Attachment G.7 - Definitions.xlsx
XLSX spreadsheet 26 KB Posted
- Attached to
- WTCHP Nationwide Provider Network Federal contract opportunity
- Solicitation number
- 75D301-21-R-71962
About this file
This document contains reporting data definitions for a federal contract opportunity to establish and operate the World Trade Center Health Program Nationwide Provider Network. Key details include:
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The National Institute for Occupational Safety and Health has a requirement to procure time and material services to establish and operate the WTCHP Nationwide Provider Network to provide services to 9/11 Responders/Survivors living outside the New York metropolitan area. Services include contract management, member services, program communications, establishing and maintaining a nationwide provider network, administering monitoring and treatment, physician determinations and certifications, medical benefits claims and billing administration, coordination of benefits with private insurance for survivors, and quality assurance controls.
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The anticipated five-year contract will be awarded using best value tradeoff procedures. Questions regarding the solicitation are due by email to the specified address by August 4, 2021 using the required question template. The reporting data definitions attachment provides over 100 data points and definitions to support contract reporting requirements.
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Text version
Reporting Data Definitions
| Reporting Data Definitions | ||
| Updated:2/4/2021 | ||
| # | Data Point | Definition |
| 1 | Authorization Create Date | The date the TPA/CCE/NPN or Program created an authorization for the requested care |
| 2 | Call Abandonment Rate | Total number of abandoned calls divided by the Total Number of Phone Calls |
| 3 | Call Busy Signal Rate | Total Number of Calls where a busy signal was received divided by the Total number of calls. |
| 4 | Call Duration - Average | Average Call Length |
| 5 | Call On Hold Duration - Average | Average length of hold time for calls |
| 6 | Caller Name | member Name |
Staff Name 7 Caller Type member Staff Provider Other with additional free text to explain
| 8 | Choice Opt In Date | Date member provided oral or written notification to opt into the Choice. |
| 9 | Choice Opt Out Date | Date member provided oral or written notification to opt out of the Choice. |
| 10 | CLIN | Contract Line Item Number |
| 11 | Clinically Indicated Date (CID) | For Wait Time eligible, date provider indicates date care is clinically indicated by - For routine urgency within 30 days of the CID, for Urgent within 48 hours, and STAT less than 24 hours. CID is also known as the Earliest Appropriate Date (EAD) in the Provider's Consult/Referral |
| 12 | Collateral of member | Non member covered as a Collateral of the member |
| 13 | Collateral SSN or Psuedo SSN | Describes the Collateral of the member SSN or Pseudo SSN which begins/ends with a "P" |
| 14 | Correspondence Type | Identifies the type of correspondence (options): |
member Choice Card
EOB
Educational Material Congressional Inquiry Other 15 Critical Findings Significant clinical condition in which PCPs should be notified - New Diagnosis of Cancer Critical Lab/Imaging Findings Suicide Notification or Suicide Attempt Urgent Follow Up Required Urgent Additional Care Needed
| 16 | Critical Findings Date | Date Contractors notified of the critical findings by the Provider |
| 17 | Date Contacted | Date of Telephone or IM contact |
| 18 | Days to First Appointment | The number of hours/calendar days between the Referral Date and the first Date of Service on a claim: |
For Emergent: <= 24 hours
For Urgent: > 24 hours and <= 48 hours For Routine: > 48 hours and <= 30 days Not Adequate: >24 hours for Emergent, >48 hours for Urgent, or >30 days for Routine
| 19 | District | Defines the District |
| 20 | Drive Time | Number of Minutes from the members Residence to Provider Seen - Calculated after appointment has occurred |
| 21 | EDIPI Number | Electronic Data Interchange Personal Identifier |
| 22 | Eligibilty Mileage | Distance from the members residence and closest faciltiy with a physician |
| 23 | EOB | Explanation of Benefits |
| 24 | Georgraphic Access Type | Based on definitions in PWS. |
Urban Rural Highly Rural 25 Health Plan Type Wait Time Distance Unusual & Excessive Burden
| 26 | ICN | Integration Control Number from MVI |
| 27 | Incident | Description of incident (Free Text) (NOTE: Please make brief and consistent as possible, only list key elements/topic) |
| 28 | Incident Closure Date | Date incident was closed and no further action was needed |
| 29 | Incident Date | Date incident occurred and reported to |
| 30 | Incident Received Date | Date incident was received by the Contractor/TPA |
