Introduction to the Virtual Research Data Center (VRDC)
|
|
- Myra Newman
- 8 years ago
- Views:
Transcription
1 Introduction to the Virtual Research Data Center (VRDC) 02/05/2014 Faith Asper, MHS Director, ResDAC Assistance Desk Jeff Whitley, Manager Information Systems General Dynamics Information Technology (GDIT)
2 About ResDAC Centers for Medicare and Medicaid (CMS) contractor Offers assistance to researchers interested in using Medicare and Medicaid data for research Staffed by a team of public health and health services research specialists Provides services related to CMS data Assistance Desk Workshops and Outreach 2
3 Overview of Webinar Describe the Virtual Research Data Center (VRDC) Data Availability and Cost Advantages of the VRDC Provide Overview of the Request Process Materials needed Access process Overview of the VRDC Environment (GDIT) 3
4 Description of the VRDC The CMS VRDC is a virtual research environment, within CMS s Chronic Condition Data Warehouse (CCW), that provides timelier access to Medicare and Medicaid program data in a more efficient and cost effective manner. 4
5 Data Available Through the VRDC All CMS identifiable data files Data File Name Master Beneficiary Summary File (MBSF): base, chronic conditions, cost & utilization, NDI Utilization: MedPAR, Inpatient, Outpatient, Home Health, Hospice, Skilled Nursing Facility, Carrier, DME Part D event and characteristics files (drug, plan, prescriber, pharmacy, formulary) Years Available ; Medicare NDI ; Medicaid NDI Assessments: MDS, OASIS, IRF-PAI, Swing Beds Medicaid: MAX, Beta-MAX ; Formulary file available (MAX) 2011 (Beta-MAX) 5
6 VRDC Restrictions - Upload User held data can be uploaded to the environment Data space maximum within the upload review area: Total allocation of 50 gigabyte (GB) per individual user is available. Uploaded files are reviewed to ensure they are virus free before files are moved to a user s library. User responsible for assuring any non-public data being uploaded into the VRDC environment is not proprietary/restricted by a license agreement.» If proprietary, user must obtain approval and include approval with data request package 6
7 VRDC Restrictions - Download Users can download aggregate/statistical data files from the environment Users may be subject to download review to ensure no identifiable data is removed from the VRDC. 1GB maximum on the size of approved files that can be downloaded. Multiple files may be downloaded but each file must be within the specified size limit (1GB). 7
8 Cost VRDC Access to the VRDC is priced by the number of seats A seat is defined as an individual with direct access into the VRDC environment. Annual seat cost is $40,000 Can have other seats for the same project for $15,000/year. Additional space can be purchased; $2,000 for each 500GB of additional space. Specifics on pricing are found in the CMS VRDC FAQs. 8
9 Advantages of the VRDC Up to 500 GB of space for data and analysis Set price/year/seat May be less expensive than current cost of obtaining portable media if requesting several years of data or very large cohort. Greater flexibility with number of years/files needed for research. Data management is centralized within the environment. Can download aggregate results. Eliminates the need for acquisition of equipment to store and analyze data. 9
10 Request Process ResDAC assists researchers with the review of materials and answering any questions about the contents of data files, cost, and process. Requestors must obtain IRB approval. Requests will be reviewed and approved by CMS Privacy Board. See the ResDAC VRDC request website for list of materials. Access to the VRDC environment occurs after the CMS DUA has been approved. 10
11 Request Process Research Requests need to include Description of the study, including objectives and design Justification for why the data requested is the minimum amount of data needed to answer the study question Explanation of how this study will benefit the Medicare and/or Medicaid programs Description of how the study findings will be disseminated 11
12 VRDC Research Request Process 12
13 Step 1: Obtain the request materials Start at the ResDAC home page 13
14 Step 1: Obtain the request materials The request materials are at the bottom of the VRDC Request page. 14
15 Step 1: Obtain request materials Download request materials 15
16 Step 2: Prepare a draft Prepare a draft of all the documents (before signing them) ResDAC will provide technical and administrative review of the materials. 16
17 Step 3: drafts to ResDAC draft documents to ResDAC will review, obtain cost invoice, provide comments and all documents back for final revisions and signatures. 17
