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Elizabeth M. Whitehorn, Director

Monthly Claims Care Coordination Data (CCCD) Partner Meeting November 2013

HFS Presenters:

  • Katey Staley

  • Nivedita "Nive" Baliga

  • Patricia Murphy

  • Paul Stieber

Meeting Objective

The objective of this meeting is to discuss all the questions that were submitted to HFS.

Please keep in mind that we have a varied audience:

  • Different types of partners: CCEs, ICP MCOs, MMAI MCOs, etc.,

  • Some partners don't yet have enrollees and only access test data,

  • Some only recently received actual claims data for the first time,

  • Others have a longer history of working with HFS claims data and

  • CCCD is a new (and hopefully improved) format.

. . . Therefore, a range of questions may have been submitted.

Meeting Organization

We will go through questions presented. Please post follow-up questions during webinar if clarification is necessary for any item. Once the questions have been reviewed we will take all members off mute for any additional questions.

These slides will be modified to include any updates as the result of today's discussion and will be posted on the CCCD Data Webpage.

Let's get to the Questions. . .

#1 Frequency of Place of Service Conversion Table

Question: Will the Place of Service Conversion Table be a monthly file or a one time file?

Answer: This is a one time file that has been posted as the Place of Service Conversion Table to the CCCD webpage.

#2 ProviderNPI as Null or Zero

Question: ProviderNPI is sometimes null or zero. Is this valid? 

Answer: Yes, it is possible for the ProviderNPI to be null or zero. There are some provider types, like Transportation providers and Waiver providers, that do not have NPIs.

#3 PlaceOfServiceCd is Null for Transportation

Question: PlaceOfServiceCd is sometimes null. Is this valid? 

Answer: Yes. PlaceOfServiceCd is null for transportation claims.

#4 CCCD Delivered by the 5th Working Day

Question: Is CCCD delivered on the 3rd of every month? Will it depend on any holiday, Saturday, or Sunday? Is a confirmation time possible?

Answer: CCCD is to be posted by the end of the 11:59 PM of 5th working day. Saturdays, Sundays, and holidays are not counted as working days.

#5 Adjustment and Joins

Question: ADJUSTMENT can be joined to other files on DCN+SERVICELINENBR+RECIPIENTID+ADJUDICATEDDT. REJECTIONSTATUSCD is not part of this. Does  that mean we need to adjust all lines for the combination of four fields? It returns two lines - one with RejectionStatusCd - N and one with Y. Do we need to consider both? Why is CorrectedNetLiabilityAmt part of key?

Answer: Adjustments are only sent when net liability amount has changed. Therefore, there is never an adjustment for a previous rejected claim. A claim can be adjusted multiple times. CorrectedNetLiabilityAmt contributes to the uniqueness of a record in the adjustment file, but is not needed to join back to the original claim. Only DCN, ServiceLineNbr, RecipientID and AdjudicatedDt should be used in the join.

#6 Place of Service and Institutional Claims

Question: There is no Place of Service code available for institutional claims. Do we need to use a default value or is it going to be added?

Answer: This will not be added. For Institutional claims, the Place of Service should be understood as the institution billing the claim.

#7 Outpatient Hospital Payment Reimbursement Group

Question: What does a value of "No" mean for OutPatientAPLGrp. We did not find this code value and its description as well? 

Answer: Unfortunately, this answer is still pending as of November 15, 2013. We did not want to delay the posting of the slides any longer. The slides will be updated when this answer is obtained.

#7 APLPROCGROUPCD and CPT codes

Question:  APLPROCGROUPCD has certain codes like 77014 and 92587, but the code description file does not have any description or code for this field?

Answer:  These are CPT codes. 

#8 Problem with PrimaryDiagInd in Test File

Question: We noticed in the test data that there are multiple diagnosis codes with a primary indicator of "Y" for the same claim. Why is this?

Answer: This issue was specific to the test data. This has never been an issue in the live data.

#9 What grouper software to assign src-drg-cd?

Question: Do you use grouper software to assign src-drg-cd?

Answer: Yes. 3M DRG Grouper 12 is used.

#10 Control File Begin and End Positions

Question: Can we get the begin and end positions for each field in the Control File?

Answer:
FileType   CHAR (25) Positions 1-25
LoadDt Date Format 'YYYY-MM-DD' Positions 26-35
RecordCount Integer Positions 36-45

#11 Dual Medicare

Question: For Dual Medicare-Medicaid claims, will each claim line appear two times; one for Medicare and the other for Medicaid? If yes, how do we distinguish these from each other?

Answer: HFS is now working on including Medicare data to CCCD. The January 2014 CCCD Partner Meeting will focus on Medicare items and this will be reviewed then.

#12 W-Codes Prior Authorizations

Question: Why are W-Code Prior Authorizations provided and what do these represent?

Answer: The need for W-Code Prior Authorizations is currently being assessed by the HFS Bureau of Managed Care.

Open Discussion

Please put your phones on mute if not speaking. . .

Future CCCD Partner Meetings

  • Wednesday, 12/11/2013; 10:00-11:00 AM Central

  • Wednesday, 1/15/2014; 10:00-11:00 AM Central

  • Wednesday, 2/19/2014; 10:00-11:00 AM Central

  • Wednesday, 3/12/2014; 10:00-11:00 AM Central

Please send feedback. . .

Complete survey at the end of this webinar and/or E-mail Paul Stieber.