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HCC by Enrollee ID

Report Name
HCC by Enrollee ID


About This Report

This report supplies aggregated condition category data by enrollee ID.


Project Type

IVA


Service Type

Full Service, Platform, Retrieval Only, Clinical Only


Intended User

Manager / Technical User


Best For

Obtaining enrollee level detailed HCC data



Using This Report

  • Download the report and use within Excel
  • Create pivot table to group values that aggregate the individual line items to discrete categories like Count of Substantiated/Unsubstantiated/Net New HCCs by Enrollee ID/Category Code



What Information Can I Filter?

Project 
Enrollee ID
Member ID 
Client Member ID
Stratum Level
Submission Status
HCC Position
Condition Category
Reported by EDGE



What Do The Fields Mean? 

Field
Data Dictionary Definition
Total Enrollees with Diagnoses(Original Measure: Total Members) This is a distinct count of members with valid diagnoses loaded into the database
Total Submittable EDGE HCCs(Original Measure: Submittable Radvde Hcc Count) This provides the count of unique enrollee id/CC combinations that are submittable and are recognized as an EDGE provided HCC
Total Enrollees with Condition Categories(Original Measure: Total member Count ) A distinct count of client member ids (source alias ID for a member)
Total EDGE HCCs(Original Measure: Total Edge Hccs) This is a distinct count of HCCs provided by EDGE for IVA 
Total Primary Submittable HCCs(Original Measure: Total Hccs) Distinct count of member/category codes where the condition category is considered 'primary', or the highest hierarchy available for the member
Total Primary Net New HCCs(Original Measure: Primary Submittable Net New Non Radvde Count) This provides the count of unique enrollee id/CC combinations that are submittable, primary (highest hierarchy), not sourced from an edge provided diagnosis (new diagnosis), and are NOT an EDGE provided HCC
Enrollees with EDGE HCCs(Original Measure: Total Members) This is a distinct count of members with valid diagnoses loaded into the database, filtered to members that have EDGE HCCs
Enrollees with All EDGE HCCs Validated(Original Measure: Total Members) This is a distinct count of members with valid diagnoses loaded into the database, filtered to members with all EDGE HCCs validated
Percent of Fully Validated Enrollees(Original Measure: Percent Validated) Percentage of members who have had all EDGE/RADVDE HCCs substantiated
HCC by Enrollee ID (Table)Displays the status of all known condition categories aggregated to the enrollee.
Client NameName of the Client
Project IDThe internal identifier associated with a project
Project NameThe name associated with a project
HIOSThe Health Insurance Oversight System (HIOS) identifier assigned by CMS to a given health plan
Full NameFull name of the member
Enrollee IDAdditional or alternate client-provided member ID or the government assigned identifier for a member in an IVA HIOS
Client Member IDThe client identifier associated with a member
Member IDThe internal identifier associated with a member
Member DOBThe date of birth of the member
Member GenderThe gender of a member
Category CodeNumerical identifier associated with the condition within a given condition model
Category NameThe description of a condition category
EDGE HCC FlagDetermines if a given condition category is an HCC recognized by CMS for IVA
RADVDE Risk ScoreRisk score calculated for the enrollee
Stratum LevelThe stratum indicator of the stratum in which the enrollee was included. Strata 1-9 represent low, medium and high-risk enrollees with at least one (1) HCC or (1) RXC for each age model. Stratum 10 includes enrollees with no HCCs and no RXCs. Note: Only the adult RA model includes RXCs therefore only the adult strata 1-3 will include enrollees with RXCs
All ClearA flag that indicates that all EDGE HCCs for a given member have been substantiated
Total ChasesDistinct count of chases
Total RetrievedDistinct count of chases where the reporting status name is retrieved, but excluding pended chases
Chases with Clinical PendsChases that have clinical type pends, indicating the need for additional coder review
Percent RetrievedRetrieved chase count/total chase count
CC positionProvides the highest available position for an HCC given the aggregation level
CC Submission StatusProvides the highest available submission status for an HCC given the aggregation level
Total CC SubmittableIndicates the number of non-unique diagnoses where the condition category (CC) is considered submittable based upon the diagnoses available, at the given aggregation level
Total CC ConditionalIndicates the number of non-unique diagnoses where the condition category (CC) is considered conditional, meaning it is missing valid credentials, at the given aggregation level
CCs in MRR StatusIndicates the number of non-unique diagnoses where the condition category (CC) is pending completion of coding, at the given aggregation level
CCs in Chase Collection StatusIndicates the number of non-unique diagnoses where the condition category (CC) is pending receipt of a chart, at the given aggregation level
Total CCs In ProgressIndicates the number of non-unique diagnoses where the condition category (CC) is in any pending status, at the given aggregation level
CCs Unsubmittable by Closed PendIndicates the number of non-unique diagnoses where the condition category (CC) is not submittable due to an unresolved Pend status, at the given aggregation level
CCs Unsubmittable by VRCIndicates the number of non-unique diagnoses where the condition category (CC) evaluates to a VRC that is not submittable, at the given aggregation level
Total CCs UnsubmittableIndicated the number of non-unique diagnoses where the condition category (CC) has a status of unsubmittable, at the given aggregation level
Grand Total CCsIndicates the total number of non-unique diagnoses that a condition category (CC) is related to, at the given aggregation level









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