From d463f91629eb062b921ed3c33386cbfc8bd587f2 Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Wed, 29 May 2024 13:43:25 -0400 Subject: [PATCH 01/20] update home-page --- _layouts/home_layout.html | 76 +++++++++++++++++++++++---------------- 1 file changed, 45 insertions(+), 31 deletions(-) diff --git a/_layouts/home_layout.html b/_layouts/home_layout.html index 56493fe..a717574 100644 --- a/_layouts/home_layout.html +++ b/_layouts/home_layout.html @@ -68,15 +68,18 @@
-

Helping Prescription Drug Sponsors Help Patients

+

Improve medication therapy with Medicare claims data

-
The AB2D API provides Prescription Drug Sponsors with secure Medicare parts - A and B claims data for their plan enrollees.
-
+
Medicare Parts A and B claims data helps Prescription Drug Plan sponsors (PDPs) align + medication therapy with insight into clinic visits, hospital stays, and other services. Provided by the Centers + for Medicare & Medicaid (CMS), the AB2D API helps them understand plan enrollees better to support more effective + and affordable care. +
+
@@ -102,28 +105,38 @@

Helping Prescription Drug Sponsors Help Patients

-

Prescription Drug Sponsors have the ability to elevate patient - health outcomes by:

+

Created by the Centers for Medicare & Medicaid (CMS), + AB2D is a healthcare application programming interface (API) for Prescription + Drug Plan sponsors (PDPs). +

+
+

+ AB2D uses the + Bulk Fast Healthcare Interoperability Resources (FHIR) + standard to share health data that PDPs can use to better serve their + plan enrollees and ultimately improve patient health. +

+
patient care -

Enhancing Patient Safety

-

Improving care coordination and medication use

+

Promote patient health and safety

+

Improve care coordination and medication adherence.

analytics -

Optimizing Therapeutic Outcomes

-

Identifying and monitoring treatment effectiveness over time

+

Improve therapeutic outcomes

+

Track treatment effectiveness over time.

medical history -

Reducing a Patient’s Burden in Providing Medical History

-

Aggregating and streamlining enrollee information

+

Simplify patient experience

+

Reduce burden on patients to remember their medication histories.

@@ -143,14 +156,15 @@

Reducing a Patient’s Burden in Providing Medical H
Accessing Claims Data
-

Accessing Claims Data

+

How can my organization connect to the AB2D API?

- Stand-alone Prescription Drug Plan (PDP) sponsors must complete a few simple steps in - order to connect to the AB2D API and access Medicare parts A and B claims data for their - enrollees. + It takes a few simple steps for active, stand-alone Prescription Drug Plan sponsors (PDPs) + to access their plan enrollees' Medicare Parts A and B claims data. These include signing + a data use agreement, assigning a technical point of contact, then trying test data in + our sandbox environment.

- Learn More About Accessing DataSign up for AB2D

@@ -169,18 +183,18 @@

Accessing Claims Data

-

Understanding AB2D Data

+

AB2D API tools and resources

- The AB2D API provides stand-alone Prescription Drug Plan (PDP) sponsors with claims data that - can be used to enhance - the use of medications and improve the long term health of beneficiaries. CMS has created some - resources to - help PDP sponsors understand and utilize this data - check out sample claim files, the AB2D data - dictionary, and more. + AB2D's Medicare Parts A and B claims data provides a holistic view of plan enrollees’ + health, giving Prescription Drug Plan Sponsors (PDPs) information they need to better + serve patients and ultimately improve their health. CMS offers sample claims data files, + a data dictionary, and other resources to help you get started.

- Learn More About Understanding Data + + View tools and resources + +
Understanding the Data
@@ -202,11 +216,11 @@

Understanding AB2D Data

Support
-

Support

+

We're here to help

- We are here for you! Browse Frequently Asked Questions, access helpful resources, and utilize - personalized support networks. + Explore frequently asked questions (FAQs) and links to helpful resources. Engage with the AB2D community in our + Google Group

Get Support From e51b69d42e1f562af4a998cd98675e67a1fd2c59 Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Wed, 29 May 2024 13:43:40 -0400 Subject: [PATCH 02/20] update accessing-claims-data --- accessing-claims-data.md | 447 +++++++++++++++++---------------------- 1 file changed, 198 insertions(+), 249 deletions(-) diff --git a/accessing-claims-data.md b/accessing-claims-data.md index 7933878..2c88052 100644 --- a/accessing-claims-data.md +++ b/accessing-claims-data.md @@ -73,11 +73,36 @@ active-nav: accessing-claims-data-nav
- - + +
+
+
+

+ Active, stand-alone Prescription Drug Plan Sponsors (PDPs) who want to access Medicare Part A and Part B claims data need to follow four steps: +

+
    +
  1. Attest (agree) to AB2D API data protocols.
    2. +
  2. Appoint a technical point of contact for your organization.
    3. +
  3. Test synthetic data in the sandbox.
    4. +
  4. Receive credentials to access production claims data.
    5. +
+
+
+
@@ -96,256 +121,180 @@ active-nav: accessing-claims-data-nav
-
-
Step 1
-
Attestation
-
-
Overview
-
-
-

- 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 active Prescription Drug Plan (PDP) Sponsor contracts looking to connect to the AB2D API. - 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 -
-
- -
-
-
-
- What type of organizations can attest? -
- expand_more -
- -
-
- Stand-alone Medicare Part D Plan (PDP) sponsors (PACE and MAPD are not eligible). -
-
-
-
- -
-
-
-
- Who can attest? -
- expand_more -
- -
-
-
    -
  • 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.
    • -
-
-
-
-
- -
-
-
-
- How does attestation affect claims data? -
- expand_more -
- -
-
-
    -
  • 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.
    • -
-
-
-
-
- -
-
-
-
- How to initially attest -
- expand_more -
- -
-
-
    -
  1. Log into HPMS
    2. -
  2. Click on “Claims Data Attestation” (under Contract Management)
    3. -
  3. Select the checkbox(es) next to one, multiple, or all contracts within the 'Contracts Without Attestation' window
    4. -
  4. Click on the "Attest" button
    5. -
  5. Review the Claims Data Usage Protocols
    6. -
  6. Select the checkbox next to: "I hereby certify that I understand the attestation above"
    7. -
  7. Click "Confirm"
    8. -
-
-
-
-
- -
-
-
-
- How to add additional attesters -
- expand_more -
- -
-
-
    -
  1. Log into HPMS
    2. -
  2. Click on "Claims Data Attestation" (under Contract Management)
    3. -
  3. Select the checkbox(es) next to one, multiple, or all contracts within the 'Attested Contract' window
    4. -
  4. Click on the "Re-Attest" button
    5. -
  5. Review the Claims Data Usage Protocols
    6. -
  6. Select the checkbox next to: "I hereby certify that I understand the attestation above"
    7. -
  7. Click "Confirm"
    8. -
-
-
-
-
-
- -
-
Step 2
-
Appoint an "AB2D Operations Specialist"
-
-
Overview
- -
-
- After attesting, Part D Plan (PDP) Sponsors will need to assign an "AB2D Data Operations Specialist" - to act as their organization’s primary technical point of contact. - -
The "AB2D Data Operations Specialist"
- -
- check -
Is a technical employee at the Part D Plan (PDP) sponsor that has the authority to access and view the data provided by the API.
+
+
Step 1
+
Begin attestation
+
+
Agreements and authorization
+
+
+

