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Evaluating Medicaid Managed Care. Encounter Data for Policy Analysis. April Grady. April 10, 2014. MACPAC. Medicaid and CHIP Payment and Access Commission
Medical claim data, referred to as “encounter data" in. Medicaid programs, is the single most important ana- lytical tool for health plans and health programs. With- out accurate and timely data, it is not possible to analyze costs, utilization, or trends; evaluate benefits; or determine the quality of services being provided to
analyze, and disseminate information on Medicaid beneficiaries, reporting requirements, which include the requirement to submit encounter data. Reporting practices mostly mirror the 1998 MSIS. Application Forms that provided a description of States' encounter data reporting requirements, (2) inform States that CMS.
7 Mar 2016 3) States can use the data they already collect as Medicaid payers (claims and encounter data) to 6) States may work with external contractors for data management and analytics related to payment . Medicaid Statistical Information System (MSIS) reporting requirements will be changing with the im-.
22 Sep 2017 The CMS MMP Encounter Team (in the. Medicare-Medicaid Coordination Office) will update the FAQ we identify additional strategies for improving the timeliness, accuracy, and completeness of MMP encounter data. MMP Submission Requirements. Q1: What are the primary requirements for submitting
30 Nov 2013 This toolkit is one of several initiatives sponsored by the Centers for Medicare & Medicaid Services (CMS) to help state Medicaid agencies (1) comply with federal encounter data reporting requirements, (2) improve the accuracy and completeness of the data, and. (3) strengthen states' capacity to analyze
19 Oct 2011 collecting, processing, and reporting Medicaid claims data, including information technology “Validating Encounter Data: Texas Medicaid Managed Care and Children's Health Insurance Program Managed policies and guidelines to analyze and correct encounter data errors for resubmission. (It is still.
17 May 2016 In this article, we summarize new regulatory requirements for Medicaid encounter data from the final rule, identify best practices for state Medicaid agencies EQR means the analysis and evaluation of aggregated information on quality, timeliness, and access to the healthcare services that an MCE or its
Clearly a plan cannot itself comply with a State's encounter data requirements if its providers do not send in encounter records. Another study of . When the unit of analysis is the plan, States might request aggregate reports on all of the Medicaid enrollees a plan served in a particular reporting period. Almost all States
eliminate the categorical requirements for Medicaid eligibility (such as pregnancy reporting of Medicaid eligibility and claims data into the Medicaid . Data elements and reference ranges used to analyze Medicaid encounter data in MAX 2011, by BOE category. Reference range for MAX 2011. Data element. Adult. Child.

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March 2018