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MHS Data and Tnex

MHS Data and Tnex. Overview. Brief Data Flow Discussion Workarounds for pre-Tnex enrollment data Status of TED Development TED vs. Net TED M2 Standard Reports. Claims Data Flow in MHS Systems. CDIS / Invoice Website. Checkbook. Claims. (Daily). TMA-Aurora. Daily. Claims.

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MHS Data and Tnex

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  1. MHS Data and Tnex

  2. Overview Brief Data Flow Discussion Workarounds for pre-Tnex enrollment data Status of TED Development TED vs. Net TED M2 Standard Reports

  3. Claims Data Flow in MHS Systems CDIS / Invoice Website Checkbook Claims (Daily) TMA-Aurora Daily Claims MDR Claims Monthly (Net Records) Claims Analysis Tool M2

  4. Interim Fix of HCSR Enrollment Data for Supplemental Care

  5. HCSR Enrollment Data • No field on HCSR to represent valid “enrollment DMISID” for AD • Enrollment information necessary for planning for supplemental care bills • Two avenues: • PSCR&I Website – Monthly report • M2 Standard Report

  6. Andrews Example (HCSR-I) or… Why this is important! • Amount Paid incurred by enrollees to Andrews (According to HCSR): $15,933,509 • Amount Paid incurred by enrollees to Andrews (According to DEERS): $1,208,691 • % of “Andrews” supp care that’s not theirs:92%

  7. McGuire AFB (0326) BMC Willow Grove (0347) Conner CTMC (7113) Dover AFB (0036) USCG Clinic New London (0034) Hanscom AFB (0310) BMC NAS Brunswick (0299) NACC Groton (0035) Walter Reed (0037) Aberdeen Proving Ground (0308) Top 10 Enrollment Sites for AD Hosp Claims, reported as Andrews * Excluding Andrews AFB. Based on Amount Paid, Total in HCSR I.

  8. Application of DEERS Enrollment to HCSR • Match HCSRs to DEERS records by patient identifier • Use DEERS DMISID if • Prime enrollment (not Plus): Small number of Plus AD enrolled • Valid during time of service

  9. Enrollment is expired!

  10. Interim Fix • RM website contains monthly reports based on DEERS Match • Match of DEERS and Claims done in MDR • FY04 updated on a monthly basis; FY03 updated periodically • All months for an FY are updated at a time, to account for adjustments in data • Not required for TED based records

  11. AD HCSR Report

  12. Fields Available • Enrollment MTF • Enrollment MTF Service • Enrollment MTF Region • FY/FM • Amount Paid, Raw & Est. to Completion • Source (Inst or Non-Inst)

  13. M2 Standard Report • Report Name: “tma.pcweb.hcsr.inv.active duty.rep” • User enters enrollment DMISID and fiscal month of data and hits “run” • Intended to run one month at a time • (M2 limitation with report publishing) • Report can be modified by user to run FY at a time • Cannot be done with M2 Standard Reports!

  14. M2 Standard Report • Step by step instructions on how to create an FY report to be posted on RM website in near future • Once report is written, can easily be: • Re-run as data are refreshed • Modified, to use for ad-hoc type queries

  15. Status in M2 of HCSRs and TEDs

  16. HCSRs and TEDs • M2 receives HCSRs on a monthly basis from Aurora • NoTED records have been received by M2 (or MDR) to date • EI/DS commited to providing visible TED records in October 2004 • M2 users have been notified and will be kept abreast of progress

  17. M2 Data Display vs. Invoices, CDIS

  18. Claims Data Flow in MHS Systems CDIS / Invoice Website Checkbook Claims (Daily) TMA-Aurora Daily Claims MDR Claims Monthly (Net Records) Claims Analysis Tool M2

  19. ICN & Line Items • Invoices (& CDIS) contain transaction level data • Each transaction contains an Internal Control Number (ICN), [with up to 25 line items for non-institutional claims] • If a claim is adjusted, it uses the same ICN as the original claim

  20. Claims, Your Invoices, and CDIS TOTAL PAID: $ 120

  21. Example of Adjustment Claim • The MTF would be billed a total of $120 for that claim • The ICN and line item number may show up on separatemonthly invoices • Doesn’t imply the bill to the MTF was in error, implies something was wrong with the claim…. • Not always a positive adjustment to a TED; could have been overpaid initally!

  22. Claims in M2 • Accounting systems need info about cash flows, budgeting, etc... • Invoice website is designed for this purpose • Management analysis type systems don’t necessarily utilize “accounting data” • More interested in costs of events, when they occur! • M2 is a management analysis system

  23. Initial Claim - $100 (Jul 2004) Adjusted Claim - $120 (Aug 2004) Adjusted Claim Example New Claim

  24. Net Claims (MDR/M2) Record ID in M2 = ICN + Suffix TED “Suffix”: Version of claim A=1st edition, B=1st adj, C=2nd adj, etc

  25. M2 Standard Reports

  26. M2 Standard Reports • Management Analysis System • Receives many different data files from MHS Data Repository • Direct Care, Claims, DEERS, etc… • 700+ users • MTFs, Major Commands, Regions, Service HQ, TMA, HA, etc..