+ To access production claims data, an executive from your organization (“Attestor”) first needs to agree (“attest") to our + Claims Data Usage Protocols. These protocols include limitations on data use and disclosure. +

-

- -
- check -
Will be technically savvy enough to connect to the AB2D API and retrieve claims data from our Sandbox and Production environments.
+
+ attestation
-

- -
- check -
Will need to provide static IP address(es) and or CIDR ranges for the network/system that is going to be accessing the AB2D API.
+
+

How do I attest?

+
    +
  1. + Log into the + Health Plan Management System (HPMS) +
    2. +
  2. + Select Claims Data Attestation (under Contract Management) +
    3. +
  3. + Choose an option for one, multiple, or all contracts in the Contracts Without Attestation window +
    4. +
  4. + Select the Attest button +
    5. +
  5. + Review the Claims Data Usage Protocols +
    6. +
  6. + Select I hereby certify that I understand the attestation above +
    7. +
  7. + Select Confirm +
    8. +
+

+ An organization can have multiple Attestors. We strongly encourage that you have multiple executives attest to each of their participating contracts. This is best practice as it prevents gaps in access if one Attestor leaves the organization. +

+

+ To add multiple Attestors: +

+

+ Follow the same steps. The Attest button will now be labeled “re-attest” under step 4. +

+

What are the requirements to be an Attestor?

+

+ An Attestor needs to: +

+
    +
  • + Be part of an active, stand-alone PDP organization (PACE and MAPD are ineligible). +
    • +
  • + Hold a current CEO, CFO, or COO role within the organization. +
    • +
  • + Attest to each contract that will connect to AB2D. +
    • +
+

How does attestation affect your claims data?

+
    +
  • + PDPs can retrieve claims data for their active plan enrollees from the date of attestation onwards. Claims data prior to their attestation date will not be provided. +
    • +
  • + PDPs must have an active Attestor at all times. Your organization will not be able to receive data during periods without an active Attestor. Access to data will only be restored once another active CEO, CFO, or COO attests. We highly recommend adding multiple Attestors to reduce the risk of lapses in your data access. +
    • +
+

When does attestation take effect?

+

+ Once an organization has attested, it follows the remaining steps in the onboarding process, which include appointing a technical specialist, testing synthetic data in the sandbox, and receiving credentials. Once these steps are complete, the organization will have access to claims data starting from the attestation date. Claims data previous to that date won't be available. +

+
- -
-
- data-specialist -
-
-
- -
-
Step 3
-
Retrieve Synthetic Claims Data
-
-
Overview
- -
-
- The Sandbox is a test environment that enables anyone to interact with the AB2D API and retrieve synthetic Medicare Parts A and B claims data. - A Part D Plan (PDP) sponsor “AB2D Data Operations Specialist” will need to verify they have retrieved synthetic claims data successfully in - order to gain access to production data. - - -
Connecting to the Sandbox
- We are providing three different ways to retrieve synthetic claims data: -
    -
  1. Postman and Swagger User Guide
    2. -
  2. Curl User Guide
    3. -
  3. Advanced User Guide
    4. -
- -
Verifying Synthetic Data Retrieval
-
    -
  • 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.
    • -
-
-
- programmer -
-
-
- -
-
Step 4
-
Accessing Claims Data in Production
-
-
Overview
- -
-
- Once a connection to the sandbox environment has been verified, the AB2D team will work directly with the Part D Plan (PDP) sponsors to - deliver production credentials. The Part D Plan (PDP) sponsor will use the production credentials to retrieve actual Medicare Parts A and B - Claims Data from our production environment. - -
- Delivering Production Credentials +
+
+
+
Step 2
+
Choose an AB2D Operations Specialist
+
+
Your technical point of contact
+
+
+

+ After attesting, you will need to assign an AB2D Data Operations Specialist (ADOS). Your ADOS will serve as the primary technical point of contact of your organization. +

-
    -
  • 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.
    • -
-
-
- production -
-
-
- Retrieving Actual Claims Data -
-
-
    -
  • 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.
    • -
  • For more information and to help answer any remaining question you may have, production documentation - can be found in the AB2D Github repository. -
    • -
-
- -
- +
+ data-specialist +
+
+

What qualifications does the ADOS need?

+
    +
  • + Employee or vendor with authority to access and view your organization’s beneficiary data +
    • +
  • + Expertise to connect to and retrieve data from the sandbox and production environments +
    • +
  • + Ability to provide static IP address(es) and/or CIDR ranges for the network/system accessing the API +
    • +
+
+
+
+
+
+
Step 3
+
Retrieve test claims data
+
+
Test the API in our sandbox
+
+
+

+ The sandbox is a test environment that allows anyone to interact with the AB2D API and retrieve test Medicare Parts A and B claims data. The ADOS will need to verify your organization’s retrieval of test data before receiving access to the AB2D API. +

+
+
+ programmer +
+
+

Connecting to the sandbox

+

+ There are three ways to retrieve test data from the sandbox, depending on your preference: Postman, Swagger, and curl. +

+
    +
  1. + Postman and Swagger User Guide +
    2. +
  2. + curl User Guide +
    3. +
  3. + Advanced User Guide +
    4. +
+

Verifying test data retrieval

+

+ The ADOS must record the Log ID from successful jobs in the sandbox and provide this ID to the AB2D team for verification. Once verified the AB2D team will provide access to the API. +

+
+
+
+
+
+
Step 4
+
Receive production API credentials
+
+
Get started with production data
+
+
+

+ Your organization must provide the AB2D team with the public static IP address(es) of the network or system connecting to the API. These will be reviewed, approved, and allow-listed as an additional layer of security. Afterward, the AB2D team will assign and provide the Attestor production credentials, which will allow your organization to use the API to retrieve real Medicare Parts A and B claims data. +

+
+
+ production +
+
+

+ Our team can work with you to troubleshoot any issues and answer questions through our Google Group +