18 Step 4: final copies to ResDAC final documents with signatures to CMS can t accept digital signatures. ResDAC will forward all to CMS for processing. 18
19 Step 5: Submit Payment After the CMS Privacy Board reviews and approves the request, CMS s requestor: DUA number with approval notice Instructions to submit payment Once the requestor submits payment, CMS will notify GDIT that they can provide the user access to the VRDC. 19
20 Resources for Help (ResDAC) ResDAC Assistance Desk Phone: Web: ResDAC Website CMS Data Request Center: VRDC request center ResConnect (Resource Library)» Tips for Completing the DUA» Request Documents for Research Identifiable Data Requests: Data Use Agreement 20
21 About GDIT (formerly Buccaneer) Centers for Medicare and Medicaid (CMS) contractor Manages and hosts the VRDC environment Staffed by a team of analysts and infrastructure/database personnel Provides data extracts, hosts the source data warehouse and access to it, develops products for accessing and reporting upon the data Maintains and operates the VRDC Help Desk (CCWHelp@GDIT.com) 21
22 Specialized VRDC Research Files Master Beneficiary Summary File: Annual file with individual segments ( ) Beneficiary Summary A/B/D» Enrollment (A,B,D enrollment indicators) / Entitlement Chronic Conditions» Incidence flags / Dates of first occurrence Cost and Use» Claims counts / Reimbursements National Death Index (Medicare ; Medicaid ) 22
23 Specialized VRDC Research File Part D Event (PDE) Characteristics files ( ) Drug : Special licensing arrangement with First DataBank. Four variables for drugs dispensed: brand name, generic name, strength, and form for the NDC code observed on the PDE. Plan: Five files: 1) plan benefit package, 2) premiums, 3) cost sharing tiers, 4) service area, and 5) Plan crosswalk. Prescriber: The HCIdea Prescriber Database is data source. Provides information on the type of provider who prescribed the medication. 23
24 Specialized VRDC Research File Part D Event (PDE) Characteristics files ( ) Pharmacy: National Council for Prescription Drug Programs (NCPDP) Database is the data source. Provides additional information about pharmacy to include common parent organization. Formulary (2010-forward): Provides information on the types of drugs covered on the formulary for each plan s Part D plan benefit package. 24
25 Specialized VRDC Research File Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) ( ) Suite of linked files that allows for the examination of all Medicare and Medicaid enrollment and claims data for those who were dually enrolled in both programs. Both Medicare claims and Medicaid Analytic extract (MAX) claims, as well as the corresponding beneficiary enrollment and demographic information, is available in annual calendar year data files. 25
26 Accessing the Data Standard SAS Datasets within SAS EG VRDC Technical Analysts to extract nonstandard data and move to user s library 26
27 VRDC Onboarding Process Upon DUA and payment confirmation, VRDC Help is notified via the VRDC Access Request System (CARS) that CMS has approved a request for access VRDC Help sends approved user security documentation for completion Upon review and acceptance of completed documentation, VRDC Help notifies user via of: VRDC Username and Password VPN access instructions 27
28 VRDC Overview 28
29 CCW Website 29
30 Website Login 30
31 VPN and VRDC Login 31
32 Virtual Desktop 32
33 File Transfer Request System (FTRS) - Upload 33
34 File Upload Process 34
35 SAS EG Environment 35
36 FTRS - Download 36
37 Output Review 37
38 File Download Process 38
39 Resources for Help (GDIT) VRDC Help Desk Phone: Public Web: CCW Website Public section contains interactive and static reports about Medicare and Medicaid data as well as Data Dictionaries of extracted files Secure website has reference user guides and instructional videos on using the VRDC 39
40 Questions Submit your question through the Q&A icon at the top of your screen. Submit a question through the Chat feature. 40
Leveraging CMS Data to Accelerate Health System Change
Leveraging CMS Data to Accelerate Health System Change Niall Brennan Chief Data Officer CMS @N_Brennan Introduction CMS is the largest single payer for health care services in the US Expected to serve
More informationCCW Medicare Part D User Guide. October 2015 Version 5.2
CCW Medicare Part D User Guide October 2015 Version 5.2 This page intentionally left blank. Overview The Medicare Part D prescription drug benefit was authorized through the Medicare Prescription Drug,
More information1.1. Who will have the main responsibility for organizing, storing, and archiving the data? Please provide name(s) and job title(s).
