Guidance for Payers and Providers

Implementation Manual

 

The Implementation Manual (manual) explains the technical and operational steps that OHS will take to implement the healthcare cost growth benchmark.  The manual contains the methodologies that OHS used to set the healthcare cost growth benchmark and the primary care target, and for calculating performance against the benchmark and primary care spending target.  The manual also contains the technical specifications for data reporting and collection, timelines, data due dates and where to upload the data.

IMPLEMENTATION MANUAL

Contact Credentialing

OHS has provided a contact form  for the carrier’s contact(s) to fill out and email to OHS@ct.gov   to be credentialed. This information is required:

  • To facilitate user access to the State‘s SFT Web Client;
  • To confirm the user is the authorized and designated contact for the carrier at registration;
  • To facilitate securing and protecting confidential data;
  • To enable OHS communicate with the contact about data error correction and validation, system or process changes and updates.

OHS will credential the contact within two business days of receipt of the filled form. The authorized user will then upload the required data files and alert OHS through email after uploading the file(s).

CONTACT FORM

The Cost Growth Benchmark Performance Submission data file is an Excel worksheet. These are the files that will be uploaded through the payer data portal.

COST GROWTH BENCHMARK PERFORMANCE SUBMISSION TEMPLATE

 

If there are problems downloading the taxonomy code listings imbedded in the implementation manual (pages 31-32 and 45-46), the Excel worksheet can be downloaded here.

COST GROWTH BENCHMARK PRIMARY CARE TAXONOMY AND PROCEDURE CODES

 

Insurers will need to provide variance information for (1) each line of business and (2) each provider entity by line of business. The excel sheet below shows an example variance calculation using made-up claims data for one hypothetical payer’s individual members.

 

EXAMPLE VARIANCE CALCULATION