Digital First: Submitting supplemental data in 2024

As health care continues to transition into the digital space, we’re adapting our data strategy to follow suit.

Patient Profile and the PIP_70 report will be retired with the close of the 2023 PIP performance year. Beginning with the 2024 performance year, we’ll accept only the following supplemental data sources for quality gap closure:

• Claims
• CPT II codes
• Direct data feeds (HL7 or APS)
• MiHIN
• MICR (immunizations)
• Epic Payer Platform (EPP)
• Disease registry
• Continuity of Care Documents (CCDs)

Why are we making this change?

Retiring Patient Profile and PIP_70 and focusing on the data sources listed above allows us to:

• Improve data quality exchanges
• Enable workflows and processes that support our ACNs’ EHRs

Patient Profile and PIP_70 submissions often contain errors which impact our reporting and performance. We’ve historically performed poorly in supplemental data audits, which could put our members, your patients, at risk of higher costs and reduced services.

Additionally, NCQA continues to expand its implementation of Electronic Data Source (ECDS) measures, preferring digital supplemental data sources to close care gaps.

Therefore, transitioning to a digital first strategy is paramount as we approach the 2024 performance year.

Wrapping up the 2023 performance year

We’ll continue to accept Patient Profile and PIP_70 report for gap closures for 2023 dates of service through Jan. 31, 2024.

Supporting you through this transition

• ACNs: Our teams are here to help you through this transition. Contact your Provider Strategy & Solutions Consultant to get started.
• Practices: Work with your ACN to ensure your hard work is captured through this Digital First strategy.