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Claims/Encounters Data Exchanges

Claims/Encounters Data Exchanges. 5/1/2013. 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. Historical Data Exchange, cont.

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Claims/Encounters Data Exchanges

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  1. Claims/Encounters Data Exchanges 5/1/2013

  2. 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

  3. 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

  4. 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 with be provided to Contractor technical staff in the next few weeks

  5. 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

  6. 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

  7. 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: 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: Acute: 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

  8. Ongoing Data Exchange, cont. • A draft format for the data exchange with be provided to Contractor technical staff in the next few weeks • Planned Future Data Exchange • Medicare Paid Claims Data – Targeted for early 2014

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