Common use of Attribution Methodology Clause in Contracts

Attribution Methodology. The State or its designee will conduct attribution monthly. The details of the attribution reports are described in the Data Use Standards, Attachment A, Exhibit 1, Section VIII (B) of this Agreement. 1. Attribution Step 1: Determine all Medicaid beneficiaries who were enrolled for at least 10 months in the study year across any of the four enrollment categories. Assign the beneficiary to the enrollment category where he/she appeared last in the study year. 2. Attribution Step 2: Claims for eligible members are identified for the presence of qualifying CPT Codes (refer to Attachment I) in the calendar year for primary care providers enrolled with Medicaid. The provider specialty must be internal medicine, general medicine, geriatric medicine, family medicine, pediatrics, or naturopathic medicine. In addition to physicians, the primary care provider may be a nurse practitioner, physician assistant, or a provider in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). 3. Attribution Step 3: For eligible beneficiaries not attributed in Step 2, assign the beneficiary to his/her primary care provider that he/she selected or was auto-assigned to in the study year. If the beneficiary changed primary care provider selection during the year, then the beneficiary is assigned to the primary care provider which he/she was assigned to last in the year. 4. Attribution is done at the rendering provider level; any ACO Participant that includes at least one ACO Provider/Supplier with Attributed Lives must have an exclusive Participant relationship with one ACO. ACO Participants who do not have lives attributed, can participate in multiple ACOs.

Attribution Methodology. The State or its designee will conduct attribution monthly. The details of the attribution reports are described in the Data Use Standards, Attachment A, Exhibit 1, Section VIII (B) of this Agreement. 1. Attribution Step 1: Determine all Medicaid beneficiaries who were enrolled for at least 10 months in the study year across any of the four three enrollment categories. Assign the beneficiary to the enrollment category where he/she appeared last in the study year. 2. Attribution Step 2: Claims for eligible members are identified for the presence of qualifying CPT Codes (refer to Attachment IH) in the calendar year for primary care providers (identified by Medicaid provider number) combined with billing practices (identified by TIN) enrolled with Medicaid. The primary care provider specialty must be internal medicine, general medicine, geriatric medicine, family medicine, pediatrics, or naturopathic medicine. In addition to physicians, the The primary care provider may must be a physician, nurse practitioner, physician assistant, or a provider in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). 3. Attribution Step 3: For eligible beneficiaries not attributed in Step 2, assign the beneficiary to his/her primary care provider that he/she selected or was auto-assigned to in the study year. If the beneficiary changed primary care provider selection during the year, then the beneficiary is assigned to the primary care provider which he/she was assigned to last in the year. 4. Attribution is done at a combination of the rendering provider leveland billing practice TIN levels; any ACO Participant that includes at least one ACO Provider/Supplier with Attributed Lives must have an exclusive Participant relationship with one ACO. ACO Participants who do not have lives attributed, attributed can participate in multiple ACOs.

Attribution Methodology. The State or its designee will conduct attribution monthly. The details of the attribution reports are described in the Data Use Standards, Attachment A, Exhibit 1, Section VIII (B) of this Agreement. 1. Attribution Step 1: Determine all Medicaid beneficiaries who were enrolled for at least 10 months in the study year across any of the four three enrollment categories. Assign the beneficiary to the enrollment category where he/she appeared last in the study year. 2. Attribution Step 2: Claims for eligible members are identified for the presence of qualifying CPT Codes (refer to Attachment I) in the calendar year for primary care providers enrolled with Medicaid. The provider specialty must be internal medicine, general medicine, geriatric medicine, family medicine, pediatrics, or naturopathic medicine. In addition to physicians, the primary care provider may be a nurse practitioner, physician assistant, or a provider in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). 3. Attribution Step 3: For eligible beneficiaries not attributed in Step 2, assign the beneficiary to his/her primary care provider that he/she selected or was auto-assigned to in the study year. If the beneficiary changed primary care provider selection during the year, then the beneficiary is assigned to the primary care provider which he/she was assigned to last in the year. 4. Attribution is done at the rendering provider level; any ACO Participant that includes at least one ACO Provider/Supplier with Attributed Lives must have an exclusive Participant relationship with one ACO. ACO Participants who do not have lives attributed, can participate in multiple ACOs.