ATAG: FFQ Overview and Update

Date: 3/12/2015

FFQ Overview and Update Goals of FFQ Initial reporting What we have learned

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

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

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

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

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

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

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

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.

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)

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.