The Data Management screen communicates the status of data loaded to Kalderos' data warehouse. If you choose to provide Kalderos with optional data per your Medicaid invoice processing system, a reconciliation between your state invoices and the claims data is also displayed. Kalderos takes the conversion factor per the Noridian crosswalk and applies to HCPC data.

Invoice Qty: sourced from client Medicaid invoice system

Paid Qty: sourced from client Medicaid invoice system

Kalderos Qty: Invoice Qty per claims data, after unit of measure adjustments applied
**A lower Kalderos Qty may indicate a program has not been loaded to Kalderos data warehouse, data in Kalderos data warehouse is mapped to an incorrect Plan ID, Invoice data may have utilization increases that are not reflected in the CLD data
A higher Kalderos Qty may indicate the state has credited previously-invoiced units as a result of the state correcting an issue or agreeing to credit units per dispute resolution

Color Coding:

  • Red: Kalderos Qty < Invoice Qty: high risk that claims data is missing from Kalderos data warehouse
  • Yellow: Some claims data exists in data warehouse, but claims data quantity is less than invoiced units (likely due to PQAS)
  • Green: Kalderos Qty >= Invoice Qty: low risk that claims data is missing from Kalderos' data warehouse
Did this answer your question?