Executive Summary for Research Identifiable Data Version /03 DATA MANAGEMENT PLAN Please reference the Data Management Plan Guidelines, Data Management Plan Evaluation Guide, and/or the FAQ document for
More informationNew Data Products: Chronic Condition Warehouse (CCW) & Medicare Current Beneficiary Survey (MCBS)
New Data Products: Chronic Condition Warehouse (CCW) & Medicare Current Beneficiary Survey (MCBS) Andy Shatto, Director, Division of Data Development and Services Group Office of Information Products and
More informationChristopher Powers, Acting Director
Transparency of Hospital Inpatient and Outpatient Pricing Data The National Summit on Health Care Price, Cost and Quality Transparency Christopher Powers, Acting Director Information Products Group, Office
More informationMedicaid Research Support Tools. Gerri Barosso, RD, MPH, MS Technical Advisor University of Minnesota
Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS Technical Advisor University of Minnesota Overview Available resources and where to find them: Medicaid program description State coverage and
More informationThe Medicare Master Beneficiary Summary File
The Medicare Master Beneficiary Summary File THE OLD AND NEW INFORMATION IT CONTAINS Marshall McBean, M.D., M.Sc. Principle Investigator and Director, ResDAC Professor, University of Minnesota Beneficiary-Level
More informationCMS Data Resources. Informing the Affordable Care Act. Jason Petroski, PhD, MPA Director, Division of Survey Management and Data Analysis
CMS Data Resources Informing the Affordable Care Act Jason Petroski, PhD, MPA Director, Division of Survey Management and Data Analysis December 5, 2012 Session Overview Describe Current and Planned Survey
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6
More informationState Medicaid Agencies Medicare Modernization Act Final Rule Fact Sheet
State Medicaid Agencies Medicare Modernization Act Final Rule Fact Sheet Guidance for States to Implement the Medicare Drug Benefit CMS is announcing new steps to assist states with the implementation
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationFrequently Asked Questions: Medicare Supplement & Medicare Advantage
Frequently Asked Questions: Medicare Supplement & Medicare Advantage Who is eligible for CBIA s Medicare program? A CBIA Health Connections participant is eligible for either plan if they are qualified
More informationMedicare-Medicaid Coordination Office
Increasing Access to Seamless, Quality and Person Centered Care Programs for Dual Eligibles Edo Banach Senior Advisor Medicare Medicaid Coordination Office Centers for Medicare & Medicaid Services March
More informationNAMD WORKING PAPER SERIES. Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data
NAMD WORKING PAPER SERIES Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data May 2012 444 North Capitol Street, Suite 309 Washington, DC 20001 Phone: 202.403.8620
More informationClaims Data: Source and Processing. Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, and Research University of Minnesota
Claims Data: Source and Processing Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, and Research University of Minnesota Overview of CMS Claims Data What is a claim? How are claims processed?
More informationSAS Programming with Medicare Administrative Data
SAS Programming with Medicare Administrative Data Matthew Gillingham From SAS Programming with Medicare Administrative Data. Full book available for purchase here. Contents About This Book... ix About
More informationMEDICARE PART D THE BASICS
THE BASICS Participation is voluntary. The income level and assets of beneficiaries determine the level of prescription assistance they will receive. Beneficiaries with incomes over 150% of the Federal
More informationNCHS-CMS Medicare Part D Event File
NCHS-CMS Medicare Part D Event File Variable Name Variable Description Type Length SURVEY NCHS Survey linked to CMS Medicare Data CHAR 16 PUBLICID * NCHS Survey Identifier - Participant Identification
More informationMaking Sense of Medicare
Making Sense of Medicare Stephanie M. Turnbull Manager, Member Benefits 1 Highlights Medicare Eligibility Types of Medicare Coverage Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicare
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationWhat Would Strengthen Medicaid LTSS?
