Any healthcare entity that works with claims or quality measures, such as Health Plans, ACOs, DCEs, Provider Groups, Specialty Networks, Third Party Administrators, etc.
Yes, as a Qualified Registry, Clinigence Health submits data for the MIPS program and provides a front-end data collection and submission tool for MSSP ACO customers. Clinigence Health also supports exports in support of several private payer at-risk programs.
Data can be automatically pushed to us via sFTP by the customer or EHR vendor, or if we are integrated with your internal database, we can extract the data and push it to our server over a secure link. For infrequent feeds, end users upload the data through our web application or sFTP. For non-integrated data sources customers, use our Chart Abstraction Tool (CAT) to manually enter the data.
We don’t specify a set frequency typically claims feeds are sent monthly, EHR feeds nightly, and others such as HIE, labs, etc. at varying frequencies. The frequency of the feed determines how current the results are.
We have a proprietary claims format but will accept other formats. We prefer EHR data in CCDa or QRDA CAT 1 format but will accept custom formats. Other HL7 formats are also supported. We work with our customers regardless of the format as long as sufficient data is included to generate the desired reports and results.
Usually within 48 hours, though this can longer for large data sets.
We have three mapping mechanisms.
-Standard codes such as ICD, CPT, RxNorm, etc. are automatically recognized.
-Non-standard data is grouped and manually mapped by our implementation team using internal tools.
-If the same non-standard data is manually mapped repeatedly the system “learns” what this data is, and this becomes for the use of the system a standard code.
We use NYU algorithm for avoidable emergency room visit identification, Johns Hopkins ACGs for the predictive modeling, risk calculations, and clinical groupings, and HCC Risk Logic.
The claims analytics is validated pre-load to check for integrity within the data set as well as large volume changes from the previous load.
Before going live, we work with the customer to validate the EHR data, especially non-standard coding. We provide sample results and ask the customer to verify these in their EHR. Once live, we scan the results daily for large changes in results from day to day.
Yes, you can set up and manage your user accounts though granting some permissions require Clinigence Health’s intervention.
We keep the original source file for the life of the customer agreement or the statutory requirements of the programs and grants in which the customer participated. We maintain up to 10 years of all data in the active databases.
We have implemented about 200 authoritative measures, including all MIPS eCQMs, dozens of MIPS CQMs, and about 60 commercial measures that are especially useful when working with claims data. We will implement and support other authoritative measures as requested.
Yes, we develop measures per your specifications. The measure architecture is such that it does not require product development. Our implementation team uses a proprietary configuration methodology to develop and deploy the measures.