Healthcare Relational Services (HCRS Data) Service Level Plan. 1 of 10

Transcription

1 Healthcare Relational Services (HCRS Data) Service Level Plan of 10

2 Healthcare Relational Services ( HCRS Data ) 1. Executive Summary 1.1 Purpose of This Document The purpose of this document is to address the method and levels of service and support for HCRS Data. This document also identifies the interaction between systems, IMS personnel and Client. This document may be updated from time to time by written agreement of both parties. Subject to the terms and conditions set forth herein, IMS will use all commercially reasonable efforts to provide to Client the services and support described herein. This support may also extend to the IMS approved third party service providers pursuant to executed IMS Third Party Access (TPA) Agreements for both report generation and data investigations. 1.2 What Is HCRS Data? HCRS Data is a single integrated source of data covering healthcare professionals, healthcare facilities, healthcare organizations and their relationships to each other. The kinds of HCRS Data covered under this service level agreement consist of two (2) components: Healthcare Professional Services (HCPS) Healthcare Organizational Services (HCOS) Healthcare Professional Services ( HCPS ) Within the HCPS component of HCRS, healthcare professional addresses are maintained, as well as other key attributes related to the individual such as self designated specialties, certification, external source identifiers and authorizations. Healthcare professionals, all key influencers and providers of healthcare which are set forth in HCPS may include the following: Physicians: Medical Doctors, Doctors of Osteopathy, residents & interns. Physician Extenders: Mid-level practitioners/nurses, physician assistants, podiatrists, dentists, optometrists, vets, nurse midwives, PhD s/researchers, psychologists, chiropractors, pharmacists, researchers, dietitians/nutritionists, Physician office administrators and diabetes educators. Administrators: managed care medical director, hospital administrator, financial, purchasing, etc. Healthcare Organizational Services ( HCOS ) Healthcare Organizational Services (HCOS) creates and manages organizational data that is reflective of the structure and contractual relationships of the US healthcare industry. Representative of approximately 500,000 healthcare organizations with highly specialized classes of trade, HCOS has the ability to align to and integrate with IMS professional, sales and prescription information. The Healthcare Organization Services (HCOS) database is a reference repository of places providing healthcare services (hospitals, single specialty/multi-specialty group practice, independent doctors offices, etc.) and the professionals who work there. 2 of 10

3 Database profile elements on these businesses include attributes such as their location, industry identifiers such as IMS identifiers, DEA & HIN, class of trade & specialty, key corporate contacts and other information relative to specific types of facilities. HCOS database also includes owner & purchasing relationships among businesses, as well as their links to DDD outlets and affiliations to professionals with IMS ID #s that link to Xponent & Xponent PlanTrak prescriptions. HCOS links and aligns in a one to one and one-to relationship structures from purchasing and distribution (Such as GPOs), linking the corporate parents or IDNs to their subsidiaries and provider facilities and to the healthcare professionals that practice at those facilities. 2. HCRS Service Support Client will be assigned an IMS HCRS Service Manager that will serve as the primary point of contact for HCRS questions, requests and concerns. 2.1 Service Meetings The IMS HCRS Service Manager will work with Client to establish a mutually agreed upon schedule for reoccurring meetings to facilitate the ongoing support of the HCRS Data licensed by Client. On behalf of Client, the HCRS Service Manager will engage and provide access to other IMS personnel to the extent reasonably necessary. In addition, IMS will provide an annual overview and review of the account. 2.2 Communications Telephone The HCRS Service Manager will make commercially reasonable efforts to respond to all phone messages within one (1) business day. If the HCRS Service Manager is out of the office, an alternate contact will be provided to Client. Client will be able to contact such alternate contact during the service manager s absence. The parties will use commercially reasonable efforts to review messages within one (1) business day. If a request is urgent, both IMS and Client will follow up via and with a phone mail message. If the HCRS Service Manager is out of the office, an automatic out-of-office response will indicate the date of return and provide an alternate contact. Client will be able to contact such alternate contact during the service team member s absence. 2.3 Communication regarding HCRS Structural Changes IMS will use commercially reasonable efforts to provide notification of HCRS structural changes to Client at least thirty (30) days in advance of implementation. Notice will be distributed by the HCRS Service Manager as well as an IMS Product News communication. 3 of 10

