• Standard Data – Data that is extracted directly from an EHR system with no manual modification needed. The data is formatted onto a spreadsheet and eventually submitted to the health plan to close care gaps.
Sample reasons why data may not be captured via claims/encounters:
o Member has secondary insurance
o Newborn well visits submitted under Mom’s insurance information.
To validate accuracy of data, a random sample of the records will be audited. Data is subject to auditor approval and the process requires resources to validate accuracy throughout the year.
• Non-Standard Data – Medical records that are manually extracted from the member’s medical record and submitted as proof of service for the specified measure. The record is uploaded to Cozeva and coded in accordance with the documentation and measure criteria.
Member self-reported services noted in the chart or proof of historical services are also considered non-standard data. Providers can upload medical records to receive credit for completed services. Records are reviewed to ensure that they meet accurate documentation requirements. The records are subject to auditor approval through the health plans’ PSV (Primary Source Verification) audit process and requires additional resources to validate accuracy throughout the year.