Quality Assurance

compliance crossword puzzle

Quality Assurance

ACA has developed flexible automated processes to ensure the validity and integrity of data transmissions, especially person level encounter (PLE) files. Existing edit checks focus on Pennsylvania HealthChoices behavioral health reporting requirements, but new edits can be implemented to suit specific client needs. These processes ensure that client data submissions will meet internal and external quality standards, including statutory reporting requirements. More importantly, they produce edit reports that describe identified data problems in detail so that they can be corrected.

Among other issues, existing edit processes address:

  • Compliance with HIPAA standardized transactions file structure requirements
  • Identification of duplicate records
  • Conformity to the Pennsylvania HealthChoices Behavioral Health Services Reporting Classification Chart (BHSRCC)

Existing edit checks validate a wide range of data elements including:

  • Procedure/Revenue codes
  • Diagnosis codes
  • Provider and consumer identifiers
  • Date formats and date logic