Master Data Management System

The Master Data Management system is an enterprise-wide service, located in the Centers for Medicare and Medicaid Services Amazon Web Services enclave comprised of concerted processes for collecting, aggregating, matching, consolidating, quality-assuring, persisting, medical notes, and distributing data about providers, Medicare beneficiary identifiers, organizations and programs to ensure consistency and control in the ongoing maintenance and use of this information. 

This system currently supports requirements to provide identity resolution, relationship management, and eligibility tracking using data from the following Centers for Medicare and Medicaid Services systems: Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems.  

Similar programmatic data from other sources may be integrated with this existing data as the Master Data Management system matures.

The Master Data Management system receives information from the following the Centers for Medicare and Medicaid Services systems data sources of the Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System.

The type of information received and maintained for the Provider Enrollment Chain and Ownership System includes, Provider/supplier information, Basic Information: Medicare Administrator Contractor, Provider Transaction Access Number, National Provider Identifier. Identifying information: Name, Date of Birth, Tax Identification Number, Specialty, State Licensed, Drug Enforcement Agency Number, and Certifications. In addition to Final Adverse Legal Actions and Medical Sanctions Information as well as Practice Location Information to include the National Provider Identifier-Provider Transaction Access Number used at this address, hours of operation, pay to location, medical records storage location, and billing agency information.

The type of information received and maintained for the National Provider Identifier Crosswalk System includes, Provider/supplier information, Basic Information to include the Medicare Administrator Contractor, National Provider Identifier, and National Provider Identifier-Provider Transaction Access Number. Identifying Information to include Name, Date of Birth, Transaction Identification Number, Specialty, State Licenses, Drug Enforcement Agency Number. Practice Location Information: National Provider Identifier-Provider Transaction Access Number used at this address, Crosswalk between National Provider Identifiers and National Provider Identifier-Provider Transaction Access Numbers.

The type of information received and maintained for the Quality Improvement and Evaluation System is Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, the Long-Term Care Hospitals Care Data Set and Skilled Nursing facilities. In addition, there is Identifying Information – Name, Centers for Medicare and Medicaid Services Certification Number, Certification date, Specialty, Practice Location Information and Mailing Address Information.

The type of information received and maintained for the Transformed Medicaid Statistical Information System is the data schema pertaining to the Transformed Medicaid Statistical Information System data source. The Transformed Medicaid Statistical Information System data includes information about beneficiary eligibility, beneficiary enrollment, and claims and managed care data. Data points to convey this information include beneficiary demographics, diagnosis codes, procedure codes, as well as claims and eligibility factors.

The type of information received and maintained for the Common Medicare Environment is Medicare beneficiary demographic data used to support managed care enrollments, Payments to Medicare Advantage plans, Identifying Information to include Name, Date Of Birth, Social Security Number, Beneficiary Link Key, Health Insurance Claim Number, Medicare Beneficiary Identifier, Transaction Identification Number, Mailing Address Information, Medicare Advantage Prescription Drug Enrollment Information, Medicare Part A, B, C, D enrollment Information, and Dual Medicare Eligibility Information.

For each data source records will be held indefinitely until no longer needed for agency use and are refreshed on a monthly cadence. 

Lastly, the system collects usernames and passwords for administrators of the system. 

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system focuses on eliminating redundancy, inconsistency, and fragmentation by having a single, synchronized, comprehensive source of authoritative data in the Medicare Beneficiary Identifier, Medical Notes, Provider, Organization, and Program domains.  For the initial release, the Master Data Management system used various existing data sources and a modern software platform to build and maintain master indexes, profiles, and relationships between the domains.

The Master Data Management system receives information from the Centers for Medicare and Medicaid Services data sources of Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System. The type of information received and maintained includes; Provider/supplier information from Provider Enrollment Chain and Ownership System, Provider/supplier information from the National Provider Identifier Crosswalk System, Medicare beneficiary demographic data used to support managed care enrollments and payments to Medicare Advantage plans from Common Medicare Environment, and Quality information that includes Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, the Long-Term Care Hospitals CARE Data Set and the Skilled Nursing Facilities.

Lastly, the system collects usernames and passwords for administrators and users of the system. System users regularly use Personally Identifiable Information to retrieve system records including using the last name, Health Insurance Claim Number, and/or Transaction Identification Number.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

• Social Security Number
• Name
• Medical Notes
• Taxpayer ID
• Date of Birth
• Mailing Address
• Other - Health Insurance Claim Number, Medicare Beneficiary Identifier, Transaction Identification Number; National Provider Identifier; Usernames and passwords for administrators and users.

• Employees
• Vendors/Suppliers/Contractors
• Patients

The Master Data Management system receives beneficiary and provider data from other Centers for Medicare and Medicaid Services applications; Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System not directly from the individual parties. As such, the programs referenced must provide the necessary notifications for individuals.

