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L.A. Care has an effective and simple solution to improve timely capture of all clinical services from our Plan Partners and PPGs.
To improve HEDIS data and rates, we are recommending that data be directly submitted to the L.A. Care HEDIS Ops team. You can bypass the data processing intermediaries, such as Transunion, to shorten lag time and limit data “leakage” and other issues.
Direct data submission is done by converting the 837 encounter format into L.A. Care’s HEDIS format. The file is then uploaded to L.A. Care’s FTP. Once received, the HEDIS Data Team will review and load the file directly to the HEDIS engine where submitted data is used to identify qualifying members and HEDIS numerator compliance. All of your data is captured!
L.A. Care uses this direct data for HEDIS rates that measures the quality of service our members receive from providers and also determines our auto assignment rate for members. Higher rates mean that you will be able to maximize the members assigned to you.
In preparation for HEDIS 2018, encourage your PPGs and Health Care Partner to submit direct data files to L.A. Care by November 30th.
If you have any questions, please contact hedisops@lacare.org.