claims: Medical Claims
In mhairi/medicalclaims: New Hampshire Health Insurance Claims
Description
Usage
Format
Source
Description
A sample of 100,000 medical insurance claims from New Hamshire.
Data comes from New Hampshire’s Comprehensive Health Information System (https://nhchis.com/).
Data is anonymised by New Hampshire.
For a more detailed data dictionary see: https://nhchis.com/DocumentDelivery/GetFile/15
Usage
1
Format
A data frame with 100,000 rows and 56 variables:
- coverage_class
This field indicated the type of record. For all medical claims records, this value will be MED. Pharmacy Claims are PHM. Dental Claims are DEN
- form_year
This field contains the date of service of medical claims in a CCYY format. Its source is the Date of Service from element (MC059) in the medical claims.
- claim_id_key
Unique identifier for the claim within the data warehouse.
- cs_claim_id_key
This field is assigned as a value-added field to associate all claim lines for a given inpatient stay under one coded value.
- services_key
This field uniquely identifies each claim service record within the warehouse.
- sv_line
This field contains the line number for this service as reported by the payer. The Line Counter begins with 1 and is incremented by 1 for each additional service line of a claim.
- form_type
This field identifies whether the claim is a UB (U), HCFA/CMS (H), Pharmacy (D) or Dental (A) type of claim.
- sv_stat
The claim status codes reference data set includes standardized claim status code values and descriptions and links to the dental claims, medical claims, and pharmacy claims data sets.
- dis_stat
See Dictionary for expanded definition. This field contains the patient discharge status code as reported by the payer. This field is inconsistently reported across data reporters; it may be underreported on inpatient records and sometimes reported on outpatient records. This field links to the REF_DIS_STAT table.
- pos
The place of services site codes reference data set includes all valid site of service (facility) values and descriptions and links to the dental claims and medical claims data sets.
- age
This field contains the age of the member in years.
- sex
This field indicates the member's gender.
- member_county
This field contains the member's county of residence if the member is a NH resident.
- member_state
This field contains the member's state and uses the two-character state abbreviation as defined by the US Postal Service
- product_type
This includes the standardized payer type values, including: PPO - Commercial PPO, POS - Commercial POS, HMO - Commercial HMO, SN1 - Special Needs Plan, - Chronic Condition, SN2 - Special Needs Plan Institutionalized, SN3 - Special Needs Plan Dual Eligible, CHP - Child Health Insurance Program, EPO - Exclusive Provider Organization, SF - Self-Funded, SL - Stop Loss, IND - Indemnity
- lob
These are standardized Lines of Business that are based upon the payer type information. These include: 1 - COMMERCIAL, 2 - MEDICAID, 3 - MEDICARE
- insurance_type
See Dictionary for expanded definition. This field contains the code identifying the member's type of insurance or insurance product and links to the REF_INSURANCE_TYPE.
- proc_code
This field contains the HCPCS or CPT code for the procedure performed. Many data reporters continue to use local codes.
- cdt_mod1
A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate that a service or procedure has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. A procedure modifier is required when a modifier clarifies or improves the reporting accuracy of the associated procedure code. This field links to the CPT Modifier reference file REF_CPT_MOD for Medical but to the REF_PROC_CODE_DENTAL for Dental.
- cdt_mod2
A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate that a service or procedure has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. A procedure modifier is required when a modifier clarifies or improves the reporting accuracy of the associated procedure code. This field links to the CPT Modifier reference file REF_CPT_MOD for Medical but to the REF_PROC_CODE_DENTAL for Dental.
- rev_code
This field is used to report the Revenue Code for hospital claims. National Uniform Billing Committee codes are used in this field. This field links to the REF_REV_CODE reference file using the Revenue Code. This is one of three medical claims fields used to report type of service (see also Procedure Code (MC055) and ICD-CM Procedure Code (MC058)).
- ub_bill_type
See Dictionary for expanded definition. This field contains the Type of Bill code as reported on a UB. This field links to the REF_BILL_TYPE reference table.
