claims_elig: Claims data member eligibility and demographics

In PHSKC-APDE/Medicaid: Query and analyze WA State Medicaid, Medicare, and APCD data

Claims data member eligibility and demographics

Description

claims_elig returns member eligibility and demographics.

Usage

claims_elig(
  conn,
  source = c("apcd", "mcaid", "mcaid_mcare", "mcare", "mcaid_mcare_pha"),
  from_date = Sys.Date() - months(18),
  to_date = Sys.Date() - months(6),
  cov_min = 0,
  covgap_max = NULL,
  mcaid_min = NULL,
  mcaid_max = NULL,
  mcare_min = NULL,
  mcare_max = NULL,
  dual_min = NULL,
  dual_max = NULL,
  pha_min = NULL,
  pha_max = NULL,
  med_covgrp = NULL,
  pharm_covgrp = NULL,
  tpl_max = NULL,
  bsp_group_cid = NULL,
  full_benefit_min = NULL,
  cov_type = NULL,
  mco_id = NULL,
  part_a_min = NULL,
  part_a_max = NULL,
  part_b_min = NULL,
  part_b_max = NULL,
  part_c_min = NULL,
  part_c_max = NULL,
  buy_in_min = NULL,
  buy_in_max = NULL,
  pha_agency = NULL,
  pha_subsidy = NULL,
  pha_voucher = NULL,
  pha_operator = NULL,
  pha_portfolio = NULL,
  id = NULL,
  age_min = NULL,
  age_max = NULL,
  female = NULL,
  male = NULL,
  gender_me = NULL,
  gender_recent = NULL,
  race_aian = NULL,
  race_asian = NULL,
  race_asian_pi = NULL,
  race_black = NULL,
  race_nhpi = NULL,
  race_latino = NULL,
  race_white = NULL,
  race_unk = NULL,
  race_me = NULL,
  race_eth_me = NULL,
  race_recent = NULL,
  race_eth_recent = NULL,
  lang_amharic = NULL,
  lang_arabic = NULL,
  lang_chinese = NULL,
  lang_english = NULL,
  lang_korean = NULL,
  lang_russian = NULL,
  lang_somali = NULL,
  lang_spanish = NULL,
  lang_ukrainian = NULL,
  lang_vietnamese = NULL,
  lang_me = NULL,
  geo_zip = NULL,
  geo_hra_code = NULL,
  geo_school_code = NULL,
  geo_region = NULL,
  geo_county_code = NULL,
  geo_ach_code = NULL,
  geo_kc_ever = NULL,
  geo_kc_min = NULL,
  timevar_denom = c("duration", "cov_days"),
  show_query = T
)

