The managed care regulation provides requirements for states and managed care plans related to Medicaid encounter data.
Managed Care Encounter Data Toolkit
This toolkit provides a practical guide to collecting, validating, and reporting Medicaid managed care encounter data. It is designed as a step-by-step guide for state Medicaid staff responsible for managing the daily operations involved in encounter data, as well as for senior managers and policymakers who oversee this function. It contains case studies, checklists, and links to resources that provide helpful tips and tools.
Medicaid Managed Care Encounter Data Validation Toolkit
This updated toolkit provides practical information about Medicaid managed care encounter data validation that states can use to improve the quality of information they receive from managed care plans and report to the Centers for Medicare & Medicaid Services (CMS). The toolkit describes activities that all States should perform to ensure high quality data, and includes examples of current State practices, checklists to assist State staff who conduct validation, and resources that provide helpful tips and tools. We have updated this toolkit to incorporate guidance about the periodic audit process for encounter data, as required at 42 CFR § 438.602(e). This toolkit provides techniques to help states ensure robust audits of their encounter data validation processes to assess the accuracy, truthfulness, and completeness of their encounter data and the sufficiency of their validation processes. The guidance is designed to support state Medicaid staff responsible for managing the daily operations involved in validating encounter data. It is also intended for senior managers and policymakers who oversee this function.
Assessing the Usability of 2011 Behavioral Health Organization Medicaid Encounter Data
CMS released the Assessing the Usability of 2011 Behavioral Health Organization Medicaid Encounter Data technical assistance brief. This brief assesses the completeness and quality of encounter data for Medicaid managed care behavioral health organizations (BHOs) in 2011. It provides an update to a similar study conducted using Medicaid Analytic eXtract 2009 data. It describes state variation in the use of delivery systems, which benefits are covered, and the types of Medicaid beneficiaries enrolled in BHOs. Please direct any questions related to this issue brief to managedcareTA@mathematica-mpr.com.