Statewide Provider Directory Project Overview Mar 2017 1 Provider - - PowerPoint PPT Presentation

Mar 2017

Statewide Provider Directory Project Overview

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Provider Directory Highlights

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Directory of accurate, trusted provider data available to vetted healthcare entities (Not consumer-facing) Authoritative data sources that feed the directory are matched, scrubbed, and given a quality score – We are starting with the trusted provider directory related data from Common Credentialing and augmenting with additional data sources Ongoing management of the data is handled by staff (“data stewards”) that ensure data displayed in the provider directory is accurate

Correct data Complete data Current data One-stop shop for Provider data

Key uses

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Efficiencies for Operations

• Access to a trusted,

single, complete source of provider and practice information

• Validate data

residing in an health care entity’s own provider directory

• Support entities’

need to meet requirements for updated/accurate provider directories Facilitate care coordination and health information exchange (HIE)

• Find Direct secure

messaging (DSM) addresses and other provider information allowing electronic clinical data to be sent to the correct recipient

• Find providers for

referrals and care coordination

• Meet meaningful use
• bjectives regarding

transitions of care Resource for health care analysis

• Source of data on

where and when providers practice to support analysis of claims and other data

• Support generation of

metrics and data analysis for quality improvement and related payment efforts

• Support research and

inform policy

Provider Directory Users

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Efficiencies for Operations Care Coordination Data resource for analytics Providers, including care coordinators Clinics Hospitals and Health Systems OHA and DHS Payers CCOs Local HIEs Independent Physicians Associations

Provider Directory Services at a glance

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Data services – Data leveraged from authoritative sources are scrubbed, scored, matched, and maintained Web portal - Query the web portal and export results* Data extracts – Predefined, static extracts of data from the provider directory Custom extracts - customizable extracts of data from the provider directory Integrated provider directory - Integrated access to and from the provider directory via an Application Program Interface (API) or web services

*Not expecting data entry component in initial phases

Types of providers in the Provider Directory

• The term “Provider” is broad
• The Provider Directory can contain data on individual practitioners,

care coordinators, organizations including facilities, hospitals, and ambulatory surgical centers.

• It is NOT required for a Provider to have an National Provider

Identifier (NPI) in order to have a record in the Provider Directory

• “Who” will be in the Provider Directory is at least initially determined

by the data sources the feed the directory and the use cases. For example: – Common Credentialing has 26 different provider types – MMIS has 77 different provider types

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High Level Provider Directory Data Types

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 Provider/Organization name  Address (street, billing, practice, mailing)  Contact info (Phone, fax, email(s), website)  Demographics (gender, language, race)  Provider type and specialty  Provider affiliations (clinics, payers) with effective dates  License and certifications (type, dates, renewals)  Identifiers (NPI, Medicaid ID, etc.)  Direct Secure Messaging Address information  Other provider/practice information: Accepting new patients, office hours, ADA accessibility

Initial data sources: Common Credentialing, MMIS, CareAccord Flat-File Directory, EHR Incentive Programs, Patient- Centered Primary Care Home (PCPCH), CCO networks Additional: Public Health, National Plan and Provider Enumeration System (NPPES), Provider Enrollment, Chain and Ownership System (PECOS), All Payer All Claim (APAC), HIEs, Other

Medicaid Managed Care Rule/ Provider Directory Data Elements Analysis

MCD Managed Care Rule Requirement Provider Directory Phase Provider’s name and group affiliation Phase 1 Street address Phase 1 Telephone number Phase 1 Website URL Phase 1 Specialty Phase 1 Accepting new enrollees Phase 2 Cultural and linguistic capabilities TBD Office/Facility accommodations for physical disabilities TBD

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Timeline

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2014

• Spring: Convene external subject matter expert workgroup
• Fall: CMS Medicaid Funding Approval

2015

• Winter: Release Request for Information (RFI)
• Spring: Convene first external advisory group meeting

2016

• Spring: Harris (System Integrator) onboard
• Summer: Issue Request for Proposal (RFP)
• Fall: Select vendor (MiHIN)

2017

• Winter: Vendor contract finalization
• Spring: Vendor onboard

2018

• Spring: Release 1
• Fall: Release 2

2019

• Spring: Release 3

Key takeaways

• The statewide Provider Directory is a tool for healthcare entities

including CCOs, to access valuable provider directory data – It will not be consumer-facing

• We are in the contracting process now, vendor (MiHIN) is expected

to be onboard Spring 2017 (pending CMS, DAS, DOJ approvals)

• The Provider Directory is expected to be operational in 2018 but is

contingent on when MiHIN contract is approved

• Work still needs to be done to cross-walk all Medicaid managed

care rule data requirements to the Provider Directory

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Questions

Karen Hale Provider Directory Program Manager Office of Health Information Technology karen.hale@state.or.us 503-602-3252

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More information can be found at: www.oregon.gov/oha/OHIT/Pages/Provider-Directory- Advisory.aspx