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  • HealthInsight New Mexico Granted Status to Produce Enhanced Performance Reports on State's Health Care Providers

HealthInsight New Mexico Granted Status to Produce Enhanced Performance Reports on State's Health Care Providers

HealthInsight New Mexico has been notified that it has been accepted by the Centers for Medicare & Medicaid Services (CMS) as a “qualified entity” (QE) under its Qualified Entity Certification Program, developed to implement Section 10332 of the Affordable Care Act. This new status, active for three years, certifies HealthInsight New Mexico as qualified to access and handle certain Medicare claims data and protect patient privacy during the process. Qualified entities are able to combine Medicare and private insurance data to create comprehensive, useful reports on provider performance, intended to help consumers get more information regarding their local doctors, hospitals and other health care providers.

To receive certain Medicare claims data, qualified entities must show that they can manage and process consumer-focused data and can prevent breaches of protected health information. HealthInsight New Mexico is in the process of submitting evidence demonstrating its compliance with this requirement. The organization will also be required to show that it is working with private insurers to access other payer data in order to produce comprehensive reports on provider performance.

Once HealthInsight New Mexico receives approval on the data security requirements, it will be allowed to request Medicare claims data in order to calculate performance measures for the state. Qualified entity certification also allows the HealthInsight organizations in Utah and Nevada to enjoy the same status once they meet the same data security requirements.

“Meeting the final QE requirements will allow us to provide more comprehensive public reporting, provide us the experience to support an all-payer claims database, and provide analytic services to support the Accountable Care Act needs here in New Mexico,” said Boyd Kleefisch, HealthInsight New Mexico executive director.

For more information on CMS’ Qualified Entity Program, visit: www.cms.gov/QEMedicareData/.