Sample Acknowledgment Receipt Format

Document Sample
Sample Acknowledgment Receipt Format Powered By Docstoc
					                                       529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls



                                Integrated Healthcare Association
                               Pay for Performance (P4P) Program:
                     Year 7 Measures: 2009 Measurement / 2010 Reporting Year
                      Physician Organization (PO) Clinical Measure File Format

1. Items in blue indicate changes in language from last year (Year 6 Measures: 2008 Measurement / 2009 Reporting
   Year).

2. As a Physician Organization, if you select to self-report the Clinical Measure component of the P4P Program, then
   you must submit your file to Diversified Data Design Corp. (DDD).

3. Your DDD P4P Clinical Measure Team consists of Cherise Funakoshi, Doris Bermejo, and Noelle Porter. Cherise,
   Doris, and Noelle can be contacted at (310) 973-2880. All e-mail inquiries should to be sent to
   DDDP4P@DDDCORP.COM

4. The DDD P4P Clinical Measure Team will need to set up, as well as provide to you, your PO Unique ID, which will
   be used as part of your file name. All file names will follow specific logic. For your TEST files:
   TP4P2010UNIQUEID.CSV. For your FINAL AUDITED file: FP4P2010UNIQUEID.CSV

5. The files that will be submitted must be comma delimited files (.CSV).
    Following the structure of a comma delimited file, any text should be enclosed in quotation marks.

6. Detailed file specifications are included in tab (2) of this document. Medicare results will be reported together with
   Commercial results in the same Clinical Measure file.

7. Please ensure your Clinical Measure IDs for both your TEST files and FINAL AUDITED file are listed in the same
   sequence as those in the MY09 Commercial and Medicare Clinical Measure ID Table in tab (4). Report all
   Commercial measures first, then all Medicare measures.

8. Your .CSV file must be e-mailed to DDDP4P@DDDCORP.COM. The subject of your e-mail MUST include your
   FILE NAME only. For your TEST files: TP4P2010UNIQUEID .CSV. For your FINAL AUDITED file:
   FP4P2010UNIQUEID .CSV.

9. Please confirm that the final TEST file you send (last submitted TEST file to DDD) includes the results you would
   like to report/send to your auditor.

10. Your file will go through basic edit checks. If there are any problems during the processing of your file, you will be
    notified and asked to make corrections and resubmit a corrected file.

11. Once your .CSV file is received and successfully processed, you will receive an e-mail notification including: (a)
    date and time of processing of your file and (b) your trailer record that was included in your file. Receipt of an e-mail
    with a date and time stamp of processing means that your file has been successfully processed.




  Released 12/2009                                         1 of 9                                   (1)Cover+Instructions
                                       529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls


12. DDD expects the following types of TEST and FINAL AUDITED files from you:
    3/26/2010 – First day for DDD to accept data layout TEST files from Self-Reporting POs and Health Plans (TEST
    file: Formatting ). TEST file name: TP4P2010UNIQUEID.CSV. This initial TEST file is to confirm that you have
    formatted to the file specification correctly.
    5/2/2010 – Last day for Self-Reporting POs and Health Plans to submit their final TEST file to DDD (TEST file:
    Final ). TEST file name: TP4P2010UNIQUEID .CSV The final TEST file is basically a final "clean" file that requires
    DDD approval before it is sent to your auditor. This file is intended to be an exact copy of the file sent to your auditor
    for approval.
    5/7/2010 – Last day for Self-Reporting POs and Health Plans to send final DDD-approved submission file to their
    auditor (for approval, zipping, and locking) in order to make 5/14/2010 submission deadline to DDD.
    05/14/2010, 5pm PST – Last day for Self-Reporting POs and Health Plans to submit auditor-locked Clinical P4P
    results to DDD (FINAL AUDITED file). FINAL AUDITED file name: FP4P2010UNIQUEID.CSV

13. Once you receive a successful e-mail confirmation for your FINAL AUDITED file, you CANNOT send another file to
    DDD.

