ECDS Overview - Horizon Blue Cross Blue Shield of New Jersey (2024)

Welcome to the Electronic Clinical Data Systems Webinar, otherwise referred to as ECDS.

During this webinar, we will review all the requirements when submitting ECDS files, as well as review best practices and helpful tips.

The ECDS is a process for sites to submit supplemental data to close quality care gaps.

It is an NCQA approved method to share members' clinical data electronically. The information must be directly populated into the ECDS file.

Additional incentives are available for selected Medicaid measures.

Before we discuss the ECDS grid requirements, let's first review the timeframes for submission and the measures currently being accepted.

Once a measure has been approved by the audit process, including file format review and medical record validation, files can be submitted monthly or quarterly up to February 28th of the following year.

Please note that dates are subject to change. Providers will be notified of any changes in advance.

These are the current HEDIS adult measures that are being accepted for the ECDS submission.

Blood Pressure Control for Patients with Diabetes.

Controlling High Blood Pressure. Breast Cancer Screening.

Care of Older Adults. Cervical Cancer Screening.

Chlamydia Screening in Women. Colorectal Cancer Screening.

Eye Exam for Patients with Diabetes.

Glycemic Status for Patients with Diabetes.

Kidney Health Evaluation for Patients with Diabetes.

Transitions of Care. Bone Mineral Density Testing.

Prenatal and Postpartum Care.

These are the current HEDIS pediatric measures currently being accepted for ECDS.

Chlamydia Screening in Women. Childhood Immunization Status.

Immunizations for Adolescents. Lead Screening in Children.

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents: BMI Percentile, Counseling for Nutrition, Counseling for Physical Activity.

Well Child Visits in the First 30 Months of Life: Rate one, 0 to 15 months; Rate two, 15 to 30 months.

Child and Adolescent Well-Care Visits.

The ECDS file sent to you must remain in the exact format, xls. When populating the file, there can be no changes made to the file.

All columns and naming of columns cannot be changed or moved.

There can be no copying, pasting, or manual entry into the ECDS file.

Members being populated into the ECDS file must be the member identified as non-compliant in the quality gap reports and reflective of the measure or measures the members fall into.

Dates of data being submitted must be within the appropriate timeframe for the measure.

The only exception would be for A1C and blood pressure readings, as we are looking for the last reading in the measurement year.

Each time a member has an A1C or blood pressure reading, and they are not coded or submitted via claims, the members should be included in your ECDS submission whether they are compliant or non-compliant in the member gap reports.

When sending member data, include all data associated with the measure, even if the member is non-compliant.

For example, if you're submitting for KED and only have GFR, you should submit this, as additional information may come from another provider, in turn, processing will combine all data received and can make the member compliant. Same can be applied to the measure CIS.

Please note, when reporting labs, the date of collection must be used.

The naming convention for an ECDS file is as follows.

The site name_EHR_SupData_ECDS_Layout_monthdayandyear the file was submitted.

The file can be sent via secure email to the provider EHR mailbox; Horizon Docs platform, using the category Quality and sub-category EHR Completed Templates; Or, if your site's using MFT, Partner to Horizon, sub-folder EHR File Feed.

And please remember to send an email notification to the provider EHR mailbox once you've uploaded files for medical records.

Files that are reviewed with measures for the first time are audited for file format.

For example, a review of the file is completed to be sure no columns have been moved, the information is formatted correctly, and there are no blanks in required fields.

After the file passes the file format review, a random selection of medical records will be requested.

The medical record review is used to validate the data in the ECDS file.

Once the file passes the audit, it is uploaded to the data team for processing.

Any approved measures will have a medical record revalidation on or after one year of the initial approval of the measures.

This will consist of 5 randomly selected charts for measures that did not have any changes with the key specifications of the measure.

Just to note, HBD has changed to GSD. This is just a name change and the HEDIS measure specifications remain the same for 2024, so there will be no need for any additional charts, just the 5 charts for revalidation.

Every time a file is received with approved measures, it still needs to be QA'd for file-format accuracy.

Once a file is reviewed for quality assurance purposes, with no issues identified, it will be uploaded to the data team for processing.

Please note that files uploaded to the data team will take 60 to 90 days to be reflected in the member gap reports.

When looking at the ECDS Excel file provided to you, you will note that there are several tabs on the bottom. Let's review these tabs.

Layout and details contains information pertaining to each column, including a brief description and number of characters allowed in the field.