Arguments

conn	SQL server connection created using odbc package
source	Which claims data source do you want to pull from?
from_date	Begin date for coverage period, "YYYY-MM-DD", defaults to 18 months prior to today's date (A)
to_date	End date for coverage period, "YYYY-MM-DD", defaults to 6 months prior to today's date (A)
cov_min	Minimum coverage required during requested date range (percent scale), defaults to 0 (A)
covgap_max	Maximum gap in continuous coverage allowed during requested date range (days) (A)
mcaid_min	Minimum Medicaid coverage allowed during requested date range (percent scale) (MD/ME)
mcaid_max	Maximum Medicaid coverage allowed during requested date range (percent scale) (MD/ME)
mcare_min	Minimum Medicare coverage allowed during requested date range (percent scale) (MD/ME)
mcare_max	Maximum Medicare coverage allowed during requested date range (percent scale) (MD/ME)
dual_min	Minimum Medicare-Medicaid dual eligibility coverage allowed during requested date range (percent scale) (A)
dual_max	Maximum Medicare-Medicaid dual eligibility coverage allowed during requested date range (percent scale) (A)
pha_min	Minimum Medicare-Medicaid pha eligibility coverage allowed during requested date range (percent scale) (PHA)
pha_max	Maximum Medicare-Medicaid pha eligibility coverage allowed during requested date range (percent scale) (PHA)
med_covgrp	Medical coverage group type in APCD data (AP)
pharm_covgrp	Pharmacy coverage group type in APCD data (AP)
tpl_max	Maximum time with third-party liability during the requested time period (percent scale) (MD)
bsp_group_cid	Most frequently reported BSP group during requested date range, case insensitive, can take multiple values (MD)
full_benefit_min	Minimum time with full benefits during the requested time period (percent scale) (MD)
cov_type	Medicaid coverage type (FFS or MC) (MD)
mco_id	Managed care organization ID (MD)
part_a_min	Maximum time enrolled in Part A of Medicare during the requested time period (percent scale) (ME)
part_b_min	Maximum time enrolled in Part B of Medicare during the requested time period (percent scale) (ME)
part_c_min	Maximum time enrolled in Part C of Medicare during the requested time period (percent scale) (ME)
buy_in_min	Minimum time with state buy in during the requested time period (percent scale) (ME)
buy_in_max	Maximum time with state buy in during the requested time period (percent scale) (ME)
pha_agency	Most frequently reported housing agency name (PHA) during the dates requested
pha_subsidy	Most frequently reported housing subsidy type (hard vs soft) during the requested date range (PHA)
pha_voucher	Most frequently reported housing voucher type during the requested date range (PHA)
pha_operator	Most frequently reported housing operator type during the requested date range (PHA)
pha_portfolio	Most frequently reported housing portfolio type during the requested date range (PHA)
id	Restrict to these specific APCD/Medicaid/Medicare/Housing IDs (A)
age_min	Minimum age for cohort (integer), age is calculated as of last day of requested date range, defaults to 0 (A)
age_max	Maximum age for cohort (integer), age is calculated as of last day of requested date range, defaults to 200 (A)
female	Alone or in combination female gender over entire member history (A)
male	Alone or in combination female gender over entire member history (A)
gender_me	Most commonly reported gender, by time enrolled, case insensitive, can take multiple values (e.g., c("female", "multiple")) (A)
gender_recent	Most recently reported gender, , case insensitive, can take multiple values (e.g., c("female", "multiple")) (AP/MD)
race_aian	Alone or in combination American Indian/Alaska Native race over entire member history (MD/ME)
race_asian	Alone or in combination Asian race over entire member history (MD/ME)
race_asian_pi	Alone or in combination Asian/Pacific Islanfer race over entire member history (ME)
race_black	Alone or in combination Black race over entire member history (MD/ME)
race_nhpi	Alone or in combination Native Hawaiian/Pacific Islander race over entire member history (MD/ME)
race_latino	Alone or in combination Latino race over entire member history (MD/ME)
race_white	Alone or in combination white race over entire member history (MD/ME)
race_unk	No recorded race over entire member history (MD/ME)
race_me	Most frequently recorded race (excluding Latino) over entire member history, case insensitive, can take multiple values (e.g., c("aian", "black")) (MD/ME)
race_eth_me	Most frequently recorded race (including Latino) over entire member history, case insensitive, can take multiple values (e.g., c("latino", "black")) (MD/ME)
race_recent	Most recently recorded race (excluding Latino), case insensitive, can take multiple values (e.g., c("aian", "black")) (MD/ME)
race_eth_recent	Most recently recorded race (including Latino), case insensitive, can take multiple values (e.g., c("latino", "black")) (MD/ME)
lang_amharic	Alone or in combination Amharic written or spoken language over entire member history (MD)
lang_arabic	Alone or in combination Arabic written or spoken language over entire member history (MD)
lang_chinese	Alone or in combination Chinese written or spoken language over entire member history (MD)
lang_english	Alone or in combination English written or spoken language over entire member history (MD)
lang_korean	Alone or in combination Korean written or spoken language over entire member history (MD)
lang_russian	Alone or in combination Russian written or spoken language over entire member history (MD)
lang_somali	Alone or in combination Somali written or spoken language over entire member history (MD)
lang_spanish	Alone or in combination Spanish written or spoken language over entire member history (MD)
lang_ukrainian	Alone or in combination Ukrainian written or spoken language over entire member history (MD)
lang_vietnamese	Alone or in combination Vietnamese written or spoken language over entire member history (MD)
lang_me	Most frequently recorded spoken/written language over entire member history, case insensitive, can take multiple values (e.g., c("chinese", "english")) (MD)
geo_zip	Most frequently reported ZIP code during requested date range, can take multiple values (e.g., c("98104", "98105")) (A)
geo_hra_code	Most frequently reported health reporting area code during requested date range, can take multiple values (e.g., c("2100", "9000")) (MD)
geo_school_code	Most frequently reported school district code during requested date range, can take multiple values (e.g., c("5307710", "5303540")) (MD)
geo_region	Most frequently mapped HRA-based region during requested date range, (choose from east, north, seattle, south), case insensitive, can take multiple values (MD)
geo_county_code	Most frequently reported county during requested date range (use FIPS codes), can take multiple values (AP/MD)
geo_ach_code	Most recently reported accountable community of health during requested data range (use ACH codes), can take multiple values (AP)
geo_kc_ever	Ever resided in King County (ME)
geo_kc_min	Minimum amount of requested date range a person needs to have resided in King County to be included (AP/ME)
timevar_denom	Which denominator is used to calculate the percentages for time-varying parameters (e.g., dual_min, geo_kc_min). Choose from duration (number of days in selected period, i.e., between from_date and to_date) or cov_days (the number of days within selected period the person was actually enrolled). Default is duration.
show_query	Print the SQL query that is being run. Useful for debugging. Default is TRUE

Details

LARGELY FOR INTERNAL USE This function builds and sends a SQL query to return a member cohort with specified parameters, including coverage time period, coverage characteristics (e.g., Medicare dual eligibility), and member demographics. Can be used on five data sources: APCD, Medicaid, and Medicare Medicaid/Medicare combined, & Medicaid/Medicare/Housing combined. Parameters below have the following key to indicate which data source they can be used against: A = All sources, AP = APCD, MD = Medicaid, ME = Medicare, PHA = Housing. Most parameters default to NULL, which means that all values are included for that field. NB: For time-varying variables, the value with the maximum time is returned for each variable independently. Therefore, incongruent combinations may arise (e.g., having a bsp_group that does not confer full Medicaid benefits but the full_benefits flag set to 1, pha_agency returns 'Non-PHA' but pha_subsidy returns 'HARD UNIT').

Examples

## Not run: 
claims_elig(conn = db.claims51, source = "apcd", 
  from_date = "2017-01-01", to_date = "2017-06-30")
claims_elig(conn = db.claims51, source = "mcaid", 
  from_date = "2017-01-01", to_date = "2017-06-30", age_min = 18, 
  age_max = 64, lang_me = c("ARABIC", "SOMALI"), zip = c("98103", "98105"))

## End(Not run)

PHSKC-APDE/Medicaid documentation built on April 19, 2024, 11:18 a.m.