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Admission Dataset Specification

Updated over a month ago

Admission Dataset Specification

Admission Dataset Specification

The "Admission Dataset Specification" contains member admissions identified based on the claim data. The admission data is based on the medical claims analysis, as there is a real-time Admission entity which is based on the ADT messages analysis. It does not have a unique key. It references Members by Member_ID and Providers by Provider_ID. It also references included Medical_Claims. It references to and from an Episode in which Admission was included.

Key Highlights

  • Comprehensive Admission Insights: This specification leaves no stone unturned, capturing every aspect of the patient admission process. It ensures a complete profile is available for healthcare management, providing a sense of reassurance in its thoroughness.

  • Integrated Health Records: This specification consolidates medical histories, diagnostic outcomes, and treatment records to coordinate patient care.

  • Financial and Clinical Data Fusion: This process merges billing details with clinical data, providing a unified view supporting healthcare delivery and administrative activities.

  • Operational Efficiency: This specification harnesses detailed logs of medical procedures and actions to optimize workflow and resource allocation, leading to streamlined operations and improved patient care.

  • Holistic Patient Management: This approach aims to improve the quality of care by gaining a well-rounded understanding of the patient journey, from initial admission to discharge and follow-up.

This dataset goes beyond simple data collection by transforming raw health information into practical insights. It aims to enhance treatment outcomes and increase operational efficiency, offering valuable support to healthcare providers.

Table: Admission

Column Details

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member admitted to the hospital.

Admit_Date

YES

DATE

Date when the member was admitted to the hospital.

Admission_ID

YES

STRING

Unique identifier for the admission record. The admission data is fully refreshed at each analytics execution. Admission_ID is assigned in the scope of analytics execution and cannot be used as a clue between two analytics executions because it can be reused.

Admit_Source

YES

INT64

Source from which the member was admitted to the hospital. Enum values:
​Newborn Admissions:
1 (Normal delivery), 2 (Premature delivery), 3 (Sick baby), 4 (Extramural birth), 9 (Information not available).
​Other Admissions:
1 (Physician referral), 2 (Clinic referral), 3 (HMO referral), 4 (Transfer from a hospital), 5 (Transfer from a skilled nursing facility), 6 (Transfer from another healthcare facility), 7 (Emergency Room), 8 (Court/Law enforcement), 9 (Information not available).

Discharge_Date

YES

DATE

Date when the member was discharged from the hospital.

Length_Of_Stay

YES

INT64

Duration of the member's stay in the hospital.

Hospital_ID

YES

STRING

Unique identifier of the hospital where the admission took place.

Exclusion

YES

BOOL

Indicator for exclusion status, possibly related to specific conditions or criteria.

Record_Type

YES

STRING

Record type calculated based on std_place. Inpatient vs Outpatient.

Diagnosis_Scheme_Code

YES

STRING

The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

Primary_Disease_Category

YES

STRING

Category of the primary disease or condition for the admission.

Primary_Disease_Stage

YES

FLOAT64

Stage or severity level of the primary disease or condition.

Diagnosis_Related_Group

YES

STRING

The diagnosis-related group code from the last room and board record. This is a pass-through field.

Calculated_Diagnosis_Related_Group

YES

STRING

Calculated diagnosis-related group based on various factors.

Allowed_Amount

YES

FLOAT64

The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

Submitted_Amount

YES

FLOAT64

The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

Net_Amount

YES

FLOAT64

The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Total_RVU_Amount

YES

FLOAT64

The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission_MDC_Code

YES

STRING

Admission MDC code, based on all claims present in the admission, can be different than mdc_cd.

Days_Since_Previous_Admission

YES

INT64

Number of days since the member's previous admission.

Days_Until_Next_Admission

YES

INT64

Number of days until the member's next admission.

Cost_Comparison

YES

INT64

Identifies how admissions compare to the MarketScan average based on Allowed Amount Total Admit for the DRG. Values: -3, -2, -1, 0, 1, 2, 3.
-3 indicates extreme outliers below the average, 3 indicates extreme outliers above the average, and 0 indicates the admission is not an outlier. The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Length_Of_Stay_Comparison

YES

INT64

Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG. Values: -3, -2, -1, 0, 1, 2, 3.
-3 indicates extreme outliers below the average, 3 indicates extreme outliers above the average, and 0 indicates the admission is not an outlier.

Admission Dataset Specification

Admission Table

Column Details

  • Per_Diem_Comparison

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG. Values range from -3 to 3, where:

    • -3 indicates extreme outliers below the average

    • 3 indicates extreme outliers above the average

    • 0 indicates the admission is not an outlier

  • The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

  • Standard_Provider_Type

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Standardized type of the provider involved in the admission. Mapped from Provider specialty.

  • Admit_Type_Code

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Type of admission. Values:

    • 1: Surgical

    • 2: Medical

    • 3: Maternity/Newborn

    • 4: Psychiatric/Substance Abuse

    • 5: Missing/Unknown

  • Standard_Facility_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Facility ID Standard value derived from Provider’s National Provider ID.

  • Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Reference to the medical episode which includes the admission.

  • Admit_Source_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the admission source.

  • Admit_Source_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Admission source categorized as NEWBORN vs NON-NEWBORN.

  • Diagnosis_Related_Group_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the diagnosis-related group for the admission.

  • Calculated_Diagnosis_Related_Group_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the calculated diagnosis-related group for the admission.

  • Admit_Type_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the admission type.

  • Patient_Status_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: UB-92 patient status code. Also known as discharge disposition code.

  • Patient_Status_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the patient's status during the admission.

  • Primary_Disease_Category_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the primary disease or condition category for the admission.

  • Visibility_Level

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Level of visibility or access permissions for the admission record.

  • Behavioral_Health_Admission_Indicator

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator for behavioral health admission related to the admission.

Admission_Diagnosis_Codes Table

Column Details

  • Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the member related to the admission.

  • Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

  • Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

  • Diagnosis_Codes_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Code representing the diagnosis associated with the admission (ICD-9 or ICD-10).

  • Diagnosis_Codes_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description of the diagnosis code for the admission.

Admission_Medical_Claims Table

Column Details

  • Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the member associated with the admission.

  • Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

  • Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

  • Medical_Claims_Claim_Number

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The unique, alphanumeric identifier for each claim submitted with the input data.

