Below are the latest announcements, updates, and other information to assist data providers in preparing to report the Medical Data Call. Data submitters should visit this website periodically for additional information regarding the Medical Data Call.
06/15/24
The Medical Data Call Manual has been republished to add new and additional reporting requirements for the Pennsylvania Medical Data Call. These changes are designed to streamline reporting processes and enhance accuracy and involve the following fields: Provider Identification Number, Provider Postal (ZIP) Code and Provider Postal (ZIP+4) Code. Housekeeping and other minor editorial changes are also included. All of the changes are highlighted in green within the Manual.
06/03/24
PCRB updated Medical Data Call Reporting Requirements to streamline process and improve accuracy. The changes involve Provider Identification Number, Provider Postal (ZIP) Code, and Provider Postal (ZIP+4) Code and will begin with 4th quarter 2024 transactional data that is due to PCRB by 3/31/2025. Please refer to Information Bulletin #016 for complete details.
06/15/23
The Medical Data Call Manual has been republished to add detailed information, tables and reporting requirements for consistent reporting of multi-data type fields, which includes further specifics on reporting Key Field Changes. Housekeeping and minor editorial changes are also included. All of the changes are highlighted in green within the Manual.
11/15/22
The PCRB is pleased to announce the release of a new Pennsylvania Medical Data Call Frequently Asked Questions (FAQ) section on our website.
10/01/22
The Medical Data Call Manual has been republished to include updates to the list of approved Place of Service Codes. Housekeeping and minor editorial changes are also included. All of the changes are highlighted in green within the Manual.
11/15/21
The Medical Data Call Manual has been republished to reflect the changes to Medical Data Call eligibility requirements. The eligibility threshold has been reduced from 1.0% to 0.5% or greater market share. Please refer to PCRB Circular No. 1772 for further information. Housekeeping and minor editorial changes are also included. All of the changes are highlighted in green within the Manual.
5/11/21
The Medical Data Call Manual and the Electronic Submission Guidelines have been republished with further clarifications on existing reporting rules and to be consistent with the industry’s Medical Data Call where applicable. The changes are effective June 1, 2021. Specific changes are regarding the following:
All of the changes are highlighted in green within the Manual.
1/13/20
The PCRB is pleased to announce the release of the Medical Data Manager (MDM). Existing users of the Medical Data Call Manager have been migrated to the Medical Data Manager (MDM.) No further action is needed for existing users. Existing users may log in and begin using MDM immediately. The new MDM is part of the suite of data management products which also include Policy Data Manager (PDM) and Unit Statistical Report Data Manager (UDM). MDM is a companion product to both PDM and UDM, which were previously released by PCRB. All products in this suite have a similar look and feel, functionality, and mostly importantly the ability to toggle between policy, USR, and medical data sets. Also, as a reminder, medical data reporting requirements did not change.
Medical Data Call submitters will begin to receive via email enhanced file processing receipts and file error messages. We have prepared a File Error Email Message Reference Guide for your convenience. This guide will assist you to interpret the new email notifications and respond accordingly. The guide is available on the PCRB website in the Medical Data Reporting section.
To monitor the status of your medical data call files that were submitted via CDX, click on the Submit tab on the menu bar, then click CDX Uploads. Additionally, to view the processing results you should navigate to the Reports tab. Users now have the option to submit files directly in the Medical Data Manager by clicking on the Submit tab, then click Submit File, or users may continue to submit files via CDX.
MDM also includes limited WCCRIT functionality which follows the WCIO data standard for receiving criticism letters. If you are interested in this function, and have previously installed the WCCRIT Viewer for Policy Data Manager (PDM) or Unit Data Manager (UDM), you will need to download and re-install the WCCRIT Viewer again to add on this function for MDM. We will provide more guidance and reference materials on this topic in the coming months as this functionality is expanded.
Please refer to the MDM Users Guide on our website for further information.
1/3/20
Update: The PCRB will be releasing the Medical Data Call Manager (MDM) on January 13, 2020. No additional action is required for existing users. Please refer to the MDM Users Guide on our website for further information.
11/4/19
The PCRB is pleased to announce the upcoming release of the Medical Data Manager (MDM) on January 6, 2020. MDM is a web-based application for submission tracking and data quality management of Medical Data transaction information.
