CRISP Directory Input File Requirement for MHBE Carriers

Transcription

1 CRISP Directry Input File Requirement fr MHBE Carriers March 22, 2013 (Versin 1.2) Table f Cntents Cntents 1. Overview Scpe Purpse Prcess Overview Prcess Flw InputFile Specificatins Frequency f Updates File Naming Cnventins File Frmat File Transmissin Input File Specificatins Full Replacement File Cntent Input File Recrds Optinal Translatin Files fr Cdes Input File Clumns.... 6

2 Revisin Histry Date Versin Sectin Updated Descriptin Authr 03/7/ Initial Draft Rachel Sherman 03/20/ Minr edits Rachel Sherman 03/22/ Additinal detail added Rachel Chesapeake Reginal infrmatin System fr ur Patients 2

3 1. Overview. 1.1 Scpe. CRISP will receive directry data frm Qualified Health Plan (QHPs) and Managed Care Organizatins (MCOs) that are part f the Maryland Health Benefit Exchange (MHBE). CRISP will wrk with Optum t standardize, cleanse and aggregate the inbund data. Inbund data will be matched t the Optum database and missing data elements may be augmented using business rules established fr the prcess. The aggregated data will then be utput int a directry file that will supprt the cnsumer shpping experience and prvider search functinality within the MHBE. 1.2 Purpse. The purpse f this dcument is t define the Directry file requirements. The file will cntain all the individual prviders and netwrks affiliated with the MHBE. 1.3 Prcess Overview. QHPs/MCOs that are part f the MHBE will submit directry input files t CRISP. Input files will be placed n a secured FTP flder. Each participating QHP/MCO will be assigned a unique file name and a passwrd prtected flder t submit input files. Directry input files will be submitted n a bi-weekly cycle using an apprved input frmat. Input files will be full replacement and cntain the surce s entire directry at the pint f file creatin. Input files will be cllected by Optum at the start f the scheduled directry cycle. Optum will cllect the latest input file placed n the surce s assigned FTP flder. Optum will aggregate the input files int a single standard prcess. This prcess will clean, standardize and cllapse inputs fields such as name, address, specialty, language and sme hspital affiliatins. The standard surce prcess utput will then be matched t the Optum database. The first level f matching is at the prvider level using the prvider demgraphic and identifiers such as SSN, DEA, and License frm the input file. The prcess cmpares the input data t the Optum database and calculates a scre based n similarities and differences in the value f thse elements. If the input data achieves a scre higher than the match threshld, it is cnsidered a match. This matching allws data cmparisns t the Optum database fr data augmentatin f missing data elements based n apprved business rules in Sectin 4. Optum will then create 4 directry extract files using the layut in Sectin 4. These files will be zipped and placed n a passwrd prtected secure FTP flder. An ntificatin will be send t Cnnecture indicating that the directry extract files have been cmpleted fr the current Chesapeake Reginal infrmatin System fr ur Patients 3

4 cycle. Cnnecture will transfer the latest directry files t their server as input fr their directry prcess. 1.4 Prcess Flw. MD/CRISP Directry Flw MHBE Cnnecture CRISP MCOs QHPs Create Directry Input File Create Directry Input File Biweekly Directry Input DHMH Cllect input Files Perfrm Initial File Review Standard Surce Prcess (Aggregate, Clean, Standardize, Cllapse Input) Cntrl Reprt (Surce files included in Directry) Reprt Listing Inputs Recrds Excluded frm Directry Prcess Invalid Input Recrds CCA Prcess (Match t Optum Database, Augment Data) Cntrl Reprt Prduce Directry File Extract Emaiil Ntificatin Place/Retrieve Directry File n FTP Flder Prcess Directry File Chesapeake Reginal infrmatin System fr ur Patients 4