- adm_src
This field is the primary identification key for each Admission Source record and links to the Admission Source element (MC021) in the medical claims file. This field is required for inpatient hospital claims. Valid codes include: 1:Physician Referral 2:Clinic Referral 3:HMO Referral 4:Transfer from Hospital 5:Transfer from a Skilled Nursing Facility 6:Transfer from another Health Care Facility 7:Emergency Room 8:Court/Law Enforcement 9:Unknown A:Transfer from a Rural Primary Care Hospital
- adm_type
This field is used to record the type of admission for all inpatient hospital bills. Many data reporters do not capture this information. This field links to the admission type reference file using the Admit_type code. Valid codes include: 1:Emergency 2:Urgent 3:Elective 4:Newborn 5:Trauma Center 9:Information Not Available
- client_los
This field contains the length of stay (in days) for an inpatient claim. It is calculated by subtracting the Admission Date (MC018) from the Discharge Date (MC069).
- icd_10_or_higher
Starting Oct. 1, 2015, CMS requires that Diagnosis and Procedures codes be submitted in ICD10 format. This column indicates that the correct ICD version is being used. 0 - ICD9 Diagnosis and Procedure Codes exist in this claim line; 1 -ICD10 or higher Diagnosis and Procedure Codes exist in this claim line This links to REF_ICD_PROC and REF_ICD_DIAG.
- icd_proc_01_pri
This field is used to report the principal ICD-CM Procedure Code. The decimal point is not coded. This field generally is available only on inpatient hospital claims. It is not consistently reported by data reporters. This is one of three medical claims fields used to report type of service (see also Procedure Code (MC055) and Revenue Code (MC054)). It links to REF_ICD_PROC.
- icd_diag_01_primary
This field contains the ICD diagnosis code for the principal diagnosis. It (along with all ICD_DIAG Data Elements, links to REF_ICD_DIAG).
- icd_diag_admit
This field contains the ICD diagnosis code indicating the reason for the inpatient admission.
- icd_diag_02
This field contains the ICD diagnosis code for the first secondary diagnosis (Other Diagnosis 1).
- serv_prov_cw_key
This field contains the consistent, unique service provider ID key across all data suppliers that links to an identified single provider in the provider detail file
- bill_prov_cw_key
This field contains the consistent, unique billing provider ID key across all data suppliers that links to an identified single provider in the provider detail file.
- qty
For Medical, this column is the count of services performed. For all observation bed service lines, set equal to one. For all other room and board service lines, regardless of the length of stay, set equal to zero. For Pharmacy, it is the number of metric units of medication dispensed. For Dental, this column is NULL.
- amt_billed
This field contains the total charges for the service as reported by the provider. This is a money field containing dollars and cents. This field may contain a negative value.
- amt_paid
This field includes all health plan payments, including withhold amounts, and excludes all member payments. This is a money field containing dollars and cents. This field may contain a negative value.
- amt_deduct
This is an amount that is required to be paid by a member before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that are not covered by the member's insurance plan. To determine the total out-of-pocket/member responsibility for this service, you must sum this field with both Copay Amount (MC065) and Coinsurance Amount (MC066). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_coins
This amount is paid by the member and reflects the percent a member must pay toward the cost of a covered service. In many health insurance plans, the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses has been incurred. Not all carriers can distinguish between the mutually exclusive fields of Copay Amount (MC065) and Coinsurance Amount. To determine the total out-of-pocket/member responsibility for this service, you must sum these two fields with Deductible Amount (MC067). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_copay
This field contains the preset, fixed dollar amount payable by a member, often on a per-visit/-service basis. Not all carriers can distinguish between the mutually exclusive fields of Copay Amount and Coinsurance Amount (MC066). To determine the total out-of-pocket/member responsibility for this service, you must sum these two fields with Deductible Amount (MC067). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_prepaid
This field contains the fee for service equivalent that would have been paid by the health care claims processor for a specific service if the service had not been capitated. Capitated services are services rendered by a provider through a contract under which payments are based upon a fixed dollar amount for each member on a monthly basis. Note that the provider did not receive this payment. Any payment for this service was made through capitation and that is not captured in this database. This is a money field containing dollars and cents. This field may contain a negative value.