MDM provides users the ability to:
Monitor status of medical submissions
View and/or export editing and validation results in various formats
Search and view medical transactions and histories
Effective January 6, 2020, existing users of Medical Data Call Manager will be automatically migrated to Medical Data Manager (MDM.) No additional action is required for existing users. Please refer to the MDM Users Guide on our website for further information.
Refer to PCRB Circular No. 1731 for more information.
Additionally, we have updated several documents on the PCRB website, including the Medical Data Call Manual, the MDM Edit Matrix and the Electronic Submission Guidelines, to reflect the upcoming release of MDM as well as the recent changes related to CDX. The Medical Data Call Manual was also updated with a clarification on the preferred provider identification number.
4/1/19
The Medical Data Call Manual has been republished with further clarifications on the existing reporting rules and to be consistent with the industry’s Medical Data Call where applicable. Specific changes are regarding merger and acquisition scenarios; business exclusion method 4; compound drug reporting; and prescription drug dispensing fee reporting. Housekeeping and minor editorial changes are also included. All of the changes are highlighted in green within the Manual.
8/6/18
Effective starting with 4th quarter 2018 transactions, the Pennsylvania Medical Data Call will implement the following data processing change regarding edit 0519-04, which indicates the replacement record does not match a previously reported record. Note that all 4th quarter 2018 transactions are due no later than 3/31/19.
Pennsylvania Medical Data Call will no longer accept a replacement record ‘03’ if there is not a matching original record ‘01’ on the database. These records will be rejected with Edit 0519-04. Currently, the Medical Data Call accepts the replacement record ‘03’ and applies it as if it were an original if there is not a matching original record ‘01’. This policy will end as of 10/1/18 and we will begin rejecting unmatched replacement records.
Upon reviewing calendar year 2017 transactions reported for Pennsylvania Medical Data Call to determine the impact of this change, we found that no carriers or data submitters had a significant volume of unmatched replacement records. However, we are bringing this to your attention because when we apply the data processing change, these records will be rejected, and if the rejected records are of sufficient volume they will cause the entire file to be rejected.
Pennsylvania Medical Data Call is aligned with the NCCI Medical Data Call regarding this data processing change to allow for a uniform approach for carriers reporting this data across most states.
11/1/17
The Medical Data Call Manual has been republished with further clarifications on existing reporting rules and to be consistent with the industry’s Medical Data Call where applicable. Housekeeping and minor editorial changes are also included. Specific changes are regarding compound drug reporting, place of service code reporting, and medical marijuana reporting. All of the changes are highlighted in green within the Manual.
5/2/17
PCRB Medical Data Call has adopted new code values for Compound Drugs and Dispensary.
Under the current program, data submitters report Compound Drugs using the proprietary code value 99999999999. While this code will still be accepted for reporting Compound Drugs, data submitters are asked to transition to the new HCPCS code J7999 (Compound Drugs – Not Otherwise Classified) as soon as possible. PCRB will continue to accept both code values until further notice.
PCRB Circular 1662 (dated 6/29/16) specified the usage of Place of Service Code 02 for Dispensary, to be used when reporting Medical Marijuana services MM001 and MM002. Subsequently, the federal government established Place of Service Code 02 for Telehealth. In order to avoid a coding conflict, we now specify the usage of Place of Service Code DS for Dispensary, to be used when reporting Medical Marijuana services MM001 and MM002. Data submitters are asked to transition to the new code value as soon as possible.
PCRB’s medical data processing systems and edit programs are ready to accept these new values at this time.
6/29/16
The PCRB has published PCRB Circular No. 1662, dated June 29, 2016, entitled "Medical Data Call Changes, Effective July 1, 2016". All data submitters are advised to review the Pennsylvania Medical Data Call Manual and other documentation found in the Medical Data Reporting section of the website to gain familiarity with the changes and updates to the reference materials.
7/11/13
The Medical Data Call Manual has been republished with new reporting rules and several important revisions. This republication includes a new section on reporting requirements when a carrier is involved in a merger or acquisition. The Place of Service Code listing was updated to include a new code for Walk-In Retail Health Clinic. The refresh includes clarifying language and updated references regarding the Provider Identification Number field, the Provider Taxonomy Code field and the Primary and Secondary Diagnostic Code fields. Lastly, the Manual contains revised rules for reporting the appropriate version of the DRG Code. All of the changes are highlighted in green within the Manual.
