New Claims System Update

Provider Manual
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6 PROVIDER NETWORK INFORMATION

6.13 Reporting Obligations

Cooperation in Meeting CMS Requirements

IntegraNet is required to provide information to CMS necessary to administer and evaluate the Medicare Advantage program and to establish and facilitate a process for current and prospective members to exercise their choice in obtaining Medicare services.

IntegraNet provides the following information:

  • Plan quality and performance indicators
  • Information on member satisfaction
  • Information on health outcomes
  • Performance Data
  • HEDIS
  • Medical Risk Adjustment
  • Providers must cooperate with IntegraNet in its data reporting obligations including collection, evaluation and participation in reporting performance data and its Quality Improvement (QI) activities to improve the quality of care, services and member experience.

    Certification of Diagnostic Data

    IntegraNet is required to submit information to CMS necessary to characterize the context and purposes of each encounter between a member and provider, supplier, physician or other practitioner (encounter data). Providers that furnish diagnostic data must certify (to the best of their knowledge, information and belief) the accuracy, completeness and truthfulness of the data.