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221. Planning and Implementing the Patient Advocacy Reporting System in the Sanford Health System | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/liability/pichert.html
     August 01, 2017 - ROI evaluation compared SHS’s pre- and post‑PARS intervention paid claims and claims-related expenses … Rethinking peer review: detecting and addressing medical malpractice claims risk. … Identifying and addressing physicians at high risk for medical malpractice claims. … Medical malpractice claims risk in urology: an empirical analysis of patient complaint data. … All trauma surgeons are not created equal: Asymmetric distribution of malpractice claims risk.

222. Planning and Implementing the Patient Advocacy Reporting System in the Sanford Health System | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/pichert.html
     August 01, 2017 - ROI evaluation compared SHS’s pre- and post‑PARS intervention paid claims and claims-related expenses … Rethinking peer review: detecting and addressing medical malpractice claims risk. … Identifying and addressing physicians at high risk for medical malpractice claims. … Medical malpractice claims risk in urology: an empirical analysis of patient complaint data. … All trauma surgeons are not created equal: Asymmetric distribution of malpractice claims risk.

223. What Happens After a Patient Safety Event? Medical Expenditures and Outcomes in Medicare (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Encinosa.pdf
     January 01, 2003 - Methods: We used inpatient, outpatient, and drug claims data for elderly Medicare enrollees with secondary … This paper is organized as follows: We introduce the employer claims data and discuss our use of the … We included all medical claims incurred within 90 days after the surgery admission date. … This is in contrast to the Utah-Colorado study, where malpractice claims adjustors proposed that 46 … The strength of our study is that we used actual insurance claims (transacted payments) to calculate

224. Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/studies/index.html?page=285
     January 01, 2024 - with SCA between 3 months and 5 years old were identified by the presence of three or more Medicaid claims … Receipt of antibiotics was identified through claims for filled prescriptions. … This study sought to determine the agreement of the primary care physician (PCP) identified by claims … Can claims data algorithms identify the physician of record? … Prevalence was estimated using claims, structured EHRs, and unstructured EHRs.

225. Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/studies/index.html?page=253
     January 01, 2024 - The authors suggest that risk prediction models that include frailty as identified in claims data can … Impact of a claims-based frailty indicator on the prediction of long-term mortality after transcatheter … They analyzed the performance of 8 claims-based algorithms that were used and selected 3 of them to apply … National trends in active surveillance for prostate cancer: validation of medicare claims-based algorithms … Postoperative ketorolac in breast and body contouring procedures: a nationwide claims analysis.

226. Memo from the Director: Equal Employment Opportunity and EEO Complaints Process (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policy/eeo/eeo-complaints-process-memo-0224.pdf
     March 27, 2023 - The official who receives such harassment claims will ensure the confidentiality of the individual making … the claims to the greatest extent possible. … This includes complainants, witnesses, and others who provide information concerning such claims.

227. The Effects of Out-of-Pocket Costs on Enrollees' Experiences With Health Plans: Implications for Consumer Reporting (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/podcasts/effects-costs-enrollees-vonglahn-20120101-transcript.pdf
     January 23, 2012 - CAHPS survey that we think of as sort of the health plan-centric items: the customer service, the claims … If I’m that person in the CAHPS survey that passes through the question, “did you have a claims experience … I had that claims experience, I had that customer service experience, I had that experience of looking … That it’s important to understand that people who are having these experiences of paying claims and … the influence of these less favorable experiences when I have an exchange with my health plan about claims

228. Approaches to Address Health Risks for Older Adults
     www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/about/ncepcr-older-adults-presentation.pptx
     March 15, 2025 - population often sees multiple specialists of different types) Uses highly fragmented care (measured in claims … participants), 2006-2021 HRS survey Pain status 8-CESD depression Physical functioning Medicare claims … information on OUD/OD diagnosis and use of prescription opioids and adjuvant analgesics from Medicare claims … 3,4 Inpatient claim with an opioid dependence code (304.0x, 304.7x, F11.2, F11.9), or ≥2 outpatient claims … dependence along with an inpatient or residential rehabilitation or detoxification care* 42 * requiring 2 claims

229. Final Progress Report: Communication to Prevent and Respond to Medical Injuries: WA State Collaborative (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/gallagher1-report.pdf
     January 01, 2024 - Claims/Compensation A key aim of the HealthPact project was to develop and evaluate a collaborative … Risk and claims managers received training in how to collect data for the evaluation via a webinar. … Risk and claims managers preferred to learn from initial experimentation by others. … • Risk managers’ and claims managers’ heavy workloads. … Claims/Compensation VII.Products and Publication

230. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module7/module7-resolution-facilitator.pptx
     August 24, 2015 - Module 7 5 It is important that clinical practitioners, risk management/claims, and financial and legal … resolution, as appropriate. 5 CANDOR Resolution Team Resources Internal (hospital or system level) Clinical Claims … For the internal organizational resources, clinical, claims/finance, and legal personnel must be coordinated … Staff who need to participate, coordinate, and align among internal groups include: Insurance/Claims

231. SyH-DR Known Data Issue: Primary Diagnosis Imputed Flag (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Primary-Diagnosis-Imputed-Flag-January2024.pdf
     January 01, 2024 - SyH-DR Known Data Issue: Primary Diagnosis Imputed Flag AHRQ Publication No. 24-0031-2-EF January 2024 Synthetic Healthcare Data for Research (SyH-DR) Known Data Issue: Primary Diagnosis Imputed Flag If you downloaded the SyH-DR data files before January 2024, the variable Primary Diagnosis Code (ICD-10) Impute…

232. Pediatric Lower Respiratory Infection Readmission Measure (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-131-fullreport.pdf
     April 05, 2017 - Administrative data (e.g., claims data). … We developed and tested the measure using multiple claims datasets. … The measure uses pediatric inpatient claims data. … Yes; hospital claims datasets are widely available. … Use of Claims Data to Measure Readmissions We developed our candidate measure to use inpatient claims

233. The Impact of Consolidation and Ownership on Primary Care - Slide Presentation (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/webinars/consolidation-ownership-slides.pdf
     April 03, 2025 - Mathematica’s four methods ► TIN affiliation with system (HCOS) ► Physician billing to a system (Medicare claims … practice 28 Changes in Primary Care Delivery: Analysis • Identified universe of PC visits in 20% claims … Link to Medicare claims (100% A, B, D, and carrier files) and Medicare Advantage Encounter files (carrier … practices over study period to build longitudinal cohort of affiliated clinicians Link to Medicare claims … 54 Primary Care in Virginia National Plan and Provider Enumeration System (NPPES) and All Payer Claims

234. | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/publications/search.html?page=5
     October 01, 2017 - Publication Date: October 2017 Publication Number: 18-0003-EF All-Payer Claims … AHRQ is undertaking activities to develop an effective and feasible approach for using all-payer claims

235. National Evaluation of the CHIPRA Quality Demonstration Program: Evaluation Highlight No.1 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/highlight01.pdf
     September 30, 2015 - • Outdated or underdeveloped claims systems, health information exchanges, and electronic health … Strategies range from producing practice-level reports from claims data to helping practices calculate … Carolina is reporting measures from claims data (in addition to other sources, such as immunization … Claims do not contain information about which providers work together, making it difficult to develop … Measures relying on data available in existing systems, such as immunization registries and claims

236. Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/studies/index.html?page=319
     January 01, 2024 - Costs, Behavioral Health Berry SD , Zullo AR , McConeghy K Defining hip fracture with claims … data: outpatient and provider claims matter. … The authors of this study found that a definition using inpatient claims identified fewer fractures than … a definition including outpatient and provider claims. … Defining hip fracture with claims data: outpatient and provider claims matter.

237. Develop Your Own? | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/develop/index.html
     June 01, 2020 - Encounter and claims data are examples of administrative data. … Data—Very Carefully Encounter and claims data are varieties of administrative data. … Some States use encounter or claims data as the basis for the calculation of Health Plan Employer Data … Claims data are likely to be complete for those services or procedures that are individually reimbursed … Some States have made significant investments in cleaning claims or encounter data to ensure accuracy

238. Metabolic Screening for Children and Adolescents Newly on Antipsychotics (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-149-fullreport.pdf
     February 01, 2019 - Administrative data (e.g., claims data). … • 2011 claims data from two MEDNET States. • 2012 claims data from one MEDNET State. … • 2009 claims data from 17 New York State Medicaid health plans. … • 2013 claims data from 73 commercial health plans nationwide. … This measure has been specified and tested in claims data only.

239. Publications and Additional Materials | Agency for Healthcare Research and Quality
     www.ahrq.gov/pqmp/publications/search.html?page=3
     September 01, 2014 - Keywords: Quality measure, Electronic health records Using Medicaid and CHIP Claims Data to Support … Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers … Keywords: Antipsychotics Identifying Sickle Cell Disease Cases Using Administrative Claims Center … Identifying sickle cell disease cases using administrative claims.

240. Overuse of Imaging for the Evaluation of Children with Simple Febrile Seizure: Final Report (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-192-fullreport.pdf
     November 01, 2019 - This measure uses medical record data after administrative claims data are used to identify the eligible … Denominator Exclusions Exclusions based on ICD-9-CM codes captured in administrative claims data: … 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 … Some denominator exclusions cannot reliably be identified using administrative claims.