Data Request Documents & Links

Use the links below to download request documents.

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The Coordination of Benefits Agreement (COBA) Specification Worksheet enables states to specify the intended use of COBA-acquired data.

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The DRA establishes the terms of use governing states’ access to Medicare data. State Medicaid agencies requesting data for the first time should submit the DRA form as part of their data request package to MMCO directly through the State Data Resource Center and not to any other organization. State Medicaid agencies should also use the DRA form to change the data requestor on the DRA.

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The DRA Data Table is required to add additional data and Medicare-Medicaid care coordination and program integrity data uses to the DRA. State Medicaid agencies with an existing DRA should submit and updated DRA DataTable with their new or additional use data request packages.

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The DRA Custodian Form is required to add custodians and analytic and administrative downstream users to the DRA for Medicare data requests for Medicare-Medicaid care coordination and program integrity activities.

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The EFT Setup Form and EFT Partner Server Questionnaire enables state Medicaid agencies to establish electronic feeds of Medicare data.

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The IEA establishes the terms governing states’ access to Medicare data for the purpose of Medicare-Medicaid care coordination or program integrity.

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The Historical Parts A and B worksheet is a key document in the Historical Parts A and B data request package, enabling states to specify which data types and variables of Medicare Parts A and B data are needed and how they will be used. This worksheet includes additional tabs for assessments data. These tabs enable states to specify which variables from MDS, OASIS, Swing Bed, and IRF-PAI assessments are needed as part of an Assessments data request package.

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The Part D worksheet is a key document in the Part D data request package, enabling states to specify which data types and variables of Medicare Parts D data are needed.

Additional Information

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