4 2.4 HCRS Baseline Service Support IMS Service Hours of Operation Monday Friday 9:00 AM 5:00 PM EST The effective date of this schedule is defined in the applicable SOW. The support described within this document will be provided by an IMS HCRS service team. 3.0 HCRS Delivery In the event the last day of delivery for a report falls on a Saturday, Sunday, legal holiday or IMS company holiday, the immediate following business day shall constitute the last day of delivery for the purposes of this paragraph. IMS Healthcare Professional Services (HCPS ) 4.1 HCPS Deliverable and Process If the provision of HCPS services is specified in the applicable SOW, the HCPS deliverables will be supplied to Client as defined in the applicable SOW and to the specifications outlined in the HCRS Addendum. The service levels with respect to HCPS services are as further described in this Section 4. The HCPS data deliverable contains information about healthcare professionals that meet the criteria and related attributes set forth in the applicable SOW and the HCRS Addendum. Such criteria and related attributes may include the following: Profile Information Addresses Address Intelligence State License Number (SLN) Authorizations Drug Enforcement Agency (DEA) Authorizations Identifier (ME, DO, NPI, etc.) Professions Specialties Regulatory Flags For a listing of detailed fields and specifications, refer to the HCPS Data Layout documentation. 4.2 HCPS Quality Control Checks and Balances IMS uses quality control checks in accordance with industry standards throughout various aspects of the HCPS database creation, updating and refreshing cycles, which includes manual maintenance. A partial list of quality controls includes: Comparison of records and trend analysis on counts for healthcare professional, address and license verification. This includes counts relative to prior months and syndicated alert files. Over 57 weekly database sweeps that are proactively captured and reviewed Daily Audit Trail which red flags any business rule violations 4 of 10

5 Automated job completion verification Automatic Data Anomaly reports 4.3 HCPS Quality Control Metrics The HCPS quality control metrics will be supplied to Client on a monthly or quarterly basis, as further defined in the applicable SOW and in the HCRS Addendum HCPS Data Inquiries and Data Investigations HCPS Data Inquiries Definition of an Inquiry: An inquiry is defined as a question or concern communicated from Client to IMS intended to obtain more information around IMS specific data, processing, overall data representation and trends. The HCRS service team shall use commercially reasonable efforts to acknowledge receipt of a data inquiry and, when possible, outline steps for response and resolution within one (1) business day of receipt HCPS Data Investigations Definition of a Data Investigation: An investigation is a challenge to the validity or currency of content within the HCPS data communicated as a request to verify, correct or update a particular portion of the HCPS Data. Most investigations by IMS require a telephone call to a provider s office or facility in question and/or by referencing source files (AMA, AOA, DEA, NPI and SLN). An investigation is initiated when Client questions the details in the data delivered by IMS. Client will initiate data investigations by using the IMS interface provided (e.g., QMS). The HCRS service and support team will use commercially reasonable efforts to coordinate and respond to requests for data investigations and adhere to the guidelines as outlined in the Service Support Schedule Types of Investigations Covered By This Service Level Agreement HCPS investigations covered by this Service Level Plan may include the following attributes to the extent such attributes are licensed by Client as described in the applicable SOW and the HCRS Requirements Document, which provides additional specifications determined by IMS: Prescriber Demographics o Prescriber name (first, middle, last) o Gender o Former names o Status o Specialty o Address Source Number o AMA, AOA, NPI validation Authorization Information 5 of 10

6 o DEA and SLN validation o SLN attribute validation i.e. license type, privilege o SLN effective and termination date Address Intelligence o Address Ranking o Address Type o Street Front ID Data Investigation Submission Requirements Client will submit all data investigations with all supporting information available in order to facilitate proper investigation by IMS. The following sets forth the information required for submission of an HCPS data investigation request (* indicates required): *Prescriber s name- First, Last IMS # (if available) Prescriber s specialty DEA # (if available) State License Number Prescriber s State Source # i.e. AMA, AOA, NPI *A clear statement of the action that needs to be taken (i.e. confirm prescriber DEA, SLN, etc) Resolution/Investigation Processes An IMS analyst will research and work to resolve each investigation by following appropriate procedures for each healthcare professional investigation to include validating each data attribute for the professional and updating the database if necessary. Upon completion of the investigation, the results will be provided to Client and the investigation will be closed in QMS HCPS Standard Investigation Volumes and Turn Around Times The Service Support Schedule sets forth the number of data investigations that will be available to Client per month / year. Provided below is a chart on estimated standard turnaround times. Client may purchase additional support for estimated accelerated turnaround times and additional record volumes. The Client Service Support Schedule provided by IMS are as mutually agreed upon by the parties. Additional fees may apply should the number of data investigations per agreed upon Service Support Schedule exceed the levels allotted. 6 of 10

