Government Program Services: Medicaid Managed Care

Medicaid Data Requirements

Equally important, but less publicized are sections of ACA under Title I that address the need for the Centers for Medicare & Medicaid (CMS) to receive from states and states to receive from Managed Care Organizations (MCOs)─data that is high in quality and consistently reported through state or CMS defined report formats.

During the past year, 2014, multiple State Medicaid Agencies initiated modernization initiatives impacting their Medicaid eligibility platforms, data standards (content and format), and encounter reporting processes/systems. At the heart of these efforts is the increasing need to improve the type and quality of data collected and ultimately, the reporting of this data to CMS. These state modernization initiatives which began in 2014 are still continuing into 2015, and are impacting both MedImpact and our MCO clients.

As a vested MCO collaborator, MedImpact is currently reviewing data transfers from our MCO partners that are integrated into pharmacy claim extracts to create encounter records, utilization analysis, cost accumulators, or broader category analysis by type of population.

Within the next several months, MedImpact's new Medicaid division, under the Government Program Services Department, will be working with MedImpact Account Management teams to outline the specific data requirements needed from our MCO clients. Future adoption by our MCO clients of new or modified data requirements will help MedImpact provide the appropriate data and files which can be transmitted consistently to State Medicaid Agencies and/or CMS and meet specific content, quality and format standards.

MedImpact will review MCO data files and then provide to our MCO partners focused input on eligibility files (both member enrollment and group files, by program), Medical OOP/accumulator files, State Registered Provider files (specifically for NPI), MCO Claims and PA history files. In the near future, the MCO historical encounter files submission and response files (when applicable) also will be reviewed.

MedImpact intends to collaboratively work with our MCO clients to ensure that MCO data submissions to state and/or CMS which require MedImpact input meet the current and future quality, data content/format, and consistency standards outlined by ACA.