Claims
Data Dictionary
Paid amounts, utilization, referrals, and diagnoses from nationwide claims.
Column added or derived by Serif Health
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Inpatient Events
- UTILIZATION_IDStringEquivalent of claim ID
- VISIT_IDString
- VISIT_TYPEString
- PATIENT_IDStringHashed unique patient identifier
- ADMIT_DATEDateAdmission dates for inpatient procedures
- DISCHARGE_DATEDateDischarge date for inpatient procedures
- CLAIM_FROM_DATEDate
- TOTAL_LOSIntegerTotal length of inpatient stay
- DRG_CODEStringDRG code - usually only available for acute inpatient care
- DRG_CODE_DESCRIPTIONStringDRG code Description
- DRG_CODE_TYPEStringMS-DRG vs APR-DRG
- DRG_CODE_VERSIONStringVersion of DRG code
- DRG_CODE_IMPUTATION_FLAGBooleanFlag to determine imputation status of DRG code
- MDC_CODEStringThree digit numeric code that groups beneficiary diagnosis codes into broad categories based on condition type and body region. a higher level grouping on MS-DRG
- MDC_DESCRIPTIONStringMDC code description
- ADMIT_SOURCE_CODEString
- ADMIT_TYPE_CODEString
- DISCHARGE_STATUS_CODEStringDischarge status code
- ACUTE_SUBACUTEStringAcute Inpatient vs Sub-acute Inpatient
- UTILIZATION_CATEGORYStringSub categories under Acute Inpatient & Sub-acute Inpatient
- ADMISSION_DIAGNOSIS_CODEStringICD 10 Dx code
- PRIMARY_DIAGNOSIS_CODEStringICD 10 Dx code
- ICD 10 Dx code
- ICD_PCS_CODESArrayICD PCS codes from all service line for the claims collected as array
- CPT_HCPCS_CODESArrayHCPCS & CPT codes from all service line for the claims collected as array
- REVENUE_CODESArrayRevenue codes from all service line for the claims collected as array
- BILL_TYPE_CODEStringBill type code. First digit is facility type code. Second digit is facility class code. Third digit is claim frequency code
- Description of the first & second digit of the bill type code
- FACILITY_NPIStringNPI of the facility or the laboratory in which the services were rendered for Institutional Claim
- Classification based on the NUCC taxonomy code for that NPI
- Specialization of the primary taxonomy code
- BILLING_NPIStringFacility that is submitting the institutional claim or the human provider who rendered the care and is submitting the professional claim
- BILLING_NPI_SPECIALTYStringSpecialization of the Billing NPI
- ATTENDING_NPIStringThe human provider that was the attending physician in a hospital setting in which the services were rendered.
- ATTENDING_NPI_SPECIALTYStringSpecialty of the Attending NPI
- OPERATING_NPIStringThe human provider that was the operating physician when operating physician data is required on the institutional claim
- OPERATING_NPI_SPECIALTYStringSpecialty of the Operating NPI
- NETWORK_STATUSString
- ENCOUNTER_TYPEString
- CLAIM_PAYER_NAME_PRIMARYString
- PATIENT_INSURANCE_GROUPString
- PAYMENT_MODELStringPayment model of the claim
- PROVIDER_ZIPStringProvider zip code
- PATIENT_ZIPStringFirst three digits of the patient zip code
- PROVIDER_STATEString
- PATIENT_STATEString
- SERVICE_AREA_TYPEString
- Komodo Health estimated total allowed amount
Non-Inpatient Events
- UTILIZATION_IDStringEquivalent of claim ID
- LINE_NUMBERIntegerEquivalent of claim service line number
- VISIT_IDString
- VISIT_TYPEString
- PATIENT_IDStringHashed unique patient identifier
- CLAIM_TYPE_CODEStringClaim type code
- SERVICE_DATEDateService From Date
- SERVICE_TO_DATEDateService To Date
- REVENUE_CODEStringRevenue code
- PROCEDURE_CODEStringProcedure code
- MODIFIERSArrayProcedure code modifier
- UNITSFloatCleaned unit
- IMPUTED_UNIT_FLAGBooleanIf unit is imputed or normalized
- UNIT_TYPEString
- NDC11StringNDC 11
- UTILIZATION_TYPEStringKH Utilization Classification L1; related to Payment model
- SERVICE_CATEGORYStringKH Utilization Classification L2, related to type of service
- SERVICE_SUBCATEGORYStringKH Utilization Classification L3, related to type of service
- PLACE_OF_SERVICEStringPlace of service code; usually provided only for claim type code ='P'
- BILL_TYPE_CODEStringBill type code; usually provided only for claim type code ='I'
- Description of the first and second digit of the bill type code
- APC_CODEStringImputed APC code
- APC_DESCRIPTIONStringImputed APC code description
- Primary diagnosis code; For facility claims, this is primary diagnosis code from header, size will be 1; For professional claims, this is the diagnosis codes that the service line was pointed to, size can be greater than 1
- DIAGNOSIS_CODESArrayAll diagnosis code assigned with the claim; primary diagnosis code will be part of the array
- ICD_PCS_CODESArrayAll ICD PCS codes that are associated with the claim
- ATTENDING_NPIStringThe human provider that was the attending physician in a hospital setting in which the services were rendered.
