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NADAC (National Average Drug Acquisition Cost)
data.medicaid.gov | Last Updated 2019-12-10T16:10:58.000ZNational Average Drug Acquisition Cost (NADAC) weekly reference data from November 2013 to current week.
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Drug Products in the Medicaid Drug Rebate Program
data.medicaid.gov | Last Updated 2019-11-26T22:09:25.000ZActive drugs that have been reported by participating drug manufacturers under the Medicaid Drug Rebate Program. All drugs are identified by National Drug Code (NDC), unit type, units per package size, product name, Food and Drug Administration (FDA) approval date, the date the drug entered the market, plus indicators to show whether the drug is an innovator or non-innovator drug; whether it is available by prescription or over-the-counter (OTC); the FDA therapeutic equivalency code; and the Drug Efficacy Study Implementation (DESI) rating and termination date. Each quarter posted represents a snapshot of data in the system at that time and is not updated by subsequent changes.
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State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data
data.medicaid.gov | Last Updated 2019-12-02T17:45:46.000ZAll states (including the District of Columbia) are required to provide data to The Centers for Medicare & Medicaid Services (CMS) on a range of indicators related to key application, eligibility, and enrollment processes within the state Medicaid and Children’s Health Insurance Programs (CHIP). These data reflect enrollment activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, as well as state program performance.
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NCCI Procedure to Procedure Edits (PTP)
data.medicaid.gov | Last Updated 2019-12-03T23:34:38.000ZThe CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment. The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.
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Drug Utilization 2017 - Minnesota
data.medicaid.gov | Last Updated 2019-11-05T20:35:04.000ZDrug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html
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NCCI Medically Unlikely Edits (MUEs)
data.medicaid.gov | Last Updated 2019-12-03T23:39:44.000ZMedically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment. The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.
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State Drug Utilization Data 2017
data.medicaid.gov | Last Updated 2019-11-05T20:35:04.000ZDrug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html
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State Drug Utilization Data 2018
data.medicaid.gov | Last Updated 2019-11-05T20:50:10.000ZDrug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html
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2016 Child and Adult Health Care Quality Measures
data.medicaid.gov | Last Updated 2018-10-25T21:15:33.000ZPerformance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2016 reporting. Source: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2016 reporting cycle. For more information, see the <a href="https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html">Children's Health Care Quality Measures</a> and <a href="https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-core-set/index.html">Adult Health Care Quality Measures</a> webpages.
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State Drug Utilization Data 2016
data.medicaid.gov | Last Updated 2019-11-05T20:23:40.000ZDrug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html