atag: ffq overview and update date: 3/12/2015. ffq overview and update goals of ffq initial...
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ATAG: FFQ Overview and Update
Date: 3/12/2015
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FFQ Overview and Update Goals of FFQ Initial reporting What we have learned
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Goals of Implementing FFQ System Customization
Submitters can directly request exceptions for non-catastrophic failures
Exceptions can be granted with more flexibility: Single file only Exception granted for a period of time Exception granted, but new thresholds defined
Timing Files are checked prior to being loaded to decrease the
response time to data submitters
Reporting Timing Results Potential new quality checks
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Initial Submissions Receipt of initial submission
2014Q4 submissions were due 1/31/2015 31 initial submissions received on time
Average day of receipt: 1/21/2015 11 submissions received in final week
4 submissions received late 4 submissions had approved APAC-3
Challenges Files must adhere to the current Data Layout specifications
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Initial Submissions Field Level Checks
Challenges Files must adhere to the current Data Layout specifications Upfront file checking – spaces in fields
Example: NPI that contains spaces after data “1234567890 ” vs “1234567890”
FILE TYPEZERO FIELD
ERRORS1+ FIELD ERRORS
ENROLLMENT 21 4 8 33MEDICAL 8 7 12 27MEMBERSHIP 31 1 1 33PHARMACY 9 8 9 26PROVIDER 7 11 9 27TOTALS 26 1 5 32
NON CATASTROPHICTOTAL FILES
CATASTROPHIC FAILURES
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Initial Submissions Quality Checks
Similar success rates on quality checks when compared to prior validation process.
Feedback from submitters resulted in a change to the quality checks Provider file – NPI or Taxonomy
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File Resubmissions Resubmissions as of 3/1/2015
137 files had been resubmitted Average turnaround time per file was 7.1 days Average turnaround for overall submission was 16.0 days
Challenges: Naming conventions
.TXT files 2015Q1 naming convention
Resubmitting previously approved files Potential for exception requests to be overwritten Some files failed second time through Additional processing time for system
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Exception Requests Exceptions requested on 22 files Working with submitters on a few exception
requests
Challenges: Prior exception requests were not ported over Resubmissions of previously accepted files
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Latest Status of Submissions Many issues have been resolved, although 19 of 34
submissions are still outstanding. 8 files still have catastrophic failures as of 3/1/2015 Working with submitters on exception requests
Challenges: Turnaround time on follow up by Milliman with data submitters Some exception requests may require a discussion over the
phone prior to ruling
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Lessons Learned Report validation
Milliman reviewed/confirmed each of the reports prior to sending to data submitters.
This will not occur for future submissions which will result in quicker feed back.
New process for checking files Upfront file checks surfaced a number of “new” issues for data
submitters. Process now in place; hopefully this does not cause issues for
future submissions.
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Lessons Learned Naming conventions
Stricter guidelines needed for file naming conventions, specifically: .txt files will be immediately rejected Files submitted for the incorrect quarter will be rejected (example:
naming convention of 2015Q1 for 2014Q4 files) Communication will be sent prior to any validation of the file so
immediate resubmission can occur.
Resubmitting previously approved files Previously, it was up to data submitters whether or not they would
resubmit an entire set of files in the event a single file had an error. With the new process, Milliman now prefers that only the needed
file(s) be resubmitted (note that control files may need to be submitted if changes are made to accompanying files)
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Lessons Learned Turnaround time on follow up by Milliman with data
submitters. We are looking to incorporate automated reminders into the
system that will: Remind submitters of upcoming due dates Remind submitters of outstanding files Timing TBD
Some exception requests may require a discussion over the phone prior to ruling Working with OHA and data submitters on best approach.