+ Explore production documentation +
+
+
+
From 0cfd1340b1ade096ae1517d44a290597e9eece78 Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Wed, 29 May 2024 13:43:53 -0400 Subject: [PATCH 03/20] update understanding-ab2d-data --- understanding-ab2d-data.md | 47 +++++++++++++++++++++----------------- 1 file changed, 26 insertions(+), 21 deletions(-) diff --git a/understanding-ab2d-data.md b/understanding-ab2d-data.md index fb0ff3c..46da1bc 100644 --- a/understanding-ab2d-data.md +++ b/understanding-ab2d-data.md @@ -1,8 +1,8 @@ --- layout: subpage_layout -title: "Understanding AB2D Data" +title: "Understand AB2D Data" date: 2019-11-02 09:21:12 -0500 -description: Understanding AB2D Data +description: Understand AB2D Data landing-page: live active-nav: understanding-the-data-nav --- @@ -17,11 +17,21 @@ active-nav: understanding-the-data-nav
Overview

- The AB2D API is a RESTful based web service providing Medicare Parts A and B claims data using the industry- - standard HL7 Fast Healthcare Interoperability Resources (FHIR) resources, specifically the - Bulk FHIR specification . The AB2D API only provides data records for active enrollees and excludes - all claims with substance abuse codes (as required by the Confidentiality of Alcohol and Drug Abuse Patient - Records Regulations, 42 CFR Part 2). + What kinds of data are available? +

+

+ AB2D is a RESTful (representational state transfer) API providing claims data for active Medicare enrollee groups. The Bulk FHIR specification lets it handle large volumes of enrollee claims data, including: +

+
    +
  • + Medicare Part A claims data. Inpatient hospital stays, care in skilled nursing facilities, and hospice care. +
    • +
  • + Medicare Part B claims data. Various doctors' services, outpatient care, medical supplies, and preventive services. +
    • +
+

+ These claims contain valuable information about enrollee health, which can help fill any gaps in the health records available to stand-alone Prescription Drug Plan sponsors (PDPs).

@@ -30,7 +40,6 @@ active-nav: understanding-the-data-nav
-
@@ -44,21 +53,19 @@ active-nav: understanding-the-data-nav
Sample AB2D Files
- The examples below were generated from synthetic claims data but are similar to the files that will be - retrieved through the AB2D API for Part D Sponsors. + These test data files will give you a good idea of the type of data available through AB2D.

-
-
@@ -66,10 +73,9 @@ active-nav: understanding-the-data-nav
Data Dictionary
- AB2D API users can leverage the AB2D Data Dictionary - for more information on the data elements. + Learn more about AB2D data elements.

-
-
creativity
-
Additional Resources
- Here are some helpful resources you can reference while using this site: +
JSON resources
+ Introductions to JSON

-
    +
    • Intro to JSON Format
      • From 23fd45a53840eab7215803581d7b2e1adaf9105c Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Wed, 29 May 2024 13:44:03 -0400 Subject: [PATCH 04/20] update overview --- overview.md | 92 ++++++++++++++++++++++++++++++++++++----------------- 1 file changed, 62 insertions(+), 30 deletions(-) diff --git a/overview.md b/overview.md index 9320d17..263f064 100644 --- a/overview.md +++ b/overview.md @@ -8,64 +8,96 @@ active-nav: overview-nav ---
      - - + +
      -

      The Medicare program provides health insurance coverage to more than 60 million people.

      +

      Claims data can make medications safe and effective for more than 22 million people.

      -
      Pharmaceuticals
      +
      + Pharmaceuticals +

      - The Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies, - known as Medicare Prescription Drug Plan (PDP) sponsors, to provide prescription drug coverage for enrollees.

      + Of the 65 million beneficiaries covered by Medicare programs, stand-alone Prescription Drug Plan Sponsors (PDPs) cover more than 22 million people. AB2D provides Medicare Parts A and B claims data to fill gaps in patients' health information for a holistic view that supports better care. +

      +

      What requirements led to AB2D?

      - The Bipartisan Budget Act of 2018 (BBA) requires the development of a process to share Medicare claims data with - PDP sponsors. The Final Rule provides additional detail on the purposes and limitations on the use of data, the data request process, and data extract content. + The AB2D API (AB2D) supports government initiatives to improve patient health. The Centers for Medicare & Medicaid (CMS) developed AB2D to follow the Bipartisan Budget Act of 2018 (BBA) and Final Rule. This is in accordance with requirements to share claims data with PDPs who have active contracts.

      +

      How does AB2D support these requirements?

      - In response to the BBA, CMS has developed an Application Programming Interface (API) known as the AB2D API. The AB2D API securely provides - active stand-alone PDP sponsor contracts with Medicare Parts A and B claims data for their enrollees. PDP sponsors will be able to utilize this claims data - to promote the appropriate use of medications and to improve health outcomes for their beneficiaries. The bulk claims data provided by the AB2D API - is formatted in Fast Healthcare Interoperability Resources (FHIR) a standard for exchanging healthcare information electronically. + AB2D provides PDPs with Medicare Parts A and B claims data. This data helps PDPs promote the best use of medications to improve health outcomes. AB2D utilizes the Bulk Fast Healthcare Interoperability Resources (FHIR) standard for exchanging healthcare information electronically in order to make data sharing efficient and secure.

      -
      - - - +
      + + +
      -
      -

      How is the AB2D API different from other CMS APIs?

      +

      CMS Claims-Based FHIR APIs

      -
      -
      -
        -
      1. The AB2D API provides FHIR-formatted bulk claims data to stand-alone PDP sponsors for their enrollees.
        2. -
      2. Blue Button 2.0 provides FHIR-formatted data for one individual Medicare beneficiary at a time, to registered applications with beneficiary authorization.
        3. -
      3. BCDA provides FHIR-formatted bulk data files to an ACO for all of the beneficiaries eligible to a given Shared Savings Program ACO. BCDA does not require individual beneficiary authorization but does allow a process for patients to opt out of data sharing.
        4. -
      4. Data at the Point of Care pilot provides FHIR-formatted bulk data files to fee-for-service providers for their active patients as needed for treatment purposes under HIPAA. Data at the Point of Care does not require individual beneficiary authorization.
        5. -
      +

      + AB2D is one of several CMS APIs that offer Medicare claims data sharing in FHIR format: +

      +

      + The Beneficiary Claims Data API helps Alternative Payment Model participants who provide high quality, coordinated care by simplifying their access to bulk Medicare Part A, B, and D claims. +

      + Visit BCDA +
      +

      + The Blue Button 2.0 API enables beneficiaries to connect their Medicare claims data to the applications, services, and research programs they trust. +