5 2. Input File Specificatins. 2.1 Frequency f Updates. Prvider directry files will be created n a bi-weekly cycle. The exact schedule will be determined. 2.2 File Naming Cnventins. Each participating QHP/MCO will be assigned a file naming cnventin. The file will names will cntain name f the file submitter (MCO/QHP). A sample file name is listed belw: Input File Name Frmat: MDCRISP_Surcename.txt 2.3 File Frmat. The directry input files are created as pipe-delimited ASCII text. A pipe will be used t separate fields. It is expected that each field will accunted fr in the layut. If there is n data in a field, there will still be a pipe t accunt fr that field and the field value will be set t Null. The field definitin in Sectin 4 lists the field attributes within the file layuts. Field attributes set t character cntaining numeric data will cntain leading zers (i.e. Zip Cde). 2.4 File Transmissin. Each QHP/MCO will be assigned a FTP flder fr their files. The FTP flders will be passwrd prtected. The QHP/MCO will place their input file in their assigned FTP flder. 3. Input File Specificatins. 3.1 Full Replacement File Cntent. The prvider input files will be full replacement files. The prvider input files will cntain the entire prvider directry at the pint f time f the file extract. These files will nt be transactinal files cntaining nly additins r updates frm the previus file. The files will als nt cntain any transactin dates r last update date related t the data within the file. 3.2 Input File Recrds. Recrds may include all individual prviders included in QHP r MCO netwrks submitted t the HBE. This includes physicians (primary care and specialists), nurses, behaviral specialists,, etc. It des nt include facilities r practices at this time (n mre and n less than ne persn per recrd). If nn-maryland prviders are included in a netwrk, they may be submitted. Chesapeake Reginal infrmatin System fr ur Patients 5

6 Each recrd n the input file will cntain unique ccurrence netwrk and practice address. There will be ne netwrk and ne address per recrd n the input file. Examples: - Prvider Jhn Smith is cntracted under 2 netwrks (NET1, NET2) by a QHP. The Prvider has 1 practicing address (1 Main Street). There will be 2 recrds n this file fr Jhn Smith Jhn Smith, NET1, 1 Main Street. Jhn Smith, NET2, 1 Main Street. - Prvider Mary Jnes is cntracted under 2 netwrks (NET3, NET4) by a QHP. The Prvider has 2 practicing addresses (1 Main Street, 10 State Street) that are cvered by bth netwrks. There will be 4 recrds n this file fr Mary Jnes. Mary Jnes, NET3, 1 Main Street. Mary Jnes, NET3, 10 State Street. Mary Jnes, NET4, 1 Main Street. Mary Jnes, NET4, 10 State Street. - Prvider Sue White is cntracted under 2 netwrks (NET5, NET6) by a QHP. The Prvider has 2 practicing addresses (1 Main Street, 10 State Street). The address at 1 Main Street is cntracted under Netwrk 5 nly. The address at 10 State Street is cntracted under Netwrk 6 nly. There will be 2 recrds n this file fr Sue White Sue White, NET5, 1 Main Street. Sue White, NET6, 10 State Street. 3.3 Optinal Translatin Files fr Cdes. QHPs/MCOs have an ptin f prviding cde fr values in the input fields such as languages spken, medical schl and specialty. These cde translatin files shuld cntain the cde and descriptin and be ASCII Text delimited by pipe similar t the prvider input files. Translatin files must be submitted in each cycle as full replacements similar t the prvider input files. 3.4 Input File Clumns. a. Data Element Name Name f input file element. Chesapeake Reginal infrmatin System fr ur Patients 6

7 b. Required/Critical Optinal. This cde nte whether the data element is required fr the prvider matching prcess. R Required fr matching. C - Highly Critical fr the matching prcess and shuld be included if pssible. Including these data elements will increase the prbability f matching. O - Optinal fields that are nt critical t the matching prcess, but will enhance the shpping experience fr cnsumers and may be displayed n the MHBE interface. c. Size. d. Field definitin e. Rules and examples Chesapeake Reginal infrmatin System fr ur Patients 7