Healthcare Relational Services (HCRS ) Service Level Agreement IMS Health Incorporated. All rights reserved. 1

Transcription

1 Healthcare Relational Services (HCRS ) Service Level Agreement IMS Health Incorporated. All rights reserved. 1

2 Healthcare Relational Services ( HCRS ) 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. This document also identifies the interaction between systems, IMS personnel and CLIENT. This document may be updated as required from time to time by IMS. Subject to the terms and conditions set forth herein, IMS will use 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? HCRS is a single integrated source of healthcare professionals, healthcare facilities, healthcare organizations and their relationships to each other. The HCRS services covered under this service level agreement consists 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 and all influencers and providers of healthcare 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. 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 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 2011 IMS Health Incorporated. All rights reserved. 2

3 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 HCRS Service Manager that will serve as the primary point of contact for HCRS questions, requests and concerns. 2.1 Service Meetings The HCRS Service Manager will work with CLIENT to establish a mutually agreed upon schedule for reoccurring meetings to facilitate the ongoing support of the offering. 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. CLIENT will be responsible for contacting 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 the request is urgent, both IMS and CLIENT should follow up via and with a phone mail message. If the HCRS Service Manager is out of the office, an automatic out-of-office e- mail response will indicate the date of return and provide an alternate contact. CLIENT will be responsible for contacting 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. 2.4 HCRS Baseline Service Support IMS Service Hours of Operation Monday Friday 9:00 AM 5:00 PM EST 2011 IMS Health Incorporated. All rights reserved. 3

4 The effective date of this schedule is defined in the Agreement. 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 Health Incorporated. All rights reserved. 4

5 IMS Healthcare Professional Services (HCPS ) 4.1 HCPS Deliverable and Process If the provision of HCPS services is specified in the Agreement, the HCPS deliverables will be supplied to CLIENT as defined in the Agreement and to the specifications outlined in the HCRS Rider. The service levels with respect to HCPS services are as further described in this Section 4. The HCPS deliverable contains healthcare professionals that meet the criteria and related attributes set forth in the Agreement and the HCRS Rider. 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 line with industry standards throughout various aspects of the HCPS database build processing cycle, 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 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 Agreement and in the HCRS Rider HCPS Data Inquiries and Data Investigations HCPS Data Inquiries Definition of an Inquiry: An inquiry is defined as a question or concern geared toward obtaining more information around IMS specific processing, overall data representation and trends, as further specified by IMS IMS Health Incorporated. All rights reserved. 5

6 The HCRS service team shall use commercially reasonable efforts to acknowledge receipt of a data inquiry within one (1) business day of receipt and outline steps for response and resolution HCPS Data Investigations Definition of a Data Investigation: An investigation is a challenge to the validity or currency of content within the HCPS deliverable. Most investigations 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 interface provided as part of the contract (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 herein Types of Investigations Covered By This Service Level Agreement HCPS investigations covered by this Service Level Agreement may include the following attributes to the extent such attributes are licensed by CLIENT as described in the Agreement 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 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 must submit all data investigations with all supporting information available in order to facilitate proper investigation. The following sets forth the information required for submission of an HCPS data investigation (* indicates required): *Prescriber s name- First, Last IMS # (if available) Prescriber s specialty DEA # (if available) State License Number Prescriber s State 2011 IMS Health Incorporated. All rights reserved. 6

7 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 standard operating 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 HCPS Standard Investigation Limits and Turn Around Times The charts below outline the number of data investigations that can be submitted by CLIENT per month / year, as well as estimated standard turnaround times. CLIENT may purchase additional support for estimated accelerated turn-around times and additional record volumes. The Client Tier levels provided by IMS are as mutually agreed upon by the parties. Additional fees may apply should the number of data investigations per agreed upon tier exceed the levels allotted below. HCPS Standard Data Investigation Allocation: Data Investigation Type Client Tier 1 Client Tier 2 One-Time Healthcare Professional(s) - Phone validation of one Attribute (Either specialty OR name OR address); OR manual processing 25 per Month/ per Month/1, within three months of receiving deliverable Healthcare Professional(s) - Full Professional Record 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 2011 IMS Health Incorporated. All rights reserved. 7

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 Rider. The HCOS deliverable contains healthcare organizations that meet the criteria and related attributes set forth in the Agreement and the HCRS Rider. 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 line with industry standards throughout various aspects of the HCOS database build processing cycle, 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 Agreement and as outlined in the HCRS Rider HCOS Data Inquiry and Investigations Definition of an HCOS Inquiry: An inquiry is defined as a question or concern geared toward obtaining more information around IMS specific 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 within one (1) business day of receipt and outline steps for response and resolution Definition of an HCOS Data Investigation: An investigation is initiated when CLIENT questions content within their HCOS deliverable. Discrepancies are 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 Agreement and HCRS Requirements Document, which provides additional specifications determined by IMS. Organization Demographics / Profile Details o Organization legal business name o Doing-business-as name 2011 IMS Health Incorporated. All rights reserved. 8

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 must submit all data investigations with all supporting information available in order to facilitate proper investigation. HCOS requires that investigations be submitted by CLIENT through the IMS Query Management System (QMS). The attached HCOS Data Investigation Excel-based form (see embedded file) must be completed and attached as part of the QMS submission HCOS Data Inquiries Form_2010.xls HCOS Data Investigation Resolution Process An IMS analyst will research and work to resolve each investigation by following standard operating procedures for each organization investigation to include updating the database if necessary. Upon completion of the investigation, the results will be provided to CLIENT HCOS Standard Data Investigation Limits and Turnaround Times The charts below outline the number of data investigations that can be submitted per month / year by CLIENT, as well as estimated standard turnaround times. The Client Tier levels provided by IMS are as mutually agreed upon by the parties. Additional fees may apply should the number of data investigations per agreed upon tier exceed the levels allotted below IMS Health Incorporated. All rights reserved. 9

10 HCOS Standard Data Investigation Allocation: Data Investigation Type Client Tier 1 Client Tier 2 One-Time Organization demographics or class of trade Organization's professional affiliations, organization's relationship(s) to another organization 25 per Month/300 4 per Month/ per Month/1,200 8 per Month/ within three months of receiving deliverable 16 within three months of receiving deliverable Organization child/parent relationships, provider affiliations, bed totals, bed-category details 6 12 n/a HCOS Standard Turnaround Times (estimates only): Business Organization Data Days for Investigations Resolution 1-10 Records Records Records Records 30 Plan of Action 50+ Records within 5 Business Days 2011 IMS Health Incorporated. All rights reserved. 10