  • Medical_Claims_Claim_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Type or category of the medical claim.

  • Medical_Claims_Claim_Line_Number

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Line number associated with the medical claim within the admission.

Admission_Procedure_Codes Table

Column Details

  • Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the member associated with the admission.

  • Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

  • Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

  • Procedure_Codes_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Code associated with the procedure performed during the admission.

  • Procedure_Codes_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description of the procedure performed during the admission.

  • Procedure_Codes_Scheme_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Procedure Code Scheme Code (CPT4/HCPCS/ICD-10).

Admission_log Table

Column Details

  • Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the member related to the admission.

  • Admit_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date when the admission occurred.

  • Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record. The LOG table contains records from all previous executions; however, Admission_ID can be reused for completely different admissions, and analytics executions are completely independent.

  • Admit_Source

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Source or reason for the admission.

  • Discharge_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date when the patient was discharged.

  • Length_Of_Stay

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Duration of the admission stay.

  • Hospital_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Identifier of the hospital where the admission took place.

  • Exclusion

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator for any exclusion or special circumstance related to the admission.

  • Record_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Record type calculated based on std_place. Inpatient vs Outpatient.

  • Diagnosis_Scheme_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

  • Medical_Claims

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Details related to medical claims associated with the admission.

    • Claim_Type: STRING - Type of claim, categorizing the nature of the medical claim.

    • Claim_Number: STRING - Unique identifier for the claim, used to track individual claims.

Admission Dataset Specification

Claim Line Number

ical_Claims.Claim_Line_Number

  • Type: INT64

  • Description: Line number within the claim, representing specific items or services.

Diagnosis Codes

Admission_log.Diagnosis_Codes

  • Type: ARRAY

  • Description: Diagnosis codes associated with the admission.\ For more information on parameters in this Array, see the Medical Claim Diagnoses table in the Medical Claim dataset.

Diagnosis_Codes.Code

  • Type: STRING

  • Description: The unique identifier or code assigned to the diagnosis, as per standardized medical coding systems.

Diagnosis_Codes.Description

  • Type: STRING

  • Description: Detailed description of the diagnosis associated with the code, providing clinical details.

Procedure Codes

Admission_log.Procedure_Codes

  • Type: ARRAY

  • Description: Procedure codes associated with the admission.\ For more information on parameters in this Array, see the Medical Claim Procedures table in the Medical Claim dataset.

Procedure_Codes.Code

  • Type: STRING

  • Description: The unique identifier or code for the medical procedure, used in healthcare documentation.

Procedure_Codes.Description

  • Type: STRING

  • Description: Detailed explanation of the medical procedure associated with the code.

Procedure_Codes.Scheme_Code

  • Type: STRING

  • Description: Code identifying the coding scheme used (e.g., ICD-10-PCS, HCPCS), which organizes procedure codes.

Procedure_Codes.Set_Code

  • Type: STRING

  • Description: Code identifying the specific set or category within the coding scheme that the procedure belongs to.

Procedure_Codes.Set_Code_Description

  • Type: STRING

  • Description: Description of the set or category to which the procedure code belongs, explaining its context or grouping within the scheme.

Procedure_Codes.Set_Type_Code

  • Type: STRING

  • Description: Code that further categorizes the procedure within its set for more specific classification.

Procedure_Codes.Set_Type_Code_Description

  • Type: STRING

  • Description: Description of the set type, providing details on the nature and context of the procedure categorization.

Admission Details

Admission_log.Primary_Disease_Category

  • Type: STRING

  • Description: Category of the primary disease related to the admission.

Admission_log.Primary_Disease_Stage

  • Type: FLOAT64

  • Description: Stage or severity of the primary disease.

  • Type: STRING

  • Description: The diagnosis-related group code from the last room and board record. This is a pass-through field.

  • Type: STRING

  • Description: Calculated diagnosis-related group for the admission.

Admission_log.Allowed_Amount

  • Type: FLOAT64

  • Description: The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

Admission_log.Submitted_Amount

  • Type: FLOAT64

  • Description: The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

Admission_log.Net_Amount

  • Type: FLOAT64

  • Description: The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Admission_log.Total_RVU_Amount

  • Type: FLOAT64

  • Description: The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission_log.Admission_MDC_Code

  • Type: STRING

  • Description: Admission MDC code, based on all claims present in the admission. Can be different than mdc_cd.

Admission_log.Days_Since_Previous_Admission

  • Type: INT64

  • Description: Number of days since the previous admission.

Admission_log.Days_Until_Next_Admission

  • Type: INT64

  • Description: Number of days until the next admission.

Admission_log.Cost_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Allowed Amount Total Admit for the DRG.\ Values:

    • -3: Extreme outliers below the average

    • -2: Significantly below average

    • -1: Below average

    • 0: Not an outlier

    • 1: Above average

    • 2: Significantly above average

    • 3: Extreme outliers above the average

    The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Admission_log.Length_Of_Stay_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG.\ Values:

    • -3: Extreme outliers below the average

    • -2: Significantly below average

    • -1: Below average

    • 0: Not an outlier

    • 1: Above average

    • 2: Significantly above average

    • 3: Extreme outliers above the average

    The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Admission_log.Per_Diem_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG.\ Values:

    • -3: Extreme outliers below the average

    • -2: Significantly below average

    • -1: Below average

    • 0: Not an outlier

    • 1: Above average

    • 2: Significantly above average

    • 3: Extreme outliers above the average

    The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Admission_log.Standard_Provider_Type

  • Type: INT64

  • Description: Standard type of provider associated with the admission.

Admission_log.Admit_Type_Code

  • Type: INT64

  • Description: Type of admission.\ Values:

  • 1: Surgical

  • 2: Medical

  • 3: Maternity/Newborn

  • 4: Psychiatric/Substance Abuse

  • 5: Missing/Unknown

Admission_log.Standard_Facility_ID

  • Type: STRING

  • Description: Facility ID Standard value from the first room and board claim in the admission.

Admission_log.Episode_ID

  • Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

Admission_log.Type

  • Type: STRING

  • Description: Type of record or data related to the admission.

Admission_log.Tenant

  • Type: STRING

  • Description: Tenant information or identifier.

