Differentiating administrative claims data

[Gowtham_Rao]

Administrative claims data is mostly of two types -

1. The HCFA 1500 claims/Professional services claims
2. The UB04 claims/Facility or institutional services claims

Is there anyway standard concept id that we could use. If not, could we add this as a concept id entry into vocabulary as a “OMOP generated”?

Use case: this is important for many health economics analysis, where the costs of professional and facility components need to be analyzed separately for variations in costs.

@jenniferduryea – i know, you know the answer or know of someone who have experienced this before.

[Gowtham_Rao]

@Christian_Reich

Request to add few new concepts to vocabulary.

Justification - will help meet the needs to classify between Professional claims and Facility claims as described above. This is very important for many quality measure calculations such as HEDIS.

@Christian_Reich also if we could get a hierarchy (parent-child) from

Parent: 44818517 OMOP generated Visit derived from encounter on claim

To Child - above

Thank you

[jenniferduryea (Jen Duryea)]

Hello my fellow claims enthusiast, @Gowtham_Rao, I’m not sure I know THE answer, but I can tell you what we have done to identify professional vs. facility claims for our internal use. We actually identify them at the condition/procedure level using type_concept_ids. When mapping ICD/CPT/HCPCS codes, from facility claims, we use the “inpatient header”, “inpatient detail”, “outpatient header”, and “outpatient detail” type_concept_ids (or ranges 38000184-38000244, 44818709-44818713 for condition_type_concept_ids). When mapping ICD/CPT/HCPCS codes from a physician claim, we use “carrier header” or “carrier detail” type_concept_ids (45756835-45756855 range for condition_type_concept_ids).

Since OHDSI’s standard for creating a visit record (i.e. from the patient’s perspective) could combine multiple types of claims (both professional and facility) into one visit_occurrence_id, we found it was best to identify facility vs. professional claim information at the condition/procedure level.

Your proposal for new visit_types are interesting and I love the idea. But it is a big departure from OHDSI’s original definition of a visit_occurrence (i.e. a visit a patient experienced - regardless of the number of procedures, claims, drugs that happened at that visit). This proposal is more in line with what we are doing internally, but we might want to see how the rest of the community feels about changing the definition of a visit (going from a patient experience to a claims-based account).

[Gowtham_Rao]

When mapping ICD/CPT/HCPCS codes, from facility claims, we use the “inpatient header”, “inpatient detail”, “outpatient header”, and “outpatient detail” type_concept_ids (or ranges 38000184-38000244, 44818709-44818713 for condition_type_concept_ids). When mapping ICD/CPT/HCPCS codes from a physician claim, we use “carrier header” or “carrier detail” type_concept_ids (45756835-45756855 range for condition_type_concept_ids).

That workaround of using ‘Condition Type Concept Id’ instead of ‘Visit Type Concept Id’ seems possible, but it still does not truly solve what we want to represent. This is important for the use case of quality measures. The representation of UB04 facility claims and HCFA 1500 has to be explicit, or else our use-case will fail. Trying to avoid extensions to the vocabulary.