  27. M2 Standard Reports • Standard Reports posted in “corporate documents” • User enters specific parameters (i.e. which enrollment DMISID, what timeframe, etc) • Reports can be modified by user if desired and saved locally • Must be done with caution!

  28. M2 Standard Reports • Advantages of using standard reports • Very easy to build • Maintenance of reports as M2 changes done centrally • Everyone looks at the same sheet of music! • Minimizes level of effort at local level when reports don’t have to be built from scratch • Documentation to be posted on website • Summary of changes to be posted as reports evolve

  29. Log onto M2 • Click on • File • Retrieve from • Corporate Documents

  30. Corporate Reports Window

  31. Double click on report title and empty report pops up Click on “air conditioner” icon (it really looks like one!) User will be prompted for DMISID, et. al

  32. User enters values of interest and clicks “ok” Format is very important!!! If you use an unexpected format, you will get unexpected results!!!

  33. Report results

  34. M2 Standard Reports • Results can be: • Manipulated/analyzed in M2 itself (slice and dice) • Downloaded to Excel • Copied onto clipboard and pasted in other software • Downloaded as text • Etc… • Basic instructions for manipulation provided in handout

  35. Overview of M2 Standard Reports • Will describe • Report Name • Description/Uses • Data Source • Data Elements • Sample Output/Examples/Notes

  36. Prime Enrollment Report • tma.pcweb.enrollment.report.rep • Source: M2 DEERS Enrollment FY04 • Data Elements: • FY/FM • Enrollment Count • Bencat • Age Group • User defined enrollment site

  37. Prime Enrollment Report • Contains Prime enrollees only • Use to measure number of enrollees an MTF is responsible for • Can be used to compare with enrollment projected for business plans • Additional detail available in M2 DEERS Enrollment file

  38. Very large drop in AD enrollment! 13K, to 10K, down to 6K Are they at war? At another MTF? Is the MTF expecting this? It’s only data…

  39. M2 Space A - Inpatient • tma.pcweb.sidr.wkld.nonmtfenr • Source: M2 SIDR • Data Elements: • FY/FM • Bencat • DRG • ACV/Enr MTF • Treatment MTF • Dispositions & RWPs • Costs

  40. MTF Space A Inpatient • Care provided in an MTF for other than that MTF’s enrollees • “Folks I’m seeing instead of my Prime” • PPS Earnings fields could be added into report by user to understand budget effects of seeing non-MTF Prime • Person identifiers can help identify high cost beneficiaries

  41. MTF Space A - Ambulatory • tma.pcweb.fy**.sadr.wkld.nonmtfenr (03 & 04) • Same functional use as inpatient report • Just like inpatient space A report, except: • Data Source is SADR • RVUs instead of RWPs • MEPRS Code instead of DRG (tells what clinic) • Encounters instead of dispositions

  42. Space A Pediatric Care at Camp Lejeune, FY03: $681K, > 4000 RVUs! -- Note: Could be a problem with enrolling newborns? Further analysis required!

  43. Leakage Report -- DRGs • tma.pcweb.hcsri.by DRG for MTF Enrollees • Source: M2 Institutional Data • Data Elements: • FY/FM • Enrollment Site • Invoice Parent • DRG • Bencat • ICN & Suffix • Admissions & RWPs • Hospital Paid and Allowed

  44. Inpatient Leakage • Hospital care provided to an MTF’s enrollees in the private sector • Why didn’t I provide this care? • Add “acceptance date” to see what you paid for on your invoice! • Person identifiers can help identify high cost or high utilization beneficiaries • This is “billed” data, not episode data!!

  45. Top DRG for Pensacola enrollees downtown (FY04): OR procedures for obesity Almost a quarter of a million dollars (Number two DRG in 03)

  46. Ambulatory Leakage • Two reports • Primary Care Leakage: tma.pcweb.hcsrn.fy**.primarycare. specialtycodes • Specialty Care Leakage: tma.pcweb.hcsrn.fy**specialtycare • Source: M2 Non-Institutional HCSR/TED • Same concept as inpatient leakage – care for your Prime going downtown! • Acceptance Date for “what’s in my invoice” questions

  47. Pediatric Care leaking downtown for Enrollees to Camp Lejeune, FY03, ~ 300K Recall Space A report: 681K of care provided at the MTF for non-enrolled! Further analysis required. What is this? Subspecialty care? Physicals?

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