Managed Care Advisory Group

3434 Granite Circle
Toledo, Ohio 43617

1-800-355-0466
info@mcaginc.com

MCAG is a revenue recovery consulting firm where teams of advisers, auditors, analysts and IT professionals provide expertise, analysis and technology to ensure our clients capture every recoverable dollar.  

© 2018 by MCAG

CPR DATA REQUIREMENTS

Data Contact 

The name, title, email address and phone number for a data contact should be provided. This contact must have IT experience and experience with or the authority to direct delivery of data files and resolution of data issues. A contact that can only indirectly request delivery, resolution etc. is insufficient to this requirement. 

Data Files 

Data must be provided in ANSI X12 EDI 835 / 837 5010 format text files. The files should be free of error; follow the 835 / 837 format to the fullest extent; and non-duplicative (both the files themselves, and the ST-SE segments within the files). In the event that errors, format issues, or duplicates are encountered, responsibility for resolution lies with the client or partner. 

Partners may provide data in a proprietary format, providing: 

  • The partner provides a sufficiently thorough schema documentation identifying the structure of file names, each file, record type, and correlation between each data point and it’s ANSI X12 EDI 835 / 837 5010 equivalent; 

  • Example data for each record type; 

  • Said format contains all data points required for the provision of service, as determined by MCAG; 

  • The format otherwise meets the expectations of MCAG in terms of structure, delimitation, etc. 

Delivery 

Files should be delivered regularly to an SFTP server owned and operated by either the client, partner or MCAG. If the SFTP server is partner-owned, and it is expected that data files for multiple clients will be delivered to the same location, then either: 

  • The files for each client should be separated into separate directories; 

  • The file names should contain an identifier clearly specifying the originating client. 

In either instance, the partner should clearly communicate to MCAG via an established process the name of the directory or identifier used prior to transmission of data files. 

Data files may be transmitted at any time during the day; however, MCAG requests that transmission take place chiefly in business off-hours (6pm EST - 6am EST) and reserves the right to require transmission at specific times in relation to particularly large volumes of files (as determined by MCAG). 

Preferentially, data files should be enclosed in .zip archives for delivery; however, MCAG will accept raw, unzipped files. If zipped, MCAG requires documentation identifying the structure of the zipped file name and expected content (e.g. “Files are zipped by production date and payer”). 

Timeframes 

Two sets of data are required for the CPRvista service: 

  • A one-time retroactive backfill; beginning the date the CPRvista contract is signed with the client and extending two years into the past. (At MCAG’s discretion, a smaller retroactive back-fill - no less than six months in length - may be accepted.) Prior to transmission, MCAG requests the following information be provided: 

 

  • The approximate number of files to be transmitted, 

  • The approximate size of the files on disk, 

  • The approximate number of claims submitted per month by the client. 

  • An ongoing, up-to-date daily feed; beginning the date the CPRvista contract is signed with the client and in perpetuity until such a time as MCAG determines that the feed should be terminated or one year after the client leaves the CPRvista service. The data files supplied by the feed should be delivered no more than five days after the date of service of the claims which they contain. 
     

Termination 

In the event that delivery of the data files must be terminated, MCAG will communicate this request to the specified data contact. In the event that delivery of the files is not terminated five business days after the request is made, MCAG reserves the right to discontinue delivery of the files by other means (including but not limited to revoking access to any and all SFTP servers owned and operated by MCAG; no longer accessing and downloading files hosted on an SFTP server owned and operated by another partner; etc.).