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EDGE HCC Performance Summary

Report Name
EDGE HCC Performance Summary


About This Report

This report gives a high level summary view of how the IVA audit is progressing.


Project Type

IVA


Service Type

Full Service, Clinical Only


Intended User

Manager / Technical User


Best For

Program managers to understand how their programs performed based on the original EDGE sample.


Using This Report

  • Identify how many EDGE HCCs became validated and how many did not
  • Measure the validation rate of each HCC
  • Determine areas for provider education by recognizing HCCs with low validation rates



What Information Can I Filter?

Condition Category



 What Do The Fields Mean?  

FieldData Dictionary Definition
Project NameThe name associated with a project
Category CodeNumerical identifier associated with the condition within a given condition model
Category NameThe description of a condition category
Total EDGE HCCsDistinct count of member EDGE/RADVDE HCCs combinations
Substantiated EDGE HCC CountCount of unique Enrollee ID/CC combinations that are substantiated and are an EDGE provided HCC
Unsubstantiated EDGE HCC CountCount of unique Enrollee ID/CC combinations that are unsubstantiated and are an EDGE provided HCC
Percent EDGE HCCs SubstantiatedPercentage of EDGE HCCs that are validated/substantiated
Submittable EDGE HCC CountCount of EDGE HCCs that can be submitted to the Government
Conditional EDGE HCC CountCount of EDGE HCCs that are valid, subject to a condition
Pending EDGE HCC CountCount of EDGE HCCs that are pending/in progress. “Pending” in this situation means the chart wasn’t coded. Either because we didn’t get the chart, something held up coding, or we stopped work due to time constraints.
Unsubmittable EDGE HCC CountCount of EDGE HCCs that cannot be submitted to the Government

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