Data Request Documents

All state Medicaid agencies, and those territory Medicaid agencies that participate in any of the covered data sharing programs, maintain a CMS Information Exchange Agreement (IEA) and a Data Request & Attestation (DRA) form. To request additional data files to support coordination and program operations for people who are dually eligible for Medicare and Medicaid, see the steps below:

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Determine Files

Determine which Medicare Data Files your state or territory wants to request and the intended data use(s).

Determine Data Use

Determine if this is a New Data Use (i.e., first time requesting a data file through the SDRC process) or an Additional Data Use (i.e., requesting additional uses for a data file already received through the SDRC process).

Review IEA and DRA

Review your state or territory’s current IEA and DRA and, as necessary, make any applicable update. Please contact the SDRC Support Team to request the current version of your state’s or territory’s IEA and/or DRA.

IEA

The IEA establishes terms, conditions, safeguards, and procedures governing states’ or territories’ access to Medicare data for the purpose of supporting dually eligible beneficiaries.

DRA

The DRA establishes the terms of use governing the state’s/territory’s access to Medicare data that contains protected health information (PHI) and/or personally identifiable information (PII) and tracks the Medicare data disclosed to the Medicaid agency.

See the Request Packages

See the request packages below, organized by data file and request type, for the necessary documents to complete the request. For help determining which data file or request package is right for your state or territory, please contact the SDRC Support Team.

Daily or Weekly Parts A & B (COBA) Data: Request Package

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Please note if the state Medicaid agency establishes a Coordination of Benefits Agreement (COBA) with CMS, daily or weekly feeds of current Parts A and B claims data are available.

New Use Request Package

Part D PDE Data: Request Package

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Please note that the conflict of interest (COI) templates provided below are suggested guidelines for creating COI letters. The order and format of the information does not need to follow the template exactly; however, the templates do contain key information requirements, and any variation should be submitted for approval from MMCO and/or CPI.

Territory Beneficiary Query (TBQ) Response File

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Please note that Additional Data Use requests are not applicable to the TBQ File.

NOTE: New and Additional Data Use requests are not applicable to the MMA File Exchange or the Buy-in File Exchange.

Attention

You are leaving the SDRC Public website and are being redirected to the new SDRC Portal website, where you can submit and track data requests, ask questions, and access SDRC resources. You will need a username and password to log into the SDRC Portal. If you are Medicaid agency staff and/or associated downstream user who would like access, please contact the SDRC Support Team for more information.

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