   Edit Checks:
1. If there is a numeric value, the RATE field must have five (5) digits after the decimal and not rounded.
2. Chlamydia Screening: All Ages – be sure the sum of the two CHLAM numerators (CHLAMSCR16 &
   CHLAMSCR21) is divided by the sum of the two CHLAM denominators.
3. Evidence-Based Cervical Cancer Screening: each measure (ECSAS1, ECSAS2, ECSAS3, ECSASOV, ECSNSOV,
   ECSTF1A24, ECSTF1A31, ECSTF2A24, ECSTF2A31, ECSTF3, ECSTFOV) has the same denominator if
   denominator has a value greater than zero. ECSASOV numerator is the sum of ECSAS1, ECSAS2, and ECSAS3
   numerators. ECSTFOV numerator is the sum of ECSTF1A24, ECSTF1A31, ECSTF2A24, ECSTF2A31, and
   ECSTF3 numerators. Note: sum of ECSASOV, ECSNSOV, and ECSTFOV rates should be close to one.

4. Annual Monitoring for Patients on Persistent Medications: Overall – be sure the sum of the three MPM numerators
   (MPM1, MPM2, & MPM3) is divided by the sum of the three MPM denominators.
5. Cholesterol Management for Patients with Cardiovascular Conditions: each measure has the same denominator
   (CMCSCR & CMC100) if denominator has a value greater than zero.
6. Appropriate Treatment for Children with Upper Respiratory Infection: do not report the rate inverted. Calculate as
   numerator/denominator.
7. Avoidance of Antibiotic Treatment for Adults with Acute Bronchitis: do not report the rate inverted. Calculate as
   numerator/denominator.
8. Use of Imaging Studies for Low Back Pain: do not report the rate inverted. Calculate as numerator/denominator.
9. Diabetes Care: HbA1c Poor Control > 9.0% – the HBACON rate should be greater than or equal to the inverted
    HBASCR (1-HBASCR) rate.
10. Coordinated Diabetes Care: each measure has the same denominator (HBASCR, HBACON, HBAC8, DLDLSCR,
    DLDL100, & NEPHSCR) if denominator has a value greater than zero, except for HBAC7 that might have a smaller
    denominator due to exclusions.




  Released 12/2009                                          2 of 9                                  (1)Cover+Instructions
                                      529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls
Physician Organization (PO) Clinical Measure File Format

File Type: Comma Delimited (.CSV)
TEST File Name: TP4P2010UNIQUEID .CSV (UNIQUEID is assigned to you by DDD.)
FINAL AUDITED File Name: FP4P2010UNIQUEID .CSV (UNIQUEID is assigned to you by DDD.)

Header Record Format
There can be only one Header Record

No. Field Name                    Description
1   Header Record Indicator       HDR
2   DMHC ID                       Unique ID per PO. Supplied by NCQA. Five (5) digits

3      DMHC Sub Unit              Sub Unit ID of DMHC ID. Supplied by NCQA. Two (2) digits

4      Total P4P Commercial       Total Commercial HMO/POS enrollment for all participating P4P Health Plans, for the
       Enrollment                 PO, as of 12/31/2009.
5      Total P4P Medicare         Total Medicare Advantage (Medicare) enrollment for all participating P4P Health
       Enrollment                 Plans, for the PO, as of 12/31/2009.
6      Submitter E-mail Address   E-mail address of submitter. An acknowledgment of receipt of file will be sent back to
                                  submitter.

Detail Record Format
There must be fifty (50) detail records per DMHC ID/Sub Unit; one record for each of the forty (40) clinical
measure IDs for the Commercial product and one record for each of the ten (10) clinical measure IDs for the
Medicare product.
For any measure a PO does not report, input zeros in the denominator and numerator field then set the Result =
"NR".

No. Field Name                    Description
1   Detail Record Indicator       Use DTL for each record
2   Measure ID                    Unique ID to identify P4P Clinical Measurement Rates. The PO must report fifty (50)
                                  measure rates (one record for each of the forty (40) clinical measure IDs for the
                                  Commercial product and ten (10) clinical measure IDs for the Medicare product) for
                                  each DMHC ID/Sub Unit. See MY09 Commercial and Medicare Clinical Measure
                                  ID Table in tab (4).
3      Measure Denominator        HMO/POS members continuously enrolled in the PO and were in any P4P Health
                                  Plan on the anchor date (for definition, refer to page 13 of the Measurement Year
                                  2009 P4P Manual located on the IHA.ORG website) who should have received the
                                  service described by the measure.
4      Measure Numerator          HMO/POS members continuously enrolled in the PO and were in any P4P Health
                                  Plan on the anchor date (for definition, refer to page 13 of the Measurement Year
                                  2009 P4P Manual located on the IHA.ORG website) who received the service
                                  described by the measure.

