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demand-driven-open-data / ddod-intake

"DDOD Intake" tracks DDOD Use Cases using GitHub issues. View the main DDOD site here
http://ddod.us
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FFM Network Adequacy data to meet directory requirements #37

Closed dportnoy closed 9 years ago

dportnoy commented 9 years ago

Description: CMS/CCIIO should already have QHP provider network data that it collects annually through the QHP certification process. The fields in this data should be adequate to meet another requirement for machine-readable files. We need to see if the fields provided are sufficient and the process can be automated. If so, we would just need to provide this data on a monthly basis.

Customer: The Provider Directory Workgroup (PDWG) formed to address CMS's requirement to maintain machine-readable provider network directories.

Related discussion: http://hhs.ddod.us/wiki/Implementation:_Provider_network_directories

dportnoy commented 9 years ago

Specifications are located here: http://hhs.ddod.us/wiki/Use_Case_37

ftrotter commented 9 years ago

This is important data. I care about this. It should also be noted that Medicare/Medicaid Advantage plans also have to demonstrate network adequacy. Is this something that can be merged? Should it be its own ticket?

dportnoy commented 9 years ago

@ftrotter Thanks for submitting FOIA request for QHP network adequacy files. Yes, I think it would make sense to have a separate request for Medicare/Medicaid Advantage plans, since it would most likely be fulfilled by different people.

dportnoy commented 9 years ago

Added network-level PUF data source (http://hhs.ddod.us/wiki/Use_Case_37) to use case writeup.

dportnoy commented 9 years ago

@ftrotter What did you hear back from FOIA on your request? We may be able to work this one as FOIA / DDOD "parallel" request.

dportnoy commented 9 years ago

Closing use case. The relevant data needed to recreate the entire network for a QHP can now be found in the "Machine-readable URL PUF" (aka, MR-PUF). The solution has been posted here: http://hhs.ddod.us/wiki/Use_Case_37#Solution