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Episode Dataset Specification

Updated over a month ago

Episode Dataset Specification

Episode Dataset Specification

The "Episode Dataset Specification" contains member episodes of care identified based on the claim data. It does not have a unique key. It references Members by Member_ID and Providers by Provider_ID. It also references included Admissions, Medical_Claims, and RX_Claims. It is referenced from Admission.

Key Components of the Dataset

Episode Overview

This section captures detailed information about the entire patient care episode, providing a holistic view that integrates various aspects of healthcare delivery.

Admissions Data

Included within the dataset are records of hospital admissions during the patient care episode. This information helps in tracking the patient's journey through different stages of care, ensuring that all interactions and interventions are documented.

Pharmacy Claims Data (RX Claims)

This part of the dataset focuses on the medication usage associated with the patient care episode. It includes detailed claims data, which is essential for analyzing treatment patterns and medication management within the episode.

Importance of the Dataset

This dataset is crucial for healthcare providers and administrators as it facilitates comprehensive analysis and effective management of patient care episodes, helping to enhance care coordination and patient outcomes.

Table Structure

Columns

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique alphanumeric patient identification number.

Episode_ID

YES

STRING

Unique identifier for the episode.

From_Date

YES

DATE

Start date of the episode.

To_Date

YES

DATE

End date of the episode.

Days

NO

ARRAY

The total number of days included in the episode record.

Group_Code

YES

INT64

The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

YES

STRING

Summary code for the group of the episode.

Condition_Code

YES

STRING

Code representing the condition associated with the episode.

Condition_Name

YES

STRING

Name or description of the condition associated with the episode.

Condition_Chronic

YES

BOOL

Indicator specifying if the condition is chronic or not.

Parent_Condition_Code

YES

STRING

Code representing the parent condition, if applicable.

Parent_Condition_Name

YES

STRING

Name or description of the parent condition, if applicable.

Condition_Confirmed

YES

BOOL

Indicator specifying if the condition is confirmed or not.

High_Stage

YES

STRING

The four-character numeric code identifying the highest stage of illness.

Severity_Code

YES

STRING

Code representing the severity of the condition.

Severity_Description

YES

STRING

Description of the severity of the condition.

Episode_Type_Description

YES

STRING

Description of the type of episode.

Total_Episode_Scale

YES

FLOAT64

Scale value for the episode.

Scale_Prediction_Error

YES

FLOAT64

Numeric value of the most intensive procedure submitted for the episode.

AHRQ_Procedure_Type

YES

INT64

Type of procedure according to the AHRQ (Agency for Healthcare Research and Quality).

Included

YES

BOOL

Flag indicating if the episode was included in another episode during inclusion logic processing.

Preliminary_Group_Code

YES

INT64

Preliminary episode group assigned before inclusion logic is run.

Has_Inpatient_Claim

YES

BOOL

Indicates if records grouped into the episode have at least one inpatient claim.

Inpatient_Allowed_Amount

YES

FLOAT64

Admission portion of the amount allowed by the plan for payment on the episode.

Inpatient_Submitted_Amount

YES

FLOAT64

Inpatient portion of the amount submitted for the episode.

Inpatient_Net_Amount

YES

FLOAT64

Admissions portion of the net payment amount on the episode.

Inpatient_Admission_Count

YES

INT64

Total count of admissions in the episode record.

Outpatient_Allowed_Amount

YES

FLOAT64

Outpatient portion of the amount allowed for payment on the episode.

Outpatient_Submitted_Amount

YES

FLOAT64

Outpatient portion of the submitted or billed charge amount for the episode.

Notes on Specific Fields

  • Days: This field is assigned using the first and last service dates within the episode (excluding drug claims). If the first and last service dates are the same, this is set to one.

  • Scale_Prediction_Error: The Medical Claims input file, proc_code, is required for this output. Values include:

  • 0: None found

  • 1: Minor Diagnostic

  • 2: Minor Therapeutic

  • 3: Major Diagnostic

  • 4: Major Therapeutic

  • Inpatient Fields: These fields aggregate data from admission records and medical input records with an inpatient record type that did not become part of an admission.

  • Outpatient Fields: These fields aggregate data from medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Episode Dataset Specification

Episode Fields

Outpatient_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The outpatient portion of the net payment amount for the episode. This field is the sum of the net payment amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of the allowed amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Admission_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of the outpatient Medical Claims linked to the episode.

Medical_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

Medical_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

Medical_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

Medical_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

RX_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all prescription drug claims linked to an episode.

RX_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all prescription drug claims linked to the episode.

RX_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode. This field is the sum of the net payment amount on all prescription drug claims linked to the episode.