Admission_log.Active_Version

  • Type: BOOL

  • Description: Active version or status of the admission record.

Admission_log.Date

  • Type: DATE

  • Description: Date associated with the admission record.

Admission_log.Sequence

  • Type: INT64

  • Description: Sequence or order of the admission record.

Admission_log.Source_System_Name

  • Type: STRING

  • Description: Name of the source system from which the admission data originates.

Admission_log.Source_Timestamp

  • Type: TIMESTAMP

  • Description: Timestamp indicating when the admission data was sourced.

Admission_log.Source_File_Name

  • Type: STRING

  • Description: Name of the source file containing the admission data.

Admission Dataset Specification

Admission Log Table

Columns and Descriptions

  • Name

  • Data Type: STRING

  • Description: Name of the source file containing admission data.

  • Schema_Version

  • Data Type: FLOAT64

  • Description: Version of the schema or data model used for admission data.

  • Admit_Source_Description

  • Data Type: STRING

  • Description: Description or details of the admission source.

  • Admit_Source_Category

  • Data Type: STRING

  • Description: Admission source: NEWBORN vs NON-NEWBORN.

  • Diagnosis_Related_Group_Description

  • Data Type: STRING

  • Description: Description or details of the diagnosis-related group for the admission.

  • Calculated_Diagnosis_Related_Group_Description

  • Data Type: STRING

  • Description: Description or details of the calculated diagnosis-related group for the admission.

  • Admit_Type_Description

  • Data Type: STRING

  • Description: Description or details of the admission type.

  • Patient_Status_Code

  • Data Type: STRING

  • Description: UB-92 patient status code. Also known as discharge disposition code.

  • Patient_Status_Description

  • Data Type: STRING

  • Description: Description or details of the patient status related to the admission.

  • Primary_Disease_Category_Description

  • Data Type: STRING

  • Description: Description or details of the primary disease category for the admission.

  • Visibility_Level

  • Data Type: INT64

  • Description: Level of visibility or access permissions for the admission record.

  • Behavioral_Health_Admission_Indicator

  • Data Type: BOOL

  • Description: Indicator for behavioral health admission related to the admission.

  • Member_Partition

  • Data Type: INT64

  • Description: Partition or segment of data related to the member.

  • _updated

  • Data Type: STRING

  • Description: Indicator for whether the admission record has been updated.

  • Action

  • Data Type: STRING

  • Description: Action or operation performed on the admission record.

Admission Raw Table

Columns and Descriptions

  • Member_ID

  • Data Type: STRING

  • Description: Unique identifier of the member associated with the admission record.

  • Admit_Date

  • Data Type: DATE

  • Description: Date when the admission took place.

  • Admission_ID

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

  • Admit_Source

  • Data Type: INT64

  • Description: Source from which the admission originated.

  • Discharge_Date

  • Data Type: DATE

  • Description: Date when the patient was discharged.

  • Length_Of_Stay

  • Data Type: INT64

  • Description: Duration of the admission in terms of days.

  • Hospital_ID

  • Data Type: STRING

  • Description: Unique identifier of the hospital where the admission occurred.

  • Exclusion

  • Data Type: BOOL

  • Description: Indicator specifying if the admission is excluded from certain analyses or calculations.

  • Record_Type

  • Data Type: STRING

  • Description: Record type calculated based on std_place.Inpatient vs Outpatient.

  • Diagnosis_Scheme_Code

  • Data Type: STRING

  • Description: The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

  • Medical_Claims

  • Data Type: ARRAY

  • Description: Details of medical claims associated with the admission. For more information on parameters in this array, see the Medical Claim table in the Medical Claim dataset.

  • Subfields:

    • Claim_Type

    • Data Type: STRING

    • Description: Describes the type of claim, categorizing the nature of the medical claim (e.g., inpatient, outpatient, pharmacy).

    • Claim_Number

    • Data Type: STRING

    • Description: A unique identifier for the claim, used to track and manage individual claims within the healthcare system.

    • Claim_Line_Number

    • Data Type: INT64

    • Description: Represents a specific item or service line within a claim, used for detailed tracking and accounting of each charge in a claim.

  • Diagnosis_Codes

  • Data Type: ARRAY

  • Description: Codes indicating the diagnoses associated with the admission. For more information on parameters in this array, see the Medical Claim Diagnosis table in the Medical Claim dataset.

  • Subfields:

    • Code

    • Data Type: STRING

    • Description: The unique identifier or code assigned to the diagnosis, following standardized medical coding systems such as ICD-10.

    • Description

    • Data Type: STRING

    • Description: Provides a detailed description of the diagnosis associated with the code, helping healthcare providers and billing staff understand the medical condition being addressed.

  • Procedure_Codes

  • Data Type: ARRAY

  • Description: Codes indicating the procedures performed during the admission. For more information on parameters in this array, see the Medical Claim Claim Line, Medical Claim Procedures tables in the Medical Claim dataset.

  • Subfields:

    • Code

    • Data Type: STRING

    • Description: The unique identifier or code for the medical procedure, used in healthcare documentation.

    • Description

    • Data Type: STRING

    • Description: Detailed explanation of the medical procedure associated with the code.

    • Scheme_Code

    • Data Type: STRING

    • Description: Code identifying the coding scheme used (e.g., ICD-10-PCS, HCPCS), which organizes procedure codes.

    • Set_Code

    • Data Type: STRING

    • Description: Code identifying the specific set or category within the coding scheme that the procedure belongs to.

    • Set_Code_Description

    • Data Type: STRING

    • Description: Description of the set or category to which the procedure code belongs, explaining its context or grouping within the scheme.

    • Set_Type_Code

    • Data Type: STRING

    • Description: Code that further categorizes the procedure within its set for more specific classification.

    • Set_Type_Code_Description

    • Data Type: STRING

    • Description: Description of the set type, providing details on the nature and context of the procedure categorization.

  • Primary_Disease_Category

  • Data Type: STRING

  • Description: Category of the primary disease or condition associated with the admission.

  • Primary_Disease_Stage

  • Data Type: FLOAT64

  • Description: Stage of the primary disease or condition associated with the admission.

  • Diagnosis_Related_Group

  • Data Type: STRING

  • Description: The diagnosis-related group code from the last room and board record. This is a pass-through field.