      + Visit BB 2.0 +
      +

      + The Data at the Point of Care API enables healthcare providers with claims data to fill-in gaps in patient history at the point of care and deliver high quality care to Medicare beneficiaries. +

      + Visit DPC
      -
      Accessing Claims Data
      - +
      CMS FHIR APIs
      \ No newline at end of file From f5e139110bad57022920339ecb475a0f8d7224a7 Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Wed, 29 May 2024 16:38:30 -0400 Subject: [PATCH 05/20] update support page (pending clarification questions) --- support.md | 342 ++++++++++++++++++++--------------------------------- 1 file changed, 127 insertions(+), 215 deletions(-) diff --git a/support.md b/support.md index 204b15f..796d8af 100644 --- a/support.md +++ b/support.md @@ -25,66 +25,57 @@ active-nav: support-nav
      -
      We Are Listening
      - If you have a question, suggestion, or feedback please post it in the AB2D Google Group! - +
      We're here to help
      + Our Google Group is the best way to ask questions, give feedback, and get the latest news on the AB2D API.
      - JOIN OUR GOOGLE GROUP + JOIN GOOGLE GROUP open_in_new
      -
      experts
      -
      - Frequently Asked Questions + Frequently asked questions
      - -

      - The production documentation can be found here. This documentation can be helpful in answering - the following - questions: + Our AB2D document repository on GitHub covers topics like:

      -

      - Accessing the production environment: -

        -
      • How do I prepare to start pulling in data from production?
        • -
      • How do I verify that my setup can successfully connect to the API?
        • + Accessing the production environment: +
          +
        • Preparing to pull data from production
          • +
        • Verifying connection to the API

        - Support: -

          -
        • Where can I find information on how to process EOBs?
          • -
        • Where can I find information on the production errors I’m seeing?
          • + Support: +
            +
          • Processing Explanations of Benefits (EOBs)
            • +
          • Production errors

          - Understanding the Data: -

            -
          • Where can I find information on the non-standard fields produced by AB2D?
            • -
          • Where can I find information on handling updated or canceled claims?
            • -
          • Where can I find information on uniquely identifying a claim?
            • -
          • Where can I find information on how patients are identified in the claims data?
            • + Understanding the Data: +
              +
            • Non-standard fields
              • +
            • Updated or canceled claims
              • +
            • Uniquely identifying a claim
              • +
            • How patients are identified in claims data

      @@ -94,302 +85,226 @@ active-nav: support-nav -
      - In February 2018, the Bipartisan Budget Act of 2018 (BBA) was signed into law and included a provision - requiring the development of a process to share Medicare fee-for-services claims data with PDP sponsors. - Section 50354 of the BBA specifically provides that the Secretary of Health and Human Services shall - establish a process under which PDP sponsors may request, beginning in plan year 2020, that the - Secretary provide on a periodic basis and in an electronic format standardized extracts of Medicare claims - data about its plan enrollees. Such extracts would contain a subset of Medicare Parts A and B claims data - as determined by the Secretary and would be as current as practicable. -
      -
      -
      - -
      - -
      -
      - In response to the Bipartisan Budget Act of 2018 (BBA) , CMS published a - - Final Rule to implement section - 50354 of the BBA, which outlines the manner in which CMS proposes to implement this requirement. + The Bipartisan Budget Act of 2018 (BBA) and subsequent CMS Final Rule require CMS to share fee-for-services claims data with PDPs. Extracts contain a subset of Medicare Parts A and B claims data. These must be shared in an electronic format through standardized extracts.
      -
      - +
      - Active stand-alone Medicare Part D Plan (PDP) sponsors. + Active stand-alone Medicare Prescription Drug Plan sponsors (PDPs) are eligible.
      -
      - +
      - PDP sponsors will be able to access the Medicare Parts A and B claims data by leveraging the AB2D - Application Programming Interface (API). -
      -
      -
      - -
      - -
      -
      - A standalone Medicare Part D Plan (PDP) sponsor must first complete the attestation process for each of - their participating Part D contracts. After attesting, the AB2D team will work directly with the “AB2D Data - Operations Specialist” and the Attestor to ensure that the (PDP) is able to retrieve Medicare Parts A and B - claims data. Learn more about accessing AB2D claims data. -
      -
      -
      - + There are 4 steps organizations need to complete to get access to AB2D data: +
        +
      1. + Authorize your organization to use the API and agree to comply with proper data use (attestation) as outlined in the BBA and CMS Final Rule +
        2. +
      2. + Assign a technical point of contact +
        3. +
      3. + Complete onboarding prerequisites +
        4. +
      4. + Access production data +
        5. +
      +
      +
+
- Attestation is a process to ensure PDP sponsors are aware of how the Medicare claims data provided by - AB2D may and may not be used, including limitations associated with reuse and redisclosure of data. - Attestation performed through the Health Plan Management System (HPMS) Claims Data Attestation - module affirms adherence to these permitted uses and limitations of this claims data as listed in - § 423.153 of the Final Rule . To attest, visit - HPMS + Attestation is the first step in onboarding to AB2D API. In this step, a CEO, CFO, or COO acknowledges they understand and agree to comply with the acceptable uses and limitations of the AB2D claims data. The Attestor completes this step within the Health Plan Management System (HPMS).
-
- +
- Attestation must be performed by a Medicare Part D Plan (PDP) Sponsor CEO, CFO, or COO. The Attestor - must hold an active CEO, CFO, or COO role within their organization. Part D Plan (PDP) sponsors are - allowed to have multiple executives attest to each participating contract. + Attestation must be performed by the CEO, CFO, or COO of a Medicare PDP organization. These individuals are called "Attestors." PDPs are allowed and actually encouraged to have more than one Attestor.
-
- +
- 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. - If your organization has a single Attestor and they leave without a replacement, then your organization - will lose access to new data until another active CEO, CFO, or COO attests. Re-attestation will restore - access to new claims data and provide historical claims data that was not accessible during the lapse in - active attestation. - Having multiple Attestors reduces the risk of data gaps due to workplace attrition and is strongly - encouraged. +

+ PDPs must have an active Attestor at all times to access claims data. Your organization will not receive data during periods without an active Attestor. If your organization only has one Attestor, and they leave without a replacement, then your organization will lose access to the API until another active CEO, CFO, or COO attests. +

+

+ Re-attestation will restore access to the API, including historical claims data that was not accessible during the lapse in active attestation. It’s strongly encouraged to add multiple Attestors to reduce the risk of gaps in data access. +