5      Rate or Result             Rate = Measure Numerator divided by Measure Denominator; numeric output with 5
                                  digits after the decimal and is not rounded. Result = Alpha characters to explain why
                                  a Rate is not reported; must use SD, NB, BR, or NR. See Audit Results Table in tab
                                  (3).
6      Product                    C = Commercial / M = Medicare
7      Audited                    Must be completed by the PO. Y = Approved for Reporting. See Audit Results Table
                                  in tab (3). Required for FINAL AUDITED file (FP4P2010UNIQUEID .CSV).




    Prepared by 12/2009                                 3 of 9                                            (2)CM Specs
                                       529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls


Trailer Record Format
There can be only one Trailer Record

No. Field Name                    Description
1   Trailer Record Indicator      Use TRL
2   Measure ID Count              Count the number of Measure IDs that are being reported. This is essentially a count
                                  of the number of DTL records. The number must be fifty (50) given that all Unique
                                  Measure IDs must be included in your file.
3      Measure Denominator        Add each record in the "Measure Denominator" column to come up with a summation
       Summation                  of all denominators for entire file.
4      Measure Numerator          Add each record in the "Measure Numerator" column to come up with a summation of
       Summation                  all numerators for entire file.




    Prepared by 12/2009                                 4 of 9                                           (2)CM Specs
                                                          529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls


Physician Organization (PO) Clinical Measure File Format

                                                                    Physician Organization
                                                                     Audit Results Table
                                    Rate/Result Field:                                                  Measure Numerator/Denominator Field:
Rate Enter the measure's numeric rate: Measure Numerator divided by Measure                 Populate numerator and denominator, calculate rate.
     Denominator.
SD   The self-reported denominator is <30.                                                  If SD, populate numerator and denominator, populate rate as SD.
NB   Enter NB if the Health Plan did not offer the health benefit required by the measure   If NB, populate numerator and denominator with 0, populate rate with
     (e.g., pharmacy).                                                                      NB.
BR   Enter BR if the measure was calculated, but the rate was materially biased.            If BR, populate numerator and denominator, populate rate as BR.
NR   The reporting entity did not report the measure.                                       If NR, populate numerator and denominator with 0, populate rate with
                                                                                            NR.
                                        Audited:
Y     Must be entered by the PO. Indicates the measure's rate/result IS audited and
      reportable. When submitted to the auditor, the auditor will then confirm or change
      the PO's audited designation. (Must be Y for all non-transition, non-testing
      measures)




    Released 12/2009                                                          5 of 9                                                  (3)Audit Results Table
                                                                            529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls



                                                                                        P4P PO Tables
                                                                  MY09 Commercial and Medicare Clinical Measure ID Table
         List of IDs for Clinical Measures (40 Measure IDs total)
         There must be fifty (50) detail records per DMHC ID/Sub Unit; one record for each of the forty (40) clinical measure IDs for the Commercial product and one record for each
         of the ten (10) clinical measure IDs for the Medicare product. Report the forty (40) Commercial measures first; then report the ten (10) Medicare measures.

