My company is not a Risk When a submission is CHIA is required to Holder so many elements coming from a non-Risk differentiate varying lines of don’t How should this Holder (TPA, Claims business to satisfy many be dealt with via the Processer, PBM, DBM, report requests. The ability Variance Request? etc.) several elements may to parse eligibility data into not be available to report. standard categories will By identifying the type of remove the burden of business in ME134 APCD requesting supplemental – ID Code, the MA APCD files from submitters to will be able to relax some identify the various types. of the intake edits based upon the business. Types of Data collected in the Member Eligibility File Subscriber / Member Information Both subscriber and member information is collected in the file. Although the focus is primarily on the member, in order to maintain Master Member IDs and link to claims when submitted, information regarding the subscriber is necessary as well. The MA APCD is now collecting elements directly related to the Subscriber (who may be the Member as well) and the policy they have through an employer, the premium paid, benefit levels and industry codes. Non-Massachusetts Resident CHIA requires that payers submitting claims and encounter data on behalf of an employer group submit claims and encounter data for employees who reside outside of Massachusetts. CHIA requires data submission for employees that are based in Massachusetts whether the employer is based in MA or the employer has a site in Massachusetts that employs individuals. This requirement is for all payers that are licensed by the MA Division of Insurance, are involved in the MA Health Connector’s Risk Adjustment Program, or are required by contract with the Group Insurance Commission to submit paid claims and encounter data for all Massachusetts residents, and all members of a Massachusetts employer group including those who reside outside of Massachusetts. For payers reporting to the MA Division of Insurance, CHIA requires data submission for all members the of the insurance contract or product is Massachusetts “situs” regardless of residence or employer (or the location of the employer that signed the contract is in Massachusetts). Demographics
My company is not a Risk Holder so many elements don’t How should this be dealt with via the Variance Request? When a submission is coming from a non-Risk Holder (TPA, Claims Processer, PBM, DBM, etc.) several elements may not be available to report. By identifying the type of business in ME134 – APCD ID Code, the MA APCD will be able to relax some of the intake edits based upon the business. CHIA is required to differentiate varying lines of business to satisfy many report requests. The ability to parse eligibility data into standard categories will remove the burden of requesting supplemental files from submitters to identify the various types. Types of Data collected in the Member Eligibility File Subscriber / Member Information Both subscriber and member information is collected in the file. Although the focus is primarily on the member, in order to maintain Master Member IDs and link to claims when submitted, information regarding the subscriber is necessary as well. The MA APCD is now collecting elements directly related to the Subscriber (who may be the Member as well) and the policy they have through an employer, the premium paid, benefit levels and industry codes. Non-Massachusetts Resident CHIA requires that payers submitting claims and encounter data on behalf of an employer group submit claims and encounter data for employees who reside outside of Massachusetts. CHIA requires data submission for employees that are based in Massachusetts whether the employer is based in MA or the employer has a site in Massachusetts that employs individuals. This requirement is for all payers that are licensed by the MA Division of Insurance, are involved in the MA Health Connector’s Risk Adjustment Program, or are required by contract with the Group Insurance Commission to submit paid claims and encounter data for all Massachusetts residents, and all members of a Massachusetts employer group including those who reside outside of Massachusetts. For payers reporting to the MA Division of Insurance, CHIA requires data submission for all members the “situs” of the insurance contract or product is Massachusetts regardless of residence or employer (or the location of the employer that signed the contract is in Massachusetts). Demographics