- ATTENDING_NPI_SPECIALTYStringSpecialty of the Attending NPI
- OPERATING_NPIStringThe human provider that was the operating physician when operating physician data is required on the institutional claim
- OPERATING_NPI_SPECIALTYStringSpecialty of the Operating NPI
- BILLING_NPIString
- FACILITY_NPIStringNPI of the facility or the laboratory in which the services were rendered for Institutional Claim
- Specialty of the Facility NPI
- RENDERING_NPIStringThe provider directly rendering the care, or in the case that a mid-level provider is rendering the care, this is the supervising provider, only found on a Professional Claim or on an outpatient facility claims; this is distinct for each service line.
- RENDERING_NPI_SPECIALTYStringSpecialty of the Rendering NPI
- REFERRING_NPIStringThe provider ordering a laboratory test or a specialty pharmacy product that is covered under the medical benefit.
- REFERRING_NPI_SPECIALTYStringSpecialty of the Referring NPI
- NETWORK_STATUSString
- ENCOUNTER_TYPEString
- CLAIM_PAYER_NAME_PRIMARYString
- PATIENT_INSURANCE_GROUPStringPayer channel
- Payer channel
- PAYMENT_MODELStringName of cost function
- PROVIDER_ZIPStringProvider zip code
- PATIENT_ZIPStringFirst three digits of the patient zip code
- PROVIDER_STATEString
- PATIENT_STATEString
- SERVICE_AREA_TYPEString
- Estimated total allowed amount
| Column | Description | Methodology |
|---|---|---|
| Inpatient Events | ||
| UTILIZATION_IDString | Equivalent of claim ID | — |
| VISIT_IDString | — | — |
| VISIT_TYPEString | — | — |
| PATIENT_IDString | Hashed unique patient identifier | — |
| ADMIT_DATEDate | Admission dates for inpatient procedures | — |
| DISCHARGE_DATEDate | Discharge date for inpatient procedures | — |
| CLAIM_FROM_DATEDate | — | — |
| CLAIM_THROUGH_DATEDate | — | — |
| TOTAL_LOSInteger | Total length of inpatient stay | — |
| DRG_CODEString | DRG code - usually only available for acute inpatient care | — |
| DRG_CODE_DESCRIPTIONString | DRG code Description | — |
| DRG_CODE_TYPEString | MS-DRG vs APR-DRG | — |
| DRG_CODE_VERSIONString | Version of DRG code | — |
| DRG_CODE_IMPUTATION_FLAGBoolean | Flag to determine imputation status of DRG code | — |
| MDC_CODEString | Three digit numeric code that groups beneficiary diagnosis codes into broad categories based on condition type and body region. a higher level grouping on MS-DRG | — |
| MDC_DESCRIPTIONString | MDC code description | — |
| ADMIT_SOURCE_CODEString | — | — |
| ADMIT_TYPE_CODEString | — | — |
| DISCHARGE_STATUS_CODEString | Discharge status code | — |
| ACUTE_SUBACUTEString | Acute Inpatient vs Sub-acute Inpatient | — |
| UTILIZATION_CATEGORYString | Sub categories under Acute Inpatient & Sub-acute Inpatient | — |
| ADMISSION_DIAGNOSIS_CODEString | ICD 10 Dx code | — |
| PRIMARY_DIAGNOSIS_CODEString | ICD 10 Dx code | — |
| SECONDARY_DIAGNOSIS_CODESArray | ICD 10 Dx code | — |
| ICD_PCS_CODESArray | ICD PCS codes from all service line for the claims collected as array | — |
| CPT_HCPCS_CODESArray | HCPCS & CPT codes from all service line for the claims collected as array | — |
| REVENUE_CODESArray | Revenue codes from all service line for the claims collected as array | — |