  • Calculated_Diagnosis_Related_Group

  • Data Type: STRING

  • Description: Calculated grouping code for diagnoses related to the admission.

  • Allowed_Amount

  • Data Type: FLOAT64

  • Description: The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

  • Submitted_Amount

  • Data Type: FLOAT64

  • Description: The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

  • Net_Amount

  • Data Type: FLOAT64

  • Description: The net amount for the admission.

Admission Dataset Specification

Admission Fields

LOAT64

  • Type: FLOAT64

  • Description: The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Total_RVU_Amount

  • Type: FLOAT64

  • Description: The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission_MDC_Code

  • Type: STRING

  • Description: Admission MDC code, based on all claims present in the admission. This can be different than mdc_cd.

Days_Since_Previous_Admission

  • Type: INT64

  • Description: Number of days since the previous admission for the same member.

Days_Until_Next_Admission

  • Type: INT64

  • Description: Number of days until the next admission for the same member.

Cost_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on the Allowed Amount Total Admit for the DRG.

  • Values:

    • -3: Extreme outliers below the average

    • -2: Significantly below average

    • -1: Below average

    • 0: Not an outlier

    • 1: Above average

    • 2: Significantly above average

    • 3: Extreme outliers above the average

  • The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Length_Of_Stay_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG.

  • Values:

    • -3: Extreme outliers below the average

    • -2: Significantly shorter than average

    • -1: Shorter than average

    • 0: Not an outlier

    • 1: Longer than average

    • 2: Significantly longer than average

    • 3: Extreme outliers above the average

  • The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Per_Diem_Comparison

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG.

  • Values:

    • -3: Extreme outliers below the average

    • -2: Significantly below average

    • -1: Below average

    • 0: Not an outlier

    • 1: Above average

    • 2: Significantly above average

    • 3: Extreme outliers above the average

  • The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Standard_Provider_Type

  • Type: INT64

  • Description: Standardized provider type associated with the admission.

Admit_Type_Code

  • Type: INT64

  • Description: Type of admission.

  • Values:

    • 1: Surgical

    • 2: Medical

    • 3: Maternity/Newborn

    • 4: Psychiatric/Substance Abuse

    • 5: Missing/Unknown

Standard_Facility_ID

  • Type: STRING

  • Description: Facility ID standard value from the first room and board claim in the admission.

Episode_ID

  • Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

Type

  • Type: STRING

  • Description: Type of record or admission.

Tenant

  • Type: STRING

  • Description: Tenant or organization associated with the admission.

Active_Version

  • Type: BOOL

  • Description: Active version or status of the admission record (always Active).

Date

  • Type: DATE

  • Description: Date of the admission or record creation/modification.

Sequence

  • Type: INT64

  • Description: Sequence number or order of the admission record.

Source_System_Name

  • Type: STRING

  • Description: Name of the source system from which the admission data originates (always named "Data Enrichment").

Source_Timestamp

  • Type: TIMESTAMP

  • Description: Timestamp indicating when the admission data was sourced.

Source_File_Name

  • Type: STRING

  • Description: Name of the source file containing the admission data.

Schema_Version

  • Type: FLOAT64

  • Description: Version of the schema or data structure used for the admission data.

Admit_Source_Description

  • Type: STRING

  • Description: Description of the admission source.

Admit_Source_Category

  • Type: STRING

  • Description: Admission source: NEWBORN vs NON-NEWBORN.

  • Type: STRING

  • Description: Description of the diagnosis-related group associated with the admission.

  • Type: STRING

  • Description: Description of the calculated diagnosis-related group associated with the admission.

Admit_Type_Description

  • Type: STRING

  • Description: Description of the admission type.

Patient_Status_Code

  • Type: STRING

  • Description: UB-92 patient status code. Also known as discharge disposition code.

Patient_Status_Description

  • Type: STRING

  • Description: Description of the status of the patient associated with the admission.

Primary_Disease_Category_Description

  • Type: STRING

  • Description: Description of the primary disease category associated with the admission.

Visibility_Level

  • Type: INT64

  • Description: Level of visibility or access permissions for the admission record.

Behavioral_Health_Admission_Indicator

  • Type: BOOL

  • Description: Indicator specifying if the admission is related to behavioral health.

Member_Partition

  • Type: INT64

  • Description: Partition or segment of members associated with the admission.

_updated

  • Type: STRING

  • Description: Timestamp indicating when the admission record was last updated.

Key Features

Comprehensive Admission Insights

This specification leaves no stone unturned, capturing every aspect of the patient admission process. It ensures a complete profile is available for healthcare management, providing a sense of reassurance in its thoroughness.

Integrated Health Records

This specification consolidates medical histories, diagnostic outcomes, and treatment records to coordinate patient care.

Financial and Clinical Data Fusion

This process merges billing details with clinical data, providing a unified view supporting healthcare delivery and administrative activities.

Operational Efficiency

This specification harnesses detailed logs of medical procedures and actions to optimize workflow and resource allocation, leading to streamlined operations and improved patient care.

Holistic Patient Management

This approach aims to improve the quality of care by gaining a well-rounded understanding of the patient journey.

Admission Dataset Specification

Admission Types

Admission Type Codes for Newborns

When Admit_Type_Code is set to Newborn:

  • 1: Normal delivery

  • 2: Premature delivery

  • 3: Sick baby

  • 4: Extramural birth (and Newborns)

  • 9: Information not available

Admission Type Codes for Non-Newborns

When admissions are other than Newborn:

  • 1: Physician referral

  • 2: Clinic referral

  • 3: HMO referral

  • 4: Transfer from a hospital

  • 5: Transfer from a skilled nursing facility

  • 6: Transfer from another healthcare facility

  • 7: Emergency Room

  • 8: Court/Law enforcement

  • 9: Information not available

Table Content

Admission Table

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member admitted to the hospital.

Admit_Date

YES

DATE

Date when the member was admitted to the hospital.

Admission_ID

YES

STRING

Unique identifier for the admission record. The admission data is fully refreshed at each analytics execution. Admission_ID is assigned in the scope of analytics execution and cannot be used as a clue between two analytics executions because it can be reused.

