Understanding the site of service for a claim is critical for understanding and interpreting medical claim data. The easiest way to assign a claim to the site of service is to use the place of service (POS) code available in the claims extract, but the POS code does not tell
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As we saw in ”Why do 5% of My Services Occur on January 1, 1960?”, NULL dates are frequently passed to claims extracts as 0 dates causing issues with trending and length of stay. To identify this issue, summarize your data by year and month as shown in the DPS Non-NULL
The International Statistical Classification of Diseases and Related Health Problems (ICD) is the most standardized set of codes used in healthcare and covers both diagnoses (CM) and procedures (PCS). Every medical claim is required to have at least one ICD-CM diagnosis code to explain why the service was rendered. All
Medical claims extracts will frequently drop the leading zeros from codes as shown in this dataset. It is important to add leading zeros back to your codes before using crosswalks and code sets. Revenue center codes should always be zero-padded to 4 digits (‘0000’). HCPCS codes can be zero-filled to 5
Claims data passed as an extract to either a vendor, state agency, or at-risk provider has usually been transferred over half a dozen times. It began its journey as billing data sent from the provider to the payer. Then it was transferred to the adjudication system (frequently this data is
Health care spending represents almost 20% of the United States GDP and just about every dollar of that spend is recorded on a medical or pharmacy claim creating one of the most useful sources of data in existence. Despite huge gains in standardization over the last twenty years administrative claims
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