SDRC

State Data
Resource Center

Resources for States Integrating Medicare and Medicaid Data

The Medicare–Medicaid Data Integration (MMDI) program has developed many tools designed to assist state Medicaid agencies (SMAs) with the acquisition, integration, and utilization of Medicare data.


Medicare Database Staging Model (DSM)
The MMDI team has created a Medicare DSM to assist SMAs with loading Medicare data into their data warehouses. The DSM is based on the record layouts of Medicare data available to SMAs and can be generated (using the supplied data definition language (DDL) into many commonly used relational database management systems. The DSM serves as a holding area from which SMAs can extract, transform, and load data into intermediate tables for integration into their data warehouses. It can also be used to complete an initial data quality check. Additionally, the DSM can be expanded to include a state's Medicaid data.

Master Patient Index (MPI) Specifications
Some SMAs may need a methodology to link their enrollees across multiple Medicare and Medicaid data sources, resulting in a longitudinal view of each enrollee. An MPI can help ensure that an enrollee is logically represented only once in the SMA’s database, across all Medicare and Medicaid data sources. To support this effort, the MMDI team has developed specifications using a deterministic approach to implement an MPI solution.

Coordination of Benefits Agreement (COBA) to Chronic Conditions Data Warehouse (CCW) Historic Part A and Part B Mapping
The MMDI team has researched, analyzed, and documented a cross-reference data mapping, which includes related data integration recommendations, to assist SMAs in understanding how COBA claims data equates to and differs from the historic Part A/B data received from the CCW.

Chiapas EDI Translator and SAS Load Script
Based on the recommended data elements highlighted in the COBA to CCW Historic Part A/B Mapping, the MMDI team implemented the Chiapas EDI Translator (a free tool offered by SDRC) to translate Enhanced COBA 837 Institutional and 837 Professional claims into a flattened (.csv) format. The MMDI team developed an additional series of SAS scripts to load the outputted .csv files into SAS data sets. The MMDI team recommends the Chiapas Load Script for any SMA that is using Chiapas, or considering using Chiapas. The Chiapas Load Script code may also be useful for SMAs who wish to validate their mapping/translation using other EDI translators. Please note that these scripts can be retrofitted to other relational database management systems, such as SQL Server or Oracle.

Part D Prescription Drug Event (PDE) Final Action Indicator Process and Algorithm
The MMDI team has developed specifications and an algorithm to assist SMAs with applying final action processing to their Part D PDE data. The algorithm sorts through all available versions of a PDE (original, adjustments, and cancellations), and creates a final action indicator to indicate which record is the most recent (or final) version. As changes to older events can be received months after they are initially processed, the algorithm should be rerun on all events each time additional PDE data are received.

COBA Final Action Indicator Process and Algorithm
The MMDI team has developed specifications and an algorithm to assist SMAs with applying final action processing to their Enhanced COBA data. The algorithm sorts through all available versions of a COBA claim (original, adjustments, and cancellations) and creates a final action indicator to indicate which claim is the most recent (or final) version. As changes to older claims can be received months after they are initially processed, the algorithm should be rerun on all COBA claims each time additional Enhanced COBA data are received.

CCW Assessment Data Request Suggestions
The intent of this document is to provide guidance to SMAs interested in requesting Medicare assessment data. It will be most helpful to those who may are unfamiliar with the assessment data and need assistance providing the required use justifications.

MBSF Population Macro & User Implementation Guide
The Master Beneficiary Summary File (MBSF) provides demographic and enrollment information that can be used to identify Medicare beneficiary sub-populations for detailed reporting and analytics, such as dual eligible or managed care enrollees. Since these descriptive data elements tend to be monthly variables, it can be challenging for SMAs to use them for annual or quarterly analyses. The Medicare-Medicaid Coordination Office (MMCO) and the CCW have developed algorithms that SMAs can use to assign beneficiaries a yearly or quarterly status based on monthly data elements. However, complex SAS programming is needed to implement the algorithms. The purpose of the MBSF Population Macro is to provide SMAs with a SAS macro to standardize the process for creating Medicare-based beneficiary demographic and enrollment indicators that can be used for data analysis related to their dual eligible population.

CCW Chronic Conditions Macro & User Implementation Guide
The Chronic Conditions Data Warehouse (CCW) developed algorithms using the diagnosis and procedure codes available in Medicare data to identify 62 different chronic conditions. While SMAs can request datasets containing flags that identify the beneficiaries with these chronic conditions in their dual eligible populations, these datasets are based on Medicare data only. Including Medicaid claims data in the calculation of the flags provides a more complete view of the prevalence of chronic conditions in a SMA's dual eligible population. The purpose of this SAS macro is to take input claims data in a common format across Medicare, Medicaid, or integrated dat and output beneficiary-level identifier flags for all 62 CCW chronic conditions.

MMDI Medicare Data Sources Diagram
This document provides a high-level overview of the Medicare data sources available to SMAs, including the Part D Prescription Drug Event (PDE) data from the Integrated Data Repository (IDR), historic Medicare claims, enrollment, and assessment data from the Chronic Conditions Data Warehouse (CCW), and Enhanced COBA claims from the Benefits Coordination and Recovery Center (BCRC). For each data source, we describe the contents, source, selection criteria, time period/currency, frequency, any additional processing (if necessary), delivery method, and format.


For more information about any of the tools, use cases, or webinars, please contact SDRC@EconometricaInc.com.