Health Connector Risk Assessment

  6. Update • Supplemental File Specifications • SENDS+ Update • Out of State membership • Feedback/Questions by email to the Connector and CHIA liaison by March 8, 2013 • Supplemental Files Due by March 31, 2013

  7. Administrative Bulletin Update

  8. Administrative Bulletin • TME Changes • Tobacco Use Flag (ME119) • ICD Procedure Codes (MC084-MC089) • Actuarial Value/Metal Level (ME120-ME121) • Purchased Through the Massachusetts Exchange Flag (ME045)

  9. Variance Process

  10. Variance Process • Certify Version 2 by February 28, 2013 • Creation of Version 3.0

  11. Volume Reports

  12. Schedule APCD Version 3.0 Schedule Update Production Due August 2013

  13. Administrative Simplification • Connector/Risk Adjustment for ACAIndicator Purchased thru HIX, Actuarial Value, Tobacco Use • Division of InsuranceNAIC Code • Group Insurance Commission • GIC ID • CHIA for Total Medical Expense, Cost Trends and Relative PricingNon Claims Payments, Payment Arrangement Type • Connector and DOIMonthly Premium, Employer ZIP, Family Size • Connector, DOI and GIC • Market Category Code • Connector, CHIA and DOI • Employer Contribution All Payer Claims Data Base Private and Public Payers

  14. Questions

  15. Questions • Questions emailed to APCD Liaisons • Questions emailed to DHCFP (CHIA-APCD@state.ma.us).  • Questions on the Data Release and Application emailed to DHCFP (apcd.data@state.ma.us)

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