Production Performance Monitoring System

The Contractor Management Information System (CMIS) assists CMS with managing and overseeing the operations of its Medicare Administrative Contractors (MACs). CMIS provides CMS staff with metrics to allow evaluation of each MACs performance against pre-established thresholds. Examples of metrics reported for each of the MACs include number of claims processed, received, denied; Medicare appeals processed, received, denied, etc. Only quantitative data is collected. There is no PII or PHI in the system.

The Production Performance Monitoring System (PULSE) provides nightly analysis of claims processed, providing the Centers for Medicare & Medicaid Services (CMS) with feedback on critical performance issues for all Medicare Administrative Contractors (MACs). PULSE currently collects data from Health Care Financing Administration (HCFA) reports, which are transmitted nightly. All of the Medicare Part B contractors send an additional financial report to the CMS Data Center daily for use by PULSE. PULSE extracts the data from these reports and calculates key indicators, averages and standard deviations to identify variances, which may indicate a claims processing performance issue.

CMIS

Medicare Administrative Contractors (MACs) transmit their CMS-1565, CMS-1566, and CMS-1522 batch reports nightly into the Contractor Management Information System (CMIS). Examples of data reported are number of claims processed, received, denied; Medicare Appeals processed, received, denied, etc.  These data represent the contractor's activities for administering the Fee-for-Service (FFS) program on behalf of CMS. The FFS program processes claims on behalf of CMS. Only quantitative and aggregate numbers are input into CMIS and/or generated by CMIS.

PULSE

On a nightly basis, Medicare contractors transmit batch report files to the Production Performance Monitoring System (PULSE) via a secure method for transmitting the files. Each Common Working File (CWF) host site transmits reports that provide quantitative information regarding claims processed. All contractors do not run a batch cycle daily. While sending daily data provides the timeliest metrics, those contractors that do not produce daily reports submit the required reports on the days that they have a batch cycle. PULSE manages the reports accordingly. The data collection process extracts available claim metrics on a nightly basis from Medicare contractors that utilize the existing claims processing systems.

PULSE collects data from CMS daily and monthly standard reports. The Health Care Financing Administration (HCFA) reports contain claims processing workload data such as Total Receipts, Adjusted Receipts, Claims Pending, and Claims Processed information. PULSE also collects the Total Benefit Dollars Paid from each contractor site from a monthly report.

All information sent to and used by the PULSE system is quantitative and aggregate data only. Therefore the PULSE system does not collect, maintain (store), or share any individual or PII data.

CMIS

The Contractor Management Information System (CMIS) collects and reports quantitative data regarding Fee-for-Service (FFS) contractor operations claims information.  The FFS program processes claims on behalf of CMS. Data is contained in an Oracle database that is presented to CMIS application users in the form of various reports that can be viewed within the CMIS system. No individual records containing PII are collected, maintained (stored), or shared, either permanently or temporarily, within the CMIS system. The system provides reports that contain quantitative and aggregate numbers only.

There are two levels of access for the CMIS system. Users are authenticated using CMS Enterprise User Administration (EUA) which is a separate, front end security system allowing access to the platform where the CMIS system resides. Separate from EUA, MicroStrategy (which is the software used to generate reports and provide analytics for users of the CMIS system) manages the access that restricts which reports users are allowed to generate and view from the CMIS system. The CMIS system itself only presents reports to users and does not handle or manage any user credentials. No credentials (ID, password, roles, etc.) are collected, maintained (stored), or shared, either permanently or temporarily, within the CMIS system.

PULSE

The Production Performance Monitoring System (PULSE) collects and reports quantitative data from Common Working File (CWF) system that maintains information about claims processed. Data for PULSE is contained in an IBM DB2 database that presents information to PULSE application users in the form of various reports that can be viewed within the system. No individual records containing PII are collected, maintained (stored), or shared, either permanently or temporarily, within the PULSE system. The system provides reports that contain aggregate numbers only.

There are two levels of access for the PULSE system. Users are authenticated using CMS Enterprise User Administration (EUA) which is a separate, front end security system allowing access to the platform where the CMIS system resides. Separate from EUA, IBM’s DB2, (which is the software used to generate reports and provide analytics for users of the PULSE system) manages the access that restricts which reports users are allowed to generate and view from the PULSE system. The PULSE system itself only presents reports to users and does not handle or manage any user credentials. No credentials (ID, password, roles, etc.) are collected, maintained (stored), or shared, either permanently or temporarily, within the PULSE system.