Em utilization file nyc download

Utilization Based on Outpatient Facility Lines We separately calculated mean line-level outpatient hospital, emergency department, and other outpatient facility utilization as a complement to the visit-level measures described above. Measuring utilization in terms of lines rather than visits provides additional useful information because it is common to receive multiple procedures or other services that would be reported on separate lines during a single visit. In aggregate, the ratio of the line-level to visit-level means was 4.

Many of the same patterns in outpatient hospital and emergency department visit-level results are mirrored in the line-level results reported in Table 3. Other outpatient facility claim types i. The mean number of lines increased modestly from to for all three utilization categories. Utilization Based on Professional Lines Professional services include services provided by physicians, other practitioners, and suppliers e. More than 95 percent of beneficiaries had at least one ED professional line per year Table 3.

We found an average of Utilization of professional services increased slightly from to Evaluation and management visits accounted for approximately 15 percent of all professional lines in each year. Surgery services increased from Otherwise, the mix of professional lines contributing to the total did not change substantively from to , although many of the differences in versus mean lines per beneficiary per year were statistically significant.

In terms of place of service, we found that more than half of professional lines in each year were in the office place of service, with smaller shares in the inpatient hospital and outpatient hospital settings 9 percent and 7 percent, respectively; see Table A. As with the type of service results above, the mix of professional lines across places of service did not shift significantly from to , although many of the individual versus differences in means were statistically significant because of the large number of beneficiary-months in our analyses.

We have identified each of these considerations through the process of developing specifications and programs to measure MA health care utilization. Most of the discussion in this section will be relevant to other applications of ED using the ED standard analytic files. Enrollment Several analytical decisions involved in the use of ED for utilization and other research areas are discussed in this section: what plan types to analyze, how to approach possible mismatches in contract enrollment, and addressing enrollment switching.

Contract IDs begin with H or R followed by 4 numerals. In the first approach, all utilization for a beneficiary in a given calendar month is assigned to the contract listed in the beneficiary enrollment table for that beneficiary-month.

In the second approach, utilization is assigned to the contract listed on the ED record itself. In general, the contract numbers identified via these two approaches matched. In an exploratory analysis using June professional lines, we found that the contract IDs derived from the enrollment table versus ED records matched Of the remaining 0. In the extremely rare case that a beneficiary has records submitted under two contracts which may occur prior to final reconciliation for a payment year , this approach avoids the complication of partitioning utilization within a month across contracts and avoids a related decision on whether beneficiaries with utilization submitted by multiple contracts should be counted in the denominator of one or multiple contracts for the purposes of calculating utilization rates.

However, the contract listed in the ED record is the contract that submitted the record for that beneficiary, so for certain research questions, the second approach may be more appropriate. We performed exploratory analyses to see how often Medicare beneficiaries switched contracts. In , 2. Less than 1 percent of beneficiaries switched between MA contracts.

This is another decision point for researchers, depending on the research questions, because the contract ID on the ED record indicates which MAO paid for the item or service.

This means that for , beneficiaries could contribute from 1 to 12 months, and the same for Most MA-enrolled beneficiaries Other MA-enrolled beneficiaries contributed fewer beneficiary-months because of new enrollment in MA, a transition out of MA, death, or a combination of the scenarios.

Note that we also allowed beneficiaries to contribute to multiple contracts and contract types over time if they switched MA contracts. Researchers should assess whether this approach or stricter continuous enrollment criteria are appropriate for their specific analyses.

For example, outpatient hospital facility records are bill type 13 in both data sources, and are claim type in ED and claim type 40 in Medicare FFS claims data. Researchers can reasonably categorize utilization using claim type only. We opted to use additional revenue center codes, HCPCS codes, and other information in addition to claim type to create more granular utilization categories see Table 2.

Our approach sometimes reassigns utilization from a primary claim type category such as outpatient hospital to another category such as emergency department. The assignment rules that we developed for ED are broadly similar to those that are frequently used for analysis of Medicare FFS claims, with three exceptions: 1. FFS claim types 71, 72, 81, and 82 distinguish between professional records that are submitted by Medicare Administrative Contractors MACs versus Durable Medical Equipment Regional Carriers DMERCs and between professional records that are for durable medical equipment, prosthetics, orthotics and supplies versus other professional services.

ED claim types do not distinguish between MACs and DMERCs because these are not relevant for Medicare Part C, although claim types and do distinguish between professional services and durable medical equipment. Chart review records CRRs are also submitted using the format and are stored as ED records; they can be linked to another ED record or unlinked. In contrast, while Medicare FFS claims data should include records for most services for which providers were paid plus FFS no-pay bills for specific situations , there are likely important gaps in FFS claims for services where payment is unlikely or impossible.

Others might share a personal anecdote about how the bill would affect them or people they care about. Leave this field blank. LBD A. Section of the education law is amended by adding a new subdivision 57 to read as follows: This act shall take effect immediately; provided that the amend- ments to sections h and g of the education law made by sections one and two of this act shall not affect the expiration of such sections and shall expire and be deemed repealed therewith.

View More 41 Lines. By contributing or voting you agree to the Terms of Participation and verify you are over All jobs within City government are assigned a specific civil service title. All titles are grouped into one of four categories:. Most positions within City government are in the competitive class. These are positions where it is possible for a test to determine an applicant's merit and fitness for the job. TA1 - Interchange Acknowledgement: Validates proper syntax and format of the outer envelope and functional groups.

A complete list of pre-adjudication edits and associated claim status codes will be posted to www. Note: The above response files will be new to the Medicaid processing system and will be implemented as providers submit the upgraded version.

During the transition period submitters of transactions will continue to receive the "F" file, , and U The U will be enhanced to include the front-end edits that will be implemented for the CA.

In response to submitter requests, NYSDOH is pleased to announce a new online "dashboard" that allows submitters to track the status of files from the moment they are received to the point of final adjudication.

The dashboard will be accessed from the www. Batches will only be viewable by the actual submitter ID used to submit the files. Users will use the same User ID and password used for transaction submission.

These changes will be seen by all providers regardless of the version submitted. The changes will impact all methods of accessing MEVS, including:. The magnitude of the changes necessary to meet the requirements of the eligibility response has forced modifications to both the and transactions within eMedNY. The following changes impact both formats except where specified. If one or more of the above Service Types are not returned in response - this indicates those services are not covered by Medicaid.

Service Types will also be returned to indicate specific exclusions or inclusions of coverage. For example, the following service types may be returned with an indication of Non-Covered this indicator is reported in EB The Hospital Inpatient example can create confusion if not properly considered. This means that the patient has coverage for outpatient including ER, lab, and X-ray hospital services only.

Today, if a member has a provider restriction, the eligibility response states "Provider Not Primary Physician. The requesting provider will be responsible for determining the applicability of the restriction based on the type of service to be provided. The name and available contact information of the plan will be included in the response. The service categories subject to UT are as follows:. With the implementation of the and D. SA transactions will no longer be supported.