Claims/Encounters Data Exchanges

1. Claims/Encounters Data Exchanges May 2013

2. Purpose & Types of Data Exchange • AHCCCS will manage exchange of encounter and claims data to Contractors in order to eliminate “blind spots” for services provided to a member shared by multiple programs • In compliance with Federal privacy regulations • Contractors should use this information to develop short- and long-term strategies to improve care coordination • Historical – provide up to 3 years of data • Ongoing – provide at least quarterly

3. 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

4. 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

5. 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 has been provided to Contractor technical staff for comment and we are in the process of updating now

6. 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

7. 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

8. 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 - Acute: 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: 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

9. Ongoing Data Exchange, cont. • A draft format for the data exchange has been provided to Contractor technical staff for comment and we are in the process of updating now • Planned Future Data Exchange • Medicare Paid Claims Data – Targeted for early 2014