What Would Strengthen Medicaid LTSS? Melanie Bella Director Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 1, 2013 Medicare-Medicaid Coordination Office Section 2602
More informationPROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS
PROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS The information listed below is Sections B of the proposed ruling
More information08/24/2015. Medicare-Medicaid Coordination Office. Medicare-Medicaid Enrollee Delivery System Transformation. Section 2602 of the Affordable Care Act
Improving Care for Medicare-Medicaid Enrollees Centers for Medicare & Medicaid Services August 19, 201 Section 2602 of the Affordable Care Act Purpose: Improve quality, reduce costs and improve the beneficiary
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationHow To Use The Cms Data File For Research
Chronic Conditions Data Warehouse Medicare Administrative Data Version 3.1 March 2015 Overview One of the goals of Section 723 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
More informationPrescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More informationNCPDP Electronic Prescribing Standards
NCPDP Electronic Prescribing Standards September 2014 1 What is NCPDP? An ANSI-accredited standards development organization. Provides a forum and marketplace for a diverse membership focused on health
More informationKaiser Permanente Guide to Medicare Basics
Kaiser Permanente Guide to Medicare Basics The National Medicare program, which was created in 1965, has given people peace of mind and the security of knowing they ll have access to health coverage. Medicare
More informationMedicare Advantage 101. Michael Taylor, PhD Medicare Advantage Branch Manager Centers for Medicare & Medicaid Services Atlanta Regional Office
Medicare Advantage 101 Michael Taylor, PhD Medicare Advantage Branch Manager Centers for Medicare & Medicaid Services Atlanta Regional Office Objectives General Overview of Medicare Advantage CMS 5 Star
More informationHow To Get A Health Insurance Plan From Ctf
Overview of Health Insurance Options for Medicare-Eligible Members The following pages offer general descriptions of the types of plans offered to CTPF retirees who are eligible for and maintain active
More informationPrescription Drug Coverage. Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP
Prescription Drug Coverage Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP Medicare Part A Prescription Drug Coverage Part A generally pays for
More informationMAPD-SNP Contract Numbers: H5852; H3132
Policy and Procedure No: 93608 PHP Transition Process Title: Part D Transition Process Department: Pharmacy Services, Managed Care Effective Date: 1/1/2006 Supercedes Policy No: PH 8.0 Reviewed/Revised
More informationUPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES
UPDATED: NOVEMBER 2009 344.1 NOTE: Enrollment in Medicare is a condition of eligibility for Medicaid. Beginning in 2006, persons entitled to Part A and/or enrolled in Part B are eligible for the prescription
More informationSECTION 12 - REIMBURSEMENT METHODOLOGY
SECTION 12 - REIMBURSEMENT METHODOLOGY 12.1 THE BASIS FOR ESTABLISHING A RATE OF PAYMENT...2 12.2 DETERMINING A FEE...2 12.2.A LONG-TERM CARE DISPENSING FEE REQUIREMENTS...3 12.3 MEDICARE/MEDICAID REIMBURSEMENT
More informationMedRIC Documentation for HRS Data Requestors
MedRIC Documentation for HRS Data Requestors Acumen, LLC 500 Airport Blvd., Suite 365 Burlingame, CA 94010 Table of Contents 1) Project Overview... 3 1.1 MedRIC... 3 1.2 MedRIC and the Health and Retirement
More informationVNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City Roberta Brill Vice President, VNS Health Plans VNS CHOICE Organization Subsidiary of the Visiting Nurse Service of New York
More informationMEDICARE PLANS. from Blue Cross and Blue Shield of Minnesota. H2461_082715_T01 CMS Accepted 09/09/2015 S5743_082715_B04_MN CMS Accepted 09/09/2015
