Common use of Claims Data Clause in Contracts

Claims Data. This data will include: (i) Three years of historical Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview from the 36 months immediately preceding the effective date of the Beneficiary’s alignment to the ACO; (ii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; (iii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; (iv) Weekly claims data files specified in the Reporting and Data Sharing Overview regarding those claims subject to the TCC Fee Reduction (if the ACO has selected TCC Payment as its Capitation Payment Mechanism) or the PCC Fee Reduction (if the ACO has selected PCC Payment as its Capitation Payment Mechanism) and, if the ACO has selected to participate in the APO, the APO Fee Reduction; (v) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; and (vi) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; and (vii) For Performance Year 2024 and each subsequent Performance Year, on at least an annual basis, as specified in the Reporting and Data Sharing Overview, data that contain hospital-specific prospective target prices for each clinical episode category.

Claims Data. This data will include: (i) Three years of historical Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview from the 36 months immediately preceding the effective date of the Beneficiary’s alignment to the ACO; (ii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; (iii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; (iv) Weekly claims data files specified in the Reporting and Data Sharing Overview regarding those claims subject to the TCC Fee Reduction (if the ACO has selected TCC Payment as its Capitation Payment Mechanism) or the PCC Fee Reduction (if the ACO has selected PCC Payment as its Capitation Payment Mechanism) and, if the ACO has selected to participate in the APO, the APO Fee Reduction; (v) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; and; (vi) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; and (vii) For Performance Year 2024 and each subsequent Performance Year, on at least an annual basis, as specified in the Reporting and Data Sharing Overview, data that contain hospital-specific prospective target prices for each clinical episode category.