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Medicare Data for Dual Eligibles for States

Medicare Data for Medicare-Medicaid enrollees to States

The Medicare-Medicaid Coordination Office is making available a process for State Medicaid Agencies to request timely Medicare Parts A, B and D data for Medicare-Medicaid enrollees to support care coordination.  Having access to Medicare data is an essential tool for States seeking to coordinate care, improve quality, and control costs for dual eligible beneficiaries.  Data that may be requested, subject to procedural limitations, are:

•         Medicare Parts A, B claims and D event data

•         Medicare Parts A, B, C, and D eligibility and enrollment data 

Territories and States Batch Query (TBQ) process: These data may be obtained through the TBQ is a voluntary batch query finder file process.  For each TBQ file the State submits, CMS will return a response file with detailed information on Eligibility and Enrollment for Medicare Parts A, B, C, and D.  A complete process description document may be here.  For additional information on the TBQ process or file layout, please contact the Medicare-Medicaid Resource box at: MedicareMedicaidCoordination@cms.hhs.gov.       

For details on how to request these data, please see the CMCS, MMCO Information Bulletin: Please click here to view.

Medicare Data for Medicare-Medicaid enrollees to States
State Medicaid Agencies interested in requesting Medicare Parts A, B and/or D data for their dual eligible beneficiaries should refer to the State Data Resource Center website, www.statedataresourcecenter.com.  The website will explain the permissible uses for each data type (e.g., care coordination, quality improvement and the development and evaluation of care coordination programs and integrated care models, etc.) and describe in detail the data request process.  Through the website, State Medicaid Agencies can access data experts who can assist in using the data for care coordination purposes.  Additional questions may be directed to MedicareMedicaidCoordination@cms.hhs.gov.