Administrator data is collected during the account request and provisioning process.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system receives beneficiary and provider data from other Centers for Medicare and Medicaid Services applications; Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System, not directly from the individual parties. As such, the programs referenced must provide the necessary notifications for individuals to opt-out of such collection and use.

Administrator data is collected during the account request and provisioning process. There is no opt-out process for this level of user. If the information is not provided, then accounts will not be provisioned, nor access granted. 

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system receives beneficiary and provider data from other Centers for Medicare and Medicaid Services applications; Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System, not directly from the individual parties. As such, the programs referenced must provide the necessary notifications for individuals parties. As such, the programs referenced must provide the necessary notifications.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system receives beneficiary and provider data from other Centers for Medicare and Medicaid Services applications; Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System, not directly from the individual parties. As such, the programs referenced must provide the necessary notifications for individuals.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system receives beneficiary and provider data from other Centers for Medicare and Medicaid Services applications; Eligibility and Enrollment Medicare Online; Provider Enrollment Chain and Ownership System; Quality Improvement and Evaluation System; Transformed Medicaid Statistical Information System; and National Provider Identifier Crosswalk System, not directly from the individual parties. As such, the programs referenced must perform the required steps to validate data integrity, availability, accuracy and relevancy. To ensure the aggregated information in the Master Data Management system is accurate and relevant, daily jobs are completed to update provider information from source systems and monthly jobs are completed to update beneficiary information from the source systems.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

• Administrators: The Master Data Management system administrators require access to provide Operations and Maintenance support which exposes them to Personally Identifiable Information. The Personally Identifiable Information exposure may extend to the data elements stored for beneficiary and provider entries for each respective data set.
• Developers: Developers access Personally Identifiable Information for testing and assisting in troubleshooting of issues that may occur with the application and/or data. Personally Identifiable Information exposure may extend to the data elements stored for beneficiary and provider entries for each respective data set.
• Contractors: Direct contractors with the Centers for Medicare and Medicaid Services provisioned credentials (e.g., Centers for Medicare and Medicaid Services Identification, Centers for Medicare and Medicaid Services electronic Mail) provide the roles of Administrators and Developers.

Access to the Master Data Management system sources, including any and all sensitive information, is guided by the Enterprise User Administration access control process. Potential users are required to apply for the Enterprise User Administration access first. Once unique identifiers are issued, roles for users requiring access to the Master Data Management system resources, including sensitive information, are established via Enterprise User Administration job codes. Once job codes are approved using the existing Centers for Medicare and Medicaid Services Enterprise User Administration process, users receive access to this system sources including Personally Identifiable Information, if appropriate. Developers and system administrators must use the same process to receive the Centers for Medicare and Medicaid Services Identifications and access. Any and all requests for administrative access is submitted to and approved by the Master Data Management system Business Owner before access is given. Privileged user reviews are conducted by the Business Owner to ensure that only authorized users have privileged access to system which may contain Personally Identifiable Information.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

The Master Data Management system utilizes role-based access to ensure that users have only the access necessary for them to perform their job functions. The information that may be accessed is defined by the users’ role. 

The process for provisioning access to a given users, via Enterprise User Administration and associated roles, requires a determination via review and approval by the system owner, while implementation is performed via the system administrator during account provisioning.

Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems. 

All users who wish to access the Master Data Management system resources are required to receive the Centers for Medicare and Medicaid Services security awareness training, which includes information related to their responsibilities for protecting sensitive the Centers for Medicare and Medicaid Services information. This training is required before initial access. All users must be recertified annually and must again complete this training.

The Centers for Medicare and Medicaid Services security awareness training covers special handling of Personally Identifiable Information /Protected Health Information, as well as best practice security techniques for day-to-day handling of information and access to the Centers for Medicare and Medicaid Services systems. The Master Data Management system contractors receive role-based training in addition to the Centers for Medicare and Medicaid Services security awareness training. This training is more locally specialized and emphasizes protection of sensitive information and incident response techniques and responsibilities. Each of these referenced trainings are conducted initially when access is requested, and again annually thereafter.

The Master Data Management System's direct contractors receive role-based training in addition to the Centers for Medicare and Medicaid Services security awareness training.

Records will be held indefinitely until no longer needed for agency use.

Personally Identifiable Information is retained and destroyed in accordance with National Archives and Records Administration Records Schedule Number DAA-0440-2015-0007 and DAA-0440-2015-0008 for Beneficiary and Provider information, respectively.  Accordingly, data will be destroyed in accordance with these requirements, no sooner than 10 years after cutoff for beneficiary information and no sooner than 7 years after cutoff for provider data, unless longer retention is authorized.

Administrative controls include access approval by management, and review of accounts.

Technical controls include event logging, roles-based access, and networking security controls.

Physical controls in place at the Amazon Web Services Data Center monitor physical access, visitor logging, and environmental access controls.

The reference systems above are covered in separate Privacy Impact Assessments. As Stakeholders for each of the referenced systems are required to complete and publish a Privacy Impact Assessment covering their respective systems.