| BILL_TYPE_CODEString | Bill type code. First digit is facility type code. Second digit is facility class code. Third digit is claim frequency code | — |
| FACILITY_TYPE_CLASS_CODE_DESCString | Description of the first & second digit of the bill type code | — |
| FACILITY_NPIString | NPI of the facility or the laboratory in which the services were rendered for Institutional Claim | — |
| FACILITY_NPI_CLASSIFICATIONString | Classification based on the NUCC taxonomy code for that NPI | — |
| FACILITY_NPI_SPECIALIZATIONString | Specialization of the primary taxonomy code | — |
| BILLING_NPIString | Facility that is submitting the institutional claim or the human provider who rendered the care and is submitting the professional claim | — |
| BILLING_NPI_CLASSIFICATIONString | — | — |
| BILLING_NPI_SPECIALIZATIONString | — | — |
| BILLING_NPI_SPECIALTYString | Specialization of the Billing NPI | — |
| ATTENDING_NPIString | The human provider that was the attending physician in a hospital setting in which the services were rendered. | — |
| ATTENDING_NPI_SPECIALTYString | Specialty of the Attending NPI | — |
| OPERATING_NPIString | The human provider that was the operating physician when operating physician data is required on the institutional claim | — |
| OPERATING_NPI_SPECIALTYString | Specialty of the Operating NPI | — |
| NETWORK_STATUSString | — | — |
| ENCOUNTER_TYPEString | — | — |
| CLAIM_PAYER_NAME_PRIMARYString | — | — |
| CLAIM_INSURANCE_GROUP_PRIMARYString | — | — |
| CLAIM_INSURANCE_SEGMENT_PRIMARYString | — | — |
| CLAIM_PAYER_NAME_SECONDARYString | — | — |
| CLAIM_INSURANCE_GROUP_SECONDARYString | — | — |
| CLAIM_INSURANCE_SEGMENT_SECONDARYString | — | — |
| PATIENT_INSURANCE_GROUPString | — | — |
| PATIENT_INSURANCE_SEGMENTString | — | — |
| PAYMENT_MODELString | Payment model of the claim | — |
| PROVIDER_ZIPString | Provider zip code | — |
| PATIENT_ZIPString | First three digits of the patient zip code | — |
| PROVIDER_STATEString | — | — |
| PATIENT_STATEString | — | — |
| SERVICE_AREA_TYPEString | — | — |
| TOTAL_PROVIDER_BILLED_AMOUNT_ORIGINALFloat | — | — |
| TOTAL_PLAN_ALLOWED_AMOUNT_ORIGINALFloat | — | — |
| TOTAL_PLAN_PAID_AMOUNT_ORIGINALFloat | — | — |
| TOTAL_PATIENT_RESPONSIBILITY_ORIGINALFloat | — | — |
| ESTIMATED_ALLOWED_AMNTFloat | Komodo Health estimated total allowed amount | — |
| Non-Inpatient Events | ||
| UTILIZATION_IDString | Equivalent of claim ID | — |
| LINE_NUMBERInteger | Equivalent of claim service line number | — |
| VISIT_IDString | — | — |
| VISIT_TYPEString | — | — |
| PATIENT_IDString | Hashed unique patient identifier | — |
| CLAIM_TYPE_CODEString | Claim type code | — |
| SERVICE_DATEDate | Service From Date | — |
| SERVICE_TO_DATEDate | Service To Date | — |
| REVENUE_CODEString | Revenue code | — |
| PROCEDURE_CODEString | Procedure code | — |
| MODIFIERSArray | Procedure code modifier | — |
| UNITSFloat | Cleaned unit | — |
| IMPUTED_UNIT_FLAGBoolean | If unit is imputed or normalized | — |
| UNIT_TYPEString | — | — |
| NDC11String | NDC 11 | — |
| UTILIZATION_TYPEString | KH Utilization Classification L1; related to Payment model | — |
| SERVICE_CATEGORYString | KH Utilization Classification L2, related to type of service | — |
| SERVICE_SUBCATEGORYString | KH Utilization Classification L3, related to type of service | — |
