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IVA Diagnosis Data

Report Name
IVA Diagnosis Data


About This Report

This report offers all relevant Risk data for IVA projects to determine the status of members, chases, condition categories (CC), and diagnosis codes.


Project Type

IVA


Service Type

Full Service, Clinical Only


Intended User

Manager / Technical User


Best For

Receiving the detailed data of every enrollee in an issuer sample.


Using This Report

  • Download the report and use within Excel
  • Identify all the Chase IDs associated with an enrollee, the submission statuses of different condition categories for an enrollee, etc. 
  • Create pivot table to group values that aggregate the individual line items to discrete categories


What Information Can I Filter?

Project
Measure
Enrollee ID
Member ID
Client Member ID
Claim ID
Chase ID
Stratum Level
Condition Category
Chase Status
Reported By EDGE



 What Do The Fields Mean? 

FieldData Dictionary Definition
Total EDGE HCCs(Original Measure: Total Edge Hccs) This is a distinct count of HCCs provided by EDGE for IVA
Total Chases(Original Measure: Total Chases) Total number of IVA Chases for the project
Total Chases Retrieved(Original Measure: Total Chases) Number of IVA Chases, in Workflow Status 'Chart QA' or later
Total Chases in Clinical Workflow Stages(Original Measure: Clinical Total Chases) Number of IVA chases that are currently in a Clinical Workflow Stage ('Abstraction', 'Overread', or 'Overread2')
Total Enrollees with Diagnoses(Original Measures: Total Members) This is a distinct count of members with valid diagnoses loaded into the database
Total Condition Categories(Original Measure: Total Condition Categories) This is a distinct count of condition categories without hierarchy, whether substantiated or not
Total Unique RA Diagnoses(Original Measure: Total Risk Adjustment Diagnoses) This is a unique count of diagnoses that map to a condition category
Total Unique RA Submittable Diagnoses(Original Measure: Total RA Submittable Unique Diagnoses) This is a count of unique diagnoses by member that are considered risk adjustment (RA) submittable, meaning it is coded, validated, not pended, has a signature, and is associated with an HCC.
IVA Diagnosis Data (Table)Provides all relevant risk data for IVA projects to determine the status of members, chases, condition categories (CC), and diagnosis codes.
HIOSThe Health Insurance Oversight System (HIOS) identifier assigned by CMS to a given health plan
Project IDThe internal identifier associated with a project
Project NameThe name associated with a project
Client IDThe internal identifier associated with a client
Client NameThe name of a client
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 IDGovernment supplied identifier for a member, IVA only
Member IDThe internal identifier associated with a member
Full NameThe first and last name associated with a member
Client Member IDThe client identifier associated with a member
Date of BirthThe date of birth of the member
GenderThe gender of a member
Chase IDThe internal identifier associated with a chase
Sample Source Alias IDThe internal identifier associated with a client
Client Chase KeyThe identifier provided by the client for a chase
MeasureDetermines the type of an associated chase, which indicates what the coder is seeking to validate
Parent Chase IDThe chaseID of the original chase that spawned the (non-parent) chaseID associated
Parent Client Chase KeyThe identifier provided by the client for a chase
Parent Measure CodeDetermines the type of an associated parent chase, which indicates what the coder is seeking to validate in the original chase
Last Process StepThe current workflow state of a given chase
Current Chase StatusThe current status of a chase
Pend CodeAn internal identifier for the various reasons that a chase may be pended, awaiting further action/or info to collect or code a medical record
Pend Code DescriptionDescription of a pend code
Pend Status IDAn internal identifier indicating the status of a given pend code
Pend Status NameDescription of a pend status ID
AIDInternal Address Identifier (AID) associated with a chase address that has been cleaned/combined and added to the master document source table
Document Source Alias IDData loaded (client provided) identifier for a chase location
Group NameThe name associated with an AID if available
Address GroupingData loaded grouper to associate various address IDs into client-desired groups
Address1First line of a master chase (AID) address
Address2Second line of a master chase (AID) address
CityThe city of a master chase (AID) address
StateThe state associated with a master chase (AID) address
Postal CodeThe zip code associated with a master chase (AID) address
Encounter Entity IDThe internal identifier assigned to an entity or associated data item recorded with a chase
Claim IDThe claim identifier provided at data load
Start DateThe start date associated with the time frame of the entire encounter
End DateThe end date associated with the time frame of the entire encounter
Enc Source Type NameIdentifies whether the associated diagnosis code was part of the data load (Client) or added by a Coder
Enc Acceptable SignatureIndicates whether there is an acceptable signature associated with a chase
Signature DeficiencyIndicates that a VRC 51 is associated with the relevant diagnosis code, which means that there is no valid signature associated with the medical record
Encounter FoundIndicates whether the coder found the data load encounter in the medical chart
Encounter Face to FaceIndicates whether the encounter reviewed qualifies as a face to face visit
Encounter Service Provider NameFull name for the encounter provider
Enc Service Provider Source Alias IDData load identifier for the encounter provider
Source Type NameIdentifies whether the associated diagnosis code was part of the data load (Client) or added by a Coder
Diag Start DateThe start date associated with the time frame of the diagnosis
Diag End DateThe end date associated with the time frame of the diagnosis
Diag Entity IDThe internal identifier assigned to an entity or associated data item recorded with a chase
ICD CodeDiagnosis code- international classification of diseases (ICD)
Validation Reason CodeThe reason provided by the coder as to whether or not the diagnosis code is represented within the medical chart
Diag Service Provider NameFull name for the diagnosing provider
Service Provider NPINational Provider Identifier (NPI) for the diagnosing provider
Service Provider Source Alias IDData load identifier for the diagnosing provider
Service Provider SpecialtyThe specialty of the diagnosing provider
Diagnosis Submit ResultIndicates whether the diagnosis is valid given the circumstances of the associated chase: if the chase has an active pend, or the diagnosis code has a VRC that is not '00', '103', '105', then unsubmittable if the diagnosis code has no matching condition category (CC), has an acceptable VRC, and an acceptable signature then NON-RA submittable if the diagnosis code has a matching condition category (CC), has an acceptable VRC, and an acceptable signature then RA submittable if the diagnosis code has no matching condition category (CC), has an acceptable VRC, and has no acceptable signature then NON-RA conditional if the diagnosis code has a matching condition category (CC), has an acceptable VRC, and has no acceptable signature then RA conditional if the diagnosis code is not acceptable, then unsubmittable and if the diagnosis code does not fall into a category above, then pending
Diagnosis ValidatedThis determines if the diagnosis code was coded and supported within the chart
Model IDInternal identification number assigned to each condition model loaded into the database
Model NameThe official name of the model software/tables loaded to represent the model
Condition CategoryNumerical identifier associated with the condition within a given condition model, a.k.a condition code
CC DescriptionThe description of a condition category
EDGE HCC FlagDetermines if a given condition category is an HCC recognized by CMS for IVA
Highest Level HCCIndicates whether the condition category is a hierarchical condition category: it is the highest applicable and substantiated condition category after hierarchy is applied
Edge HccThe list provided by the government of recognized HCCs for a given enrollee in IVA
Special Handling CodeClient provided chase instructions
Service Facility Type CodeA code that identifies where the service was rendered
Service CodeA Procedure Code that identifies the service rendered: CPT or HCPC
RA Eligible FlagIndicates whether the medical claim is RA eligible or not
RXC Eligible FlagIndicates whether the medical claim is RXC eligible or not
Absolute Cc Submission StatusProvides the highest available submission status for an HCC given the aggregation level
Absolute Cc PositionProvides the highest available position for an HCC given the aggregation level


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