Alright, thanks for all the feedback. There are multiple things to address, but breaking it down into responses below.
@Vojtech_Huser :
I think Christian_Reich explained the Open/Closed difference and what happens during adjudication. The main thing I’m concerned with is that I will eventually be combining data from Open claims into the same place as data from Closed claims, and I need to have a clear way for researchers to know the provenance. I’m not the best person to speak to the different use cases for Open vs Closed, I just want to make sure that people can clearly tell which data they’re looking at.
@MPhilofsky thanks for confirming that those 3 OMOP codes would be how I call out the provenance in the cost table.
“These shouldn’t be just in the COST table, but in all the clinical event tables that get populated from a claim.”
This might be what I’m missing. Can we build out an example? Lets say I have a closed claims data source (e.g., Medicaid payer data) showing that a patient had a procedure that is 100% paid for by Medicaid.
Are you saying that the record in the procedure_occurrence table would have a value of ‘OMOP4822218’ (Payer system (Primary payer) Closed Claims) in the procedure_type_concept_id field?
Also, the corresponding row in the cost table would have the exact same value of ‘OMOP4822218’ in the cost_type_concept_id field? And this cost record would have cost_event_id linking to the procedure record (or possibly both the procedure_occurrence record and the cost record link to the same visit_detail id, tbd)?
You lost me here:
“That’s not OMOP CDM. It does NOT model claims.”
I misspoke when I said “episode of care”. I’m planning on visit_occurrence being aggregated up from visit_detail similar to the discussion in the decision time for visit_detail thread and this separate comment by Gowthan_Rao. The grain for visit_occurrence will be coarser than the claim_header and we’ll use temporal association so that a visit_occurrence is bound by Admission/Discharge/Transfer.
Does that correction address your concern?