7 HCPS Turn Around Times (estimates only): Healthcare Professional Investigations Business Days for Resolution 1-10 Records Records Records Records Records Plan of Action within 5 Business Days 7 of 10

8 IMS Healthcare Organizational Services (HCOS ) 5.1 HCOS Deliverable and Process If the provision of HCOS services is specified in the Agreement, the HCOS deliverable will be supplied to Client on a monthly or quarterly basis as defined in the Agreement and as outlined in the HCRS Addendum. The HCOS deliverable contains healthcare organizations that meet the criteria and related attributes set forth in the applicable SOW and the HCRS Addendum. The service levels with respect to HCOS services are as further described in this Section HCOS Quality Control Checks and Balances IMS uses quality control checks in accordance with industry standards throughout various aspects of the HCOS database creation, updating and refreshing cycles, which includes manual maintenance. A partial list of quality controls includes: Comparison of records and trend analysis Over 100 data value checks that are proactively captured and reviewed Daily Audit Trail which red flags any business rule violations Automated job completion verification Automatic Data Anomaly reports 5.3 HCOS Quality Control Metrics The HCPS quality control metrics will be supplied to Client on a monthly or quarterly basis as defined in the applicable SOW and as outlined in the HCRS Addendum HCOS Data Inquiry and Investigations Definition of an HCOS Inquiry: An inquiry is defined as a question or concern communicated from Client to IMS intended to obtain more information around IMS specific data, processing, overall data representation and trends. An inquiry does not include investigating data pertaining to a specific organization. The HCRS service team shall use commercially reasonable efforts to acknowledge receipt of a data inquiry and, when possible, outline steps for response and resolution within one (1) business day of receipt Definition of an HCOS Data Investigation: An investigation is initiated when Client questions content within their HCOS deliverable. Discrepancies will be researched by IMS Types of HCOS Investigations Covered by This Agreement HCOS inquiries covered by this Service Level Agreement may include the following attributes, to the extent such attributes are licensed by Client as described in the applicable SOW and HCRS Requirements Document, which provides additional specifications of the data provided by IMS. Organization Demographics / Profile Details o Organization legal business name o Doing-business-as name 8 of 10

9 o Address, City, State, Zip Profile Details o Class of trade o Licensed, census, staffed beds, totals and/or bed breakdown (hospitals/nursing homes) Organization Relationship Detail o Corporate parent of an organization or organization affiliates of a corporate parent o GPO o Pharmacy Provider Organization Identifiers o DEA, HIN, NPI, PHS, MPN Organization Affiliations o Professionals affiliated to the site Organization Contacts o Select HCOS-supported contacts for hospitals, nursing homes, corporate parents, GPOs HCOS Data Investigation Submission Requirements Client will submit all data investigation requests with all available supporting information in order to facilitate proper investigation by IMS. HCOS investigations will be submitted by Client through the IMS Query Management System (QMS). The attached HCOS Data Investigation Excel-based form (see embedded file) will be completed and attached as part of the QMS submission (investigation request) HCOS Data Inquiries Form_2010.xls HCOS Data Investigation Resolution Process An IMS analyst will research and work to resolve each investigation by following appropriate procedures for each organization investigation which include updating the database, if necessary. Upon completion of the investigation, the results will be provided to Client and the investigation will be closed out in QMS HCOS Standard Data Investigation Volumes and Turnaround Times The Service Support Schedule sets forth the number of data investigations that will be available per month / year to Client. The estimated standard turnaround times are provided in the chart below. The Client s Service Support Schedule provided by IMS is as mutually agreed upon by the parties. Additional fees may apply should the number of data investigations per agreed upon Service Support Schedule exceed the levels allotted below. 9 of 10

10 HCOS Standard Turnaround Times (estimates only): Organization Data Investigations Business Days for Resolution 1-10 Records Records Records Records Records Plan of Action within 5 Business Days 10 of 10