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 Name | Name of the Client |
| Project ID | The internal identifier associated with a project |
| Project Name | The name associated with a project |
| HIOS | The Health Insurance Oversight System (HIOS) identifier assigned by CMS to a given health plan |
| Full Name | Full name of the member |
| Enrollee ID | Additional or alternate client-provided member ID or the government assigned identifier for a member in an IVA HIOS |
| Client Member ID | The client identifier associated with a member |
| Member ID | The internal identifier associated with a member |
| Member DOB | The date of birth of the member |
| Member Gender | The gender of a member |
| Category Code | Numerical identifier associated with the condition within a given condition model |
| Category Name | The description of a condition category |
| EDGE HCC Flag | Determines if a given condition category is an HCC recognized by CMS for IVA |
| RADVDE Risk Score | Risk score calculated for the enrollee |
| Stratum Level | The 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 Clear | A flag that indicates that all EDGE HCCs for a given member have been substantiated |
| Total Chases | Distinct count of chases |
| Total Retrieved | Distinct count of chases where the reporting status name is retrieved, but excluding pended chases |
| Chases with Clinical Pends | Chases that have clinical type pends, indicating the need for additional coder review |
| Percent Retrieved | Retrieved chase count/total chase count |
| CC position | Provides the highest available position for an HCC given the aggregation level |
| CC Submission Status | Provides the highest available submission status for an HCC given the aggregation level |
| Total CC Submittable | Indicates 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 Conditional | Indicates 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 Status | Indicates 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 Status | Indicates 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 Progress | Indicates 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 Pend | Indicates 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 VRC | Indicates 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 Unsubmittable | Indicated the number of non-unique diagnoses where the condition category (CC) has a status of unsubmittable, at the given aggregation level |
| Grand Total CCs | Indicates the total number of non-unique diagnoses that a condition category (CC) is related to, at the given aggregation level |