File Layout is the actual ECDS file that your information from your EMR will be populated into.

Column Description gives a more detailed description of each column.

Measure Name Acronyms. In this tab you will find the measures currently being accepted and the acronyms for the measures. The name and acronyms must match exactly what is in the tab in the ECDS file layout.

You cannot change or add your own measure or acronyms.

Provider type, depending on the provider of service. This is where you will find the acronym for the provider type.

Again, you can only populate the ECDS file with the acronyms found here. Reminder, some measures have a specific provider type, for example, EED and WCC.

This slide, and the next, gives you more information about each column in the ECDS file. Let's review these columns and requirements.

Column A, Member Key is a required field.

Column B, Provider Key is a required field.

Column C, Reference ID is always left blank.

Column D, Date of Service is a required field.

Column E, Date of Service Thru is a required field and should be the same date as Column D.

Column F, Provider Type is a required field.

Column G, Provider Taxonomy can be left blank.

Column H, CPTPx depends on service.

Column I, HCPCSPx depends on service.

Column J, LOINC code depends on service.

Column K, SNOMED depends on service.

Column L, ICDDx depends on service.

Column M, ICDDx10 depends on service.

Column N, RxNorm can be left blank.

Column O, CVX depends on service.

Column P, Modifier can be left blank.

Column Q, Rx Provider Flag is a required field.

Column R, PCP Flag is a required field.

Column S, Quantity Dispensed should always be populated with 1.

Column T, ICDPx depends on service.

Column U, ICDPx10 depends on service.

Column V, Supp Source is a required field.

Column W, Result Labs only required.

Column X, Measure is a required field.

Column Y, Measure Name is a required field.

Column Z, Submeasure is a required field for CIS and IMA.

Column AA, Member ID is a required field.

Column AB, Member Last Name is a required field.

Column AC, Member First Name is a required field.

Column AD, Member Date of Birth is a required field.

These are the 2024 measures for R&R ECDS incentives for Medicaid line of business and the potential incentives are only available after benchmarks are met and surpassed.

Helpful tips and reminders. Column C, Reference ID. This column should remain blank.

Column D and E, Date of Service and Date of Service Thru. Both columns should be populated with the same date of service.

Column W, Results. Do not enter blood pressure results, lab values only.

Column Z, Sub-Measure, used for immunization names.

Measures requiring a specific provider type: EED, WCC, W30, WCV, COA, TRC, and PPC.

Additional helpful tips and reminders.

CBP and BPD require 3 lines per member in the ECDS file. One line is for systolic, one line is for diastolic, and one line is for E/M codes, evaluation and management.

Collection dates must be used for labs and tests.

The member ID numbers used to populate the ECDS file in Column AA are found in the member gap reports.

For Value Based reports, the ID number can be found in column I. For the Braven reports, the ID can be found in column D.

For the R&R Medicaid and DSNP, the IDs can be found in column F.

Please be sure to review your files for quality assurance prior to submission.

The date at the end of the ECDS file represents the date you submitted the file.

Medical records must match the data points in the ECDS files.

Helpful tips and reminders. All lines of business can be on one measure file for ECDS.

Do not move, add, or delete any columns in the ECDS file.

It must be populated from the EMR into the exact format of the ECDS file.

ECDS files can be sent to Horizon monthly or quarterly.

The NCQA suggested codes to close quality care gaps are located on the billing tips sheets, which is located in the Horizon Provider Resource Center.

Codes selected must represent the services, tests, results as identified in the medical record.

Frequently asked questions. What lines of business can be taken via electronic file feeds? All lines of business.

Who can submit files this way? All practices using an EMR can use this method.

For ECDS questions, who do the providers reach out to? Please email the

Can I move or delete the columns? No, columns cannot be moved or deleted.

How often can I submit files? Files can be submitted to Horizon monthly or quarterly.

Where do I find the approved NCQA suggested codes? Billing tips sheets can be found in the Horizon Provider Resource Center.

Where do I find the member IDs and unique ID numbers? Member IDs can be found on the member gap reports.

Thank you for attending the ECDS webinar. Please feel free to direct any questions you may have to the Provider EHR Mailbox or any of the 3 ECDS team members listed on the slide.

Please take a moment to fill out this brief survey because your feedback is appreciated.

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ECDS Overview  -  Horizon Blue Cross Blue Shield of New Jersey (2024)
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