7/2/12
Effective immediately, PCRB is generating file transmittal receipts for Medical Data Call data submissions. After each data submission is processed by PCRB, the system will automatically generate one email message to notify data submitters of Accepted or Rejected status.
The Medical Data Call Electronic Submission Guidelines have been updated to include information on the new file transmittal receipts. There is also a clarification to the guidelines for test vs. production submissions. The updated document replaces the prior April 1, 2012 release and continues to include the CDX instructions and other essential information needed for carriers to submit medical data transactions.
Additionally, the Medical Data Call Edit Matrix has been updated to include a new description for edit 0108-02 which is related to Jurisdiction State Code. The edit matrix contains details on the edits performed for each file submission.
7/11/11
The Medical Data Call Manager was recently modified to incorporate a new edit category. These changes represent title and presentation changes only and no changes have been made to the existing edits. Edits which involve more than one data element have been re-labeled as Relational edits. Users will observe the new Relational edits in the Quality Tracking – File Level and Quality Tracking – Aggregate Level options. The Relational edits will be displayed in a similar format as the Critical, Priority and Low edits.
An updated Medical Data Call Manager User’s Guide is available within this web application and is also available in the Help Section located in the Application Login area of the PCRB’s website.
6/6/11
Effective June 6, 2011, the PCRB will begin to strictly enforce the Medical Data Call transaction file reporting schedule as shown below. This schedule remains consistent with the reporting rules as published in the Pennsylvania Medical Data Call Manual. For those data providers continuing to send files outside the appropriate transaction submission period, please note that such files will be rejected.
|
Medical Data Call Transaction File Reporting Schedule |
||
| Reporting Quarter | Original Files Due End of: |
Delete Files and Replacement Files Received Before: |
| 1Q - current year | 2Q - current year | 4Q - current year |
| 2Q - current year | 3Q - current year | 1Q - following year |
| 3Q - current year | 4Q - current year | 2Q - following year |
| 4Q - current year | 1Q - following year | 3Q - following year |
6/1/11
The Medical Data Call Manager was recently updated to include an industry benchmark feature. The Quality Tracking – Benchmark option allows users to view aggregate quality statistics as compared to the industry aggregate quality statistics. The aggregate quality statistics are refreshed as additional files are received during the same reporting quarter for the carrier group. Within this option, the industry is comprised of all carrier groups who are eligible to participate in Pennsylvania Medical Data Call. The PCRB will refresh this report on a twice weekly basis.
An updated Medical Data Call Manager User’s Guide is available within this web application and is also available in the Help Section located in the Application Login area of the PCRB’s website.
Quarter End Validation will be made available to carriers in the near future in the Medical Data Call Manager.
The Medical Data Call Manual has been republished with an important revision. This republication includes a clarification regarding the Record Total in the Section V - Reporting Rules for Delete File transactions.
The PCRB added a new section on the Medical Data Reporting web page which is the Medical Data Call Manager. This section provides information on how to access the Medical Data Call Manager as well as a summary of the features of the Medical Data Call Manager application.
The PCRB added a new section on the Medical Data Reporting web page which is the Medical Data Call Transaction Reporting Calendar. The calendar may be used by carriers as a reference tool for data file submission due dates.
3/9/11
The Medical Data Call Manager was recently updated to include an aggregate quality tracking function. The Quality Tracking – Aggregate Level option allows users to view aggregate quality statistics which are refreshed as additional files are received during the same reporting quarter for the carrier group. The PCRB will refresh this report on a twice weekly basis.
An updated Medical Data Call Manager User’s Guide is available within this web application and is also available in the Help Section located in the Application Login area of the PCRB’s website.
Quarter End Validation will be made available to carriers in the near future.
The following are a few important reminders regarding data submissions for Medical Data Call:
The Submission File Identifier in the Submission Control Record (trailer record) must be unique for every data submission -- including any submission following a rejected submission or a test submission. The only exception to this rule is when the data submission is a file replacement transaction. For file replacement transactions, the Submission File Identifier must match the Submission File Identifier from the data submission to be replaced.
Verify that prior transaction files have been processed successfully before sending the next transaction file.
Quarterly Data Submitters: Please separate quarters into distinct data submission files. Do not combine multiple quarters into a single data submission file.