| 31 | Incident Status | Status of the incident |
| 32 | Incident Type | Indicator to distinguish the type of incident that is being reported -- Complaint |
Customer Service Information Security Quality HIPAA/Pricy Safety
| 33 | Inpatient Discharge Date | Date in which the patient discharged from inpatient hospitalization status |
| 34 | Medical Documentation Uploaded | provided Medical Documentation uploaded/electronically ailable to Contractor |
| 35 | Medical Record Return Date | Date medical documentation (including Imaging CDs and report) was returned to the Medical Center |
| 36 | Mileage | Number of Miles from the members Residence to Provider Seen - Calculated after appointment has occurred |
| 37 | OHI Name | Name of the other health insurance (ex. AARP, Aetna, BlueCross BlueShield, etc.) (NOTE: Please keep OHI names consistent for reporting purposes). |
| 38 | OHI Payment Amount | Amount the other insurance paid toward the episode of care |
| 39 | Other Health Insurance | member's Other Health Insurance Status Yes/No |
| 40 | PCF | Postal Code for Foreign Address |
| 41 | PFA | Province for Foreign Address |
| 42 | Provider Address 1 | Rendering Provider's Address |
| Provider Address 2 | Rendering Provider's Address | |
| Provider Address 3 | Rendering Provider's Address | |
| Provider City | Rendering Provider City | |
| Provider State | Rendering Provider State | |
| Provider Zip | Rendering Provider Zip | |
| Provider DEA Number | Rendering Provider DEA Number | |
| 43 | Provider Name | Name of the provider actually providing the care to the patient |
| 44 | Provider NPI | Rendering Provider's NPI |
| 45 | Provider Participation | Indicator of providers participation in the network or out of the network : |
Opt In Opt Out
46 Reason for Decline Description/Justification on why patient was declined services requested - Service Not Covered under Medical Benefits Package Not Clinically Appropriate
| 47 | Reason for Denials | Listing of specific reasons why services were denied and the total number per reason |
| 48 | Referral End Date | Date which referral expires |
| 49 | Referral Number | Unique Identifier coupled with Station ID |
| 50 | Referral Return Date | Date care/referral was returned to the due to no contact from the member NOTE: Contractually respond must be received within 10 business days from the date of the letter, if no contact was made from the three (3) phone call attempts |
| 51 | Referral Start Date | Date which referral begins |
| 52 | Referral Title | For Wait Time Eligilble, Title of Provider Consult which indicates Specialty Needs |
| 53 | Referral Urgency | STAT |
Urgent Routine
| 54 | REJ | Rejected - Print Vendor Rejected File (Refer to Contract Appendix 1.12) |
| 55 | Relationship | The relationship of the individual to the deceased member |
| 56 | Request Status | Status of the request |
| 57 | Resolution to Call | Description of call resolution (Free Text) (NOTE: Please make brief and consistent as possible, only list key elements/topic of discussion) |
| 58 | RET | Returned - Print Vendor Returned File |
| 59 | Retro Authorization | Indicator for authorizations that are created after the appointment has been scheduled and/or completed. NOTE: Only applies to Emergency, Home Infusion, Skilled Home Health as part of Home Infusion, Inpatient |
| 60 | Returned Mail | Refer to Returned Mail tab for individual data elements: |
Region Correspondence Type member Choice Card
EOB
Educational Material Other Date Returned member Name member Address City State Zip Code Follow Up Action
| 61 | Service Connection | Refers to Conditions |
| 62 | Specialty Requested | Type of service being requested |
| 63 | Standard Met | YES/NO indicator which determines of the critical findings standard was met in accordance to the contract |
| Tax Identification Number | Rendering Provider's Tax Identification Number | |
| 64 | Time Contractor Notified | Time Contractors notified the Medical Center of the critical findings |
| 65 | Timeliness of Caller Response | Average Time in Seconds to Answer a Phone Call from Either the member or Staff |
| 66 | Timing of Report | Reports will include dates of data inclusion |
| 67 | Total # of Appeals (Cumulative) | Total number of member appeals to services which have been denied because services are not medically necessary within the cumulative base or option year |
| 68 | Total # of Appeals (Reporting Period) | Total number of member appeals to services which have been denied because services are not medically necessary within the reporting period for the week or month |
| 69 | Total # of Authorizations (Cumulative) | Total number of authorizations within the cumulative base or option year |
| 70 | Total # of Authorizations (Reporting Period) | Total number of authorizations within the reporting period for the week or month |
| 71 | Total # of Calls (Cumulative) | Total number of calls made to the call center within the cumulative base or option year |