- inpatient_flag
This field indicates whether the current line is from an inpatient claim. The Inpatient flag is set to Y for any claim with at least one claim line having the following condition present: a REVENUE element (MC054) value of 110-239 or a BILLTYPE element (MC036) value of 11-12, 41-42, of 51-52. This flag is derived from the HCG value where the HCG high level category is hospital inpatient. Valid codes include: Y - Yes, an inpatient record; N - No, not an inpatient record
- mr_line_case_key
This is the key of the HCG value that links to the REF_HCG table to provide HCG information about the claim
- cases
Cases are a measurement of unique services. The meaning of the value found in cases vary by service type. For hospital inpatient services, cases represent admits. Hospital outpatient services, cases essentially represent unique events at the outpatient facility. For professional and other (ancillary) services, cases are visits, services, tests, etc. depending on the type of service. For prescription drugs, cases represent scripts. If cases are negative this represents an adjustment to a previously received service line.
- utils
Utilization is the count of the number of distinct services. Utilization counts differ according to the type of service. For hospital inpatient services it is the number of days spent in the facility. For hospital outpatient services it is the number of procedures delivered. For professional services it is the number of services delivered. For Rx services it is the number of prescriptions. For ancillary services it is the number of procedures performed. If the utilization is negative this represents an adjustment to a previously received service line.
- ndc
This field contains the National Drug Code. Each drug product listed under Section 510 of the Federal Food, Drug, and Cosmetic Act is assigned a unique 10-digit, three-segment number. This number, known as the National Drug Code (NDC), identifies the labeler/vendor, product, and trade package size. The first segment, the labeler/vendor code, is assigned by the FDA. A labeler is any firm that manufactures, repacks, or distributes a drug product. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code, identifies package sizes. Both the product and package codes are assigned by the firm. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1.
- claim_status_orig
This field contains the status of the claim as reported by the payer on the remittance. Note that the claim status code is specific to each service line of a claim. Claims processed as secondary may have dramatically lower payments for services rendered because another payer had primary responsibility. A small number of payers are unable to distinguish claims processed as primary from those processed as secondary. In studying the cost of a specific procedure, a claim that is not processed as primary may reflect only a partial payment. This field links to the REF_CLAIM_STATUS table. Valid codes include: 01:Processed as primary 02:Processed as secondary 03:Processed as tertiary 04:Denied 19:Processed as primary, forwarded to additional payer(s) 20:Processed as secondary, forwarded to additional payer(s) 21:Processed as tertiary, forwarded to additional payer(s) 22:Reversal of previous payment -1:Not specified (no claim status reported) -2:Not valid (invalid claim status code reported)
- ecode_orig
This field describes an injury, poisoning, or adverse effect using an ICD E-Code diagnosis. The user should search the Principal Diagnosis and Other Diagnosis fields (MC041, MC042, MC043, MC044, MC045, MC046, MC047, MC048, MC049, MC050, MC051, MC052, MC053) to identify all submitted ECodes. Note that the same E-Code may be reported in this field and in an Other Diagnosis field, depending upon the data reporter. This field links to the REF_ICD_DIAG file.
- claim_adjustment_logic
This code denotes the method of claim adjustment logic that was applied to create the final status of the claim for the Claim Final Status view. This is based upon information provided by data submitters during the registration process. However, it can be modified if the data proves that a different method is required. This field links to the REF_PROCESSING_RULES table.
- imputed_service_key
This field contains an identification number representing a specific service defined as a unique member and date of service
- cash
HealthyHive variable that combines deductible, copay, and coinsures to represent total out-of-pocket spending
- total
HealthyHive variable that adds 'cash' and 'amt_paid' to show total price of service.
- cpt_desc
CPT (proc_code) description.
- mr_line_new_desc
This field contains Milliman HCG MR_LINE_KEY. This links to the MR_LINE_CASE_KEY in the service tables and claims files in the extracts.
- mr_line_setting
Description for Milliman HCG
- mr_line_abbrdesc
Description 2 for Milliman HCG
- mr_line_hcg
Description 3 for Milliman HCG
- new_diag_desc
Diagnosis Description
- total_by_n
When qty is not zero, this is total divided by qty. Needed to reflect per unit spending for items like physician-administered drugs. This calculation controls for difference dosage levels at the patient level.
Source
mhairi/medicalclaims documentation built on May 20, 2020, 10:15 a.m.
R Package Documentation
Browse R Packages
We want your feedback!
Note that we can't provide technical support on individual packages. You should contact the package authors for that.
