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1. Use of Electronic Medical Records and Administrative Claims Data for Assessing Type 2 Diabetes Care | Effective Health Care (EHC) Program
   effectivehealthcare-admin.ahrq.gov/products/diabetes-claims-data/research
   November 01, 2017 - Evidence Reports Use of Electronic Medical Records and Administrative Claims … SHARE: Use of Electronic Medical Records and Administrative Claims … may be validated using full-text information from the same EMR, whereas validation of administrative claims … Project Timeline Use of Electronic Medical Records and Administrative Claims Data for Assessing Type … https://effectivehealthcare.ahrq.gov/products/diabetes-claims-data/research  

2. Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims Databases | Effective Health Care (EHC) Program
   effectivehealthcare-admin.ahrq.gov/products/medicine-safety-databases/abstract
   November 01, 2017 - Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims … Research and Surveillance Methods for Improving Medication Safety Using Administrative Claims … process measures such as misuse, over- and under-use of prescription medications based on dispensing claims … evaluate based on the typical structure of Medicare, Medicaid, SCHIP, and managed care administrative claims … We will test the process measures using data from state Medicaid claims files.

3. Data Development for Patient Safety — A Pilot Study using Medicare Part B Drug Data | Effective Health Care (EHC) Program
   effectivehealthcare-admin.ahrq.gov/products/patient-safety-drug-data/abstract
   April 01, 2018 - Page Contents Topic Abstract Medicare administrative claims … Medicare claims provide a broad picture of the health services received by individuals, with considerable … of frameworks to organize claims data into structures that link relevant interventions, outcomes and … The analysis will exploit information available in Part B claims on drugs, to produce a framework that … can be readily adapted to incorporate Part D claims when they come on line next year.

4. Data Points #5: Prevalence and Medicare Reimbursement by Recurrent International Classification of Diseases Categories, 2006-2009 | Effective Health Care (EHC) Program
   effectivehealthcare-admin.ahrq.gov/products/icd-categories-prevalence-reimbursement/research
   December 01, 2019 - Inpatient Claims Pneumonia (Organism Unspecified) as a Principal Diagnosis on All Claims and on Skilled … Claims and on Inpatient Claims Osteoarthrosis and Allied Disorders as a Principal Diagnosis on All … Claims and on Carrier Claims Care Involving Use of Rehabilitation Procedures as a Principal Diagnosis … on All Claims and on Skilled Nursing Facility Claims Tables Beneficiary and Claim Counts, by File … Home Health Claims. Select for Excel File (2.8 MB), or PDF (7.0 MB). Hospice Claims.

5. Icd-Categories-Prevalence-Reimbursement Research (pdf file)
   effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/icd-categories-prevalence-reimbursement_research.pdf
   January 01, 2011 - In 2009, nearly 14.7 million inpatient claims were submit- ted to Medicare. … claims (as identified via the Carrier file) were submitted. … Medicare Part C claims were not considered. … DEFINITIONS AND METHODS Determination of Counts of Beneficiaries and Claims For each study year, claims … Claims were further stratified by the setting from which they arose.

6. Treatment of Dementia Among Community-Dwelling and Institutionalized Medicare Beneficiaries | Effective Health Care (EHC) Program
   effectivehealthcare-admin.ahrq.gov/products/dementia-databases-methods/research
   January 01, 2020 - Measurements: ADRD was identified by ICD-9 codes in Medicare claims and self/proxy reports. … This information is augmented with data from Medicare administrative files and paid claims for Part A … Medicare claims included both Part A and B claims, and any diagnosis (not just primary) of ADRD was counted … In LTC facilities claims miss 19% while medical record/MDS reports miss 27% of ADRD cases. … The accuracy of medicare claims data in identifying Alzheimer's disease.

