Specifications include, but are not limited to: The State seeks a Contractor to provide a solution that: • Allows for the intake and processing of medical, dental, and pharmaceutical claims data and associated eligibility records. The combined data must be available for analysis by approved users. • Performs data collection and validation services for VHCURES. Beginning with submitter registration and ending with processed, standardized data. The process shall span a series of complicated steps that include mapping submitters’ data, benchmarking data, vetting data against an extensive library of data quality validations, tuning acceptance thresholds, verifying quality, mapping identifiers, compiling records, and consolidating the resulting data into an accurate resource for follow-on research and online reporting. • Enables access to a secure data and analytic enclave/environment. The enclave is a secure, cloudbased environment where authorized users can access tools and data to perform analyses and reporting. The enclave offers a highly performant environment for running analytic queries and reporting on VHCURES data. In addition, enclave is an effective environment for sharing VHCURES data across multiple State users. • Utilizes a Master Patient Index. Foundational to an APCD is a unique member identifier that allows data users to track an individual over time and across health plans. With more than 70 health plans submitting data to VHCURES, each with their own proprietary enrollment and adjudication systems and plan-specific identifiers, generating a reliable master patient index (MPI) is critical. • Utilizes a Master Provider Index that accurately and consistently identifies a provider across plans and over time. Like the Master Patient Index process, the Master Provider Index is also a critical component of any data aggregation and reporting solution. Master Provider Index development processes involve a complex series of algorithms, both deterministic and probabilistic, internal, and external reference files, and automated linkage steps. • Prepares analytic files and data extracts for distribution to external non-VT state agency users according to specifications, timelines and fee schedules developed in consultation with GMCB. • Develops and implements a process for collection, intake, and processing of four non-claims-based payment data files. Deliver analysis-ready data files to GMCB, including data quality reviews and documentation, and create a segregated area in enclave for these files.