RX_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode. This field is the sum of the inpatient, outpatient, and pharmacy allowed amounts.

Total_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total amount submitted for the episode. This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

Total_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total net payment amount for the episode. This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

Total_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of claims in the episode. If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple Medical Claims.

Total_EM_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of all E\&M claims in the episode.

Total_RVU_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed_Care_Provider_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

Managed_Care_Provider_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

Managed_Care_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

Managed_Care_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary_Provider_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

Primary_Provider_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Primary_Provider_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total net pay amount associated with the primary provider summed from the Medical Claims Input field, net_pay.

Primary_Provider_RVU_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualified_Specific_Condition

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified according to "Condition Specific" rules. If the episode does not qualify, then this flag will be false.

Qualified_Generic

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified per the "Generic" rules. If the episode is not qualified according to any one of the Generic rules, then this flag will be false.

Qualified_History_And_Physical

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the "History and Physical" rules. If the episode is not qualified according to any one of the his_and_phy rules, then this flag will be false.

Qualification_Sufficient

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y. This flag will be N if the episode can be qualified. Whenever this flag is Y, the qe_flag is always N, and when this flag is N, then the qe_flag can get a Y or N based on the other three flags: qe_cond_spec_flag, qe_his_and_phys_flag, or qe_generic_flag.

Completion_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The date on which the episode can be considered complete (not likely to include new claims).

Medical_From_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The first date of a medical claim linked to the episode, based on the Medical Claims input label, svc_date.

Medical_To_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The last date of a medical claim linked to the episode, based on the Medical Claims input label, end_date.

Visibility_Level

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Level of visibility or access control for the episode data.

Table Fields

Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique alphanumeric patient identification number.

Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the episode.

Admissions_Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

Admissions_Diagnosis_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Category of diagnosis related to the admission.

Admissions_Stage

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Stage related to the admission.

Episode Dataset Specification

Admissions

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Diagnosis-related group (DRG) associated with the admission, which categorizes patients by diagnosis, procedure, and other factors for billing and management purposes.

Prescription Claims

RX_Claims_Claim_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the prescription claim.

RX_Claims_Time_Window_Months

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Time window in months for the prescription claim.

RX_Claims_Episode_Score

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Score related to the prescription claim within the episode.

RX_Claims_Specificity

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Specificity of the prescription claim within the episode.

Medical Claims

Medical_Claims_Claim_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Claim type code: "PROF" or "INST".

Medical_Claims_Claim_Type_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Description of the medical claim type.

Medical_Claims_Claim_Number

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Number of the medical claim.

Medical_Claims_Claim_Line_Number

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Claim’s item line number.

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Diagnosis-related group (DRG) related to the medical claim.

Medical_Claims_Diagnosis_Reorder

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Reorder indicator for the diagnosis related to the medical claim.

Medical_Claims_Diagnosis_Codes

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Codes associated with the diagnosis in the medical claim.

Medical_Claims_Procedure_Codes

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: Codes associated with procedures in the medical claim.

Medical_Claims_Diagnosis_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Category of the diagnosis in the medical claim.

Episode Details

Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique alphanumeric patient identification number.

Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the episode.

From_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Start date of the episode.

To_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: End date of the episode.

Days

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Duration of the episode in days.

Group_Code

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Code summarizing the group information for the episode.

Condition_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Condition Code based on Group Code.

Condition_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Human-readable name of the condition related to the episode.

Condition_Chronic

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Chronic Condition Indicator.

Parent_Condition_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Parent Condition Code based on Group Code.

Parent_Condition_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Parent condition human-readable name.

Condition_Confirmed

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator confirming the diagnosis of the condition.

High_Stage

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The four-character numeric code identifying the highest stage of illness for an episode.

Severity_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Condition severity code.

Severity_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Condition severity name.

Episode_Type_Description

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Episode Type Description.

Total_Episode_Scale

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The episode cost scale prediction error.

Scale_Prediction_Error

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: Scale value for expected allowed payments, where 1.00 is average.

AHRQ_Procedure_Type

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The one-character numeric value of the most intensive procedure submitted for the episode.

  • Values:

    • 0 (None found)

    • 1 (Minor Diagnostic)

    • 2 (Minor Therapeutic)

    • 3 (Major Diagnostic)

    • 4 (Major Therapeutic)

  • Note: The Medical Claims input file, proc_code, is required for this output.

Included

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag indicates if the episode was included in another episode during inclusion logic processing.

Preliminary_Group_Code

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The preliminary episode group assigned before inclusion logic is run.

Has_Inpatient_Claim

  • Is Nullable: YES

  • Data Type: BOOL

  • Description:

  • If records grouped into the episode are completely outpatient, then false.