         Please keep in the same order as this submission file.
         No. Measure Name                                         Measure ID       Edit Checks                                           Product(s)    Comments
         1    Childhood Immunization Status: DTaP                 CISDTP                                                                 Commercial    Four Diphtheria, Tetanus,
                                                                                                                                                       Acellular pertussis
         2     Childhood Immunization Status: Hepatitis B         CISHEPB                                                                Commercial    Three Hepatitis B
         3     Childhood Immunization Status: Hib                 CISHIB                                                                 Commercial    Two H influenza type B
                                                                                   Note: All CIS denominators should be close, but may
         4     Childhood Immunization Status: IPV                 CISIPV                                                                 Commercial    Three Polio
                                                                                   slightly vary due to antigen specific exclusions
         5     Childhood Immunization Status: MMR                 CISMMR                                                                 Commercial    One Measles, Mumps, Rubella
         6     Childhood Immunization Status: PCV                 CISPNC                                                                 Commercial    Four Pneumococcal Conjugate
                                                                                                                                                       Vaccines
         7     Childhood Immunization Status: VZV                 CISVZV                                                                 Commercial    One Chicken Pox
         8     Chlamydia Screening: Ages 16-20                    CHLAMSCR16                                                             Commercial
         9     Chlamydia Screening: Ages 21-24                    CHLAMSCR21                                                             Commercial
         10    Chlamydia Screening: All Ages                      CHLAMSCR         Sum of the two CHLAM numerators divided by the sum    Commercial
                                                                                   of the two CHLAM denominators
         11    Evidence-Based Cervical Cancer Screening -         ECSAS1                                                                 Commercial    New Measure
               Appropriately Screened With Hyst: Ages 24-65
         12    Evidence-Based Cervical Cancer Screening -         ECSAS2                                                                 Commercial    New Measure
               Appropriately Screened No Hyst: Ages 24-65
         13    Evidence-Based Cervical Cancer Screening -         ECSAS3                                                                 Commercial    New Measure
               Appropriately Screened No Pap Test: Ages 67+
         14    Evidence-Based Cervical Cancer Screening -         ECSASOV                                                                Commercial    New Measure
               Appropriately Screened: All Ages
                                                                                   Each measure has the same denominator if denominator
         15    Evidence-Based Cervical Cancer Screening - Not     ECSNSOV                                                               Commercial     New Measure
                                                                                   has a value greater than zero. ECSASOV numerator is
               Screened No Hyst: Ages 24-65
                                                                                   the sum of ECSAS1, ECSAS2, and ECSAS3
         16    Evidence-Based Cervical Cancer Screening - Too     ECSTF1A24                                                             Commercial     New Measure
                                                                                   numerators. ECSTFOV numerator is the sum of
               Frequently With Hyst: Ages 24-30
                                                                                   ECSTF1A24, ECSTF1A31, ECSTF2A24, ECSTF2A31,
         17    Evidence-Based Cervical Cancer Screening - Too     ECSTF1A31                                                             Commercial     New Measure
                                                                                   and ECSTF3 numerators. Note: sum of ECSASOV,
               Frequently With Hyst: Ages 31-65
                                                                                   ECSNSOV, and ECSTFOV rates should be close to one.
         18    Evidence-Based Cervical Cancer Screening - Too     ECSTF2A24                                                             Commercial     New Measure
               Frequently No Hyst: Ages 24-30
         19    Evidence-Based Cervical Cancer Screening - Too     ECSTF2A31                                                              Commercial    New Measure
               Frequently No Hyst: Ages 31-65
         20    Evidence-Based Cervical Cancer Screening - Too     ECSTF3                                                                 Commercial    New Measure
               Frequently With Pap Test: Ages 67+
         21    Evidence-Based Cervical Cancer Screening - Too     ECSTFOV                                                                Commercial    New Measure
               Frequently: All Ages
         22    Breast Cancer Screening: Ages 42-69                BCSOV                                                                  Commercial
                                                                                                                                         Medicare
         23    Colorectal Cancer Screening: Ages 51-75            COL                                                                    Commercial    Decreased the upper age limit
                                                                                                                                         Medicare      to 75 years of age.
         24    Annual Monitoring for Patients on Persistent       MPM1                                                                   Commercial
               Medications: ACE or ARB



Released 12/2009                                                                             6 of 9                                                                     (4)Clin Meas ID Table
                                                                            529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls



                                                                                        P4P PO Tables
                                                                  MY09 Commercial and Medicare Clinical Measure ID Table
         List of IDs for Clinical Measures (40 Measure IDs total)
         There must be fifty (50) detail records per DMHC ID/Sub Unit; one record for each of the forty (40) clinical measure IDs for the Commercial product and one record for each
         of the ten (10) clinical measure IDs for the Medicare product. Report the forty (40) Commercial measures first; then report the ten (10) Medicare measures.

