Data Submission Guide (DSG) Training Webinar The Arkansas Healthcare Transparency Initiative and the Arkansas All-Payer Claims Database (APCD)

Transcription

1 Data Submission Guide (DSG) Training Webinar The Arkansas Healthcare Transparency Initiative and the Arkansas All-Payer Claims Database (APCD)

2 Agenda About the Arkansas Center for Health Improvement (ACHI) What will be submitted? Data Submission Guide (DSG) All-Payer Claims Database (APCD) solution Timelines Exemptions Exceptions Technical support DSG Changes 2

3 About ACHI The Arkansas Center for Health Improvement (ACHI) is a nonpartisan, independent health policy center dedicated to improving the health of Arkansans Established in 1998, creating a much needed intersection between research and policy ACHI has proven experience in the management and integration of health data to support research and health policy 3

4 ACHI s Mission, Vision & Values Mission Statement To be a catalyst for improving the health of Arkansans through evidence-based research, public issue advocacy, and collaborative program development. Vision Statement To be a trusted health policy leader committed to innovations that improve the health of Arkansans. Core Values Trust, Innovation, Initiative, Commitment 4

5 ACHI Major Accomplishments Year Accomplishment 2000 Tobacco Settlement Proceeds Act 2003 Act 1035 of 2003 Arkansas Health Data Initiative (HDI) 2006 ARHealth Networks established 2006 Act 8 of Clean Indoor Air Act 2009 Act 180 of Tobacco Excise Tax 2009 Act 394 of Graduated Driver License regulations 2009 Act 308 of Primary Seat Belt Law 2010 Establishment of the Office of Health Information Technology (OHIT) and State Health Alliance Records Exchange (SHARE) 5

6 Year ACHI Major Accomplishments continued Accomplishment 2011 Act 197 Of 2011 Fluoridated Drinking Water 2011 Present Multi-payer Arkansas Health Care Payment Improvement Initiative (ACHPII) 2012 Arkansas Workforce Strategic Plan 2013 present State Innovation Model Population Health 2013 present Arkansas Health Care Independence Program and Health Insurance Marketplace 2015 Act 1233 of 2015 Arkansas Healthcare Transparency Initiative 6

7 What Will Be Submitted? Submitting entities must provide the following data categories unless granted an exemption: Member Enrollment data Unique identifiers (no personal identifiers) Demographic and geographic information Medical claims Pharmacy claims Dental claims Provider data Control Counts Look-up tables 7

8 Arkansas Insurance Department (AID) Rule 100* Further defines covered individual thresholds for submitting entities Describes test data and historical files Provides exemption process for submitting entities References the Data Submission Guide (DSG) for technical specifications Provides phased data submission timeline Defines DSG change process * Rule 100: Arkansas Healthcare Transparency Initiative Standards issued pursuant to Act 1233 of 2015 of the Arkansas 90th General Assembly. 8

9 Data Submission Guide (DSG) Provides submitting entities with: Data variables Data submission and format requirements Encryption protocols Web portal onboarding process Data exception process Available on the APCD Website: 9

10 Secure Data Transfer Data release of de-identified data only APCD Data Solution University of Arkansas for Medical Sciences (UAMS) Information Secure Infrastructure APCD Data Submission APCD Secure Processing Zones APCD Data Landing Zone Encrypted Data Receipt APCD Staging Zone Data Load and Validation APCD Data Analyses Zone Data Warehouse APCD Website Researchers Encrypt Data for APCD - Authorized access only - No decrypted data 10 - Data decryption dual authentication - Data transformation - Data quality reporting - Health system analyses using de-identified data - Medical reimbursement transparency reporting Providers - Unique ID hashing 10

11 Onboarding Timeline DSG Webinars: Provide a platform for submitting entities to ask questions about the APCD DSG Schedule: Tuesday, 10/20 Tuesday, 11/3 Tuesday, 11/17 Tuesday, 12/1 Onboarding Webinars Provide file encryption, web portal, and data submission training for submitting entities Schedule: Thursday, 11/5 Thursday, 11/12 Thursday, 11/19 Thursday, 12/3 11

12 Submission Timeline Test files expected to be submitted no later than January 1, 2016 Historical data and quarterly submission will be based on a phased data submission schedule Submitting entities are divided into four groups First historical data submission will be received by 3/31/2016 and the last on 12/31/2016 First quarterly submission will be on 3/31/2017 for all groups 12

13 Submitting Entity Exemption A submitting entity may submit an exemption request to the AID Commissioner requesting an extension, variation, or waiver of a rule requirement Good cause standard 30-day timeframe for AID response to any exemption request Submitting entities must be registered before exemption requests can be submitted 13

14 Submitting Entity Exception A submitting entity may submit an exception request to ACHI identifying required data elements that cannot be provided 15-day timeframe for ACHI response to any exception request Submitting entities must be registered before submitting exception requests Exceptions can be submitted after 11/2/2015 Exception form can be found on APCD website 14

15 DSG Changes Periodically, corrections may have to be made to the DSG document including but not limited to: Document formatting changes Editing changes Incorrect requirements Material DSG changes affecting submitting entity programming or processing are made annually, 120 days prior to required data delivery date Submitting entities will be notified when material changes occur 15

16 DSG Change Notification Submitting entities will be notified using several channels Notifications tab of the APCD web portal APCD website alerts with link to change listing 16

17 DSG Changes Periodic technical corrections to the DSG can be found at this link: 17

18 Q&A 18

19 DSG FAQ Question Our NAIC group qualifies as a submitting entity and that includes several qualifying NAIC companies. Our NAIC group cannot meet the statutory deadline for test file submission. Is each NAIC company required to submit an exemption form? Where can I find registration, exemption and exception forms? How will I know if my submitted forms have received and approved? Answer Exemption forms are submitted at the NAIC group level, covering all NAIC companies related to the NAIC group. Forms are available at acknowledgement will be received in response to each form submission. 19

20 DSG FAQ Question Our NAIC group qualifies as a submitting entity but some of or NAIC companies don t meet the threshold for 2K beneficiaries in Do we need to submit an exemption form for those companies? Answer Yes. An exemption form must be completed for these companies. Our NAIC group qualifies as a submitting entity. We have several NAIC specialty companies that meet the 2K beneficiary threshold but do not provide comprehensive medical, dental and pharmacy coverage. Does each one need to fill out an exception form declaring that it will only submit files for their respective specialty? Yes. Each NAIC company that qualifies in part must provide exception forms for the data categories they cannot supply. For example, PBMs must complete an exception form for Medical and Dental claims. 20

21 APCD Technical Support Phone: Contact Information Website: Hours of Operation:* Monday through Friday 9:00 AM 4:00 PM, Central Standard Time *excluding state and federal holidays 21