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41. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Tables 11 & 12 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-tables11-12.pdf
    October 17, 2019 - 546)*** 0.4 (0.4) 5.6 (8.6) 8.0 (11.8) 0.1 (0.2) 79.7 (16.8) 2.6 (1.5) 3.7 (6.1) Subset following claims … (8.2) 8.1 (12.3) 0.1 (0.5) 79.3 (16.9) 2.7 (2.1) 4.1 (6.2) Subset following claims … missing or unmatched ZIP code, yielding n=546 (98.0%). **** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=426 (98.2%). ***** Among the subset of children following claims … CT exclusions (n=426)**** 10.8 (14.9) Subset following claims MRI exclusions (n=489)***** 9.6 (13.4

42. 1b.4_Input_File_Specifications_508 (xls file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/input-file-specifications.xlsx
    January 01, 2014 - Medical Claims Reference Name Concept Description Variable Type Note claim_header_id Claim level … unique identifier text or numeric Can be derived, just need a way to uniquely identify claims. … unique identifier text or numeric Can be derived, just need a way to uniquely identify claims. … Note: Comorbidity source table is in wide form, unlike the medical claims source table DX2 The ICD9 … End of Table Pharmacy Claims Pharmacy Claims Reference Name Concept Description Required Variable

43. Findings | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/findings.html
    July 01, 2022 - Based on APCD claims data, no further details on the site. … Use additional datasets aside from claims. … Furthermore, data are typically limited to claims only. … The basics of all-payer claims databases: a primer for states . … However, claims data are not available in real time.

44. Planning Grants Final Evaluation Report: Longitudinal Evaluation of the PSML Reform Demonstration Program (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/publications/files/psml-planning-grants-final-report.pdf
    May 01, 2016 - First, an actuarial review of claims concluded that the use of an ACEx2 system might stabilize claims … inflation and reduce costs through an accelerated claims process. … The RMCM was modeled after the University of Michigan Claims Management Model. … During this time period, 41 claims had sufficient data for analysis. … Claims were categorized by six unique claim types that ranged from grievances to formal claims against

45. Synthetic Healthcare Database for Research Description of Data Elements (Codebook) (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Codebook.pdf
    December 01, 2023 - Synthetic Healthcare Database for Research (SyH-DR) A Synthetic Nationally Representative All-Payer Claims … The commercial claims files do not contain any discharge codes that indicate a death occurred (i.e., … Missing 1 Encounter claims (i.e., Medicare Advantage or Medicaid managed care organizations) do not … wounds, were removed from the claims’ files. … Missing 1 Encounter claims (i.e., Medicare Advantage or Medicaid managed care organizations) do not

46. Transcranial Doppler (TCD) Ultrasonography Screening for Children with SCD; and Appropriate Antibiotic Prophylaxis (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra-1416-p007-2-ef.pdf
    November 01, 2015 - Claims data. … Claims data. … (MAX) administrative claims data from six States with a moderate to high prevalence of SCD … ● This measure was also tested using administrative claims acquired directly from the respective … Caveats These measures are based on administrative claims; incomplete reporting of claims or SCD diagnosis

47. CHIPRA 235: Section 6, Table 5. Reasons for Variance (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-235-section-6-table-5.pdf
    January 01, 2013 - code was added/updated after Analyst 1 data extraction 1 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 2 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 2 Data update: Specialty-related visit claims … code was added/updated after Analyst 1 data extraction 1 Data update: Specialty-related visit claims … taxonomy record was added after Analyst 1 data extraction 1 Data update: Specialty-related visit claims

48. Chipra-141-Section-2-Tech-Specs (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-141-section-2-tech-specs.pdf
    December 01, 2012 - Algorithm to identify children with complex and non-complex chronic conditions using Medicaid claims … file that includes all claims (inpatient, outpatient, managed care encounter data) and has at … The Process: 1) 'Claims' dataset: claims are read in and the decimals are stripped from the … ICD-9 codes with or without decimals are thus accommodated. 2) Claims are sorted by person … <---- 1) SET LOCATION OF CLAIMS DATA TO BE USED; %let icdnum=25;

49. Appendix B. Journal Articles Included in Literature Review | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/app-b.html
    June 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … The value of all-payer claims databases to states. N C Med J 2014 May-Jun;75(3):211-3. … All payer claims database. Colo Nurse 2011 Nov;111(4):8. PMID:22216536. … Measuring care continuity: a comparison of claims-based methods. Med Care 2016 May;54(5):e30-4. … Patient out-of-pocket payments for oral oncolytics: results from a 2009 US claims data analysis.

50. Section 8.A, Data Availability (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-153-section-8a.pdf
    January 01, 2011 - Some states do not report enrollment data, and none reports claims for their state funded (S-CHIP) … Additionally, while some states usually provide managed care claims, others do not (Byrd and Verdier … Testing managed care claims data quality in each state Managed care claims data is sometimes absent … States highlighted in Gray did not meet criteria to be utilized for studying appendectomy claims. … All claims data in these states is reported via FFS or PCCM, wherein claims are billed as FFS.

