Each month, health plans and PBMs who partner with PQS, submit pharmacy adjudicated claims data along with medical claims and member eligibility details. Quality measure data calculations are then conducted and performance scores are updated for display within EQUIPP. By the 15th of each month, users will see their performance data updated in EQUIPP.
The information available to view in EQUIPP is calculated with adjudicated claims data provided by health plans and PBMs illustrated by the following steps:
- PQS receives adjudicated claims data and member eligibility details from health plans and PBMs for the prior month.
- Claims that are not adjudicated (i.e. cash or discount cards) through the patient’s insurance are not captured.
- Eligibility information includes coverage end dates for plan members no longer enrolled with the health plan
- PQS validates the data and completes measure calculations according to measure specifications
- PQS updates pharmacy network and configurations
- After final quality assurance and validation processes are successful, the new data is released and is displayed to EQUIPP end users
PQS has created a downloadable PDF of the visual below that shows the process of how pharmacy data is received and transmitted: How Pharmacy Data is Transmitted
Data Refresh Frequency
- Performance scores on each medication-related quality measure is updated monthly. For example, a data performance refresh that will occur in August, health plans and PBMs submit the data in July which represents claims and performance from January through June.
- PQS validates the submissions and calculates performance scores to be displayed in EQUIPP in August.
- EQUIPP® exceeds industry standards by having data represented with a 45 day lag time.
- There are various segments of performance reporting in the healthcare industry which may have a delay of months from other care providers.
*Example Refresh Timeline
A performance refresh for August reflects data submitted by health plans and PBMs in July. This data represents a measurement period of January through June. PQS validates the data submissions and calculates performance scores which are updated for display in August.