2016 MEDICARE PLANS from Blue Cross and Blue Shield of Minnesota H2461_082715_T01 CMS Accepted 09/09/2015 S5743_082715_B04_MN CMS Accepted 09/09/2015 CHOOSING YOUR MEDICARE PLAN Medicare options designed
More informationAnnual Notice of Changes for 2016
Upper Peninsula Health Plan Advantage (HMO) offered by Upper Peninsula Health Plan, LLC Annual Notice of Changes for 2016 You are currently enrolled as a member of Upper Peninsula Health Plan Advantage
More informationMedicare Advantage and Part D Proposed Rule for Contract Year 2015 Prepared for Healthcare Leadership Council. January 2014 Avalere Health LLC 1
Medicare Advantage and Part D Proposed Rule for Contract Year 2015 Prepared for Healthcare Leadership Council January 2014 Avalere Health LLC 1 Overview On January 6, the Centers for Medicare & Medicaid
More informationTable of Contents. 2 P a g e
Table of Contents Introduction... 3 Important Contact Information... 3 Pharmacy Rights... 3 Claims Adjudication... 3 Reversals... 4 Required Data Fields... 4 Identification cards... 4 Required Identification
More informationSummary of benefits. 2009 idaho, utah. Health Net orange prescription drug plan
Health Net orange prescription drug plan Summary of benefits 2009 idaho, utah Benefits effective January 1, 2009 (S5678-064) PDP Option 1 (S5678-063) PDP Value Option 2 Section I INTRODUCTION TO SUMMARY
More informationH7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas
H7833_150304MO01 Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas Agenda Connecting Medicare and Medicaid Eligible Members Service Coordination
More information2016 Evidence of Coverage for Passport Advantage
2016 Evidence of Coverage for Passport Advantage EVIDENCE OF COVERAGE January 1, 2016 - December 31, 2016 Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Passport
More informationPHARMACY DEPARTMENT Sheryl D. Waudby, MS, RPh Pharmacy Director
PHARMACY DEPARTMENT Sheryl D. Waudby, MS, RPh Pharmacy Director Pharmacy Benefit Manager (PBM) Formulary Generics Prior Authorization Process Specialty Pharmacy UPHP Web Site Reasons Why a Prescription
More informationHelping you make the right Medicare decisions. Use. Choose. your benefits effectively. your health. care plan. Improve. and manage.
Helping you make the right Medicare decisions Choose your health care plan Use your benefits effectively Improve and manage your health Your Guide to Selecting Medicare Coverage for 2015 What s Inside
More informationSTEPPING INTO MEDICARE. Invaluable help from the name you know and trust Blue Cross and Blue Shield of Illinois
STEPPING INTO MEDICARE Invaluable help from the name you know and trust Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Illinois offers a great array of plans that pick up where Medicare
More informationMedicare Coverage Gap Discount Program Dispute Resolution
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE DATE: March 5, 2012 TO: FROM: SUBJECT: Pharmaceutical
More informationMedicare Prescription Drug Benefit
Medicare Prescription Drug Benefit Karen Tritz Overview Overview of new Medicare Prescription Drug Benefit The Timing and Process Implications for Working People with Disabilities Overview of Medicare
More informationFirst Name Middle Initial Last Name. Home Address. City State Zip. E-mail Date of Birth Sex: Male Female
800.334.1330 254.773.1330 fax 254.774.7652 4912 Midway Drive Post Office Box 6130 Temple, TX 76503-6130 www.carehealthplan.com A. PLEASE INDICATE WHICH PLAN YOU WISH TO ENROLL IN: Plan #4000 - Supplement
More informationMedicare Insurance That Keeps Healthcare Decisions in the Hands of Local Providers
Important Information for Providers Medicare Insurance That Keeps Healthcare Decisions in the Hands of Local Providers INT.197.07 Underwritten by Sterling Life Insurance Company Sterling Life Insurance
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...
