1 / 8

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.

ciqala
Download Presentation

Claims/Encounters Data Exchanges

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related