         Please keep in the same order as this submission file.
         No. Measure Name                                         Measure ID       Edit Checks                                           Product(s)    Comments
         25 Annual Monitoring for Patients on Persistent          MPM2                                                                   Commercial
              Medications: Digoxin
         26 Annual Monitoring for Patients on Persistent          MPM3                                                                   Commercial
              Medications: Diuretics
         27 Annual Monitoring for Patients on Persistent          MPMOV            Sum of the numerators divided by the sum of the       Commercial
              Medications: Overall                                                 denominators of MPM1, MPM2, & MPM3
         28 Cholesterol Management for Patients with              CMCSCR                                                                 Commercial
              Cardiovascular Conditions: LDL-C Screening                           Cholesterol Management: each measure has same         Medicare
         29 Cholesterol Management for Patients with              CMC100           denominator if denominator has a value greater than   Commercial
              Cardiovascular Conditions: LDL-C Control < 100                       zero                                                  Medicare
              mg/dL
         30 Appropriate Testing for Children with Pharyngitis     CWP                                                                    Commercial
         31 Appropriate Treatment for Children with Upper         URI              Do not report rate inverted. Calculate                Commercial
              Respiratory Infection                                                Numerator/Denominator
         32 Avoidance of Antibiotic Treatment for Adults with     AAB              Do not report rate inverted. Calculate                Commercial
              Acute Bronchitis                                                     Numerator/Denominator
         33 Use of Imaging Studies for Low Back Pain              LBP              Do not report rate inverted. Calculate                Commercial
                                                                                   Numerator/Denominator
         34    Diabetes Care: HbA1c Screening                     HBASCR                                                                Commercial
                                                                                                                                        Medicare
         35    Diabetes Care: HbA1c Poor Control > 9.0%           HBACON                                                                Commercial
                                                                                                                                        Medicare
         36    Diabetes Care: HbA1c Control < 8.0%                HBAC8            Coordinated Diabetes Care: each measure has the same Commercial
                                                                                   denominator if denominator has a value greater than  Medicare
         37    Diabetes Care: HbA1c Control < 7.0%                HBAC7            zero, except for HBAC7. The HBACON rate should be    Commercial     New Measure
         38    Diabetes Care: LDL-C Screening                     DLDLSCR          greater than or equal to the inverted HBASCR (1-     Commercial
                                                                                   HBASCR) rate.                                        Medicare
         39    Diabetes Care: LDL-C Control < 100 mg/dL           DLDL100                                                               Commercial
                                                                                                                                        Medicare
         40    Diabetes Care: Nephropathy Monitoring              NEPHSCR                                                               Commercial
                                                                                                                                        Medicare




Released 12/2009                                                                              7 of 9                                                                    (4)Clin Meas ID Table
                                                                               529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls

       Sample Physician Organization (PO) Clinical Measure File
       File Type: Comma Delimited (.CSV)
       TEST File Name: TP4P2010UNIQUEID.CSV (Use UNIQUEID assigned to you by DDD)
       Audit should always be Y
       Report the forty (40) Commercial measures first (Product = C); then report the ten (10) Medicare measures (Product = M).
       *DTL CNT - used to illustrate the fifty (50) detail records per DMHC ID/Sub Unit only.
       The yellow highlighted area is the only part of your record layout.

       Sample File #1: POs contracting with one or more Health Plan must submit fifty (50) detail records; one record for each of the forty (40) clinical measure IDs for the Commercial
       product and one record for each of the ten (10) clinical measure IDs for the Medicare product. Examples of NR for certain measures.