More informationAnnual Notice of Changes for 2015
Express Scripts Medicare (PDP) for Consolidated Associations of Railroad Employees (CARE) Annual Notice of Changes for 2015 You are currently enrolled as a member of Express Scripts Medicare (PDP). The
More informationMedicare. Prescription Drug Plan Guide. Simple steps to help you choose the right prescription drug coverage
Medicare Prescription Drug Plan Guide An educational resource developed by Simple steps to help you choose the right prescription drug coverage and published by Rite Aid Corporation. Rite Aid pharmacists
More informationERASMUS + EUROPEAN VOLUNTARY SERVICE Decentralized actions ROLE OF NATIONAL AGENCIES, SENDING AND HOSTING ORGANIZATIONS WITHIN THE INSURANCE CONTRACT
ERASMUS + EUROPEAN VOLUNTARY SERVICE Decentralized actions ROLE OF NATIONAL AGENCIES, SENDING AND HOSTING ORGANIZATIONS WITHIN THE INSURANCE CONTRACT 1 ROLE OF NATIONAL AGENCIES Provide the passwords (starting
More informationExceptions and Appeals for Drug Therapies: A Guide for Healthcare Providers
Exceptions and Appeals for Drug Therapies: A Guide for Healthcare Providers Table of Contents Introduction... 5 Prior Authorization... 7 Overview... 7 Step Therapy... 7 Quantity Limits... 7 The Prior Authorization
More informationSummary of Benefits. (PDP), Blue MedicareRx Plus SM. (PDP) and Blue MedicareRx Premier SM
Summary of Benefits for SM, Plus SM and Premier SM Available in Maine and New Hampshire A -approved Part D sponsor. Anthem Insurance Companies, Inc. (AICI) is the legal entity who has contracted with the
More informationCMS Perspectives on Transparency and The Use of Data to Drive Patient Centered Care
CMS Perspectives on Transparency and The Use of Data to Drive Patient Centered Care Niall Brennan Chief Data Officer Centers for Medicare & Medicaid Services @N_Brennan Introduction CMS is the largest
More informationDeveloped by the Centers for Medicare & Medicaid Services
Developed by the Centers for Medicare & Medicaid Services Every year millions of dollars are improperly spent because of fraud, waste, and abuse. It affects everyone. Including YOU. This training will
More informationEvidence of Coverage:
January 1 December 31, 2016 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Advantra Silver (HMO) This booklet gives you the details about
More informationOFFICE OF COMMUNICATIONS. Date: September 19, 2014. To: All Medicare Part D Plans. Director, Web and New Media Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Office of Communications 7500 Security Boulevard, Mail Stop S1-01-26 Baltimore, Maryland 21244-1850 OFFICE OF COMMUNICATIONS
More informationPHARMACY MANUAL. Walgreens Health Initiatives, Inc. 2275 Half Day Road, Suite 250 Bannockburn, IL 60015
PHARMACY MANUAL Walgreens Health Initiatives, Inc. 2275 Half Day Road, Suite 250 Bannockburn, IL 60015 Walgreens Health Initiatives, Inc. ( WHI ) is pleased to include you in our network of participating
More informationFAQs on the Required National Provider Identifier (NPI)
FAQs on the Required National Provider Identifier (NPI) Provided by the National Community Pharmacists Association (NCPA) and the National Council for Prescription Drug Programs (NCPDP) At-A-Glance: Important!
More informationPrescription Drug Benefits
Prescription Drug Benefits This insert will accompany the Medicare- Coordinating Plans Member Handbook for enrollees who are eligible for and have elected these benefits. Important Notice... 1 Using Your
More informationSUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.10. 1. INTRODUCTION. The Commissioner of Workers Compensation
Part 2. Texas Department of Insurance, Page 1 of 10 SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.10 1. INTRODUCTION. The Commissioner of Workers Compensation ( Commissioner ), Texas
More informationPart D payment system
Part D payment system paymentbasics Revised: October 204 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 70 Washington, DC 2000 ph: 202-220-3700 fax: 202-220-3759
More informationMemo To: Component Executive Directors From: Dr. Mark Feldman Subject: Updated Medicare Information for Members
Memo To: Component Executive Directors From: Dr. Mark Feldman Subject: Updated Medicare Information for Members The Centers for Medicare and Medicaid Services (CMS) has updated information on the Medicare
More informationBest Practice Recommendation for
Best Practice Recommendation for Exchanging & Processing about Pharmacy Benefit Management Version 091714a Issue Date Version Explanation Table of Contents Improvement Opportunity:... 1 Summary of Recommendation:...
