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Accessing Claims Data |
2019-11-02 09:21:12 -0500 |
Accessing Claims Data |
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accessing-claims-data-nav |
Active, stand-alone Prescription Drug Plan (PDP) sponsors who want to access Medicare Part A and Part B claims data need to follow four steps:
- Attest (agree) to AB2D API data protocols.
- Appoint a technical point of contact for your organization.
- Test synthetic data in the sandbox.
- Receive credentials to access production claims data.
To access production claims data, an executive from your organization (“Attestor”) first needs to agree (“attest") to our Claims Data Usage Protocols. These protocols include limitations on data use and disclosure.
- Log into the Health Plan Management System (HPMS)
- Select Claims Data Attestation (under Contract Management)
- Choose an option for one, multiple, or all contracts in the Contracts Without Attestation window
- Select the Attest button
- Review the Claims Data Usage Protocols
- Select I hereby certify that I understand the attestation above
- Select Confirm
An organization can have multiple Attestors. We strongly encourage that you have multiple executives attest to each of their participating contracts. This is best practice as it prevents gaps in access if one Attestor leaves the organization.
To add multiple Attestors:
Follow the same steps. The Attest button will now be labeled “re-attest” under step 4.
An Attestor needs to:
- be part of an active, stand-alone PDP organization (PACE and MAPD are ineligible).
- hold a current CEO, CFO, or COO role within the organization.
- attest to each contract that will connect to AB2D.
- PDPs can retrieve claims data for their active plan enrollees from the date of attestation onwards. Claims data prior to their attestation date will not be provided.
- PDPs must have an active Attestor at all times. Your organization will not be able to receive data during periods without an active Attestor. Access to data will only be restored once another active CEO, CFO, or COO attests. We highly recommend adding multiple Attestors to reduce the risk of lapses in your data access.
Once an organization has attested, it follows the remaining steps in the onboarding process, which include appointing a technical specialist, testing synthetic data in the sandbox, and receiving credentials. Once these steps are complete, the organization will have access to claims data starting from the attestation date. Claims data previous to that date won't be available.
After attesting, you will need to assign an AB2D Data Operations Specialist (ADOS). Your ADOS will serve as the primary technical point of contact of your organization.
- employee or vendor with authority to access and view your organization’s beneficiary data
- expertise to connect to and retrieve data from the sandbox and production environments
- ability to provide static IP address(es) and/or CIDR ranges for the network/system accessing the API
The sandbox is a test environment that allows anyone to interact with the AB2D API and retrieve test Medicare Parts A and B claims data. The ADOS will need to verify your organization’s retrieval of test data before receiving access to the AB2D API.
There are three ways to retrieve test data from the sandbox, depending on your preference: Postman, Swagger, and curl.
The ADOS must record the Log ID from successful jobs in the sandbox and provide this ID to the AB2D team for verification. Once verified the AB2D team will provide access to the API.
Your organization must provide the AB2D team with the public static IP address(es) of the network or system connecting to the API. These will be reviewed, approved, and allow-listed as an additional layer of security. Afterward, the AB2D team will assign and provide the Attestor production credentials, which will allow your organization to use the API to retrieve real Medicare Parts A and B claims data.
Our team can work with you to troubleshoot any issues and answer questions through our Google Group
Explore production documentation