Admit_Source

YES

INT64

Source from which the member was admitted to the hospital. Enum values:
​For Newborns:
​1: Normal delivery
​2: Premature delivery
​3: Sick baby
​4: Extramural birth (and Newborns)
​9: Information not available
​For Non-Newborns:
​1: Physician referral
​2: Clinic referral
​3: HMO referral
​4: Transfer from a hospital
​5: Transfer from a skilled nursing facility
​6: Transfer from another healthcare facility
​7: Emergency Room
​8: Court/Law enforcement
​9: Information not available

Discharge_Date

YES

DATE

Date when the member was discharged from the hospital.

Length_Of_Stay

YES

INT64

Duration of the member's stay in the hospital.

Hospital_ID

YES

STRING

Unique identifier of the hospital where the admission took place.

Exclusion

YES

BOOL

Indicator for exclusion status, possibly related to specific conditions or criteria.

Record_Type

YES

STRING

Record type calculated based on std_place. Inpatient vs Outpatient.

Diagnosis_Scheme_Code

YES

STRING

The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

Primary_Disease_Category

YES

STRING

Category of the primary disease or condition for the admission.

Primary_Disease_Stage

YES

FLOAT64

Stage or severity level of the primary disease or condition.

Diagnosis_Related_Group

YES

STRING

The diagnosis-related group code from the last room and board record. This is a pass-through field.

Calculated_Diagnosis_Related_Group

YES

STRING

Calculated diagnosis-related group based on various factors.

Allowed_Amount

YES

FLOAT64

The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

Submitted_Amount

YES

FLOAT64

The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

Net_Amount

YES

FLOAT64

The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Total_RVU_Amount

YES

FLOAT64

The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission_MDC_Code

YES

STRING

Admission MDC code, based on all claims present in the admission, can be different than mdc_cd.

Days_Since_Previous_Admission

YES

INT64

Number of days since the member's previous admission.

Days_Until_Next_Admission

YES

INT64

Number of days until the member's next admission.

Cost_Comparison

YES

INT64

Identifies how admissions compare to the MarketScan average based on Allowed Amount Total Admit for the DRG. Values:
​-3: Extreme outliers below the average
​3: Extreme outliers above the average
​0: Admission is not an outlier.
The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Length_Of_Stay_Comparison

YES

INT64

Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG. Values:
​-3: Extreme outliers below the average
​3: Extreme outliers above the average
​0: Admission is not an outlier.
The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Per_Diem_Comparison

YES

INT64

Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG. Values:
​-3: Extreme outliers below the average
​3: Extreme outliers above the average
​0: Admission is not an outlier.
The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Standard_Provider_Type

YES

INT64

Standardized type of the provider involved in the admission. Mapped from Provider specialty.

Admit_Type_Code

YES

INT64

Type of admission. Enum values:
​1: Surgical
​2: Medical
​3: Maternity/Newborn
​4: Psychiatric/Substance Abuse
​5: Missing/Unknown

Standard_Facility_ID

YES

STRING

Facility ID Standard value.

Admission Dataset Specification

Admission Table

Column Name

Is Nullable

Data Type

Description

Episode_ID

YES

STRING

Reference to the medical episode which includes the admission.

Admit_Source_Description

YES

STRING

Description or details of the admission source.

Admit_Source_Category

YES

STRING

Admission source: NEWBORN vs NON-NEWBORN.

Diagnosis_Related_Group_Description

YES

STRING

Description or details of the diagnosis-related group for the admission.

Calculated_Diagnosis_Related_Group_Description

YES

STRING

Description or details of the calculated diagnosis-related group for the admission.

Admit_Type_Description

YES

STRING

Description or details of the admission type.

Patient_Status_Code

YES

STRING

UB-92 patient status code. Also known as discharge disposition code.

Patient_Status_Description

YES

STRING

Description or details of the patient's status during the admission.

Primary_Disease_Category_Description

YES

STRING

Description or details of the primary disease or condition category for the admission.

Visibility_Level

YES

INT64

Level of visibility or access permissions for the admission record.

Behavioral_Health_Admission_Indicator

YES

BOOL

Indicator for behavioral health admission related to the admission.

Admission Diagnosis Codes Table

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member related to the admission.

Admission_ID

YES

STRING

Unique identifier for the admission record.

Episode_ID

YES

STRING

Identifier for the episode of care associated with the admission.

Diagnosis_Codes_Code

YES

STRING

Code representing the diagnosis associated with the admission (ICD-9 or ICD-10).

Diagnosis_Codes_Description

YES

STRING

Description of the diagnosis code for the admission.

Admission Medical Claims Table

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member associated with the admission.

Admission_ID

YES

STRING

Unique identifier for the admission record.

Episode_ID

YES

STRING

Identifier for the episode of care associated with the admission.

Medical_Claims_Claim_Number

YES

STRING

The unique, alphanumeric identifier for each claim submitted with the input data.

Medical_Claims_Claim_Type

YES

STRING

Type or category of the medical claim.

Medical_Claims_Claim_Line_Number

YES

INT64

Line number associated with the medical claim within the admission.

Admission Procedure Codes Table

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member associated with the admission.

Admission_ID

YES

STRING

Unique identifier for the admission record.

Episode_ID

YES

STRING

Identifier for the episode of care associated with the admission.

Procedure_Codes_Code

YES

STRING

Code associated with the procedure performed during the admission.

Procedure_Codes_Description

YES

STRING

Description of the procedure performed during the admission.

Procedure_Codes_Scheme_Code

YES

STRING

Procedure Code Scheme Code (CPT4/HCPCS/ICD-10).

Admission Log Table

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique identifier of the member related to the admission.

Admit_Date

YES

DATE

Date when the admission occurred.

Admission_ID

YES

STRING

Unique identifier for the admission record. The LOG table contains records from all previous executions; however, Admission_ID can be reused for completely different admissions, and analytics executions are completely independent. It is a key difference from other entity logs.

Admit_Source

YES

INT64

Source or reason for the admission.

Discharge_Date

YES

DATE

Date when the patient was discharged.

Length_Of_Stay

YES

INT64

Duration of the admission stay.

Hospital_ID

YES

STRING

Identifier of the hospital where the admission took place.

Exclusion

YES

BOOL

Indicator for any exclusion or special circumstance related to the admission.

Record_Type

YES

STRING

Record type calculated based on std_place. Inpatient vs Outpatient.