5/6/10
The Medical Data Call Manual has been republished with several important revisions. This republication includes details on two new key field changes which are required for the proper linking of individual medical transactions. Policy Number Identifier and Policy Effective Date are now being treated as key fields. The update also describes the addition of two new Paid Procedure Code types: Compound Drugs and Per Diem. Lastly, the refresh includes clarifying language, updated references, and revised formatting. All of the changes are highlighted in green within the Manual.
The Medical Data Call Manager is now available on the PCRB's website. This new web application will provide carriers, and their data providers, a central location to monitor their medical data call submissions, review quality statistics and download returned medical data call records. The Medical Data Call Manager User’s Guide is included within the application and is also available in the Help Section located in the secure portion of the PCRB’s website.
The Medical Data Call Manager is being rolled out in two phases. The current release (Phase I) includes Submission Tracking functionality. Phase II will include Quality Tracking and Quarter End Validation functionality. Phase II will be made available to carriers in the near future.
By using the secure portion of the PCRB’s website, carrier users can request access to the Medical Data Call Manager from their Carrier Group Administrator (CGA) via the “Request Access to Application” link located within the blue or green side bar. The user will then be prompted to select the Medical Data Call Manager.
The Medical Data Call Electronic Submission Guidelines document has been updated to clarify the electronic transmission record (ETR), and to provide additional guidance regarding the file naming conventions. There is also refreshed content on the file acceptance and carrier notification process as well as information on the PCRB’s Medical Data Call Manager web application.
In the weeks ahead, the PCRB will be contacting you regarding your Medical Data Call preparedness which includes either determining your plans to submit test files or discussing the results your test file submissions.
11/30/09
The Medical Data Call Implementation Guide has been republished as the Medical Data Call Manual. This republication includes some clarifying language and examples, and provides additional information on the certification, editing and validation processes.
The Medical Data Call Manual completely replaces the release of the May 15, 2009 Medical Data Call Implementation Guide and continues to include the reporting layout, general rules, participation requirements and business exclusions, reporting frequencies and responsibilities, editing strategy and other essential information needed for subject carriers to continue to prepare for the submission of medical data transactions. The Medical Data Call Edit Matrix on the website has also been updated and is available for download. This matrix contains details on edits that will be performed on Medical Data Call submissions by the PCRB.
Additionally, a Medical Data Call Electronic Submission Guidelines document has been added to the list of available medical call information posted on the PCRB’s website. This document outlines the electronic testing process and requirements. Data providers are reminded that mandatory testing (certification) begins April 2010 and must be completed by July 2010. If a data provider is ready to test prior to the mandatory testing period please email us at [email protected] or contact us by phone at (215) 568-2371.
We also invite and encourage Medical Data Call reporters to attend the Medical Data Call training sessions at NCCI’s 2010 Data Educational Program on Data Reporting Fundamentals (January 26-27th) and/or Data Provider Forum (January 28-29th) to learn more about the Medical Data Call. Both programs are free of charge and will be held at the Palm Beach County Convention Center in West Palm Beach, Florida. If you are interested in registering for these programs, please visit NCCI’s website at www.ncci.com. Note that these programs are specifically intended for entities that will be reporting the NCCI Medical Data Call. However, NCCI has graciously invited independent PCRBs and/or their Medical Data Call reporters to participate in these sessions.
5/15/09
The Medical Data Call Implementation Guide has been updated to include some clarifying language and examples. The updated guide replaces the prior January 6, 2009 release and continues to include the reporting layout, general rules, participation requirements and business exclusions, reporting frequencies and responsibilities, editing strategy and other essential information needed for carriers to continue to prepare for the submission of medical data transactions.
Additionally, a Medical Data Call Edit Matrix has been added to the website and is available for download. This matrix contains details on the edits that will be performed by the PCRB.
1/6/09
The PCRB has adopted a Medical Data Call beginning with medical transactions occurring during 3rd quarter 2010.
The Medical Data Call Implementation Guide is now available. This guide includes the reporting layout, general rules, participation requirements and business exclusions, reporting frequencies and responsibilities, editing strategy and other essential information needed for carriers to begin preparing. The posting of this document completes Phase I on the documentation process.
Phase 2 will occur in the first-half of 2009, when the PCRB will expand on the Medical Data Call Implementation Guide and reformat the guide into a Medical Data Call Manual. The Medical Data Call Manual will be comparable to the PCRB’s other manual products such as the Statistical Plan Manuals.
The PCRB will continue to publish industry announcements, timelines, and other important information including training information as we proceed with the implementation of the Medical Data Call.