DTL
CNT*          SAMPLE PHYSICIAN ORGANIZATION CLINICAL MEASURE FILE                                                                              COMMENTS
       HDR          11111         00   16688      4121 submitter@po.com
DTL
CNT*   DTL    Measure ID Denominator Numerator             Rate      Product     Audit                                  Edit Check                                         Comments
1      DTL    CISDTP         468       414                0.88461       C         Y                                                                      Four Diphtheria, Tetanus, Acellular pertussis
2      DTL    CISHEPB        468       422                0.90170       C         Y                                                                      Three Hepatitis B
3      DTL    CISHIB         469       435                0.92750       C         Y                 Note: All CIS denominators should be close, but      Two H influenza type B
4      DTL    CISIPV         470       430                0.91489       C         Y                 may slightly vary due to antigen specific exclusions Three Polio
5      DTL    CISMMR         468       434                0.92735       C         Y                                                                      One Measles, Mumps, Rubella
6      DTL    CISPNC         470       380                0.80851       C         Y                                                                      Four Pneumococcal Conjugate Vaccines
7      DTL    CISVZV         471       428                0.90870       C         Y                                                                      One Chicken Pox
8      DTL    CHLAMSCR16    2210       800                0.36199       C         Y
9      DTL    CHLAMSCR21    8268       5072               0.61344       C         Y
10     DTL    CHLAMSCR     10478       5872               0.56041       C         Y                 Sum of the two CHLAM numerators divided by the
                                                                                                    sum of the two CHLAM denominators
11     DTL    ECSAS1                2505       621        0.24790       C          Y                                                                     New Measure
12     DTL    ECSAS2                2505       312        0.12455       C          Y                Each measure has the same denominator if             New Measure
13     DTL    ECSAS3                2505       113        0.04510       C          Y                denominator has a value greater than zero.           New Measure
14     DTL    ECSASOV               2505       1046       0.41756       C          Y                ECSASOV numerator is the sum of ECSAS1,              New Measure
15     DTL    ECSNSOV               2505       169        0.06746       C          Y                ECSAS2, and ECSAS3 numerators. ECSTFOV               New Measure
16     DTL    ECSTF1A24             2505       270        0.10778       C          Y                numerator is the sum of ECSTF1A24,                   New Measure
17     DTL    ECSTF1A31             2505       206        0.08223       C          Y                ECSTF1A31, ECSTF2A24, ECSTF2A31, and                 New Measure
18     DTL    ECSTF2A24             2505        80        0.03193       C          Y                ECSTF3 numerators. Note: sum of ECSASOV,             New Measure
19     DTL    ECSTF2A31             2505       623        0.24870       C          Y                ECSNSOV, and ECSTFOV rates should be close           New Measure
20     DTL    ECSTF3                2505       111        0.04431       C          Y                to one.                                              New Measure
21     DTL    ECSTFOV               2505       1290       0.51497       C          Y                                                                     New Measure
22     DTL    BCSOV                   0         0              NR       C          Y
23     DTL    COL                    564       324        0.57446       C          Y
24     DTL    MPM1                  1689       1317       0.77975       C          Y
25     DTL    MPM2                  1500       1189       0.79266       C          Y
26     DTL    MPM3                  1308       996        0.76146       C          Y
27     DTL    MPMOV                 4497       3502       0.77874       C          Y                Sum of the numerators divided by the sum of the
                                                                                                    denominators of MPM1, MPM2, & MPM3
28     DTL    CMCSCR                1318        989       0.75037       C          Y                Cholesterol Management: each measure has
                                                                                                    same denominator if denominator has a value
29     DTL    CMC100                1318        376       0.28528       C          Y
                                                                                                    greater than zero
30     DTL    CWP                   108          53       0.49074       C          Y
31     DTL    URI                   986         759       0.76977       C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
32     DTL    AAB                   291          65       0.22336       C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
33     DTL    LBP                    0           0              NR      C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
34     DTL    HBASCR                4021       3200       0.79582       C          Y
35     DTL    HBACON                4021       1021       0.25391       C          Y                Coordinated Diabetes Care: each measure has the
36     DTL    HBAC8                 4021       1200       0.29843       C          Y                same denominator if denominator has a value
37     DTL    HBAC7                 3501       800        0.22850       C          Y                greater than zero, except for HBAC7. The        New Measure
38     DTL    DLDLSCR               4021       2989       0.74334       C          Y                HBACON rate should be greater than or equal to
39     DTL    DLDL100               4021       1399       0.34792       C          Y                the inverted HBASCR (1-HBASCR) rate.
40     DTL    NEPHSCR               4021       2800       0.69634       C          Y
41     DTL    BCSOV                  35         15        0.42857       M          Y
42     DTL    COL                    614       340        0.55374       M          Y                                                                     Decreased the upper age limit to 75 years of
                                                                                                                                                         age.
43     DTL    CMCSCR                2004       1006       0.50199       M          Y                Cholesterol Management: each measure has
                                                                                                    same denominator if denominator has a value
44     DTL    CMC100                2004        854       0.42614       M          Y
                                                                                                    greater than zero
45     DTL    HBASCR                3452        2151      0.62311       M          Y
                                                                                                    Coordinated Diabetes Care: each measure has the
46     DTL    HBACON                3452        1301      0.37688       M          Y
                                                                                                    same denominator if denominator has a value
47     DTL    HBAC8                 3452        850       0.24623       M          Y
                                                                                                    greater than zero. The HBACON rate should be
48     DTL    DLDLSCR               3452        2564      0.74275       M          Y
                                                                                                    greater than or equal to the inverted HBASCR (1-
49     DTL    DLDL100               3452        1956      0.56662       M          Y
                                                                                                    HBASCR) rate.
50     DTL    NEPHSCR               3452        3179      0.92091       M          Y
       TRL    50                   118370      56723