More informationTHE A,B,C,D S OF MEDICARE
THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION
More informationUnderstanding Medicare and How It Works
Understanding Medicare and How It Works Get the facts about your Medicare insurance options 1 What Is Medicare? 2 Medicare is a health insurance program for people 65 or older or under 65 and with certain
More informationMartin s Point Generations Advantage Policy and Procedure Form
SCOPE: Martin s Point Generations Advantage Policy and Procedure Form Policy #: PartD.923 Effective Date: 4/16/10 Policy Title: Part D Transition Policy Section of Manual: Medicare Prescription Drug Benefit
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE April 8, 2011 EFFECTIVE DATE April 8, 2011 MEDICAL ASSISTANCE BULLETIN NUMBER 03-11-01, 09-11-02, 14-11-01, 18-11-01 24-11-03, 27-11-02, 31-11-02, 33-11-02 SUBJECT Electronic Prescribing Internet-based
More information8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
More informationMedicare Advantage and Part D Fraud, Waste, and Abuse Training. October 2010
Medicare Advantage and Part D Fraud, Waste, and Abuse Training October 2010 Introduction 2008: United States spent $2.3 trillion on health care. Federal fiscal year 2010: Medicare expected to cover an
More informationWhat is the prior authorization process for Skilled Nursing Facility Admission?
MyCare Long Term Care (LTC) Nursing Facility FAQs The nursing facility network is an essential part of the health care delivery system and we value your partnership. We appreciate the compassion you offer
More informationCMMI Payment Bundling Initiative
CMMI Payment Bundling Initiative Table of Contents Questions & Answers... 2 Technical... 2 General... 3 Inpatient... 12 Skilled Nursing Facility (SNF)... 18 Outpatient... 20 Home Health... 23 Carrier...
More informationUser Guide. COBRA Employer Manual
Experience Excellence COBRA Manual User Guide COBRA Employer Manual COBRA Responsibilities and Deadlines Under COBRA, specific notices must be provided to covered employees and their families explaining
More informationTEXAS VENDOR DRUG PROGRAM PHARMACY PROVIDER PROCEDURE MANUAL
1 OF 10 DOCUMENT HISTORY LOG STATUS REVISION EFFECTIVE DESCRIPTION Revision 1.1 Sep. 1, 2015 Baseline 1.0 Feb. 1, 2015 3.1 Eligible Entity 5 CAD Claim Submission o Instruction update and email address.
More information2013 SUMMARY OF BENEFITS
22222 2013 SUMMARY OF BENEFITS Plus Prescription Drug Plans S5670 S5768 Y0022_PDP_2013_S5670_036_S5768_009_S5768_129SBa Accepted FH13SB06VP2 22 SECTION I INTRODUCTION TO SUMMARY OF BENEFITS Thank you for
More informationMedicare Part D & Ryan White HIV/AIDS Program As of November 2008
Medicare Part D & Ryan White HIV/AIDS Program As of November 2008 The below discussion can guide Ryan White HIV/AIDS programs in understanding implications of the Medicare Part D prescription drug benefit
More informationit's quite a variety of issues.
>> So this talk is on the Medicaid Research Support Tools. And what I want to be able to do in this presentation is give you an idea. We've mentioned resources over the course of this workshop. There are
More informationMedicare Part D Prescription Drug Coverage
Medicare Part D Prescription Drug Coverage GENERAL INFORMATION Coverage Medicare Part D coverage is available to everyone enrolled in Medicare Drug plans are offered by insurance companies and other private
More informationMedicare Part D. Low Income Subsidies Operational Issues
Medicare Part D Low Income Subsidies Operational Issues Low-Income Subsidies Federal government will subsidize low-income beneficiaries for all or part of their premiums, deductibles, and copays. Dual
More informationYour Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP
January 1 December 31, 2015 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP This booklet gives you the
More informationHealth Net Member Services: For help or information, please call Member Services or go to our Plan website at www.healthnet.com.
