AR Healthcare Transparency Initiative - Data Submission Guide Modification

Arkansas Insurance Department Asa Hutchinson Allen Kerr Governor Commissioner 1200 West Third Street, Little Rock, AR 72201-1904 · (501) 371-2600 · (501) 371-2618 fax · www.insurance.arkansas.gov Information (800) 282-9134 · Consumer Services (800) 852-5494 · Seniors (800) 224-6330 · Criminal Inv. (866) 660-0888 BULLETIN NO.: 9-2018 TO: ALL ACCIDENT AND HEALTH INSURERS, HEALTH MAINTENANCE ORGANIZATIONS AND HOSPITAL AND MEDICAL SERVICE CORPORATIONS & OTHER INTERESTED PARTIES FROM: ARKANSAS INSURANCE DEPARTMENT SUBJECT: ARKANSAS HEALTHCARE TRANSPARENCY INITIATIVE, DATA SUBMISSION GUIDE MODIFICATION DATE: NOVEMBER 28, 2018 On August 3, 2018, via Bulletin 7-2018, the Arkansas Insurance Department published for public comment a revised version of the Data Submission Guide (“DSG”) for the Arkansas Healthcare Transparency Initiative (“Transparency Initiative”), providing that interested parties had 30 days to comment. Proposed revisions to the DSG include the addition of: 1. New Pharmacy Fields — Data elements were added to include the Generic Product Identifier (GPI) number, specialty drug flag, as well as new currency fields that capture additional payment information for improved cost and utilization analyses. 2. New File Type – Pharmacy Benefit Manager Data – A new file type was added to capture future pharmacy benefit manager data submissions. These data would be submitted in a separate file than other pharmacy data. 3. New Dental Field Value Requirements — Dental field values have been captured as free text, requiring additional programming to separate values. The new requirements instruct submitting entities to place a comma between each value in Tooth Number (DC047), Dental Quadrant (DC048), and Tooth Surface (DC049) fields. 4. Supplemental Payment Data — Submission requirements for Medicaid Supplemental Payment data have been added. File type codes, file naming structures, and provisions for future submission design are included. 5. Data Integrity Audit Process — A process has been added to enable the periodic exchange of audit files between the Arkansas APCD team and submitting entities to address claims versioning questions or other data issues. 6. Consistent Value Requirements — Requirement added to ensure consistent format, values, and length of key member/subscriber data elements across all file types. 7. Exception Request Carry-over — Added wording to describe exception request carry over requirements between DSGs. 8. Provider Name Placement — Added instructions for the placement of provider middle name or last name suffix information. Other changes include:  Updated the responses to several FAQs.  Added Annual Registration requirement.  Updated the field lengths and/or formats of several data elements to better capture and maintain the data received.  Reworded currency fields to clarify definitions.  Clarified the ISO country code value requirement, specifying a three-digit number.  Removed option that allows nulls instead of a date filler of ‘9999-12-31’.  Specified that quotes and double quotes should not be included in data element definitions. Material revisions of the DSG are governed by AID Rule 100, promulgated pursuant to the authority granted in Ark. Code Ann. §23-61-901, et seq. and other applicable laws or rules. Comments received during the comment period were reviewed by the Arkansas Insurance Department (“AID”), and the Arkansas Center for Health Improvement (“ACHI”). These comments were integrated into the final revised version which was reviewed by the Arkansas Healthcare Transparency Initiative Board at their Quarterly Board Meeting with no recommended changes. This final revised version of the DSG is hereby approved by the Commissioner. Concurrently with this bulletin, the AID has posted the Approved final revised version of the DSG at www.insurance.arkansas.gov. This approved version of the final revised version of the DSG will be effective for the data files submitted not less than 120 days after the posting of the final revised version of the DSG on the AID website. November 28, 2018 ALLEN KERR DATE INSURANCE COMMISSIONER STATE OF ARKANSAS