-
- +
- Section § 423.153(c) of the Final Rule specifies that PDP sponsors receiving Medicare claims data for their - corresponding PDP plan enrollees may use the data for: - (i) Optimizing therapeutic outcomes through improved medication use; - (ii) improving care coordination so as to prevent adverse healthcare outcomes; - (iii) for any other purpose described in the first or second paragraph of “health care operations” under 45 - CFR 164.501, or that qualify as “fraud and abuse detection or compliance activities” under 45 CFR - 164.506(c)(4). -
-
-
- -
- -
-
- Section § 423.153(c) of the Final Rule - specifies that PDP sponsors receiving Medicare Parts A and B claims - data for their PDP plan enrollees may not use the data for the following purposes: - (i) To inform coverage determinations under Part D; - (ii) To conduct retroactive reviews of medically accepted indications determinations; - (iii) To facilitate enrollment changes to a different prescription drug plan or an MA-PD plan offered by the - same parent organization; or - (iv) To inform marketing of benefits. -
-
-
- -
- -
-
- The Health Plan Management System (HPMS) Claims Data Attestation module can be used by PDP - Sponsors to submit a request for Medicare claims data (by contract) beginning January 1, 2020. -
-
-
- + The Final Rule specifies that data may used for: +
    +
  • + Optimizing therapeutic outcomes through improved medication use +
    • +
  • + Improving care coordination +
    • +
  • + Other purposes [that qualify] as “fraud and abuse detection or compliance activities” +
    • +
+

+ The following uses are not permitted: +

+
    +
  1. + (i) To inform coverage determinations under Part D; +
    2. +
  2. + (ii) To conduct retroactive reviews of medically accepted indications determinations; +
    3. +
  3. + (iii) To facilitate enrollment changes to a different prescription drug plan or an MA-PD plan offered by the same parent organization; +
    4. +
  4. + (iv) To inform marketing of benefits. +
    5. +
+
+
+
- The AB2D API leverages the Bulk - FHIR Specification - which uses the file format: NDJSON, New Line Delimited JSON - . An NDJSON file provides a single record on each line, which makes it - easy for various tools to look at and process one record at a time before moving on to the next one. + The AB2D API uses the Bulk FHIR Specification in the New Line Delimited JSON format. An NDJSON file provides a single record on each line. This makes it easy for various tools to look at and process one record at a time.
-
- +
- Medicare Parts A and B claims data elements (fields) in the standardized extract as specified in the rule: -
    -
  • An enrollee identifier
    • -
  • Diagnosis and procedure codes (for example, ICD-10 diagnosis and Healthcare Common
    • + Medicare Parts A and B data elements (fields) in the standardized extract include: +
      +
    • + An enrollee identifier +
      • +
    • + Diagnosis and procedure codes (e.g., ICD-10 diagnosis and Healthcare Common) +
    - Procedure Coding System (HCPCS) codes) -
      -
    • Dates of service
      • -
    • Place of service
      • -
    • Provider numbers (for example, NPI)
      • -
    • Claim processing and linking identifiers/codes (for example, claim ID, and claim type code)
      • + Healthcare Common Procedure Coding System (HCPCS) codes: +
        +
      • + Dates of service +
        • +
      • + Place of service +
        • +
      • + National Provider Identifier Standard (NPI) numbers for providers +
        • +
      • + Claim processing and linking identifiers/codes (e.g., claim ID and claim type code) +
-
- +
- Section 1860D-4(c)(6)(D) of the Act provides that the Secretary shall make standardized extracts available - to PDP sponsors with data that is the most current as practicable. While we understand that historical - data may assist PDP sponsors, we must adhere to the statutory language. As this program matures, PDP - sponsors will amass historical data. + PDPs will only have access to data starting on their attestation date onwards. Claims data previous to that date will not be available. It’s best for PDPs to attest as soon as possible, regardless of their implementation timeline, in order to get access to earlier claims data.
-
- +
- CMS will continue to evaluate the data elements provided to PDP sponsors to determine if data elements - should be added or removed based on the information needed to carry out the permitted uses of the - data. Any proposed changes would be established through rulemaking. + CMS evaluates the data elements provided to PDPs based on how well they support the acceptable uses. Any proposed changes would be established through rule-making. If you have any feedback, please let our team know in the Google Group.
-
- +
- The AB2D API will leverage the Beneficiary FHIR Data (BFD) server, which receives data from the Chronic - Condition Warehouse (CCW). The majority of the BFD data is refreshed weekly with a few data elements - being loaded monthly. + The AB2D API uses the Beneficiary FHIR Data (BFD) server. BFD receives data from the Chronic Condition Warehouse (CCW). The majority of the BFD data is refreshed weekly, with a few data elements being loaded monthly.
-
- + \ No newline at end of file From d59b7eb831670e2fec1e3194c2f559d492900533 Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Thu, 30 May 2024 11:02:49 -0400 Subject: [PATCH 06/20] remove bullets on non-permited list per feedback --- support.md | 4 ++-- 1 file changed, 2 insertions(+), 2 deletions(-) diff --git a/support.md b/support.md index 796d8af..23744dd 100644 --- a/support.md +++ b/support.md @@ -209,7 +209,7 @@ active-nav: support-nav

The following uses are not permitted:

-
    +
    • (i) To inform coverage determinations under Part D;
      • @@ -222,7 +222,7 @@ active-nav: support-nav
    • (iv) To inform marketing of benefits.
      • -
+ From 1df425941b00d833c90b6fc42686536255d4abec Mon Sep 17 00:00:00 2001 From: Rwolfe-Nava Date: Thu, 30 May 2024 11:13:24 -0400 Subject: [PATCH 07/20] update link targets to be consistent with on/off site --- _layouts/home_layout.html | 2 +- accessing-claims-data.md | 6 +++--- support.md | 2 +- 3 files changed, 5 insertions(+), 5 deletions(-) diff --git a/_layouts/home_layout.html b/_layouts/home_layout.html index a717574..f0d1b79 100644 --- a/_layouts/home_layout.html +++ b/_layouts/home_layout.html @@ -115,7 +115,7 @@

Created by the Centers for Medicare & Medicaid (CMS)

AB2D uses the - Bulk Fast Healthcare Interoperability Resources (FHIR) + Bulk Fast Healthcare Interoperability Resources (FHIR) standard to share health data that PDPs can use to better serve their plan enrollees and ultimately improve patient health.

diff --git a/accessing-claims-data.md b/accessing-claims-data.md index 2c88052..cd5b113 100644 --- a/accessing-claims-data.md +++ b/accessing-claims-data.md @@ -255,13 +255,13 @@ active-nav: accessing-claims-data-nav

  1. - Postman and Swagger User Guide + Postman and Swagger User Guide
  2. - curl User Guide + curl User Guide
  3. - Advanced User Guide + Advanced User Guide

