Chapter 6 Master Itemization Report (MIR), Client Trajectory Report and Payability Guide

Transcription

1 Chapter 6 Master Itemization Report (MIR), Client Trajectory Report and Payability Guide

2 Section 1: MIR Background The Master Itemization Report (MIR) is the monthly report which provides an itemized listing, as well as a summary, of the services recognized by Public Health Solutions payment system. The MIR report compares summary totals of services submitted for payment with target projections and presents information about services recognized by Public Health Solutions payment system that have been reviewed and found to be problematic. Contracts that enter data into AIRS transmit their data individually to Public Health Solutions via extracts that the agency uploads to Data Link via DUET. Approximately weekly, the AIRS data in Public Health Solutions payment system are refreshed from Data Link. Contracts that enter their data in eshare do not need to transmit data individually, as Public Health Solutions receives a consolidated cross-agency transmission of eshare data from NYCDOHMH. Once a month, Public Health Solutions creates MIRs from this data and sends them to agencies. The Public Health Solutions Contracts Unit sends the MIR, and, for confidentiality reasons, only Program Managers receive it. A separate notification is sent simultaneously to the Senior Administrator and Fiscal Manager alerting them that the report has been sent to the Program Manager. In the interim between the regularly distributed monthly MIR reports, you may request that your Contract Manager provide a current MIR representing data received most recently. Upon receipt of the MIR, you should review it and compare the data to internal reports indicating delivered and submitted services to Public Health Solutions for reimbursement. Investigating Discrepancies in the MIR At times, you may believe that you have submitted items for payment that have not been recognized by Public Health Solutions. In such instances, you should take the following steps: 1. Find a couple of specific examples of services that should have been paid but do NOT appear on the MIR. Verify that the examples have been properly entered in eshare. If necessary, contact eshare at If the missing records were entered into eshare, then send those examples via to the Public Health Solutions Contract Manager. Note: Please follow the steps above before contacting Public Health Solutions about apparent discrepancies The MIR also indicates services that have discrepancies in the data submission (duplicates, exceeding service caps, etc). Agencies should review these flagged services, and contact the Public Health Solutions Contract Manager with any questions

3 MIR Sections Listed below are the sections of the MIR, with a description of each section: Section I [DATA INCLUDED] contains information about when the MIR was run and the most recent data extract file that affected the service count. Section I-A [Public Health Solutions INFORMATION SYSTEM ACCOUNTING DISCREPANCIES UNDER INVESTIGATION] notes any discrepancies that may arise in the aggregation of item-level data into Public Health Solutions payment system. This section is for informational purposes only. It is usually blank. Any discrepancies that do arise will be investigated and corrected by Public Health Solutions as soon as possible. Section II [YEAR-TO-DATE TOTALS BY SERVICE] shows, for each service type, the yearto-date total count of services, and their value, recognized by the Public Health Solutions payment system, and compares them to year-to-date projections. Note that in some instances, including Care Coordination programs, per-member-per-day fees may show no projections in the MIR. Section III [SUMMARY OF ISSUES NOTED] shows a count, description and calculated value of those items which have been recognized by Public Health Solutions payment system but are in some way problematic and will require further attention. Some such items may need to be corrected, some may need to be attested, and some may be subject to recoupment during closeout. Section IV [MONTH TOTALS FOR SERVICES SUBMITTED AND RECOGNIZED] shows the monthly total counts of services, and their value, recognized by the Public Health Solutions payment system, and compares them to monthly projections. Some of these services may have already been paid, while others may be in the queue awaiting payment. Section V [ITEMS RECOGNIZED] shows the item-level data that informed Public Health Solutions payment system. The client ID, date of service, service type and units of service are included. Items identified as problematic are shaded in color, and the nature of the problem is detailed

4 Section 2: Client Trajectory Report (Care Coordination Only) Client Trajectories Monetary Value Report and Income Predictor Tool (Care Coordination Contracts Only) The Care Coordination Client Trajectories Monetary Value Report ( Client Trajectory Report ) is sent monthly to Care Coordination contractors. It provides a listing, for the entire contract year, of every enrolled client. For each client, the report displays the full sequence of periods of payable and non-payable enrollment in the program. These periods reflect changes in programmatic track, disenrollment and reenrollment, temporary suspensions, and the assessment of individual days as payable or non-payable based on the services provided to the client. Income Predictor Tool (IPT) (Care Coordination Contracts Only) The Care Coordination Income Predictor Tool (IPT) report is distributed each month along with the MIR and the Client Trajectory Report (CTR). This report allows Care Coordination providers to view their performance against their budgeted service family amounts each month and on a year-to-date basis, and allows them to better predict what their monthly and annual program income will be. Please contact your HIVCS Contract Manager if you have any question about these reports

5 Section 3: Public Health Solutions Guide to Requirements for Service Payability and Data Reporting (Payability Guide) The Guide to Requirements for Service Payability and Data Reporting (Payability Guide) has been developed by Public Health Solutions and NYCDOHMH to provide organizations with guidance on submitting data for performance-based contracts. The major emphasis of the guide is on the requirements for payment, but the guide also covers certain requirements for contract compliance, and provides information on other data reporting and evaluation requirements. The guide, which is updated quarterly, brings together the most pertinent information about services and data reporting, and can be found on the Public Health Solutions website. Click the link below to view the most up-to-date version