The countdown is on for the June 15 deadline to submit your HEDIS 2018® data, and there’s no shortage of details to keep track of to ensure your submission is accurate, locked on time, and approved by your auditor. In the latest episode of Cotiviti’s “From the Trenches” podcast, we hear from Cotiviti product manager Jamison Gillitzer and senior data analyst Charan Govind, who offer important reminders to help health plans dot their i’s and cross their t’s in these final weeks of the HEDIS 2018 season.
From the Trenches is a new podcast from Cotiviti Technologies, a leader in healthcare data analytics, exploring the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and payer-provider collaboration. Check out all our episodes in your browser, or subscribe on your smartphone or tablet with Apple Podcasts, TuneIn, Google Play, and Stitcher.
About our guests:
Charan Govind’s responsibilities include successful HEDIS submission for health plans by providing insights on HEDIS measure-related questions and other troubleshooting of their data. He works to identify gaps in health plan’s data to help explain their HEDIS rates and validate other state-related submissions.
In general, there is a lot of back and forth with plans and their auditors over the coming weeks leading up to their final submission. As mentioned on last month’s podcast, MRRV officially began on May 9. Plans and auditors are in the thick of validating medical record review compliance and exclusion data to be used for their submission.
Once this audit is passed, plans will want to generate their IDSS and PLD files, validate they match using the Cotiviti PLD Validation report, and address any variances. Once all variances are accounted for, files can be loaded to the IDSS site, to CMS, and plan locked for auditor review. Very important: plans must be plan locked by June 1.
Between June 1 and 15, auditors are doing their final pass on submitted rates and if all looks good, applying “auditor lock.” Once the auditor lock is applied, plans are all clear to mark their submission final and submit their final rates. The deadline to “mark final” is June 15.
One thing to make sure to do prior to generating their IDSS files is to update their IDSS Sample Data Elements from the IDSS creation tool within Quality Reporter, which is the HEDIS reporting component of Cotiviti’s Quality Improvement solution. Doing this will ensure the latest hybrid compliance numbers are included in their XML and updated with the latest hybrid chart review. Plans will also want to make sure to run that they "Load/Reload IDSS_2018_INFO" table from this same screen to make sure they are using the latest data tags for HEDIS 2018.
Take time to ensure that IDSS and PLD match using the PLD Validation Report in Quality Reporter. It can save you the headache of needing to regenerate files and re-submit to CMS if validation isn't done prior to submission and a variance is found
Another to keep in mind when loading data to IDSS is to make sure to address all Tier 1 validation errors and understand and address if necessary any Tier 2 validation warnings prior to plan locking. Make sure you do not plan lock until all of your data is loaded, complete, and correct, because once you plan lock, you will not be able to make any edits without having your auditor unlock the submission for you.
If you're a Medicare plan, do not mark your submission final until the PLD file has been accepted by CMS. If you “mark final” and your PLD is not accepted, you may need to work with NCQA to unlock your IDSS submission to make updates.
One thing that should have already occurred is the locking of sample tables once MRRV starts. The Cotiviti data analyst team has scripts that can be shared to ensure that no data entry takes place after the NCQA deadline of May 9.
Balancing your PLD submission with IDSS is very important. Another important piece of PLD is ensuring that all members in your Medicare PLD file have a valid HIC number. The Medicare PLD Validation report does contain a count of null or missing HIC numbers in your PLD file. CMS can impose penalties for plans with invalid HIC numbers.
Another thing to remember is to make sure all measures have been run on the most recent, certified version of the code. You can use the Measure Status report in Quality Reporter to ensure you have run the most recent certified version of each measure. The GUIDs in this report should be the same as the ones that appear on Cotiviti’s full certification report from NCQA, and the “Measure Processed Date” should be after the “Certification Date."
Just as a general reminder, PCR has a separate PLD file—something to keep in mind while submitting.
Lastly, we recommend that clients keep their submission runs active until at least they have performed their next year's production run for comparison purposes. As part of Cotiviti’s standard practice, we will archive input files after the data run has taken place.
More and more states are requiring state-specific submissions, and it's important to make sure you are prepared for these submissions as well. This means reviewing rates with plenty of time before the submission deadline, ensuring you meet all auditor validation requirements, and generating or submitting all the required outputs by the state’s deadline.
In general, the Cotiviti data analyst and client services teams are here to help troubleshoot areas of concern that arise during submission, whether that might be from warnings on the IDSS site, or from your auditor, we are here to make sure you are able to report accurately and on time.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Podcast music credit: "Inhaling Freedom" by Nazar Rybak, via HookSounds.