Diagnosis_Scheme_Code

YES

STRING

The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

Medical_Claims

NO

ARRAY

Details related to medical claims associated with the admission. For more information on parameters in this Array, see the Medical Claim table in the Medical Claim dataset.

Diagnosis_Codes

NO

ARRAY

Diagnosis codes associated with the admission. For more information on parameters in this Array, see the Medical Claim Diagnoses table in the Medical Claim dataset.

Medical Claims Array

Column Name

Data Type

Description

Claim_Type

STRING

Type of claim, categorizing the nature of the medical claim.

Claim_Number

STRING

Unique identifier for the claim, used to track individual claims.

Claim_Line_Number

INT64

Line number within the claim, representing specific items or services.

Diagnosis Codes Array

Column Name

Data Type

Description

Code

STRING

The unique identifier or code assigned to the diagnosis.

Admission Dataset Specification

Diagnosis Codes

Description

  • Type: STRING

  • Details: Detailed description of the diagnosis associated with the code, providing clinical details.

Procedure Codes

Procedure Codes Array

  • Type: ARRAY

  • Details: Procedure codes associated with the admission. For more information on parameters in this array, see the Medical Claim Procedures table in the Medical Claim dataset.

Code

  • Type: STRING

  • Details: The unique identifier or code for the medical procedure, used in healthcare documentation.

Description

  • Type: STRING

  • Details: Detailed explanation of the medical procedure associated with the code.

Scheme Code

  • Type: STRING

  • Details: Code identifying the coding scheme used (e.g., ICD-10-PCS, HCPCS), which organizes procedure codes.

Set Code

  • Type: STRING

  • Details: Code identifying the specific set or category within the coding scheme that the procedure belongs to.

Set Code Description

  • Type: STRING

  • Details: Description of the set or category to which the procedure code belongs, explaining its context or grouping within the scheme.

Set Type Code

  • Type: STRING

  • Details: Code that further categorizes the procedure within its set for more specific classification.

Set Type Code Description

  • Type: STRING

  • Details: Description of the set type, providing details on the nature and context of the procedure categorization.

Admission Log

Primary Disease Category

  • Type: STRING

  • Details: Category of the primary disease related to the admission.

Primary Disease Stage

  • Type: FLOAT64

  • Details: Stage or severity of the primary disease.

  • Type: STRING

  • Details: The diagnosis-related group code from the last room and board record. This is a pass-through field.

  • Type: STRING

  • Details: Calculated diagnosis-related group for the admission.

Allowed Amount

  • Type: FLOAT64

  • Details: The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

Submitted Amount

  • Type: FLOAT64

  • Details: The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

Net Amount

  • Type: FLOAT64

  • Details: The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Total RVU Amount

  • Type: FLOAT64

  • Details: The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission MDC Code

  • Type: STRING

  • Details: Admission MDC code, based on all claims present in the admission. This can be different than mdc_cd.

Days Since Previous Admission

  • Type: INT64

  • Details: Number of days since the previous admission.

Days Until Next Admission

  • Type: INT64

  • Details: Number of days until the next admission.

Cost Comparison

  • Type: INT64

  • Details: Identifies how admissions compare to the MarketScan average based on Allowed Amount Total Admit for the DRG. Values:

  • -3: Extreme outliers below the average

  • -2: Below average

  • -1: Slightly below average

  • 0: Not an outlier

  • 1: Slightly above average

  • 2: Above average

  • 3: Extreme outliers above the average\ The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Length of Stay Comparison

  • Type: INT64

  • Details: Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG. Values:

  • -3: Extreme outliers below the average

  • -2: Below average

  • -1: Slightly below average

  • 0: Not an outlier

  • 1: Slightly above average

  • 2: Above average

  • 3: Extreme outliers above the average\ The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Per Diem Comparison

  • Type: INT64

  • Details: Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG. Values:

  • -3: Extreme outliers below the average

  • -2: Below average

  • -1: Slightly below average

  • 0: Not an outlier

  • 1: Slightly above average

  • 2: Above average

  • 3: Extreme outliers above the average\ The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Standard Provider Type

  • Type: INT64

  • Details: Standard type of provider associated with the admission.

Admit Type Code

  • Type: INT64

  • Details: Type of admission. Values:

  • 1: Surgical

  • 2: Medical

  • 3: Maternity/Newborn

  • 4: Psychiatric/Substance Abuse

  • 5: Missing/Unknown

Standard Facility ID

  • Type: STRING

  • Details: Facility ID standard value from the first room and board claim in the admission.

Episode ID

  • Type: STRING

  • Details: Identifier for the episode of care associated with the admission.

Type

  • Type: STRING

  • Details: Type of record or data related to the admission.

Tenant

  • Type: STRING

  • Details: Tenant information or identifier.

Active Version

  • Type: BOOL

  • Details: Active version or status of the admission record.

Date

  • Type: DATE

  • Details: Date associated with the admission record.

Sequence

  • Type: INT64

  • Details: Sequence or order of the admission record.

Source System Name

  • Type: STRING

  • Details: Name of the source system from which the admission data originates.

Source Timestamp

  • Type: TIMESTAMP

  • Details: Timestamp indicating when the admission data was sourced.

Admission Dataset Specification

Admission Log Table

Columns

  • File_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Name of the source file containing admission data.

  • Schema_Version

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: Version of the schema or data model used for admission data.

  • Admit_Source_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the admission source.

  • Admit_Source_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Admission source: NEWBORN vs NON-NEWBORN.

  • Diagnosis_Related_Group_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the diagnosis-related group for the admission.

  • Calculated_Diagnosis_Related_Group_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the calculated diagnosis-related group for the admission.

  • Admit_Type_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the admission type.

  • Patient_Status_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: UB-92 patient status code. Also known as discharge disposition code.

  • Patient_Status_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the patient status related to the admission.

  • Primary_Disease_Category_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description or details of the primary disease category for the admission.

  • Visibility_Level

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Level of visibility or access permissions for the admission record.

  • Behavioral_Health_Admission_Indicator

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator for behavioral health admission related to the admission.

  • Member_Partition

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Partition or segment of data related to the member.

  • _updated

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Indicator for whether the admission record has been updated.

  • Action

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Action or operation performed on the admission record.