7. S58 (pdf file)
   effectivehealthcare-admin.ahrq.gov/sites/default/files/s58.pdf
   October 01, 2007 - Although claims files in some states include “pseudo- claims” for services to capitated beneficiaries … An algorithm using nonpharmacy claims produced 88% sensitivity; adding phar- macy claims produced 95% … Challenges and Best Practices in Working With Medicaid Claims Data Challenges Best Practices Claims … and Medicaid claims for non-Medicare-covered services. … Accuracy of diagnoses of schizophrenia in Medicaid claims.

8. Clinical-Care-Rapid-Review-Appendix-C (xls file)
   effectivehealthcare-admin.ahrq.gov/sites/default/files/related_files/clinical-care-rapid-review-appendix-c.xlsx
   January 01, 2018 - A claims management committee would ultimately review all claims and advise on settling or going to trial … A claims management committee would ultimately review all claims and advise on settling or going to trial … a service recovery offer being accepted without a release of claims. … a service recovery offer being accepted without a release of claims. … a service recovery offer being accepted without a release of claims.

9. Radiotherapy-Proton-Beam Research (pdf file)
   effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/radiotherapy-proton-beam_research.pdf
   May 01, 2012 - Denied claims were excluded from the analysis. … **Reimbursement is calculated for all claims in each year. … analysis of denied claims proved difficult. … Most commonly, claims were denied for being submitted multiple times. … Denied claims accounted for 5 percent of the claims submitted in each year.

10. Adaptation of Data Mining Algorithms Assessing the Comparative Effectiveness and Safety of NSAIDs | Effective Health Care (EHC) Program
    effectivehealthcare-admin.ahrq.gov/products/nsaids-safety-data-mining/research
    November 01, 2017 - Adaptation of Bayesian Data Mining Algorithms to Longitudinal Claims Data: Coxib Safety as an Example … Their adaptation for use with longitudinal data such as administrative claims has not been previously … empirical Bayes Multi-item Gamma Poisson Shrinkage (MGPS) algorithm to longitudinal administrative claims … Further work will be needed to extend these findings to different types of drug exposures and to other claims

11. Diabetes-Drugs-Utilization Research (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/diabetes-drugs-utilization_research.pdf
    March 01, 2011 - rosiglitazone.11 A recent study showed up to a 54 percent decrease in rosiglit- azone prescription claims … Beneficiaries with prescription claims for sulfonylureas also frequently had prescription claims for … A pronounced reduction in claims occurred from 2007 to 2009, likely driven by highly publicized concerns … Claims for meglitinides decreased from 2006-2009 (3 percent to 2 percent). … Similarly, claims for alpha-gluco- sidase inhibitors decreased from 0.6 percent to 0.4 percent.

12. Distributed Ambulatory Research in Therapeutics Network (DARTNet): Informing Practice and Improving Depression Care | Effective Health Care (EHC) Program
    effectivehealthcare-admin.ahrq.gov/products/depression-care-distributed-networks/abstract
    December 01, 2019 - Access additional data including medication fulfillment data, diagnostic data, claims and point-of-care … This will be conducted in three phases: Phase 1: Claims Database Study Utilization - Conduct population-based … cohort studies of new episodes of major depression using commercially available national claims data … Depression – Compare the responsiveness and remission rates for major depression treatments, beginning with claims-based … Phase 2: DARTNet EHR Database Study The second phase will compare the findings of the claims database

13. Disposition of Comments_Technical Brief No. 44: Measuring Primary Healthcare Spending (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/related_files/primary-healthcare-spending-disposition-comments.pdf
    May 17, 2024 - Recommend deleting “Some non-claims payments are referred to as Alternative Payment Models. … an analysis of dummy claims as part of the method for estimating non-claims spending; that is, I believe … to assign a dollar value to those dummy claims based on the RVU of the dummy claim. … I believe MA also may include this method for its non-claims estimates. … and non-claims data.