| 72 | Total # of Calls (Reporting Period) | Total number of calls made to the call center within the reporting period for the week or month |
| 73 | Total # of Completed Appointments (Cumulative) | Total number of Initial and Last Appointments scheduled and completed within the cumulative base or option year |
| 74 | Total # of Completed Appointments (Reporting Period) | Total number of Initial and Last Appointments scheduled and completed within the reporting period for the week or month |
| 75 | Total # of Denial of Care (Cumulative) | Total number of members wanting care but denied by the PC3/TPA contractor due to medical benefits package exemption or no clinical appropriateness within the cumulative base or option year |
| 76 | Total # of Denial of Care (Reporting Period) | Total number of members wanting care but denied by the PC3/TPA contractor due to medical benefits package exemption or no clinical appropriateness within the reporting period for the week or month |
| 77 | Total # of Mailing (Cumulative) | Total number of cards mailed during the cumulative base or option year |
| 78 | Total # of Mailing (Reporting Month) | Total number of cards mailed within the reporting period for the week or month |
| 79 | Total # of Other Calls (Cumulative) | Total number of calls made to the call center that are not accounted for in the above requirements within the cumulative base or option year |
| 80 | Total # of Other Calls (Reporting Period) | Total number of calls made to the call center that are not accounted for in the above requirements within the reporting period for the week or month |
| 81 | Total # of Provider Calls (Cumulative) | Total number of Provider calls made to the call center within the cumulative base or option year |
| 82 | Total # of Provider Calls (Reporting Period) | Total number of Provider calls made to the call center within the reporting period for the week or month |
| 83 | Total # of Employee Calls (Cumulative) | Total number of calls made by Employees to the call center within the cumulative base or option year |
| 84 | Total # of Employee Calls (Reporting Period) | Total number of calls made by Employees to the call center within the reporting period for the week or month |
| 85 | Total # of member Calls (Cumulative) | Total number of member calls made to the call center within the cumulative base or option year |
| 86 | Total # of member Calls (Reporting Period) | Total number of member calls made to the call center within the reporting period for the week or month |
| 87 | Transfers | If transferred to an ARU, 100% of all telephone calls shall be acknowledged within 20 seconds |
| 88 | Type of Care | Inpatient |
Outpatient Home Care Residential Care
LTAC
| 89 | Facility | Name of facility who orginiated the Referral |
| 90 | Facility Station ID | Assigned number that identifies each Medical Center |
| 91 | member (NSC / SC) | Indicator to identify member's eligibility status of NSC vs SC |
| 92 | member Address 1 |
member Address Lines 1 93 member Address 2 member Address Lines 2 94 member Address 3 member Address Lines 3
| 95 | member Choice Card | Date Card was mailed |
| 96 | member City | Corresponding City of member Address |
| 97 | member Date of Birth (DOB) | member's Date of Birth |
| 98 | member Date of Death | Self explanatory |
| 99 | member Integrated Service Network | The assigned region of the member or Staff member |
| 100 | member SSN | Full 9 digit SSN |
| 101 | member State | Corresponding State of members Address |
| 102 | member Zip code | membert's Zip Code |
| 103 | member's Country of Residence | Identifies Country associated with member's Address |
| 104 | member's First Name | First Name |
| 105 | member's MI | Middle Initial |
| 106 | member's Name | Last Name |
| 107 | member's Suffix | Jr, Sr, II, III, etc |
| 108 | Wait time | This refers to patients on the 30 day listing, whose appointments could not be scheduled within 30 days at the MC |
| 109 | Wait time Metrics (Call Center)1 | Refer to Call Center Metrics tab for individual data elements: |
member Name Caller Type Provider member Employee Other member Call Category Eligibility/Participation in Choice (Opt In/Out) Find a Physician General Program Information New Authorization Request Authorization Information Claim Status Copays
OHI
Appeals Complaints Pharmacy
110 Wait time Metrics (Call Center)2 Provider Call Category Status of Claim Authorization Information Report of No-Show(s) Rescheduled Appointment(s) General Program Information/Education Provide Other Health Insurance (OHI) coverage Copay Information Eligibility Status - Service Connected/Special Authority/Non-Service Connected Condition Credentialing and Contracting Call Date Completely & Fully Resolve Timely FCR (First Call Resolution) <=10 Days > Days <=10 Days Date of Fully Resolved
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