Verifying test data retrieval

diff --git a/support.md b/support.md index 23744dd..86774d1 100644 --- a/support.md +++ b/support.md @@ -119,7 +119,7 @@ active-nav: support-nav
- There are 4 steps organizations need to complete to get access to AB2D data: + There are 4 steps organizations need to complete to get access to AB2D data:
  1. Authorize your organization to use the API and agree to comply with proper data use (attestation) as outlined in the BBA and CMS Final Rule From c8b511a53be74ece43fe58ab975316021ca371f9 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Mon, 8 Jul 2024 14:56:03 -0700 Subject: [PATCH 08/20] static website update --- _layouts/home_layout.html | 31 +++++---- accessing-claims-data.md | 17 +++-- overview.md | 129 +++++++++++++++++++++++++++++++------ support.md | 68 +++++++++---------- understanding-ab2d-data.md | 6 +- 5 files changed, 171 insertions(+), 80 deletions(-) diff --git a/_layouts/home_layout.html b/_layouts/home_layout.html index f0d1b79..fd10523 100644 --- a/_layouts/home_layout.html +++ b/_layouts/home_layout.html @@ -70,10 +70,11 @@

    Improve medication therapy with Medicare claims data

    -
    Medicare Parts A and B claims data helps Prescription Drug Plan sponsors (PDPs) align - medication therapy with insight into clinic visits, hospital stays, and other services. Provided by the Centers - for Medicare & Medicaid (CMS), the AB2D API helps them understand plan enrollees better to support more effective - and affordable care. +
    Medicare Parts A and B claims data helps Prescription Drug Plan (PDP) sponsors align + medication therapy with insight into clinic visits, hospital stays, and other services. Provided + by the Centers for Medicare & Medicaid (CMS), + the AB2D API helps PDPs understand plan + enrollees better to support more effective and affordable care.
    @@ -105,7 +105,7 @@ active-nav: support-nav
    - Active stand-alone Medicare Prescription Drug Plan sponsors (PDPs) are eligible. + Active stand-alone Medicare Prescription Drug Plan (PDP) sponsors are eligible.
    @@ -122,16 +122,16 @@ active-nav: support-nav There are 4 steps organizations need to complete to get access to AB2D data:
    1. - Authorize your organization to use the API and agree to comply with proper data use (attestation) as outlined in the BBA and CMS Final Rule + Authorize your organization to use the API and agree to comply with proper data use (attestation) as outlined in the BBA and CMS final rule.
    2. - Assign a technical point of contact + Assign a technical point of contact.
    3. - Complete onboarding prerequisites + Complete onboarding prerequisites.
    4. - Access production data + Access production data.
@@ -194,16 +194,16 @@ active-nav: support-nav
- The Final Rule specifies that data may used for: -
    + The final rule specifies that data may used for: +
    • - Optimizing therapeutic outcomes through improved medication use + optimizing therapeutic outcomes through improved medication use
    • - Improving care coordination + improving care coordination
    • - Other purposes [that qualify] as “fraud and abuse detection or compliance activities” + other purposes [that qualify] as “fraud and abuse detection or compliance activities”

    @@ -211,7 +211,7 @@ active-nav: support-nav

    • - (i) To inform coverage determinations under Part D; + "(i) To inform coverage determinations under Part D;
    • (ii) To conduct retroactive reviews of medically accepted indications determinations; @@ -220,7 +220,7 @@ active-nav: support-nav (iii) To facilitate enrollment changes to a different prescription drug plan or an MA-PD plan offered by the same parent organization;
    • - (iv) To inform marketing of benefits. + (iv) To inform marketing of benefits."
@@ -236,7 +236,7 @@ active-nav: support-nav
- The AB2D API uses the Bulk FHIR Specification in the New Line Delimited JSON format. An NDJSON file provides a single record on each line. This makes it easy for various tools to look at and process one record at a time. + The AB2D API uses the Bulk Fast Healthcare Interoperability Resources (FHIR) in the New Line Delimited JSON format. An NDJSON file provides a single record on each line. This makes it easy for various tools to look at and process one record at a time.
@@ -251,27 +251,27 @@ active-nav: support-nav
Medicare Parts A and B data elements (fields) in the standardized extract include: -
    +
    • - An enrollee identifier + an enrollee identifier
    • - Diagnosis and procedure codes (e.g., ICD-10 diagnosis and Healthcare Common) + diagnosis and procedure codes (e.g., ICD-10 diagnosis and Healthcare Common)
    Healthcare Common Procedure Coding System (HCPCS) codes: -
      +
      • - Dates of service + dates of service
      • - Place of service + place of service
      • - National Provider Identifier Standard (NPI) numbers for providers + national Provider Identifier Standard (NPI) numbers for providers
      • - Claim processing and linking identifiers/codes (e.g., claim ID and claim type code) + claim processing and linking identifiers/codes (e.g., claim ID and claim type code)
diff --git a/understanding-ab2d-data.md b/understanding-ab2d-data.md index 46da1bc..73d372a 100644 --- a/understanding-ab2d-data.md +++ b/understanding-ab2d-data.md @@ -20,7 +20,7 @@ active-nav: understanding-the-data-nav What kinds of data are available?

- AB2D is a RESTful (representational state transfer) API providing claims data for active Medicare enrollee groups. The Bulk FHIR specification lets it handle large volumes of enrollee claims data, including: + AB2D is a RESTful (representational state transfer) API providing claims data for active Medicare enrollee groups. The Bulk Fast Healthcare Interoperability Resources (FHIR) lets it handle large volumes of enrollee claims data, including:

  • @@ -31,7 +31,7 @@ active-nav: understanding-the-data-nav

- These claims contain valuable information about enrollee health, which can help fill any gaps in the health records available to stand-alone Prescription Drug Plan sponsors (PDPs). + These claims contain valuable information about enrollee health, which can help fill any gaps in the health records available to stand-alonePrescription Drug Plan (PDP) sponsors.

@@ -57,7 +57,7 @@ active-nav: understanding-the-data-nav

  • - AB2D v2 (latest version) Parts A and Parts B Sample Export (FHIR R4) + AB2D v2 (recommended version) Parts A and Parts B Sample Export (FHIR R4)
  • AB2D v1 Parts A and Parts B Sample Export (FHIR STU3) From 490f15b19fb0fcc2ac0697fb6fd08b923d3bc798 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 15:17:47 -0700 Subject: [PATCH 09/20] wip --- overview.md | 11 ++++++----- 1 file changed, 6 insertions(+), 5 deletions(-) diff --git a/overview.md b/overview.md index a4bae85..f9e04b6 100644 --- a/overview.md +++ b/overview.md @@ -70,15 +70,16 @@ active-nav: overview-nav > -
    +
    -

    What are the use cases for the AB2D API?