14. Diabetes-Foot-Ulcer-Amputation-Economics Research (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/diabetes-foot-ulcer-amputation-economics_research.pdf
    January 01, 2011 - In this population, all Part D claims in the given year with a National Drug Code (NDC) corresponding … antidiabetic (results online only), anti-infective (results online only), or all medication drug claims … the ingredient cost, dispensing fee, sales tax, and vaccine administration fee across all Part D claims … pay, other true out-of-pocket amount, and low-income cost-sharing subsidy amount across all Part D claims … For selected services on skilled nursing facility (SNF) claims, the total claim reimbursement was simply

15. Treatment of Dementia Among Community-Dwelling and Institutionalized Medicare Beneficiaries (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/dementia-databases-methods_research.pdf
    May 01, 2008 - Measurements: ADRD was identified by ICD-9 codes in Medicare claims and self/proxy reports. … This information is augmented with data from Medicare administrative files and paid claims for Part … Medicare claims included both Part A and B claims, and any diagnosis (not just primary) of ADRD was … In LTC facilities claims miss 19% while medical record/MDS reports miss 27% of ADRD cases. … The accuracy of medicare claims data in identifying Alzheimer's disease.

16. Cancer-Drugs-Utilization-Cost Research (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/cancer-drugs-utilization-cost_research.pdf
    January 01, 2011 - Counts of beneficiaries with anticancer biologic claims, by active ingredient, can be found online ( … Expenditures related to biologics billed for in other Medi- care claims files (such as the Inpatient … The Common Working File (CWF) was used to identify claims for biologics billed under Medicare Parts … Biologics were identified in Medicare Part D claims via National Drug Codes (NDCs) (codes available … Therefore, claims for panitu- mumab prior to January 1, 2007, were excluded from these analyses.

17. Testing Cancer Quality Measures for End-of-Life Care | Effective Health Care (EHC) Program
    effectivehealthcare-admin.ahrq.gov/products/cancer-end-of-life-quality-meaures/research
    January 01, 2020 - Linked Medicare claims, pharmaceutical claims, and cancer registry data from 1994 - 2003 for New Jersey … The purpose of this analysis is to further evaluate claims-based indicators of the quality of care at … Methods Data Sources Linked Medicare claims, pharmaceutical claims and cancer registry data for … Evaluating claims-based indicators of the intensity of end-of-life cancer care. … Coding accuracy of administrative drug claims in the Ontario Drug Benefit database.

18. S9 (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/s9.pdf
    October 01, 2007 - the Health Plan Management System), beneficiary enrollment files, and prescription drug event (PDE) claims-type … PDE data are claims-like records of beneficiary-specific records submitted by the Part D plans (both … Normally, these claims-like data would not be an output of a program reimbursed under a capitation-based … PDE data, in particular, theoretically provide beneficiary claims-level data that could be linked to … †According to experts, there has historically been a 5.5% decrease in prescription drug claims volume

19. PHS 398 (Rev. 9/04), Continuation Page (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/upenn-final-report-2005-certs-ce-supplement.pdf
    January 01, 2005 - Background: Probably the most important concern with using claims data for research is its validity. … Based on these and other studies, our experience suggests that in any study using claims data, with … Utilizing CMS data, investigators identified inpatient diagnoses of SCD/VA via presence of an ICD-9 claims … Presence of a claims diagnosis from the codeset was considered a positive “test” for SCD/VA. … This may be improved by focusing on primary claims diagnoses only or utilizing, as true cases, only

20. PHS 398 (Rev. 9/04), Continuation Page (pdf file)
    effectivehealthcare-admin.ahrq.gov/sites/default/files/pdf/administrative-data-validity_research.pdf
    January 01, 2007 - Background: Probably the most important concern with using claims data for research is its validity. … Based on these and other studies, our experience suggests that in any study using claims data, with … Utilizing CMS data, investigators identified inpatient diagnoses of SCD/VA via presence of an ICD-9 claims … Presence of a claims diagnosis from the codeset was considered a positive “test” for SCD/VA. … This may be improved by focusing on primary claims diagnoses only or utilizing, as true cases, only