Admission Raw Table

Columns

  • Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the member associated with the admission record.

  • Admit_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date when the admission took place.

  • Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

  • Admit_Source

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Source from which the admission originated.

  • Discharge_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date when the patient was discharged.

  • Length_Of_Stay

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Duration of the admission in terms of days.

  • Hospital_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier of the hospital where the admission occurred.

  • Exclusion

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator specifying if the admission is excluded from certain analyses or calculations.

  • Record_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Record type calculated based on std_place. Inpatient vs Outpatient.

  • Diagnosis_Scheme_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The ICD procedure or diagnosis coding system: ICD10 vs ICD9.

  • Medical_Claims

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Details of medical claims associated with the admission.

    • Medical_Claims.Claim_Type

    • Data Type: STRING

    • Description: Describes the type of claim, categorizing the nature of the medical claim. This can refer to types such as inpatient, outpatient, pharmacy, and so forth.

    • Medical_Claims.Claim_Number

    • Data Type: STRING

    • Description: A unique identifier for the claim, used to track and manage individual claims within the healthcare system.

    • Medical_Claims.Claim_Line_Number

    • Data Type: INT64

    • Description: Represents a specific item or service line within a claim, used for detailed tracking and accounting of each charge in a claim.

  • Diagnosis_Codes

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Codes indicating the diagnoses associated with the admission.

    • Diagnosis_Codes.Code

    • Data Type: STRING

    • Description: The unique identifier or code assigned to the diagnosis, following standardized medical coding systems such as ICD-10.

    • Diagnosis_Codes.Description

    • Data Type: STRING

    • Description: Provides a detailed description of the diagnosis associated with the code, helping healthcare providers and billing staff understand the medical condition being addressed.

  • Procedure_Codes

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Codes indicating the procedures performed during the admission.

    • Procedure_Codes.Code

    • Data Type: STRING

    • Description: The unique identifier or code for the medical procedure, used in healthcare documentation.

    • Procedure_Codes.Description

    • Data Type: STRING

    • Description: Detailed explanation of the medical procedure associated with the code.

    • Procedure_Codes.Scheme_Code

    • Data Type: STRING

    • Description: Code identifying the coding scheme used (e.g., ICD-10-PCS, HCPCS), which organizes procedure codes.

    • Procedure_Codes.Set_Code

    • Data Type: STRING

    • Description: Code identifying the specific set or category within the coding scheme that the procedure belongs to.

    • Procedure_Codes.Set_Code_Description

    • Data Type: STRING

    • Description: Description of the set or category to which the procedure code belongs, explaining its context or grouping within the scheme.

    • Procedure_Codes.Set_Type_Code

    • Data Type: STRING

    • Description: Code that further categorizes the procedure within its set for more specific classification.

    • Procedure_Codes.Set_Type_Code_Description

    • Data Type: STRING

    • Description: Description of the set type, providing details on the nature and context of the procedure categorization.

  • Primary_Disease_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Category of the primary disease or condition associated with the admission.

  • Primary_Disease_Stage

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: Stage of the primary disease or condition associated with the admission.

  • Diagnosis_Related_Group

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The diagnosis-related group code from the last room and board record. This is a pass-through field.

Admission Dataset Specification

Admission_raw Fields

  • Required: YES

  • Type: STRING

  • Description: Calculated grouping code for diagnoses related to the admission.

Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total allowed amount for the admission. This field is the sum of the allowed amount on all claims grouped into the admission.

Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total submitted or billed charge amount for the admission. This field is the sum of the submitted charge amounts of all claims grouped into an admission.

Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net payment for the admission. This field is the sum of the net payment of all claims grouped into the admission.

Total_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total relative value units for the admission. This field is the sum of the RVU amounts of all claims grouped into the admission.

Admission_MDC_Code

  • Required: YES

  • Type: STRING

  • Description: Admission MDC code, based on all claims present in the admission, can be different than mdc_cd.

Days_Since_Previous_Admission

  • Required: YES

  • Type: INT64

  • Description: Number of days since the previous admission for the same member.

Days_Until_Next_Admission

  • Required: YES

  • Type: INT64

  • Description: Number of days until the next admission for the same member.

Cost_Comparison

  • Required: YES

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Allowed Amount Total Admit for the DRG.

  • Values: -3, -2, -1, 0, 1, 2, 3

  • Explanation:

    • -3: Extreme outliers below the average.

    • 3: Extreme outliers above the average.

    • 0: Admission is not an outlier.

  • Note: The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Length_Of_Stay_Comparison

  • Required: YES

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Length of Stay (LOS) for the DRG.

  • Values: -3, -2, -1, 0, 1, 2, 3

  • Explanation:

    • -3: Extreme outliers below the average.

    • 3: Extreme outliers above the average.

    • 0: Admission is not an outlier.

  • Note: The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Per_Diem_Comparison

  • Required: YES

  • Type: INT64

  • Description: Identifies how admissions compare to the MarketScan average based on Total Allowed Amount per day for the DRG.

  • Values: -3, -2, -1, 0, 1, 2, 3

  • Explanation:

    • -3: Extreme outliers below the average.

    • 3: Extreme outliers above the average.

    • 0: Admission is not an outlier.

  • Note: The field will be blank if the DRG is not found or if all the MarketScan benchmark amounts for the DRG are 0.

Standard_Provider_Type

  • Required: YES

  • Type: INT64

  • Description: Standardized provider type associated with the admission.

Admit_Type_Code

  • Required: YES

  • Type: INT64

  • Description: Type of admission.

  • Values:

    • 1: Surgical

    • 2: Medical

    • 3: Maternity/Newborn

    • 4: Psychiatric/Substance Abuse

    • 5: Missing/Unknown

Standard_Facility_ID

  • Required: YES

  • Type: STRING

  • Description: Facility ID Standard value from the first room and board claim in the admission.

Episode_ID

  • Required: YES

  • Type: STRING

  • Description: Identifier for the episode of care associated with the admission.

Type

  • Required: YES

  • Type: STRING

  • Description: Type of record or admission.

Tenant

  • Required: YES

  • Type: STRING

  • Description: Tenant or organization associated with the admission.

Active_Version

  • Required: YES

  • Type: BOOL

  • Description: Active version or status of the admission record (always Active).

