Request Process Details

As indicated in the Medicare Data Available section of this site, CMS’s Medicare Medicaid Coordination Office (MMCO) has made certain Medicare data available to state Medicaid agencies for Medicare-Medicaid care coordination and program integrity activities. Because the available data time periods (e.g., daily, weekly, monthly, or yearly) and data acquisition methods (new, additional data use, or update) can vary for these data types, there are a number of configuration options for the state Medicaid agencies’ data request packages.

In general, though, a state Medicaid agency can request historical Parts A and B data—including enrollment, claims, and assessments data (MDS, OASIS, Swing Bed, and IRF-PAI)—and Part D data (also known as Prescription Drug Event (PDE) data). Additionally, if the state Medicaid agency establishes a Coordination of Benefits Agreement (COBA) with CMS, daily or weekly feeds of current Parts A and B data are available. To help state Medicaid agencies determine the forms necessary to their request, SDRC has compiled request package files for each of the major request types—New, Additional Data Use, and Update—and published them below. SDRC also defined the processes governing all of the permutations for these requests in the following document: Data Request Process for Care Coordination and Program Integrity.

NOTE: A single request package is grouped according to the type of data a state Medicaid agency requires (e.g., historical Parts A and B data).

Historical Parts A and B Data: Request Package Files

New Use Request Package

Additional Data Use Request Package

Assessments Data: Request Package Files

New Use Request Package

Additional Data Use Request Package

Daily or Weekly Parts A & B (COBA) Data: Request Package Files

Please note if the state Medicaid agency establishes a Coordination of Benefits Agreement (COBA) with CMS, daily or weekly feeds of current Parts A and B claims data are available.

New Use Request Package

Part D Data: Request Package Files

New Use Request Package

Please note that the conflict of interest templates provided below are suggested guidelines for creating conflict of interest letters. The order and format of the information does not need to follow the template exactly; however, the templates do contain key information requirements, and any variation should be submitted for approval from MMCO and/ or CPI.

Additional Data Use Request Package

Please note that the conflict of interest templates provided below are suggested guidelines for creating conflict of interest letters. The order and format of the information does not need to follow the template exactly; however, the templates do contain key information requirements, and any variation should be submitted for approval from MMCO and/ or CPI.

Territory Beneficiary Query (TBQ) Response File

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