Encounter data is information submitted by health care providers, such as doctors and hospitals, that documents both the clinical conditions they diagnose as well as the services and items delivered to beneficiaries to treat these conditions.
Contracted PPGs, Specialty Plans, Vendors, Hospitals and LTSS Providers are responsible for gathering, processing, and submitting Encounter Data for the services provided to all L.A. Care Members. Encounter Data is the primary source of information about the delivery of services provided by healthcare or atypical providers to L.A. Care Members.
Why is encounter data important?
Complete, accurate and timely Encounter Data is key for determining needed changes and improvements in health related programs. L.A. Care also uses Encounter Data for monitoring and oversight functions including HEDIS reporting, Capitation Rate development, and for meeting various regulatory requirements.
This data helps establish and the following as it relates to rates, access and important trends.
- Accountability: utilization, access, and quality analysis.
- Rate setting and risk adjustment.
- Studies of small, high-policy-interest populations.
- Community-wide studies.
- Other research and evaluation studies.
How to submit encounter data to L.A. Care
PPGs and Hospitals with capitated arrangements who submit encounter data to L.A. Care must use TransUnion Healthcare’s services under the below mentioned terms and conditions free of charge. L.A. Care will reimburse TransUnion Healthcare for services rendered to all contracted PPGs.
To use TransUnion Healthcare services, PPGs and Hospitals are required to:
- Submit Encounter Data to TransUnion Healthcare within the parameters required by TransUnion Healthcare.
- Submit Encounter Data to TransUnion Healthcare no more than sixty (60) calendar days after the end date of service in which the encounter occurred to ensure routine and timely submission of Encounter Data to L.A. Care