Overview of Steps for Accessing Claims Data
Guidance for the Overview of Steps for Accessing Claims Data
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 01, 2020
Accessing Claims Data
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Accessing Claims Data
In order to access Medicare Parts A and B claims data, a Prescription Drug Plan (PDP) Sponsor must first complete the attestation process for each of their participating Prescription Drug Plan (PDP) Sponsor contracts. During this process, a Prescription Drug Plan (PDP) Sponsor formally reviews and agrees to comply with the Claims Data Usage Protocols . These protocols regulate how their organization may or may not use the Medicare claims data provided by the AB2D API, including limitations associated with the reuse and disclosure of the data.
- Attestation must be performed by a Medicare Part D Plan (PDP) Sponsor CEO, CFO, or COO.
- An Attestor must hold an active CEO, CFO, or COO role within their organization.
- Part D Plan (PDP) sponsors can have multiple executives attest to each of their participating contracts. This is considered best practice and is strongly encouraged.
- Attested Part D Plan (PDP) sponsors are able to retrieve claims data for active plan enrollees from the date of attestation onwards. Claims data prior to the attestation date will not be provided.
- Participating Part D Plan (PDP) sponsors must have an active Attestor at all times and will not receive data during periods where the (PDP) sponsor does not have an active Attestor. Data access will be restored once another active CEO, CFO, or COO attests. We highly recommend that Part D Plan (PDP) sponsors have multiple executives attest to contracts to reduce the risk of lapses in access to data based on attestation status.
- Log into HPMS
- Click on “Claims Data Attestation” (under Contract Management)
- Select the checkbox(es) next to one, multiple, or all contracts within the 'Contracts Without Attestation' window
- Click on the "Attest" button
- Review the Claims Data Usage Protocols
- Select the checkbox next to: "I hereby certify that I understand the attestation above"
- Click "Confirm"
- Log into HPMS
- Click on "Claims Data Attestation" (under Contract Management)
- Select the checkbox(es) next to one, multiple, or all contracts within the 'Attested Contract' window
- Click on the "Re-Attest" button
- Review the Claims Data Usage Protocols
- Select the checkbox next to: "I hereby certify that I understand the attestation above"
- Click "Confirm"
- The "AB2D Data Operations Specialist" will need to record the Log ID from jobs that were executed successfully; retrieving synthetic claims data in our Sandbox environment.
- The "AB2D Data Operations Specialist" will provide the Log ID from one of these jobs to the AB2D Team.
- After the "AB2D Data Operations Specialist" has provided their IP addresses and verified synthetic data retrieval, the AB2D team will work directly with the Attestor(s) to provide their organization’s production credentials.
- Using the production credentials, the Part D Plan (PDP) sponsors will connect to the AB2D API in our production environment to download actual Medicare Parts A and B claims data.
- The AB2D team will work closely with the organization and its "AB2D Data Operations Specialist" to answer any questions or troubleshoot any issues they have connecting to the AB2D API.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.