| PLACE_OF_SERVICEString | Place of service code; usually provided only for claim type code ='P' | — |
| BILL_TYPE_CODEString | Bill type code; usually provided only for claim type code ='I' | — |
| FACILITY_TYPE_CLASS_CODE_DESCString | Description of the first and second digit of the bill type code | — |
| APC_CODEString | Imputed APC code | — |
| APC_DESCRIPTIONString | Imputed APC code description | — |
| PRIMARY_DIAGNOSIS_CODE_ARRAYArray | Primary diagnosis code; For facility claims, this is primary diagnosis code from header, size will be 1; For professional claims, this is the diagnosis codes that the service line was pointed to, size can be greater than 1 | — |
| DIAGNOSIS_CODESArray | All diagnosis code assigned with the claim; primary diagnosis code will be part of the array | — |
| ICD_PCS_CODESArray | All ICD PCS codes that are associated with the claim | — |
| ATTENDING_NPIString | The human provider that was the attending physician in a hospital setting in which the services were rendered. | — |
| ATTENDING_NPI_SPECIALTYString | Specialty of the Attending NPI | — |
| OPERATING_NPIString | The human provider that was the operating physician when operating physician data is required on the institutional claim | — |
| OPERATING_NPI_SPECIALTYString | Specialty of the Operating NPI | — |
| BILLING_NPIString | — | — |
| BILLING_NPI_CLASSIFICATIONString | — | — |
| BILLING_NPI_SPECIALIZATIONString | — | — |
| FACILITY_NPIString | NPI of the facility or the laboratory in which the services were rendered for Institutional Claim | — |
| FACILITY_NPI_CLASSIFICATIONString | — | — |
| FACILITY_NPI_SPECIALIZATIONString | Specialty of the Facility NPI | — |
| RENDERING_NPIString | The provider directly rendering the care, or in the case that a mid-level provider is rendering the care, this is the supervising provider, only found on a Professional Claim or on an outpatient facility claims; this is distinct for each service line. | — |
| RENDERING_NPI_SPECIALTYString | Specialty of the Rendering NPI | — |
| REFERRING_NPIString | The provider ordering a laboratory test or a specialty pharmacy product that is covered under the medical benefit. | — |
| REFERRING_NPI_SPECIALTYString | Specialty of the Referring NPI | — |
| NETWORK_STATUSString | — | — |
| ENCOUNTER_TYPEString | — | — |
| CLAIM_PAYER_NAME_PRIMARYString | — | — |
| CLAIM_INSURANCE_GROUP_PRIMARYString | — | — |
| CLAIM_INSURANCE_SEGMENT_PRIMARYString | — | — |
| CLAIM_PAYER_NAME_SECONDARYString | — | — |
| CLAIM_INSURANCE_GROUP_SECONDARYString | — | — |
| CLAIM_INSURANCE_SEGMENT_SECONDARYString | — | — |
| PATIENT_INSURANCE_GROUPString | Payer channel | — |
| PATIENT_INSURANCE_SEGMENTString | Payer channel | — |
| PAYMENT_MODELString | Name of cost function | — |
| PROVIDER_ZIPString | Provider zip code | — |
| PATIENT_ZIPString | First three digits of the patient zip code | — |
| PROVIDER_STATEString | — | — |
| PATIENT_STATEString | — | — |
| SERVICE_AREA_TYPEString | — | — |
| PROVIDER_BILLED_AMOUNT_ORIGINALFloat | — | — |
| PLAN_ALLOWED_AMOUNT_ORIGINALFloat | — | — |
| PLAN_PAID_AMOUNT_ORIGINALFloat | — | — |
| ESTIMATED_ALLOWED_AMNTFloat | Estimated total allowed amount | — |
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