through an encounter data system or other methods. The system must be able to ensure that data received from providers are accurate and complete and verify the accuracy and timeliness of reported data; screen the data for completeness, logic, and consistency; and collect service information in standardized formats to the extent feasible and appropriate. The findings of this assessment follow. Exhibit 9: Information Systems Capability Assessment Findings BMCHP CCA Fallon SWH Tufts UHC Adequate documentation; Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable data integration, data control and performance measure development Claims systems and process Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable adequacy; no non-standard used for claims All primary and secondary Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable coding schemes captured Appropriate membership and Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable enrollment file processing Appropriate appeals data Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable systems and accurate classification of appeal types and appeal reasons Adequate call center systems Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable and processes Required measures received Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable a designation “Reportable” & KEPRO did not identify any significant issues resulting from PMV. In fact, no issues at all were identified for two of the six plans. The few recommendations made related to source code, medical record review, and supplemental data. (BMCHP)
through an encounter data system or other methods. The system must be able to ensure that data received from providers are accurate and complete and verify the accuracy and timeliness of reported data; screen the data for completeness, logic, and consistency; and collect service information in standardized formats to the extent feasible and appropriate. The findings of this assessment follow. Exhibit 9: Information Systems Capability Assessment Findings BMCHP CCA Fallon SWH Tufts UHC Adequate documentation; data integration, data control and performance measure development Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable Claims systems and process adequacy; no non-standard used for claims Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable All primary and secondary coding schemes captured Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable Appropriate membership and enrollment file processing Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable Appropriate appeals data systems and accurate classification of appeal types and appeal reasons Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable Adequate call center systems and processes Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable Required measures received a “Reportable” designation Acceptable Acceptable Acceptable Acceptable Acceptable Acceptable & KEPRO did not identify any significant issues resulting from PMV. In fact, no issues at all were identified for two of the six plans. The few recommendations made related to source code, medical record review, and supplemental data. (BMCHP)
2017-sco-eqr-technical-report.docx