    -
    +

    What are the other CMS claims-based FHIR APIs?

    +
    +
    -

    Find MTM program enrollees

    +

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.

    @@ -89,7 +90,7 @@ active-nav: overview-nav
    -

    Boost health outcomes

    +

    Boost health outcomes

    Enhance MTM enrollee health and program results by improving medication use and adherence.

    From 11ed5e8eaadd54116f0bdc92b317507e9abfcdd0 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 15:26:38 -0700 Subject: [PATCH 10/20] wip --- overview.md | 18 +++++++++--------- 1 file changed, 9 insertions(+), 9 deletions(-) diff --git a/overview.md b/overview.md index f9e04b6..cd7d7fd 100644 --- a/overview.md +++ b/overview.md @@ -73,12 +73,12 @@ active-nav: overview-nav
    -

    What are the other CMS claims-based FHIR APIs?

    +

    What are the use cases for the AB2D API?

    -
    -
    +
    +

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.

    @@ -88,8 +88,8 @@ active-nav: overview-nav

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    -
    -
    +
    +

    Boost health outcomes

    Enhance MTM enrollee health and program results by improving medication use and adherence.

    @@ -105,8 +105,8 @@ active-nav: overview-nav

    Medication adherence is one of the quality measures used to rate PDPs. AB2D data can address medication adherence, as well as statin use in persons with diabetes or other medication therapy problems, by proactively identifying MTM enrollees who may benefit from targeted intervention. As a result, this may help improve their health, the effectiveness of your programs, and your Star Ratings.

    -
    -
    +
    +

    Prevent fraud, waste, and abuse

    Identify suspicious activity from providers or suppliers through access to mass data.

    @@ -123,8 +123,8 @@ active-nav: overview-nav

    Due to final rule regulations, AB2D data can be used to detect fraud, waste, and abuse from providers and suppliers only. This can’t be used to influence coverage determination for enrollees.

    -
    -
    +
    +

    Enhance MTM services

    Leverage insights from enrollee medical histories for more effective services.

    From b926025f2e9d0cfcf998ec76a80f9cf768546e6b Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 17:37:52 -0700 Subject: [PATCH 11/20] wip --- overview.md | 52 ++++++++++++++++++++++++++-------------------------- 1 file changed, 26 insertions(+), 26 deletions(-) diff --git a/overview.md b/overview.md index cd7d7fd..2a61ab5 100644 --- a/overview.md +++ b/overview.md @@ -78,23 +78,23 @@ active-nav: overview-nav
    -
    -

    Find MTM program enrollees

    -

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.

    +
    +

    Find MTM program enrollees

    +
    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.
    -
    -
    +
    +

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    +
    +
    +
    +

    Boost health outcomes

    +
    Enhance MTM enrollee health and program results by improving medication use and adherence.
    -
    -
    -

    Boost health outcomes

    -

    Enhance MTM enrollee health and program results by improving medication use and adherence.

    -
    -
    -
    +
    +

    Part D Star Ratings evaluate the quality of services received by beneficiaries in your plan. CMS offers incentives to Prescription Drug Plan (PDP) sponsors with high Star Ratings:

      @@ -104,15 +104,15 @@ active-nav: overview-nav

    Medication adherence is one of the quality measures used to rate PDPs. AB2D data can address medication adherence, as well as statin use in persons with diabetes or other medication therapy problems, by proactively identifying MTM enrollees who may benefit from targeted intervention. As a result, this may help improve their health, the effectiveness of your programs, and your Star Ratings.

    +
    +
    +
    +

    Prevent fraud, waste, and abuse

    +
    Identify suspicious activity from providers or suppliers through access to mass data.
    -
    -
    -

    Prevent fraud, waste, and abuse

    -

    Identify suspicious activity from providers or suppliers through access to mass data.

    -
    -
    -
    -
    +
    +
    +

    Find suspicious patterns from providers or suppliers to reduce fraud and financial losses. By adding AB2D’s Bulk FHIR data to your existing data streams, you can conduct trend analysis and search mass enrollee data to quickly identify:

    • duplicate billing
      • @@ -121,15 +121,15 @@ active-nav: overview-nav
    • outliers in cost or service frequency

    Due to final rule regulations, AB2D data can be used to detect fraud, waste, and abuse from providers and suppliers only. This can’t be used to influence coverage determination for enrollees.

    +
    +
    +
    +
    +

    Enhance MTM services

    +
    Leverage insights from enrollee medical histories for more effective services.
    -
    -

    Enhance MTM services

    -

    Leverage insights from enrollee medical histories for more effective services.

    -
    -
    -

    Plan sponsors can use AB2D data to get a holistic overview of enrollees' health histories. This allows for more informed discussions between the MTM provider and enrollee during comprehensive or targeted medication reviews:

      From 9d4a6d671d85812f1827b0065815961e1f6021ff Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 17:45:40 -0700 Subject: [PATCH 12/20] wip --- overview.md | 8 ++++---- 1 file changed, 4 insertions(+), 4 deletions(-) diff --git a/overview.md b/overview.md index 2a61ab5..c7b662d 100644 --- a/overview.md +++ b/overview.md @@ -84,7 +84,7 @@ active-nav: overview-nav
    -
    +

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    @@ -95,7 +95,7 @@ active-nav: overview-nav
    -
    +

    Part D Star Ratings evaluate the quality of services received by beneficiaries in your plan. CMS offers incentives to Prescription Drug Plan (PDP) sponsors with high Star Ratings:

    • CMS highlights contracts with an overall rating of 5 stars.
      • @@ -112,7 +112,7 @@ active-nav: overview-nav
    -
    +

    Find suspicious patterns from providers or suppliers to reduce fraud and financial losses. By adding AB2D’s Bulk FHIR data to your existing data streams, you can conduct trend analysis and search mass enrollee data to quickly identify:

    • duplicate billing
      • @@ -130,7 +130,7 @@ active-nav: overview-nav
    -
    +

    Plan sponsors can use AB2D data to get a holistic overview of enrollees' health histories. This allows for more informed discussions between the MTM provider and enrollee during comprehensive or targeted medication reviews:

    • Promote safe and effective medication use.
      • From d10b60f3c5bb7838cd1c82eb90fc727d74b2f393 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:07:05 -0700 Subject: [PATCH 13/20] wip --- overview.md | 8 +++----- 1 file changed, 3 insertions(+), 5 deletions(-) diff --git a/overview.md b/overview.md index c7b662d..44eefe2 100644 --- a/overview.md +++ b/overview.md @@ -53,7 +53,7 @@ active-nav: overview-nav
    -
    -

