Medicaid managed care encounter data: what, why, and where next?
Howell, Embry M
Date of Pub
Managed care now serves 23 percent of the Medicaid population. With the shift to capitation, the fee-for-service (FFS) billing
mechanism that has generated much of the administrative data used in policy planning and research no longer exists. This article
provides an overview of the types of encounter data currently being required for plans and the problems and issues with providing
and analyzing such data. It is based on a review of documentation and interviews with representatives of nine States and the
Health Care Financing Administration (HCFA). The article concludes by providing recommendations for HCFA, States, and plans
in creating and improving encounter data systems.
Capitation Fee : Data Collection/standards : Documentation/standards : Health Services Accessibility : Health Services Research
: Insurance Claim Reporting/standards : Managed Care Programs/economics/organization & administration/utilization : Medicaid/organization
& administration/utilization : Quality of Health Care : State Health Plans/organization & administration/utilization : United
States : Utilization Review/organization & administration