f Your Medicare Health Benefits and Services as a Member of Health Net Value Orange Option 2 This mailing gives you the details about your Medicare health coverage from January 1 December 31, 2009, and
More informationDual Eligible and Low-Income Medicare Beneficiaries and Part D
Dual Eligible and Low-Income Medicare Beneficiaries and Part D Presentation to National Medicaid Congress by Andy Schneider, Senior Advisor June 5, 2006 What is the Experience of Dual Eligible and Low-Income
More informationMEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016
PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 (800)262-4414 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 Se habla español
More informationMedicare + GEHA. Protect yourself from unexpected health care expenses
Medicare + GEHA Protect yourself from unexpected health care expenses Table of contents Facts about Medicare 5 Medicare Part A 6 Medicare Part B 6 Medicare Part C 7 Medicare Part D 8 GEHA + Medicare 10
More informationMedicare Advantage Program. Michael Taylor, PhD Medicare Advantage Manager
Medicare Advantage Program Michael Taylor, PhD Medicare Advantage Manager Objectives General Overview of Medicare Advantage CMS 5 Star Ratings Medicare Part C & D Audit Process Coping with Contract Terminations
More informationMEDICARE BASICS WHAT TO KNOW AND WHAT TO EXPECT WITH MEDICARE
MEDICARE BASICS WHAT TO KNOW AND WHAT TO EXPECT WITH MEDICARE AGENDA What is original Medicare? The A, B, C, and D s of Medicare Enrollment periods Medicare Advantage star rating system Where you can find
More informationBayCrest Insurance Services, 1275 S. Winchester Blvd., B, San Jose, CA 95128 Allan S. Eckmann. Medicare 2014
BayCrest Insurance Services, 1275 S. Winchester Blvd., B, San Jose, CA 95128 Allan S. Eckmann What is Medicare? Medicare 2014 Medicare is a Health Insurance Program for: * People age 65 or older * People
More informationMedigap Insurance 54110-0306
Medigap Insurance Overview A summary of the insurance policies to supplement and fill gaps in Medicare coverage. How to be a smart shopper for Medigap insurance Medigap policies Medigap and Medicare prescription
More informationMedicare and the Cost of Cancer Treatment
1.800.847.9680 Medicare and the Cost of Cancer Treatment This article is for both the person facing cancer today, wanting to know what to expect from their Medicare insurance as well as for the person
More information2013 SUMMARY OF BENEFITS
2013 SUMMARY OF BENEFITS Plus Prescription Drug Plans S5670 S5768 Y0022_PDP_2013_S5670_138_S5768_119_S5768_150_SBb Accepted FH13SB935 SECTION I INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your interest
More informationDecember 2014. Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency
December 2014 Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency I. Background Federal Employees Health Benefits (FEHB) Program Report on Health
More informationWhen Public Payment Declines, Does Cost-Shifting Occur? Hospital and Physician Responses. November 13, 2002 Washington, DC
When Public Payment Declines, Does Cost-Shifting Occur? Hospital and Physician Responses November 13, 2002 Washington, DC These materials were commissioned by the Robert Wood Johnson Foundation for use
More informationMedicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15
Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may
More informationMedicare Advantage Outreach and Education Bulletin
Medicare Advantage Outreach and Education Bulletin 2012 California Medicare Advantage Update Dear Healthcare Provider, Annual benefits changes for Medicare Advantage plan members will be effective January
More informationHEALTHSPAN MEDICARE HEALTH PLAN
This is an advertisement. HealthSpan Medicare Advantage for Federal Members (HMO) YOUR GUIDE TO CHOOSING A HEALTHSPAN MEDICARE HEALTH PLAN INCREASE YOUR COVERAGE without increasing your FEHB premium. MAKE
More informationNovember 2009 Special Edition
NOVEMBER 2009 MEDICAID UPDATE Volume 25, Number 14, www.nyhealth.gov DAVID A. PATERSON GOVERNOR State of New York RICHARD F. DAINES, M.D. COMMISSIONER New York State DOH DEBORAH BACHRACH DEPUTY COMMISSIONER
More informationMedicare Coverage Gap Discount Program (Filling the Donut Hole)
Medicare Coverage Gap Discount Program (Filling the Donut Hole) Summary: Requires drug manufacturers to provide a 50 percent discount to Part D beneficiaries for brand name drugs and biologics purchased
More information