Description Usage Format Source
Description
A sample of 100,000 medical insurance claims from New Hamshire. Data comes from New Hampshire’s Comprehensive Health Information System (https://nhchis.com/). Data is anonymised by New Hampshire. For a more detailed data dictionary see: https://nhchis.com/DocumentDelivery/GetFile/15
Usage
1 |
Format
A data frame with 100,000 rows and 56 variables:
- coverage_class
This field indicated the type of record. For all medical claims records, this value will be MED. Pharmacy Claims are PHM. Dental Claims are DEN
- form_year
This field contains the date of service of medical claims in a CCYY format. Its source is the Date of Service from element (MC059) in the medical claims.
- claim_id_key
Unique identifier for the claim within the data warehouse.
- cs_claim_id_key
This field is assigned as a value-added field to associate all claim lines for a given inpatient stay under one coded value.
- services_key
This field uniquely identifies each claim service record within the warehouse.
- sv_line
This field contains the line number for this service as reported by the payer. The Line Counter begins with 1 and is incremented by 1 for each additional service line of a claim.
- form_type
This field identifies whether the claim is a UB (U), HCFA/CMS (H), Pharmacy (D) or Dental (A) type of claim.
- sv_stat
The claim status codes reference data set includes standardized claim status code values and descriptions and links to the dental claims, medical claims, and pharmacy claims data sets.
- dis_stat
See Dictionary for expanded definition. This field contains the patient discharge status code as reported by the payer. This field is inconsistently reported across data reporters; it may be underreported on inpatient records and sometimes reported on outpatient records. This field links to the REF_DIS_STAT table.
- pos
The place of services site codes reference data set includes all valid site of service (facility) values and descriptions and links to the dental claims and medical claims data sets.
- age
This field contains the age of the member in years.
- sex
This field indicates the member's gender.
- member_county
This field contains the member's county of residence if the member is a NH resident.
- member_state
This field contains the member's state and uses the two-character state abbreviation as defined by the US Postal Service
- product_type
This includes the standardized payer type values, including: PPO - Commercial PPO, POS - Commercial POS, HMO - Commercial HMO, SN1 - Special Needs Plan, - Chronic Condition, SN2 - Special Needs Plan Institutionalized, SN3 - Special Needs Plan Dual Eligible, CHP - Child Health Insurance Program, EPO - Exclusive Provider Organization, SF - Self-Funded, SL - Stop Loss, IND - Indemnity
- lob
These are standardized Lines of Business that are based upon the payer type information. These include: 1 - COMMERCIAL, 2 - MEDICAID, 3 - MEDICARE
- insurance_type
See Dictionary for expanded definition. This field contains the code identifying the member's type of insurance or insurance product and links to the REF_INSURANCE_TYPE.
- proc_code
This field contains the HCPCS or CPT code for the procedure performed. Many data reporters continue to use local codes.
- cdt_mod1
A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate that a service or procedure has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. A procedure modifier is required when a modifier clarifies or improves the reporting accuracy of the associated procedure code. This field links to the CPT Modifier reference file REF_CPT_MOD for Medical but to the REF_PROC_CODE_DENTAL for Dental.
- cdt_mod2
A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate that a service or procedure has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. A procedure modifier is required when a modifier clarifies or improves the reporting accuracy of the associated procedure code. This field links to the CPT Modifier reference file REF_CPT_MOD for Medical but to the REF_PROC_CODE_DENTAL for Dental.
- rev_code
This field is used to report the Revenue Code for hospital claims. National Uniform Billing Committee codes are used in this field. This field links to the REF_REV_CODE reference file using the Revenue Code. This is one of three medical claims fields used to report type of service (see also Procedure Code (MC055) and ICD-CM Procedure Code (MC058)).
- ub_bill_type
See Dictionary for expanded definition. This field contains the Type of Bill code as reported on a UB. This field links to the REF_BILL_TYPE reference table.
