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. For more information about any of the tools, use cases, or webinars listed below, please contact MMDIMgmt@FeiSystems.com.


Medicare Database Staging Model (DSM)
The MMDI team has created a Medicare DSM to assist SMAs in loading Medicare data in 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 and expanded to include a State’s Medicaid data.

Master Patient Index (MPI) Specifications
With receipt of the Medicare data, some SMAs may need a methodology with which they can link their enrollees across multiple data sources to create a longitudinal view of each enrollee. An MPI can help ensure that an enrollee is logically represented only once in the State’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 and Part B data received from CCW.

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 an event record (original and adjustments), and creates a final action indicator to indicate which is the most recent (or final) version. As adjustments for older events can be received across a series of months, 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 claim (original and adjustments) and creates a final action indicator to indicate which is the most recent (or final) version. As adjustments for older claims can be received across a series of months, the algorithm should be rerun on all 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, but who may be unfamiliar enough with the data that providing the required use justifications presents a challenge.


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