The MCEs that provide services to MassHealth and Commonwealth Care members should include services for both populations in the financial report. Please see Financial under section for specific instructions on “Monthly Report” 6.0 “Media Requirements” report layout and submission. How to Use this Document This is intended as a reference document. Its purpose is to identify the data Encounter Data Set Request elements that MassHealth needs to load into encounter database. The goal of this document is to clarify the standard record layout, format, and values that MassHealth will accept. Data Element Clarifications In 2.0 Set section provides clarifications and expectations on data elements like DRG, “Data Clarification” Diagnosis Codes, Procedure Codes, and Provider IDs. Data Elements The information contained in the Data Elements sections defines each of the fields included in the record layout. When appropriate, a list of valid values is included there. Nationally recognized coding schemes have been used whenever they exist. Encounter Record Layout Section Record specifies encounter file layout. All the MCEs must use that format 4.0 “Encounter Layout” when compiling the Encounter Data file that might contain all or any Claim Category (facility, professional, dental, etc.). MassHealth requests that the encounter data file is provided in a pipe-delimited text file with each service on a separate line. Contact MassHealth if you need further clarification. Media Requirements and Data Formats Section Requirements and Data complete information about all the files that 6.0 “Media Formats” contains should be submitted to EHS DW. MCEs submit their data to MassHealth through a secure FTP server. Each MCE has a home directory on this server and is given an ID with public key/private key-based login. Please also note the security requirements for Internet transmissions noted in the Media Requirements section. Standard Data Values Section Data contains tables referenced in the specific fields of the Data Elements section 7.0 “Standard Values” (Tables A through H). Data Quality Checks This section within and Quality Edits, Reasonability and provides the validity 8.0 “Quantity Validity Checks” and quality criteria that encounter data are expected to meet.
The MCEs that provide services to MassHealth and Commonwealth Care members should include services for both populations in the financial report. Please see “Monthly Financial Report” under section 6.0 “Media Requirements” for specific instructions on report layout and submission. How to Use this Document This Encounter Data Set Request is intended as a reference document. Its purpose is to identify the data elements that MassHealth needs to load into encounter database. The goal of this document is to clarify the standard record layout, format, and values that MassHealth will accept. Data Element Clarifications In 2.0 “Data Set Clarification” section provides clarifications and expectations on data elements like DRG, Diagnosis Codes, Procedure Codes, and Provider IDs. Data Elements The information contained in the Data Elements sections defines each of the fields included in the record layout. When appropriate, a list of valid values is included there. Nationally recognized coding schemes have been used whenever they exist. Encounter Record Layout Section 4.0 “Encounter Record Layout” specifies encounter file layout. All the MCEs must use that format when compiling the Encounter Data file that might contain all or any Claim Category (facility, professional, dental, etc.). MassHealth requests that the encounter data file is provided in a pipe-delimited text file with each service on a separate line. Contact MassHealth if you need further clarification. Media Requirements and Data Formats Section 6.0 “Media Requirements and Data Formats” contains complete information about all the files that should be submitted to EHS DW. MCEs submit their data to MassHealth through a secure FTP server. Each MCE has a home directory on this server and is given an ID with public key/private key-based login. Please also note the security requirements for Internet transmissions noted in the Media Requirements section. Standard Data Values Section 7.0 “Standard Data Values” contains tables referenced in the specific fields of the Data Elements section (Tables A through H). Data Quality Checks This section within 8.0 “Quantity and Quality Edits, Reasonability and Validity Checks” provides the validity and quality criteria that encounter data are expected to meet.
Fully-Executed-Senior-Whole-Health-First-Amended-Restated-SCO-Contract-January-2018.docx