- adm_src
This field is the primary identification key for each Admission Source record and links to the Admission Source element (MC021) in the medical claims file. This field is required for inpatient hospital claims. Valid codes include: 1:Physician Referral 2:Clinic Referral 3:HMO Referral 4:Transfer from Hospital 5:Transfer from a Skilled Nursing Facility 6:Transfer from another Health Care Facility 7:Emergency Room 8:Court/Law Enforcement 9:Unknown A:Transfer from a Rural Primary Care Hospital
- adm_type
This field is used to record the type of admission for all inpatient hospital bills. Many data reporters do not capture this information. This field links to the admission type reference file using the Admit_type code. Valid codes include: 1:Emergency 2:Urgent 3:Elective 4:Newborn 5:Trauma Center 9:Information Not Available
- client_los
This field contains the length of stay (in days) for an inpatient claim. It is calculated by subtracting the Admission Date (MC018) from the Discharge Date (MC069).
- icd_10_or_higher
Starting Oct. 1, 2015, CMS requires that Diagnosis and Procedures codes be submitted in ICD10 format. This column indicates that the correct ICD version is being used. 0 - ICD9 Diagnosis and Procedure Codes exist in this claim line; 1 -ICD10 or higher Diagnosis and Procedure Codes exist in this claim line This links to REF_ICD_PROC and REF_ICD_DIAG.
- icd_proc_01_pri
This field is used to report the principal ICD-CM Procedure Code. The decimal point is not coded. This field generally is available only on inpatient hospital claims. It is not consistently reported by data reporters. This is one of three medical claims fields used to report type of service (see also Procedure Code (MC055) and Revenue Code (MC054)). It links to REF_ICD_PROC.
- icd_diag_01_primary
This field contains the ICD diagnosis code for the principal diagnosis. It (along with all ICD_DIAG Data Elements, links to REF_ICD_DIAG).
- icd_diag_admit
This field contains the ICD diagnosis code indicating the reason for the inpatient admission.
- icd_diag_02
This field contains the ICD diagnosis code for the first secondary diagnosis (Other Diagnosis 1).
- serv_prov_cw_key
This field contains the consistent, unique service provider ID key across all data suppliers that links to an identified single provider in the provider detail file
- bill_prov_cw_key
This field contains the consistent, unique billing provider ID key across all data suppliers that links to an identified single provider in the provider detail file.
- qty
For Medical, this column is the count of services performed. For all observation bed service lines, set equal to one. For all other room and board service lines, regardless of the length of stay, set equal to zero. For Pharmacy, it is the number of metric units of medication dispensed. For Dental, this column is NULL.
- amt_billed
This field contains the total charges for the service as reported by the provider. This is a money field containing dollars and cents. This field may contain a negative value.
- amt_paid
This field includes all health plan payments, including withhold amounts, and excludes all member payments. This is a money field containing dollars and cents. This field may contain a negative value.
- amt_deduct
This is an amount that is required to be paid by a member before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that are not covered by the member's insurance plan. To determine the total out-of-pocket/member responsibility for this service, you must sum this field with both Copay Amount (MC065) and Coinsurance Amount (MC066). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_coins
This amount is paid by the member and reflects the percent a member must pay toward the cost of a covered service. In many health insurance plans, the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses has been incurred. Not all carriers can distinguish between the mutually exclusive fields of Copay Amount (MC065) and Coinsurance Amount. To determine the total out-of-pocket/member responsibility for this service, you must sum these two fields with Deductible Amount (MC067). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_copay
This field contains the preset, fixed dollar amount payable by a member, often on a per-visit/-service basis. Not all carriers can distinguish between the mutually exclusive fields of Copay Amount and Coinsurance Amount (MC066). To determine the total out-of-pocket/member responsibility for this service, you must sum these two fields with Deductible Amount (MC067). This is a money field containing dollars and cents. This field may contain a negative value.
- amt_prepaid
This field contains the fee for service equivalent that would have been paid by the health care claims processor for a specific service if the service had not been capitated. Capitated services are services rendered by a provider through a contract under which payments are based upon a fixed dollar amount for each member on a monthly basis. Note that the provider did not receive this payment. Any payment for this service was made through capitation and that is not captured in this database. This is a money field containing dollars and cents. This field may contain a negative value.
