encounter data

encounter data

information showing use of provider services by health plan enrollees that is used to develop cost profiles of a particular group of enrollees and then to guide decisions about or provide justification for the maintenance or adjustment of premiums.

encounter data

Lab medicine Pt-related data–EKGs, CXRs, H&P–generated at the time he/she is seen in a health care setting.
References in periodicals archive ?
To identify maternal HCV infection, Wisconsin Medicaid encounter data for pregnant women who delivered one or more infants during 2011--2015 were extracted and linked by maternal name and maternal date of birth to WEDSS.
Episource offers risk adjustment analytics, retrospective chart reviews, quality reporting, encounter data submissions, and clinical services to help healthcare payer and provider organisations meet their members' needs.
Encounter data are records that reflect health care services and expenditures LME/MCOs pay to providers of those services.
Medical encounter data from theater accessed through MSAT and TMDS
For 2012, only 12 Medicaid focused plans reported encounter data and one Medi-Cal health insurer's Medicaid enrollment was below 70% in 2012.
Amid such criticism, the Office of Inspector General, in its 2014 Work Plan vowed to review the extent to which CMS is verifying the accuracy of MA encounter data and risk adjustment reporting.
Conference Focus: How patient encounter data, including ER visit and hospital discharge reports are used by embedded case managers to target high-risk patients; Critical skills needed for embedded case managers, including the experience Caldwell seeks when recruiting for this role; Impact embedded case managers in Caldwell's primary care practices have had on its 30-day readmission rates; engaging physicians in work flow processes to support embedded case management, including details on how Caldwell maximizes transitional care management codes; and case load management strategies, protocols and outreach strategies employed by the embedded case managers.
Although CIVHC has the data from managed behavioral health organizations (MBHOs), it's encounter data and not in the warehouse with other all payer claims, said Sonn.
Encounter data are becoming more important in research on Medicaid MH and SA service provision because these services are increasingly being delivered through comprehensive MCOs that contract to provide the full range of medical services (also known as health maintenance organizations, or HMOs) and by those that contract to provide only behavioral health services (behavioral health organizations, or BHOs).
141) Developments include engaging an External Quality Review Organization ("EQRO"), creating and reporting of Healthcare Effectiveness Data and Information Set ("HEDIS") measures and performance measures by MCOs, implementation of a performance improvement strategy, improving performance improvement projects ("PIPs") in coordination with the EQRO and within each MCO, creating a new fiscal agent system, and creating the Medicaid Encounter Data System.
The ADSP aggregates and analyzes data from across the continuum of care -- such as medical claims, EMR encounter data, and lab and pharmacy data -- to provide comprehensive health care analytics and a complete view of patient care.
Additional comments highlighted the capacity of the system to summarize client encounter data.