New Encounter Data Certification Requirements


CMS is happy to announce that beginning March 10, 2022, the Encounter Data certification process for Medicare Advantage Organizations (MAOs) and other entities will change. Below outlines the new criteria required for certification. Please note, existing submitters already certified, will not need to recertify.

 

ENCOUNTER TESTING/CERTIFICATION

All Plans

(Medicare Advantage, Cost, PACE)

and Third-Party Submitters

1 file containing a minimum of 50 encounters

Submission Requirements:

 

  • Files must be identified using the Authorization Information Qualifier data element “Additional Data Identification” in the ISA segment (ISA01 = 03).
  • Files must be identified using the Authorization Information data element to identify the “Test Certification File” in the ISA segment (ISA02 = TSTCERTFIL).
  • Files must be identified as “Test” in the ISA segment (ISA15 = T).
  • All files must pass with 100% acceptance rate.
  • In the event more than the required number of encounters are submitted, the file must still receive a 100% acceptance rate.
  • Upon certification for one of the 3 Encounter Data lines of business (Part A, Part B and DME), the submitter will be certified for ALL Encounter Data lines of business.

 

In the event you have any questions, please contact us at: 1-877-534-2772 (Option 2) or by email at: csscoperations@palmettogba.com.

Last Updated: 03/03/2022