1. Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) March 10, 2015

2. Agenda Housekeeping Total Medical Expenses (TME) 2015 Annual Premiums Data Request Risk Adjustment Supplemental Diagnosis Submission Wrap Up

3. Housekeeping Version 4 MA APCD Submissions Risk Adjustment Member Month Tracker ACA Enrollment Reports Provider MDM Premiums

4. 2015 PAYER DATA REPORTING UPDATE ON TOTAL MEDICAL EXPENSES (TME) March 10, 2015 This information only applies to the applicable payers for the annual TME data submission in May.

5. File TypeFileDeadline TMECY 2013 Final TMEMay 1, 2015 CY 2014 Preliminary TMEMay 1, 2015 APMCY 2014 APMMay 15, 2015 RPCY 2014 Hospital RPJune 1, 2015 CY 2013 Physician Group Relative PriceJune 1, 2015 CY 2014 Other Provider Relative PriceJune 1, 2015 PPMCY 2014 Provider Payment MethodsPostponed* NADACY 2014 RP Network Average Dollar AmountPostponed* Payer Filing Schedule - UPDATE *For more information, please see Administrative Bulletin 15-03; 957 CMR 2.00: Payer Data Reporting available at: http://chiamass.gov/assets/docs/g/chia-ab/1503.pdf.http://chiamass.gov/assets/docs/g/chia-ab/1503.pdf

6. Report Product Type Code in field ZR003 (instead of PCP Indicator). Enable CHIA to conduct analysis on TME by product type Align the zip code level information between TME and APM data Proposed TME Revision Product Type Code Definition 1 HMO and POS 2 PPO 3 Indemnity 4 Other (e.g. EPO)

7. Data Specification Manuals (DSMs) distributed to payers 3/11/2015 Technical Advisory Webinar Thursday, 3/12/2015 @2pm EST Webinar Registration: https://attendee.gotowebinar.com/register/3525989019669581569 Phone: 1-888-710-9336 Participant passcode: 330-6530 Next Steps

8. Please call or email your designated CHIA contact with any questions or comments: Questions or Comments? ContactPayers Ellyn Boukus Ellyn.Boukus@State.MA.US Cigna, Fallon, Minuteman Health, Network Health, Tufts (commercial) James Gorry James.Gorry@State.MA.US BMC HealthNet, HPHC, United (commercial and Medicare Advantage) Maria Joy Maria.Joy@State.MA.US Aetna, Health New England, Tufts (Medicare Advantage), UniCare Kait O’Brien Kaitlyn.E.O’Brien@State.MA.US BCBS, Celticare, Neighborhood Health Plan, MassHealth Caitlin Sullivan Caitlin.Sullivan2@State.MA.US All Payers

9. 2015 PAYER DATA REPORTING ANNUAL PREMIUMS DATA REQUEST.

10. Annual Premiums Data Request  Payer Questions o Submitting 2012 and 2013 Data o Fully-/Self-Insured Splits  Additional Questions?  Timeline 10

11. Submitting 2012 and 2013 Data Question: Can payers use the same data submitted last year for 2012 and 2013 in this year’s Request? Answer: No. Please generate fresh data for 2012 and 2013, re-running queries to account for retro-activity, complete run-out, and specification consistency. 11

12. Fully-/Self-Insured Splits Question: CHIA is requesting premiums and claims data be split by fully- insured and self-insured. Should we go back to 2012 and 2013 and split out that data? Answer: Yes. We ask that payers split out claims data by fully- and self-insured for all three years, not just for 2014. 12

13. Additional Questions Are there any other questions at this time? 13

14. Timeline Annual Premiums Data Request: 2015 Timeline 14 Month(s)Milestone April 14, 2015 Second post-Request TAG May 6, 2015 Data due to Oliver Wyman May - June 2015 Data verification July - August 2015 “Annual Report” analysis September 2015 (early) “Annual Report” publication

15. Contact Information General Questions: Kevin Meives Senior Health Policy Analyst CHIA Health System Performance Analytic Team Kevin.Meives@state.ma.us 15 Technical Questions: Dianna Welch Principal Oliver Wyman Actuarial Consulting, Inc. (414) 277-4657 Dianna.Welch@oliverwyman.com

16. 2015 PAYER DATA REPORTING RA SUPPLEMENTAL DIAGNOSIS SUBMISSION.

17. RA Supplemental Diagnoses (SD) Draft Submission Guide distributed Comment Period through March 18, 2015 Quarterly Submission – March, June, Sept, Dec First Submission – June 2015 due by July 31, 2015 Optional – SD is an optional submission for RA only

18. RA Supplemental Diagnoses (SD) Submission Guide Overview

19. Wrap Up Questions?

20. Next Meetings April 14, 2015 @ 2:00 pm May 12, 2015 @ 2:00 pm