Health Homes Implementation Process, Frequently Asked Questions

FAQ Categories

Claims Data Questions

We want to receive claims data to show why patients were included in the list so that we can see total cost. Will we see this data?
MHD has recently shared with health home organizations their respective lists of patient DCNs that have been assigned based on prior year claim data.
Can we access MO HealthNet data directly and would it be timely?
MHD posts the most current 36 months of paid claims history for each patient via CyberAccess. If your facility is not already using CyberAccess, please email us for information on how to register as a secure user of this web-based tool. Regular use of CyberAccess for Care Coordination is a required Health Home Activity and will be a monitored performance indicator. Health Homes are expected to use CyberAccess at a minimum average rate of once per member per month.
Will we receive total patient cost claims data (hospital, specialty care, pharmacy, primary care, etc.) from MO HealthNet and from Medicaid Managed Care companies so we can manage costs? How often will the claims data be shared?
Summary data reports will be generated for Health Homes on a regular basis to assist with utilization and financial management.
How recently was the claims data?
Paid dates from September 2010 through August 2011 were used.
May we obtain the ICD9 codes to validate the total eligible participants listed on the DCN report?
Yes, the ICD9 codes can be made available for your internal review and validation, although this is not the only criteria used to identify participants who are appropriate for inclusion in the Health Home program.
We have identified a large number of patients omitted from our initial data pull. These patients had been seen/internally assigned to our nurse practitioner (with the MD, of course, the collaborating physician). We feel those patients should have been included in the original data submission for eligibility determination for the practice. What is the process for submitting these additional records for validation and inclusion/assignment to our practice?
It is expected that MHD’s data and your individual practice data may differ, as there are many factors that influence these reports (Medicaid eligibility, other sites treating the patient, lack of Medicaid claims data to validate diagnoses, etc.). MHD’s data is being used for the program start-up. After the program start date, Health Homes may contact MHD with requested additions and deletions of assigned patients. MHD may stipulate specific forms and processes for such additions and deletions.