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HCC by Stratum

Report Name
HCC by Stratum


About This Report

This report tracks progress of IVA Program by Stratum level.


Project Type

IVA


Service Type

Full Service, Clinical Only


Intended User

Manager / Technical User


Best For

Acquiring the counts of members and HCCs in each stratum category.  


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 Total RADVDE HCC Count, Total Non-RADVDE Hcc Count, Counts of Submittable, Unsubmittable, Conditional and Pending HCCs



What Information Can I Filter?

Project
Stratum Level



 What Do The Fields Mean? 

Field
Data Dictionary Definition
Total RADVDE HCCs (Original Measure: Total Radvde Hcc Count) This provides the count of unique enrollee id/CC combinations that are recognized as an EDGE provided HCC
Total Primary RADVDE HCCs(Original Measure: Primary Submittable Radvde Hcc Count ) This provides the count of unique enrollee id / CC combinations that are primary (highest hierarchy), submittable, and are recognized as an EDGE provided HCC
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
Total Primary Non RADVDE HCCs(Original Measure: Primary Submittable Non Net New Non Radvde Hcc Count) This provides the count of unique enrollee id / CC combinations that are submittable, primary (highest hierarchy), sourced from an edge provided diagnosis, and are NOT an EDGE provided HCC
Total Primary HCCs(Original Measure: Total Submittable Primary Hccs) This provides the count of unique enrollee id / CC combinations that are submittable and primary (highest hierarchy)
Percent of Primary RADVDE HCCs(Original Measure: Percent Primary Radvde Hccs) Percentage of primary submittable RADVDE HCCs over the total identified count of RADVDE HCCs
Percent Primary Net New HCCs(Original Measure Percent Primary Net New Hccs) Percentage of primary net new HCCs over the total identified count of RADVDE HCCs
Primary Non Net New Non RADVDE HCCs (Original Measure: Percent Primary Non Net New Non Radvde Hccs) Percentage of non net new non radvde HCCs over the total identified count of RADVDE HCCs
Percent Primary HCCs (Original Measure: Percent Primary Hccs) Percentage of primary HCCs over the total identified count of RADVDE HCCs
HCC by Stratum (Table)Aggregates condition category (CC) up to the stratum level, counting the statuses of individual member/cc combinations
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
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
Enrollee CountA distinct count measure of the associated data items
Primary Submittable Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are primary (highest hierarchy), submittable, and are recognized as an EDGE provided HCC
Subordinate Submittable Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are subordinate (lower hierarchy), submittable, and are recognized as an EDGE provided HCC
Submittable Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are submittable and are recognized as an EDGE provided HCC
Conditional Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are conditional (requires valid signature), not submittable, and are recognized as an EDGE provided HCC
Pending Radvde Hcc Chart Inhouse CountThis provides the count of unique enrollee id / CC combinations that are pending (have yet to be coded), not submittable nor conditional, chart received, and are recognized as an EDGE provided HCC
Pending Radvde Hcc Chart Outstanding CountThis provides the count of unique enrollee id / CC combinations that are pending (have yet to be coded), not submittable nor conditional, chart has not been received, and are recognized as an EDGE provided HCC
Pending Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are pending (have yet to be coded), not submittable nor conditional, and are recognized as an EDGE provided HCC
Unsubmittable By Pend Code Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are unsubmittable, not submittable, conditional, or pending, has a pend code associated with the chase, and are recognized as an EDGE provided HCC
Unsubmittable By Vrc Radvde Hcc CountThis provides the count of unique enrollee id /CC combinations that are unsubmittable, not submittable, conditional, or pending, has a VRC that designates an invalid diagnosis, and are recognized as an EDGE provided HCC
Unsubmittable Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are unsubmittable, not submittable, conditional, or pending, and are recognized as an EDGE provided HCC
Total Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are recognized as an EDGE provided HCC
Primary Submittable Net New Non Radvde CountThis 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
Subordinate Submittable Net New Non Radvde CountThis provides the count of unique enrollee id / CC combinations that are submittable, subordinate (lower hierarchy), not sourced from an edge provided diagnosis (new diagnosis), and are NOT an EDGE provided HCC
Submittable Net New Non Radvde CountThis provides the count of unique enrollee id / CC combinations that are submittable, not sourced from an edge provided diagnosis (new diagnosis), and are NOT an EDGE provided HCC
Primary Submittable Non Net New Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are submittable, primary (highest hierarchy), sourced from an edge provided diagnosis, and are NOT an EDGE provided HCC
Subordinate Submittable Non Net New Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are submittable, subordinate (lower hierarchy), sourced from an edge provided diagnosis, and are NOT an EDGE provided HCC
Submittable Non Net New Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are submittable, sourced from an edge provided diagnosis, and are NOT an EDGE provided HCC
Submittable Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are submittable and are NOT an EDGE provided HCC
Conditional Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are conditional (requires valid signature), not submittable, and are NOT an EDGE provided HCC
Pending Non Radvde Hcc Chart In House CountThis provides the count of unique enrollee id / CC combinations that are pending (have yet to be coded), not submittable nor conditional, chart received, and are NOT an EDGE provided HCC
Pending Non Radvde Hcc Chart Outstanding CountThis provides the count of unique enrollee id / CC combinations that are pending (have yet to be coded), not submittable nor conditional, and are NOT an EDGE provided HCC
Pending Non Radvde Hcc CountThis provides the count of unique enrollee id /CC combinations that are pending (have yet to be coded), not submittable nor conditional, and are NOT an EDGE provided HCC
Unsubmittable By Pend Code Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are unsubmittable, not submittable, conditional, or pending, has a pend code associated with the chase, and are NOT an EDGE provided HCC
Unsubmittable By Vrc Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are unsubmittable, not submittable, conditional, or pending, has a VRC that designates an invalid diagnosis, and are NOT an EDGE provided HCC
Unsubmittable Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are unsubmittable, not submittable, conditional, or pending, and are NOT an EDGE provided HCC
Total Non Radvde Hcc CountThis provides the count of unique enrollee id / CC combinations that are NOT an EDGE provided HCC
Total Submittable Primary HccsThis provides the count of unique enrollee id / CC combinations that are submittable and primary (highest hierarchy)
Total Submittable Subordinate HccsThis provides the count of unique enrollee id / CC combinations that are submittable and subordinate (lower hierarchy)
Total Submittable HccsThis provides the count of unique enrollee id / CC combinations that are submittable

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