Decision Support System & Data Warehouse
The Decision Support System (DSS) / Data Warehouse (DW) business area covers software tools used by authorized State employees to extract and/or analyze Medicaid data in order to inform program decisions, policy decisions, and report on the delivery of the Medicaid Program.
CMS-Required Outcomes (2)
State-Specific Examples (14)
Outcome statements from other states, gathered and shared by CMS in the certification repository — the best available reference for drafting your own.
MOState-specific outcome
Transform MHD from a transactional, request as needed data approach to a business intelligence driven model recognizing and treating data as an asset.
- Performance will be measured by:
- Conducting an initial data maturity analysis and prioritizing recommendations and review every two (2) years.
- Establishing a Data Governance Council who is engaged and meets at a minimum of quarterly and has at least 60% participation as measured by attendence.
- Appointing Data Stewards who meet a minimum bi-monthly as measured by meeting schedule and has recommendation for data definitions of at least three (3) per month.
MOState-specific outcome
The Data Manager will monitor report writing performance and appropriate use of standards and perform analysis for future needs.
- Performance will be measured by:
- 100% of reports are requested through Jira Service Desk within three (3) months of Go-Live of the entire solution.
- 80% of reports are approved as written in the first review within six (6) months of Go-Live of the entire solution.
- Semi-annually management will review administrative dashboards for volume, timeliness, and accuracy.
- One (1) addidtional data mart recommended annually.
- Twelve additional reports are added to the schedule annually.
NEIncrease Efficiency
The system assists the state in monitoring quality and cost by alerting appropriate staff members when state-defined thresholds against state-defined metrics have been breached. (For example, the state has decided to monitor items such as managed care payments and controlled substance.)
- The system supports various business processes' reporting requirements through quick data propagation and data query returns.
NEIncrease Data Quality and Utility
The system enables the SMA to comply with federal reporting requirements. These include, but are not necessarily limited to: - TMSIS (Transformed Medicaid Statistical Information System) - CMS 416 (EPSDT) - Statistical Enrollment Data System (SEDS) - Medicaid Administrative Reporting System (MRS)
- The solution includes analytical and reporting capabilities, both ad hoc and predefined to support key policy decision making/use cases and various business processes' reporting requirements. Examples include the ability to generate predictive analytics, automated DMA reports, personalized dashboards and organizational favorites for MLTC executives and policy-makers and business area leads.
NEIncrease Data Quality and Utility
Data warehouse (DW) supports seamless inbound and/or outbound data sharing through data interfaces and appropriate standards including a broad set of data from required state and federal sources.
- The system enables the SMA to comply with federal reporting requirements.
NEIncrease Data Quality and Utility
The data warehouse accurately maps data from the various data streams
- Expand user base of Decision Support System (DSS) to support key policy decision making/use cases and various business processes' reporting requirements. The solution includes analytical and reporting capabilities, both ad hoc and predefined to support key policy decision making/use cases and various business processes' reporting requirements.
NEIncrease Data Quality and Utility
The system performs data quality checks on inbound data (formatting, completeness, duplication, etc.). It rejects erroneous data and notifies the data source so that the data can be corrected and re-submitted.
- Extensible and scalable to maintain provider, recipient, claims processing, encounter, and other data to support agency management reports and analyses.
NEIncrease Data Quality and Utility
SMA has architected the data warehouse to be extensible and scalable in order to accommodate what the state has projected its future business needs to be.
- Provide tools and services to guide informed decision making within the State to ensure optimal operational and policy decisions.
NEIncrease Data Quality and Utility
SMA has a data management strategy / plan that addresses current and future needs (e.g. data fields, elements, structure, reuse of data elements and de-duplication to enforce single version of truth).
- The system processes encounters from all authorized channels in approved formats and validates that encounters include all required information (in correct formats e.g. standard code sets). The system rejects invalid encounters. It identifies errors, attaches pre-defined error code(s) to rejected / denied encounters, and communicates those errors to the Managed Care Entity.
NEIncrease Data Quality and Utility
The system maintains provider, recipient, claims processing, encounter, and reference data to support agency management reports and analyses.
- SMA utilizes encounter records and system generated encounter processing reports for MCO performance and contractor monitoring.
NEIncrease Data Quality and Utility
SMA utilizes encounter records to monitor quality and cost of care provided to enrollees in managed care.
- SMA utilizes automated case management and reports for fraud and abuse analysis and investigations. The system provides access to post payment data and flexibility to conduct ad hoc research for a case.
NEIncrease Automation of Program Integrity Activities
SMA utilizes automated case management and reports for fraud and abuse analysis and investigations.
- SMA utilizes system generated reports to evaluate program trends and identify outliers in Provider billing practices and Member service utilization to identify potential utilization anomalies.
NEIncrease Automation of Program Integrity Activities
The system generates reports to evaluate program trends and identify outliers in Provider billing practices and Member service utilization to identify potential utilization anomalies.
- SMA utilizes automated case management and reports for fraud and abuse analysis and investigations.
NEIncrease Automation of Program Integrity Activities
The system provides access to post payment data and flexibility to conduct ad hoc research for a case.
- SMA utilizes automated case management and reports for fraud and abuse analysis and investigations.