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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-p-fac-notes.htmlMay 01, 2017 - We'll talk at the end a little bit about tips that we can use to evaluate these manufacturer claims that … are presented to you and how we can objectively use the claims that the manufacturers are making in … Those are additional claims that manufacturers can make that limit the intended scope of their product … Slide 9: Evaluating Manufacturer Claims When we're looking at these manufacturer claims, we know … We also might be thinking about the manufacturer claims related to the particular product as it relates
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm3a.htmlOctober 01, 2014 - When using claims data to identify potential members, States should ensure that they have the necessary … means to run the claims data internally or that their vendor employs the necessary staff. … Claims and encounter data, including inappropriate emergency room (ER) utilization. … State staff can develop a stratification methodology relying on claims and demographic data. … in a particular year to forecast total claims paid in the following year.
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Prospectscare (pdf file)
www.ahrq.gov/sites/default/files/publications/files/prospectscare.pdfJune 01, 2012 - , HIE* (if includes claims data) or payer files Use claims data to examine instances of redundant … All-Payer Claims Databases (APCD) –Large-scale databases that systematically collect health care claims … data (medical claims, pharmacy claims, eligibility files, provider files, and dental claims) from a … Using Claims Data for Measurement Panelists suggested several ways in which claims data, particularly … , pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from -
www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Data-Elements-2023Dec.pdfDecember 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
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Codebook.pdfDecember 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
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www.ahrq.gov/patient-safety/capacity/candor/demo-program/plan-grants/summary.htmlMay 01, 2016 - clinical safety interventions; and (3) exploring resolution methods as a means to divert potential 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
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Measures: Availability of Outpatient Maternal Fetal Medicine and Special Care for Women .... (pdf file)
www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_1415-p009-1-ef.pdfMarch 01, 2015 - Administrative claims data, supplemented by medical records (paper or electronic) for mother’s race … Administrative claims data, supplemented by medical records (paper or electronic) for mother’s race … to implement, as the data elements required are available and easy to abstract from administrative claims … Measure Testing ● The measure developer tested the reliability of administrative claims data by identifying … detailed analysis with the New York Department of Health using New York State Medicaid data to identify claims -
www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/rust_r24grant.pdfSeptember 01, 2013 - Create a dataset that links Medicaid claims data with socio- economic, contextual, and healthcare and … Data Sources 2004–2007 Medicaid Analytic Extract claims data files for 14 southern States Medicare-linked … claims data for dual-eligible beneficiaries Health Resources and Services Administration Area Resource … Research Infrastructure (Continued) Pilot Study This pilot study used the multi-state Medicaid claims
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Data-Dictionary-Contents-2024mar.csvApril 01, 2024 - Data Dictionary Contents This SyH-DR Data Dictionary is a catalog of all variables in the SyH-DR claims … Files Person-Level Variables Commercial Person-Level, Medicaid Person-Level, Medicare Person-Level Claims-Level
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/implementation-guide/appendix-p-transcript.docxApril 13, 2017 - We'll talk at the end a little bit about tips that we can use to evaluate these manufacturer claims that … are presented to you and how we can objectively use the claims that the manufacturers are making in … Those are additional claims that manufacturers can make that limit the intended scope of their product … , where they intend it to be used.2 (Slide 9) When we're looking at these manufacturer claims, … We also might be thinking about the manufacturer claims related to the particular product as it relates
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-144-section-2.pdfJanuary 01, 2020 - Children with Disabilities Algorithm (CWDA) A Claims-Based Tool for Identifying Children with Disabilities … &indata out=claims;by &sid &claimid; run; data claims(keep=&sid &claimid cwda3_gt75); set … claims(keep=&sid &claimid &icdvar.1-&icdvar. … &claimid then output; run; proc sort data=claims; by &sid; data out. … &outdata(keep=&sid cwda); set claims; by &sid; retain cwda3_gt75_sum; if first.
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www.ahrq.gov/data/apcd/envscan/conclusion.htmlJune 01, 2017 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices … and Evidence Conclusion Previous Page Next Page Table of Contents All-Payer Claims
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/cantor_r24grant.pdfSeptember 01, 2013 - infrastructure for conducting comparative effectiveness research (CER) using Medicaid and charity care claims … Build a sustainable longitudinal database of hospital, Medicaid, and charity care claims and encounter … innovations for medically complex, low-income patients in New Jersey Data Sources New Jersey Medicaid claims … /encounter data, charity care claims data, all-payer hospital billing data, and mortality data.
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www.ahrq.gov/news/blog/ahrqviews/maternal-health-indicators.htmlOctober 01, 2024 - improvement strategies and conduct epidemiological or research studies using administrative (billing or claims … researchers, professional organizations, and others—provided valuable insights about how to improve a claims-based … to construct area-level measures of severe maternal morbidity using readily available administrative claims
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www.ahrq.gov/research/findings/studies/index.html?page=306January 01, 2024 - The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data … In this article, the investigators discuss the validation of MVC's claims-based algorithm. … They indicate that their findings suggest that the MVC claims-based algorithm identifies and classifies … Validation of a claims-based algorithm to characterize episodes of care. … Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
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Pediatric Medical Complexity Algorithm (pdf file)
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-141-fullreport.pdfJuly 01, 2017 - Administrative data (e.g., claims data). … SCH data included administrative claims from inpatient, ED, and day surgery encounters. … WA-Medicaid data included all inpatient and outpatient claims provided to the state. … SCH data included administrative claims from inpatient, ED, and day surgery encounters. … WA-Medicaid data included all inpatient and outpatient claims provided to the State. -
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0198-fullreport.pdfNovember 01, 2019 - This measure uses medical record data after administrative claims data are used to identify the eligible … Administrative data (e.g., claims data); paper medical record; electronic medical record. … This measure uses medical record data after administrative claims are used to identify the eligible … The HIRD includes automated computerized claims data and enrollment information for approximately 60 … Some denominator exclusions cannot be reliably identified using administrative claims.
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CHIPRA 194: Overuse of Imaging for the Evaluation of Children With Primary Headache Report (pdf file)
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-fullreport.pdfApril 01, 2019 - This measure uses administrative claims data to identify the eligible population for medical record … Administrative data (e.g., claims data); paper medical record; electronic medical record. … The HIRD includes automated computerized claims data and enrollment information for approximately 60 … Specifically for this measure, administrative claims were used to determine the number of children 4 … Children with codes associated with these claims-based exclusions were removed from the chart review -
Section 12, Tables 4 and 5. (pdf file)
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-141-section-12-table-4-5.pdfDecember 31, 2010 - 51,851 (6%) 134,764 (16%) 608,966 (74%) 33,431 (4%) * we had demographic data for 679 children and claims … data for 678, resulting in different n for the text and table † we used 3 years of claims data from … specificity for COMBO and PMCA in managed care and fee-for-service subsets of Washington State Medicaid claims -
www.ahrq.gov/patient-safety/settings/hospital/candor/modules/worksheet2.htmlAugust 01, 2022 - Analyze the organization's frequency of adverse events and malpractice claims to support the rationale … Number of claims asserted. … Number of law suits filed compared to the claims settled or dismissed for < $500. … calculate the projected costs of harm events in terms of reimbursement loss, penalties, risk management claims
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