51. Ratio of Magnetic Resonance Imaging Scans to Computed Tomography Scans for the Evaluation of Children with Atraumatic Seizure: Table 7 - 10 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-tables7-10.pdf
    January 01, 2006 - days after the date of evaluation for atraumatic seizure, was calculated using 5 consecutive years of claims … data drawn from Medicaid Analytic eXtract (MAX) administrative claims data provided by the Centers … range) 0.98 (0.81-0.99) Table 9: Contingency Table for Presence of Exclusions in Administrative Claims … Measurement Year Exclusion Documented in Charts Present Absent Total Exclusion present based on claims … 97 Total 13 91 104 Table 10: Contingency Table for Presence of Exclusions in Administrative Claims

52. Tables 7-10 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-196-section-6.pdf
    January 01, 2006 - after the date of evaluation for atraumatic headache, was calculated using 5 consecutive years of claims … data drawn from Medicaid Analytic eXtract (MAX) administrative claims data provided by the Centers … range) 0.99 (0.90-1.00) Table 9: Contingency Table for Presence of Exclusions in Administrative Claims … Measurement Year Exclusion Documented in Charts Present Absent Total Exclusion present based on claims … 62 Total 18 48 66 Table 10: Contingency Table for Presence of Exclusions in Administrative Claims

53. Project Context | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/context.html
    June 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … These are large-scale databases that systematically collect medical claims, facility claims, pharmacy … claims, and dental claims (typically, but not always), as well as eligibility and provider files from … For example, Medicare and Medicaid claims cover important populations but leave out a large portion of

54. Overuse of Imaging for the Evaluation of Children with Simple Febrile Seizure: Tables 12 - 15 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0192-tables12-15.pdf
    October 16, 2019 - 7.2 (10.2) 8.5 (12.5) 0.2 (0.6) 75.1 (18.7) 3.2 (2.2) 5.4 (7) Subset following claims … missing or unmatched ZIP code, yielding n=458 (97.4%). ** Among the subset of children following claims … ‡ Mean (SD) Eligible children who had a febrile seizure (n=458)* 13.7 (15.8) Subset following claims … missing or unmatched ZIP code, yielding n=458 (97.4%). ** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=457 (97.2%). ** Among the subset of children following claims

55. Section 6.A, Figures 1 to 4 and Table 5 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0138-section-6a.pdf
    December 01, 2013 - tested using a sample drawn from 5 consecutive years of Medicaid Analytic eXtract (MAX) administrative claims … tested using a sample drawn from 5 consecutive years of Medicaid Analytic eXtract (MAX) administrative claims …                                                       Figure 3: Michigan Medicaid Claims … CHAMPS) compared with a corresponding sample drawn from Medicaid Analytic eXtract (MAX) administrative claims … Figure 4: Michigan Medicaid Claims Results Compared with MAX data for 350‐Day Rate 0% 5% 10%

56. Conclusion | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/data/apcd/envscan/conclusion.html
    June 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Health Information Knowledgebase Data Sources Available from AHRQ All-Payer Claims … Practices and Evidence Conclusion Previous Page Next Page Table of Contents All-Payer Claims

57. Executive Summary | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/summary.html
    August 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Johns Hopkins University Analysis of hospital claims showed that suboptimal care at hospital discharge … accounted for a considerable proportion of malpractice claims and involved failures in multiple domains … Wishard Health Services (now subsumed under Eskenazi Health) The project evaluated a new claims model … Claims processed through the new system fared better than or the same as those processed through the

58. Comparative Health System Performance Initiative: National Bureau of Economic Research Center of Excellence | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/chsp/about-chsp/centers/nber.html
    July 01, 2019 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … These States have different health systems and all-payer claims databases (APCDs), which have facilitated … The team identifies health systems in claims data using tax identification numbers and Medicare provider … Administrative and claims data that can be used to measure the use of PCOR-based evidence, related clinical … These include Medicare claims data, national commercial insurance claims data, cancer registry data,

59. Tables 8-11 (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-195-tables%208-11.pdf
    December 18, 2019 - 2,918)** 0.5 (1.0) 4.9 (7.9) 8.0 (12.6) 0.1 (0.2) 80.2 (16.8) 2.6 (1.4) 3.7 (6.1) Subset following claims … )*** 0.5 (1.0) 4.8 (7.8) 8.2 (12.7) 0.1 (0.2) 80.3 (16.8) 2.6 (1.4) 3.6 (6.0) Subset following claims … headache (n=5,807)* 9.7 (13.5) Subset who had a CT or MRI (n=2,918)** 9.8 (13.6) Subset following claims … denominator exclusions (n=2,386)*** 9.5 (13.3) Subset following claims numerator exclusions (n=1,985 … CT or MRI (n=2,917)** $69,540 $29,624 $16,036 $47,028 $63,542 $85,462 $219,688 Subset following claims

60. Implementation Guide for the CANDOR Process: Appendix B | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/patient-safety/settings/hospital/candor/impguide/apb.html
    August 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … investigation and analysis process for the organization Risk management staff, nurse manager, legal, claims … developing, educating, and implementing the resolution process for the organization Risk management staff, claims … designee Risk Management Champion Reinforces goals of the CANDOR process; educates risk, legal, claims … process; serves as liaison to promote and support CANDOR process implementation with the risk, legal, and claims