                Released 12/2009                                                                 8 of 9                                                                 (5)Sample PO File
                                                                              529a1006-dbfb-4e51-bd7f-4b7fe143176f.xls

       Sample Physician Organization (PO) Clinical Measure File
       File Type: Comma Delimited (.CSV)
       TEST File Name: TP4P2010UNIQUEID.CSV (Use UNIQUEID assigned to you by DDD)
       Audit should always be Y
       Report the forty (40) Commercial measures first (Product = C); then report the ten (10) Medicare measures (Product = M).
       *DTL CNT - used to illustrate the fifty (50) detail records per DMHC ID/Sub Unit only.
       The yellow highlighted area is the only part of your record layout.

       Sample File #2: POs contracting with one or more Health Plan must submit fifty (50) detail records; one record for each of the forty (40) clinical measure IDs for the Commercial
       product and one record for each of the ten (10) clinical measure IDs for the Medicare product. Examples of SD for certain measures.


DTL                                                                                                                                            COMMENTS
CNT*        SAMPLE PHYSICIAN ORGANIZATION CLINICAL MEASURE FILE
       HDR 22222                00   100131     4512 submitter2@po.com
DTL
CNT*   DTL    Measure ID Denominator Numerator             Rate   Product        Audit                                  Edit Check                                         Comments
1      DTL    CISDTP        135        110                0.81481    C            Y                                                                      Four Diphtheria, Tetanus, Acellular pertussis
2      DTL    CISHEPB       134        116                0.86567    C            Y                                                                      Three Hepatitis B
3      DTL    CISHIB        135        128                0.94814    C            Y                 Note: All CIS denominators should be close, but      Two H influenza type B
4      DTL    CISIPV        134        122                0.91044    C            Y                 may slightly vary due to antigen specific exclusions Three Polio
5      DTL    CISMMR        137        126                0.91970    C            Y                                                                      One Measles, Mumps, Rubella
6      DTL    CISPNC        138         89                0.64492    C            Y                                                                      Four Pneumococcal Conjugate Vaccines
7      DTL    CISVZV        135        119                0.88148    C            Y                                                                      One Chicken Pox
8      DTL    CHLAMSCR16      5         4                      SD    C            Y
9      DTL    CHLAMSCR21     10         6                      SD    C            Y
10     DTL    CHLAMSCR       15         10                     SD    C            Y                 Sum of the two CHLAM numerators divided by the
                                                                                                    sum of the two CHLAM denominators
11     DTL    ECSAS1               2800        575        0.20535       C          Y                                                                     New Measure
12     DTL    ECSAS2               2800        549        0.19607       C          Y                Each measure has the same denominator if             New Measure
13     DTL    ECSAS3               2800        120        0.04285       C          Y                denominator has a value greater than zero.           New Measure
14     DTL    ECSASOV              2800        1244       0.44428       C          Y                ECSASOV numerator is the sum of ECSAS1,              New Measure
15     DTL    ECSNSOV              2800        234        0.08357       C          Y                ECSAS2, and ECSAS3 numerators. ECSTFOV               New Measure
16     DTL    ECSTF1A24            2800        128        0.04571       C          Y                numerator is the sum of ECSTF1A24,                   New Measure
17     DTL    ECSTF1A31            2800        120        0.04285       C          Y                ECSTF1A31, ECSTF2A24, ECSTF2A31, and                 New Measure
18     DTL    ECSTF2A21            2800        313        0.11178       C          Y                ECSTF3 numerators. Note: sum of ECSASOV,             New Measure
19     DTL    ECSTF2A31            2800        375        0.13392       C          Y                ECSNSOV, and ECSTFOV rates should be close           New Measure
20     DTL    ECSTF3               2800        386        0.13785       C          Y                to one.                                              New Measure
21     DTL    ECSTFOV              2800        1322       0.47214       C          Y                                                                     New Measure
22     DTL    BCSOV                5570        4695       0.84290       C          Y