- inpatient_flag
This field indicates whether the current line is from an inpatient claim. The Inpatient flag is set to Y for any claim with at least one claim line having the following condition present: a REVENUE element (MC054) value of 110-239 or a BILLTYPE element (MC036) value of 11-12, 41-42, of 51-52. This flag is derived from the HCG value where the HCG high level category is hospital inpatient. Valid codes include: Y - Yes, an inpatient record; N - No, not an inpatient record
- mr_line_case_key
This is the key of the HCG value that links to the REF_HCG table to provide HCG information about the claim
- cases
Cases are a measurement of unique services. The meaning of the value found in cases vary by service type. For hospital inpatient services, cases represent admits. Hospital outpatient services, cases essentially represent unique events at the outpatient facility. For professional and other (ancillary) services, cases are visits, services, tests, etc. depending on the type of service. For prescription drugs, cases represent scripts. If cases are negative this represents an adjustment to a previously received service line.
- utils
Utilization is the count of the number of distinct services. Utilization counts differ according to the type of service. For hospital inpatient services it is the number of days spent in the facility. For hospital outpatient services it is the number of procedures delivered. For professional services it is the number of services delivered. For Rx services it is the number of prescriptions. For ancillary services it is the number of procedures performed. If the utilization is negative this represents an adjustment to a previously received service line.
- ndc
This field contains the National Drug Code. Each drug product listed under Section 510 of the Federal Food, Drug, and Cosmetic Act is assigned a unique 10-digit, three-segment number. This number, known as the National Drug Code (NDC), identifies the labeler/vendor, product, and trade package size. The first segment, the labeler/vendor code, is assigned by the FDA. A labeler is any firm that manufactures, repacks, or distributes a drug product. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code, identifies package sizes. Both the product and package codes are assigned by the firm. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1.
- claim_status_orig
This field contains the status of the claim as reported by the payer on the remittance. Note that the claim status code is specific to each service line of a claim. Claims processed as secondary may have dramatically lower payments for services rendered because another payer had primary responsibility. A small number of payers are unable to distinguish claims processed as primary from those processed as secondary. In studying the cost of a specific procedure, a claim that is not processed as primary may reflect only a partial payment. This field links to the REF_CLAIM_STATUS table. Valid codes include: 01:Processed as primary 02:Processed as secondary 03:Processed as tertiary 04:Denied 19:Processed as primary, forwarded to additional payer(s) 20:Processed as secondary, forwarded to additional payer(s) 21:Processed as tertiary, forwarded to additional payer(s) 22:Reversal of previous payment -1:Not specified (no claim status reported) -2:Not valid (invalid claim status code reported)
- ecode_orig
This field describes an injury, poisoning, or adverse effect using an ICD E-Code diagnosis. The user should search the Principal Diagnosis and Other Diagnosis fields (MC041, MC042, MC043, MC044, MC045, MC046, MC047, MC048, MC049, MC050, MC051, MC052, MC053) to identify all submitted ECodes. Note that the same E-Code may be reported in this field and in an Other Diagnosis field, depending upon the data reporter. This field links to the REF_ICD_DIAG file.
- claim_adjustment_logic
This code denotes the method of claim adjustment logic that was applied to create the final status of the claim for the Claim Final Status view. This is based upon information provided by data submitters during the registration process. However, it can be modified if the data proves that a different method is required. This field links to the REF_PROCESSING_RULES table.
- imputed_service_key
This field contains an identification number representing a specific service defined as a unique member and date of service
- cash
HealthyHive variable that combines deductible, copay, and coinsures to represent total out-of-pocket spending
- total
HealthyHive variable that adds 'cash' and 'amt_paid' to show total price of service.
- cpt_desc
CPT (proc_code) description.
- mr_line_new_desc
This field contains Milliman HCG MR_LINE_KEY. This links to the MR_LINE_CASE_KEY in the service tables and claims files in the extracts.
- mr_line_setting
Description for Milliman HCG
- mr_line_abbrdesc
Description 2 for Milliman HCG
- mr_line_hcg
Description 3 for Milliman HCG
- new_diag_desc
Diagnosis Description
- total_by_n
When qty is not zero, this is total divided by qty. Needed to reflect per unit spending for items like physician-administered drugs. This calculation controls for difference dosage levels at the patient level.
Source
R Package Documentation
Browse R Packages
We want your feedback!
Note that we can't provide technical support on individual packages. You should contact the package authors for that.
Embedding an R snippet on your website
Add the following code to your website.
For more information on customizing the embed code, read Embedding Snippets.