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Coordination of Benefits in CDM 6.0

(Nadya Zvyagina) #1


I am trying to use Cost table of CDM 6.0

I have the following fields in one source record - cob, coins, copay, deductible, netpayment, totalpayment,
where the following is generally true: totalpayment = cob + coins + copay + deductible + netpayment

I am mostly interested in how to convert (what will be cost_concept_id and cost_type_concept_id for):

  1. cob (coordination of benefits) - amount paid by some secondary payer
  2. netpayment - amount paid by primary payer
  3. Is it necessary to create a separate record for total payment?

Could anyone please advise?

(Gowtham Rao) #2

Cost_concept_id: concepts for copay, deductible, netpayment etc
Cost_type_concept_id: _ type_concept_id is for provenance like EHR, claims etc.

COB (primary payer, secondary payer) would be the cost_type_concept_id

Depends on your source data.

(Nadya Zvyagina) #3

Gawtham, thank you for the quick reply!
I am a bit confused about type concepts from Cost Type vocabulary because currently they mean the system the record comes from.

Have I understood you right that for cob variable I should use ‘Payer system (Secondary payer)’ type concept despite the fact that the source record resides in Primary payer system?

(Gowtham Rao) #4

Both of these type concepts represent provenance of data. If the payer system is primary, i would use primary payer; otherwise secondary payer


(Nadya Zvyagina) #5

Both these variables (cob and netpayment) reside in the system of primary payer. But if I use Primary both for cob and netpayment then will it be possible to distinguish them after the conversion? They both will be represented as ‘Paid’ concept_id + ‘Payer system (primary payer)’ type_concept_id. I am a bit confused here.

(Gowtham Rao) #6

@nzvyagina if you have two payers for a single visit record, one is primary and second is secondary - you can distinguish the records originating from those two different payer systems using the data provenance field cost.cost_type_concept_id (as discussed above).

For each of the payers, you can differentiate the various types of financial transactions (paid, allowed, charged etc) using cost.cost_concept_id field.

(Nadya Zvyagina) #7

Gowtham, thank you very much! It is getting clearer now!