23     DTL    COL                   811        564        0.69543       C          Y
24     DTL    MPM1                 1689        1318       0.78034       C          Y
25     DTL    MPM2                  22          14        0.63636       C          Y
26     DTL    MPM3                 1308        996        0.76146       C          Y
27     DTL    MPMOV                3019        2328       0.77111       C          Y                Sum of the numerators divided by the sum of the
                                                                                                    denominators of MPM1, MPM2, & MPM3
28     DTL    CMCSCR               2000         200       0.10000       C          Y                Cholesterol Management: each measure has
                                                                                                    same denominator if denominator has a value
29     DTL    CMC100               2000         651       0.32550       C          Y
                                                                                                    greater than zero
30     DTL    URI                   29           15             SD      C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
31     DTL    CWP                   108          53       0.49074       C          Y
32     DTL    AAB                   291          65       0.22336       C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
33     DTL    LBP                   305         243       0.79672       C          Y                Do not report rate inverted. Calculate
                                                                                                    Numerator/Denominator
34     DTL    HBASCR               1501         987       0.65756       C          Y
35     DTL    HBACON               1501         800       0.53297       C          Y                Coordinated Diabetes Care: each measure has the
36     DTL    HBAC8                1501         100       0.66822       C          Y                same denominator if denominator has a value
37     DTL    HBAC7                1200          87       0.07250       C          Y                greater than zero, except for HBAC7. The        New Measure
38     DTL    DLDLSCR              1501         785       0.52298       C          Y                HBACON rate should be greater than or equal to
39     DTL    DLDL100              1501         988       0.65822       C          Y                the inverted HBASCR (1-HBASCR) rate.
40     DTL    NEPHSCR              1501         581       0.38707       C          Y
41     DTL    BCSOV                 378         140       0.37037       M          Y
42     DTL    COL                   564         102       0.18085       M          Y                                                                     Decreased the upper age limit to 75 years of
                                                                                                                                                         age.
43     DTL    CMCSCR               2100        2043       0.97285       M          Y                Cholesterol Management: each measure has
                                                                                                    same denominator if denominator has a value
44     DTL    CMC100               2100        1995       0.95000       M          Y
                                                                                                    greater than zero
45     DTL    HBASCR               3451         2934      0.85018       M          Y
                                                                                                    Coordinated Diabetes Care: each measure has the
46     DTL    HBACON               3451         1392      0.40336       M          Y
                                                                                                    same denominator if denominator has a value
47     DTL    HBAC8                3451         1542      0.44682       M          Y
                                                                                                    greater than zero. The HBACON rate should be
48     DTL    DLDLSCR              3451         2902      0.84091       M          Y
                                                                                                    greater than or equal to the inverted HBASCR (1-
49     DTL    DLDL100              3451         2859      0.82845       M          Y
                                                                                                    HBASCR) rate.
50     DTL    NEPHSCR              3451         1981      0.57403       M          Y
       TRL    50                   84984       39556




                Released 12/2009                                                                 9 of 9                                                                 (5)Sample PO File

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:341
posted:7/28/2011
language:English
pages:9
Description: Sample Acknowledgment Receipt Format document sample