Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 947 Date: August 12, 2011

Transcription

1 anual ystem Pub One-Time Notification epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 947 ate: ugust 12, 2011 hange equest 7496 UBJT: evisions to hange equest 7362: ntegrated ata epository () laims ourcing from hared ystems mplementation to equire Transmission of N istory ata. UY O NG: The has determined that it will use the hared ystems claims data for fraud, waste and abuse detection. T T: January 1, 2012 for conference calls and pril 1, 2012 for submission of Ns. PLNTTON T: January 3, 2012 for conference calls and pril 2, 2012 for submission of Ns. isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the newrevised information only, and not the entire table of contents.. NG N NUL NTUTON: (N if manual is not updated) =, N=N, =LT N PT TON UBTON TTL N. UNNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) andor arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

2 . TTNT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment One-Time Notification Pub Transmittal: 947 ate: ugust 12, 2011 hange equest: 7496 UBJT: evisions to hange equest 7362: ntegrated ata epository () laims ourcing from hared ystems mplementation to equire Transmission of N istory ata ffective ate: January 1, 2012 for conference calls and pril 1, 2012 for submission of Ns. mplementation ate: January 3, 2012 for conference calls and pril 2, 2012 for submission of Ns.. GNL NOTON. Background: The hared ystems () will receive feeds from the three shared systems the, and. pecifically, the nterprise ata enters (s) will send files for each shared system that are based on the copybooks the shared systems maintainers currently provide to the hared ystems Team. Once files are received, the enters for edicare & edicaid ervices () requires the to perform a file consistency validation on each file sent by the shared systems prior to accepting the file and to retain the files at the Baltimore ata enter (B). n addition to the daily feeds, the will also receive history extracts containing historical data starting with October To facilitate transmitting the history extract through Network ata over (N), hange equest () Transmittal 895, required changes to the shared systems files and submission processes. This extends those requirements to the ertificate of edical Necessity (N) history data in the ip edicare ystem (). The ystem aintainers shall break the N history extracts into smaller segments to allow the file transmission via N for loading into the. The N can support transmission of files up to 120GB. inally, this requires ongoing research hours and bi-weekly conference calls with the maintainers, edicare dministrative ontractors (s), and s. These conference calls are necessary to the successful completion of the project. The recommends 100 hours for each,, and hared ystems aintainers (). B. Policy: The has determined that it will use the hared ystems claims data for fraud, waste and abuse detection.

4 . BUN QUNT TBL Number equirement esponsibility (place an in each hared- ystem OT B aintainers The ystem aintainers shall send the N history extract (N record and Question sets) from each workload via N in at least two parts: 1) October 2010 to current go-live date 2) October 2005 to eptember ystem aintainers shall split the N history extracts into smaller segments as needed, based on: 1) ate (files should be broken down by fiscal year), and 2) ize limitation (maximum file size 120GB for N) The N history records shall contain the latest version of the Quality ontrol Number (QN) including both the QN base (first thirteen digits of the QN) and the recertificationrevision level (last two digits of QN) The ata enters shall assign unique names to the N history files produced from each workload, such that the filename has the following format: P

5 Number equirement esponsibility (place an in each hared- ystem OT B aintainers The following file naming convention shall be used for the N history files: T nbound ile Naming onvention: P#T.ON..NNNNN..YY.T T pplication nbound ile Naming onvention: P#.N.T.NNNNN..YY.T T here: - P = ile extract instance P Production extract file evelopment extract file T Test extract file - NNNNN = orkloadystem or ontractor Number as described in = iscal Year (xample 06 for ) - = ile counter (e.g. if file for year 06 is split to 5 files based on the file size, the counter will be from 01 to 05) - YY.TT = The T process will modify the date and timestamp of the filename. The time inserted will be astern tandard Time. xamples: - T nbound ile Name (Production): P#T.ON T P - pplication nbound ile Name (Production): P#.N.T T The following orkloadystem s and ontractor Numbers shall be used in the N history extract file names: P YL PTON OKL O UNT ONTTONOT J N JB NG P

6 Number equirement esponsibility (place an in each hared- ystem OT B aintainers J GN J Noridian The ata enters shall send the full file names created at the transmitting data center to the B via secure upon generating the files The ata enters, via secure and upon transmission of the files, shall notify the implementation team of the total number of history files from each workload as validation that all files are received ll parties shall continue ongoing research and participation in scheduled conference calls The conference calls shall occur at least every other week The conference calls shall continue at least until the shared systems modules for the shared systems are implemented at the. P P. PO UTON TBL Number equirement esponsibility (place an in each hared- ystem OT B aintainers None. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation.

7 -ef equireme nt Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: This is associated with ONTT Pre-mplementation ontact(s): nthony odge at or John tewart at or Patte ppling at or Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable.. UNNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), andor arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.