Welcome to the Fall 2009 edition of the Onpoint CDM (Claims Data Manager) Newsletter. This edition focuses on system process, data harmonization, public health data use, state legislative rule changes, proposed system changes, and additional state collection efforts.

11/30/2009 - Data submissions for October 2009 due to Onpoint CDM
12/31/2009 - Data submissions for November 2009 due to Onpoint CDM

 

The National Claims Data Management System (NCDMS) began operating under its new name, Onpoint CDM (Claims Data Manager), on October 1, 2009. Onpoint CDM remains operated and owned by Onpoint Health Data, previously known as the Maine Health Information Center (MHIC). Read more »

Our two previous quarterly newsletters have focused on system process, specifically what data elements are collected and how the system handles the extraction, transformation, and loading of the data into a warehouse. This newsletter examines another critical part of the system workflow: the initial implementation phase with health plans. Common issues that occur often are related to: product type, relationship code, how to handle denied claims, and invalid procedural and diagnosis codes. Read more »

 

The Regional All Payer Healthcare Information Council (RAPHIC) and Onpoint Health Data have been working with state agencies to standardize collection layouts for improved data accuracy and utility. To date, collection layouts for three data sources -- member enrollment information, medical paid claims, and pharmacy paid claims -- have been standardized for Maine, New Hampshire, and Vermont. Dental claims information will be collected only for Maine and New Hampshire, but again using the same format. These changes take effect for all three states on February 1, 2010.

To help ensure a smooth transition to the harmonized data collection rules, a test system is being hosted in parallel with Onpoint CDM from November 1, 2009, through January 31, 2010. The test system allows submitters to upload extracts of required files for compliance testing. Detailed emails have been sent out in the last few weeks informing submitters of the changes and timeline for testing. Those details are as follows.... Read more »

Most state and private initiatives collecting healthcare claim or encounter data are doing so for similar purposes: to gain a better understanding of healthcare service use, cost, and quality. To help New Hampshire Medicaid better understand these three key areas, the state selected Onpoint Health Data in 2005 to build and maintain a commercial and Medicaid all settings claims database and to provide extensive analytic support to department staff. In particular, New Hampshire's Department of Health & Human Services' Office of Medicaid Business & Policy has done some of the most extensive state Medicaid analyses with their claims database. Read more »

New Rule Update - Chapter 243 Data Collection Rule
Maine submitters should note that the Maine Health Data Organization has finalized rule changes to Chapter 243 Uniform Reporting System for Health Care Claims Data Sets. HIPAA references in the rule also have been updated to include reference mappings to the new X12 5010 standard. Read more »

 

New Hampshire submitters should note that the New Hampshire Insurance Department (NHID) has finalized rule changes in association with legislation relating to Chapter Ins 4000 Uniform Reporting System for Health Care Claims Data Sets. This is the legislation that governs the submission of claims data sets to Onpoint CDM. Read more »

Consolidated Data Sets
The latest release of the consolidated data sets containing 2005, 2006, 2007, and 2008 (through June 2009) incurred data have been delivered to the New Hampshire Department of Health & Human Services and the NHID. Work also is being performed to provide integrated group- and practice-level detail in conjunction with the current provider information as a part of the New Hampshire consolidated data set. This information is being provided by the NHID and now is available as part of the consolidated data set. Read more »

 

Vermont submitters should note that the Vermont Healthcare Claims Uniform Reporting & Evaluation System (VHCURES) is nearly complete with submitters providing production data. VHCURES also contains historical data from January 2007. Data analysis and review is ongoing on this data set. Most payers have been reviewed and verified, and consolidation has been carried out for most payers. Read more »

 

To date, submitters are in the active testing process. A total of 56 submitters, representing 76 data sources, are required to submit data for Minnesota residents. To date, more than 80 percent have submitted test data. During the past 90 days, we have processed over 650 submissions with a total of 95 million records.

Understanding the Testing Process
The Minnesota testing process begins with the submission of one complete month of data (preferably January 2008) for each of the required data types. The testing process then moves through the following stages.... Read more »

Requesting a Variance for Minnesota Data
Minnesota has a process for approving payer exceptions that is more formal than those of other states managed by Onpoint CDM. Read more »

Update - Medicare Supplement Insurance
At this time, the Minnesota Department of Health will not require submission of Medicare Supplement Insurance enrollment or claims records by health plan companies or third-party administrators (TPAs). All other claims and enrollment files associated with health plan coverage for covered individuals must continue to be submitted by all data submitters. Additionally, all health plan companies and third-party administrators, as defined within Minnesota Rules, Chapter 4653, must still register annually regardless of the proportion of their claims that come from Medicare Supplement Insurance coverage. Read more »

Notice
A Request for Proposal (RFP) was issued by the Minnesota Department of Health to secure services for implementation of the provider peer grouping using the enrollment and claims data. Proposals are due December 23, 2009.

 

 
For basic questions about Onpoint CDM, including system requirements, scheduled maintenance, and upgrades, try our Support pages. For in-depth FAQs, both general and state specific, visit our client pages for Maine, Minnesota, New Hampshire, and Vermont.

If you need additional help with questions regarding the new data collection rules and testing process, inquiries should be sent to the appropriate state-specific e-mail address for Maine, Minnesota, New Hampshire, and Vermont.

Onpoint CDM also can be reached directly by e-mail or phone (207 623-2555).

 

Onpoint CDM is owned and operated by Onpoint Health Data, an independent nonprofit providing reliable data, trusted research, and independent analysis to the healthcare community.