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Concept for payer in Payer_Plan_Period where type of plan is undefined


#1

Hello!

This assumption is about payer concept populating in Payer_Plan_Period table depending from the type of plan value (planType) on Detail Enrollment table for MarketScan Databases, Commercial Claims and Encounters dataset (CCAE).

We populate payer_concept_id for Сommersial Claims and Encounters dataset in the following way:
payer_concept_id = 412 where type of plan is ‘EPO’,
payer_concept_id = 329 where type of plan is ‘HMO’,
payer_concept_id = 331 where type of plan is ‘POS’ or ‘POS with capitation’,
payer_concept_id = 330 where type of plan is ‘PPO’,
payer_concept_id = 0 otherwise including where type of plan is empty.

Wouldn’t it be better to put 327 (“Private Health Insurance” the parent of commercial claims) into payer_concept_id instead of 0 where no information about payer?
And what about 328 (“Private Health Insurance - Managed Care”) concept?

Could you please advise which concept is better to put (0, 327 or maybe another) if the plan type is empty or not defined with respect to the payer but the type of dataset is Commercial Claims and Encounters.

Thanks in advance!
@Christian_Reich @MPhilofsky @Dymshyts @Gowtham_Rao


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