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How can we identify cost records with capitation in the Truven data?

Implementers
#1

There is a filed “CAP_SVC” in Truven F, S, O, D tables to indicate whether the individual service or claim was paid on a capitated basis. Per OMOP mapping spec for Truven CCAE MDCR, we use both ENROLLMENT_DETAIL’s DATATYP (i.e. DATATYP=2, 4 for identifying capitated plan) and PLANTYP (e.g. HMO, PPO, etc.) to define PAYER_PLAN_PERIOD.PAYER_SOURCE_VALUE. Can we say if the first character of PAYER_SOURCE_VALUE is “C” the service was paid by the plan on a capitated basis?

#2

@marziGolbaz:

We generally don’t allow micro-coding of information into existing fields. The payer_source_value should contain the name of the Payer. If anything, you want to do this initial C thing in the plan_source_value.

Instead of doing that, I think you have two choices:

  • The information goes into the COST table. You could request a new field for the amount of capitation
  • You create extra non-CDM fields (or maybe even a table) that provides more details for the plan.

Do you currently use the CAP_SVC flag for any use case? Which one?

t