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    -
    +

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    @@ -144,7 +142,7 @@ active-nav: overview-nav
    From a4cb94b30b2ad025ff159302d71ae6df11a77cfd Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:09:40 -0700 Subject: [PATCH 14/20] wip --- overview.md | 7 ++----- 1 file changed, 2 insertions(+), 5 deletions(-) diff --git a/overview.md b/overview.md index 44eefe2..f5f6a89 100644 --- a/overview.md +++ b/overview.md @@ -81,11 +81,8 @@ active-nav: overview-nav

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.
    -
    -
    -
    -

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    -
    +

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    +

    Boost health outcomes

    From 436aa4336016a69c2b7d25c7edb0c0862ced682f Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:15:51 -0700 Subject: [PATCH 15/20] wip --- overview.md | 41 ++--------------------------------------- 1 file changed, 2 insertions(+), 39 deletions(-) diff --git a/overview.md b/overview.md index f5f6a89..60f7459 100644 --- a/overview.md +++ b/overview.md @@ -78,19 +78,13 @@ active-nav: overview-nav
    -

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    -
    +
    -

    Boost health outcomes

    Enhance MTM enrollee health and program results by improving medication use and adherence.
    -
    -
    -
    -

    Part D Star Ratings evaluate the quality of services received by beneficiaries in your plan. CMS offers incentives to Prescription Drug Plan (PDP) sponsors with high Star Ratings:

    • CMS highlights contracts with an overall rating of 5 stars.
      • @@ -101,13 +95,8 @@ active-nav: overview-nav
    -

    Prevent fraud, waste, and abuse

    Identify suspicious activity from providers or suppliers through access to mass data.
    -
    -
    -
    -

    Find suspicious patterns from providers or suppliers to reduce fraud and financial losses. By adding AB2D’s Bulk FHIR data to your existing data streams, you can conduct trend analysis and search mass enrollee data to quickly identify:

    • duplicate billing
      • @@ -119,13 +108,8 @@ active-nav: overview-nav
    -

    Enhance MTM services

    Leverage insights from enrollee medical histories for more effective services.
    -
    -
    -
    -

    Plan sponsors can use AB2D data to get a holistic overview of enrollees' health histories. This allows for more informed discussions between the MTM provider and enrollee during comprehensive or targeted medication reviews:

    • Promote safe and effective medication use.
      • @@ -136,28 +120,7 @@ active-nav: overview-nav
    • Allocate resources efficiently to save on costs.
    -
    - -
    - - - +
    From a4e474d6c5332debb9acff0594091a48f35814e6 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:42:14 -0700 Subject: [PATCH 16/20] wip --- overview.md | 2 ++ 1 file changed, 2 insertions(+) diff --git a/overview.md b/overview.md index 60f7459..6f286fc 100644 --- a/overview.md +++ b/overview.md @@ -78,9 +78,11 @@ active-nav: overview-nav
    +

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    +

    Boost health outcomes

    From 04cfc3412695ac7f59ca5e1992efe82711630401 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:50:37 -0700 Subject: [PATCH 17/20] wip --- overview.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/overview.md b/overview.md index 6f286fc..de1151a 100644 --- a/overview.md +++ b/overview.md @@ -81,7 +81,7 @@ active-nav: overview-nav

    Find MTM program enrollees

    Identify Medication Therapy Management enrollees by using data for a more thorough search capability.
    -

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    +

    AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.

    From 3c1adabe552d1d56ce2ed819e445ab5d48cbf8c6 Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Tue, 9 Jul 2024 18:56:14 -0700 Subject: [PATCH 18/20] wip --- overview.md | 5 ++++- 1 file changed, 4 insertions(+), 1 deletion(-) diff --git a/overview.md b/overview.md index de1151a..42038a0 100644 --- a/overview.md +++ b/overview.md @@ -13,7 +13,6 @@ active-nav: overview-nav class="shape-divider" version="1.1" xmlns="http://www.w3.org/2000/svg" - x="0px" y="0px" viewBox="0 0 1034.2 43.8" @@ -85,6 +84,7 @@ active-nav: overview-nav
    +

    Boost health outcomes

    Enhance MTM enrollee health and program results by improving medication use and adherence.

    Part D Star Ratings evaluate the quality of services received by beneficiaries in your plan. CMS offers incentives to Prescription Drug Plan (PDP) sponsors with high Star Ratings:

    @@ -97,6 +97,7 @@ active-nav: overview-nav
    +

    Prevent fraud, waste, and abuse

    Identify suspicious activity from providers or suppliers through access to mass data.

    Find suspicious patterns from providers or suppliers to reduce fraud and financial losses. By adding AB2D’s Bulk FHIR data to your existing data streams, you can conduct trend analysis and search mass enrollee data to quickly identify:

    @@ -110,6 +111,7 @@ active-nav: overview-nav
    +

    Enhance MTM services

    Leverage insights from enrollee medical histories for more effective services.

    Plan sponsors can use AB2D data to get a holistic overview of enrollees' health histories. This allows for more informed discussions between the MTM provider and enrollee during comprehensive or targeted medication reviews:

    @@ -123,6 +125,7 @@ active-nav: overview-nav
+
From 0ee96a173da40270964e16744cd54758e9aac47c Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Wed, 10 Jul 2024 08:15:10 -0700 Subject: [PATCH 19/20] wip --- overview.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/overview.md b/overview.md index 42038a0..bf5fec0 100644 --- a/overview.md +++ b/overview.md @@ -110,7 +110,7 @@ active-nav: overview-nav

Due to final rule regulations, AB2D data can be used to detect fraud, waste, and abuse from providers and suppliers only. This can’t be used to influence coverage determination for enrollees.

-
+

Enhance MTM services

Leverage insights from enrollee medical histories for more effective services.
From e22d70452b765d9dc633febab19cefefe7d3718f Mon Sep 17 00:00:00 2001 From: smirnovaae Date: Thu, 11 Jul 2024 09:56:19 -0700 Subject: [PATCH 20/20] wip --- _layouts/home_layout.html | 8 -------- 1 file changed, 8 deletions(-) diff --git a/_layouts/home_layout.html b/_layouts/home_layout.html index fd10523..d301599 100644 --- a/_layouts/home_layout.html +++ b/_layouts/home_layout.html @@ -111,14 +111,6 @@

Prescription Drug Plan sponsors can use the AB2D API

-
-

- AB2D uses the - Bulk Fast Healthcare Interoperability Resources (FHIR) - standard to share health data that PDPs can use to better serve their - plan enrollees and ultimately improve patient health. -

-
patient care

Find MTM program enrollees

Identify Medication Therapy Management enrollees by using claims data for a more thorough search capability.