Date

  • Required: YES

  • Type: DATE

  • Description: Date of the admission or record creation/modification.

Sequence

  • Required: YES

  • Type: INT64

  • Description: Sequence number or order of the admission record.

Source_System_Name

  • Required: YES

  • Type: STRING

  • Description: Name of the source system from which the admission data originates (always named “Data Enrichment").

Source_Timestamp

  • Required: YES

  • Type: TIMESTAMP

  • Description: Timestamp indicating when the admission data was sourced.

Source_File_Name

  • Required: YES

  • Type: STRING

  • Description: Name of the source file containing the admission data.

Schema_Version

  • Required: YES

  • Type: FLOAT64

  • Description: Version of the schema or data structure used for the admission data.

Admit_Source_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the admission source.

Admit_Source_Category

  • Required: YES

  • Type: STRING

  • Description: Admission source: NEWBORN vs NON-NEWBORN.

  • Required: YES

  • Type: STRING

  • Description: Description of the diagnosis-related group associated with the admission.

  • Required: YES

  • Type: STRING

  • Description: Description of the calculated diagnosis-related group associated with the admission.

Admit_Type_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the admission type.

Patient_Status_Code

  • Required: YES

  • Type: STRING

  • Description: UB-92 patient status code. Also known as discharge disposition code.

Patient_Status_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the status of the patient associated with the admission.

Primary_Disease_Category_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the primary disease category associated with the admission.

Visibility_Level

  • Required: YES

  • Type: INT64

  • Description: Level of visibility or access permissions for the admission record.

Behavioral_Health_Admission_Indicator

  • Required: YES

  • Type: BOOL

  • Description: Indicator specifying if the admission is related to behavioral health.

Member_Partition

  • Required: YES

  • Type: INT64

  • Description: Partition or segment of members associated with the admission.

_updated

  • Required: YES

  • Type: STRING

  • Description: Timestamp indicating when the admission record was last updated.

Admission Dataset Specification

Overview

The Admission Dataset Specification defines the structure, fields, and requirements for data used in Care Intelligence systems. This specification ensures consistent and accurate data processing across all modules and features.

Dataset Structure

Core Fields

The admission dataset includes the following core fields:

  • Patient ID: A unique identifier for each patient.

  • Admission Date: The date the patient was admitted.

  • Discharge Date: The date the patient was discharged.

  • Primary Diagnosis Code: The primary diagnosis associated with the patient's admission.

  • Secondary Diagnosis Codes: Any additional diagnosis codes relevant to the admission.

  • Procedure Codes: Codes for procedures performed during the admission.

Optional Fields

Optional fields can be included to enhance dataset utility:

  • Insurance Provider: The patient's insurance provider.

  • Attending Physician: The name or ID of the attending physician.

  • Room Number: The room assigned to the patient during admission.

  • Admission Type: Emergency, elective, or other types of admission.

Field Specifications

Patient ID

  • Type: String

  • Format: Alphanumeric, up to 20 characters

  • Example: PAT123456

Admission Date

  • Type: Date

  • Format: YYYY-MM-DD

  • Example: 2023-10-15

Discharge Date

  • Type: Date

  • Format: YYYY-MM-DD

  • Example: 2023-10-20

Primary Diagnosis Code

  • Type: String

  • Format: ICD-10 code

  • Example: I10 (Hypertension)

Secondary Diagnosis Codes

  • Type: Array of Strings

  • Format: ICD-10 codes

  • Example: ["E11", "I50"] (Type 2 Diabetes, Heart Failure)

Procedure Codes

  • Type: Array of Strings

  • Format: CPT or ICD-10-PCS codes

  • Example: ["99213", "0JH60DZ"]

Data Validation Rules

Required Fields

The following fields are mandatory and must be present in every dataset:

  • Patient ID

  • Admission Date

  • Discharge Date

  • Primary Diagnosis Code

Format Validation

Each field must adhere to its specified format. Examples include:

  • Dates must be in YYYY-MM-DD format.

  • Diagnosis and procedure codes must match the respective coding standards (ICD-10, CPT, etc.).

Logical Consistency

  • Discharge Date must be later than or equal to Admission Date.

  • Procedure Codes must correspond to valid procedures performed during the admission.

Example Dataset

json \ { \ "Patient ID": "PAT123456", \ "Admission Date": "2023-10-15", \ "Discharge Date": "2023-10-20", \ "Primary Diagnosis Code": "I10", \ "Secondary Diagnosis Codes": ["E11", "I50"], \ "Procedure Codes": ["99213", "0JH60DZ"], \ "Insurance Provider": "HealthCare Inc.", \ "Attending Physician": "Dr. Jane Smith", \ "Room Number": "305", \ "Admission Type": "Emergency" \ }

Integration Guidelines

Data Submission

  • Ensure datasets are submitted in JSON format.

  • Validate all fields prior to submission to avoid processing errors.

API Endpoints

Care Intelligence systems provide the following API endpoints for dataset submission:

  • POST /admissions: Submit a new admission dataset.

  • GET /admissions/{patient_id}: Retrieve admission data for a specific patient.

  • PUT /admissions/{patient_id}: Update admission data for a specific patient.

  • DELETE /admissions/{patient_id}: Remove admission data for a specific patient.

Error Handling

Common error codes and their meanings:

  • 400 Bad Request: Invalid dataset format or missing required fields.

  • 404 Not Found: Patient ID not found in the system.

  • 500 Internal Server Error: Unexpected server issue; retry submission.

Frequently Asked Questions (FAQs)

What happens if a required field is missing?

The system will reject the dataset and return a 400 Bad Request error. Ensure all required fields are included and properly formatted.

Can I include additional fields not listed in the specification?

Yes, additional fields can be included, but they will be ignored unless explicitly supported by the system.

How do I handle updates to the dataset?

Use the PUT /admissions/{patient_id} endpoint to submit updates. Ensure the Patient ID matches the existing record.

Change Log

Version 1.0

  • Initial release of the Admission Dataset Specification.

  • Defined core and optional fields.

  • Provided validation rules and example dataset.

Related Articles
Request Dataset Specification
Assessment Dataset Specification
Episode Dataset Specification
Medical Claim Dataset Specification
Activity Stream Entry Dataset Specification
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