  • If the records grouped into the episode have at least one inpatient claim, then true.

Inpatient_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The admission portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the allowed amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The inpatient portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the submitted charge amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The admissions portion of the net payment amount on the episode. This field is the sum of the net payment amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the net payment amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Admission_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of admissions in the episode record. When MEG is run with admission build, this field is the count of admissions built by the grouper that were included in the episode.

Outpatient_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The outpatient portion of the amount allowed for payment on the episode. This field is the sum of the allowed amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of allowed amounts on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The outpatient portion of the submitted or billed charge amount for the episode. This field is the sum of the submitted charge amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of submitted charge amounts on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Episode Dataset Specification

Fields and Descriptions

Outpatient Fields

  • Outpatient_Net_Amount

  • Type: FLOAT64

  • Description: The outpatient portion of the net payment amount for the episode.

    • This field is the sum of the net payment amount on all non-admission records within the episode.

    • When MEG is run with admission build, this field is the sum of the allowed amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

  • Outpatient_Admission_Count

  • Type: INT64

  • Description: The total count of the outpatient medical claims linked to the episode.

Medical Fields

  • Medical_Allowed_Amount

  • Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

  • Medical_Submitted_Amount

  • Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

  • Medical_Net_Amount

  • Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

  • Medical_Count

  • Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

Prescription Drug (RX) Fields

  • RX_Allowed_Amount

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode.

    • This field is the sum of the allowed amount on all prescription drug claims linked to an episode.

  • RX_Submitted_Amount

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode.

    • This field is the sum of the submitted charge amount on all prescription drug claims linked to the episode.

  • RX_Net_Amount

  • Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode.

    • This field is the sum of the net payment amount on all prescription drug claims linked to the episode.

  • RX_Count

  • Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total Fields

  • Total_Allowed_Amount

  • Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode.

    • This field is the sum of the inpatient, outpatient, and pharmacy allowed amounts.

  • Total_Submitted_Amount

  • Type: FLOAT64

  • Description: The total amount submitted for the episode.

    • This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

  • Total_Net_Amount

  • Type: FLOAT64

  • Description: The total net payment amount for the episode.

    • This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

  • Total_Count

  • Type: INT64

  • Description: The total count of claims in the episode.

    • If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple medical claims.

  • Total_EM_Count

  • Type: INT64

  • Description: The total count of all E\&M claims in the episode.

  • Total_RVU_Amount

  • Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed Care Fields

  • Managed_Care_Provider_ID

  • Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

  • Managed_Care_Provider_Type

  • Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

  • Managed_Care_Allowed_Amount

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

  • Managed_Care_Submitted_Amount

  • Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

  • Managed_Care_Net_Amount

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

  • Managed_Care_Count

  • Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary Provider Fields

  • Primary_Provider_ID

  • Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

  • Primary_Provider_Type

  • Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

  • Primary_Provider_Allowed_Amount

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

  • Primary_Provider_Submitted_Amount

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

  • Primary_Provider_Net_Amount

  • Type: FLOAT64

  • Description: The total net pay amount associated with the primary provider summed from the medical claims input field, net_pay.

  • Primary_Provider_RVU_Amount

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualification Flags

  • Qualified_Specific_Condition

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to "Condition Specific" rules. If the episode does not qualify, then this flag will be false.

  • Qualified_Generic

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified per the "Generic" rules. If the episode is not qualified according to any one of the Generic rules, then this flag will be false.

  • Qualified_History_And_Physical

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the "History and Physical" rules. If the episode is not qualified according to any one of the his_and_phys rules, then this flag will be false.

  • Qualification_Sufficient

  • Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y.

    • This flag will be N if the episode can be qualified.

    • Whenever this flag is Y, the qe_flag is always N.

    • When this flag is N, then the qe_flag can get a Y or N based on the other three flags: qe_cond_spec_flag, qe_his_and_phys_flag, or qe_generic_flag.

Dates

  • Completion_Date

  • Type: DATE

  • Description: Date when the episode was completed.

  • Medical_From_Date

  • Type: DATE

  • Description: Start date for medical services related to the episode.

  • Medical_To_Date

  • Type: DATE

  • Description: End date for medical services related to the episode.

Medical Claims

  • Medical_Claims

  • Type: ARRAY

  • Description: List of medical claims related to the episode.

Medical Claims Fields

  • Medical_Claims.Claim_Type

  • Type: STRING

  • Description: The type of medical claim, such as inpatient, outpatient, pharmacy, etc., categorizing the nature of the claim.

  • Medical_Claims.Claim_Type_Description

  • Type: STRING

  • Description: A detailed description of the claim type, providing additional context about the services covered under this claim type.

  • Medical_Claims.Claim_Number

  • Type: STRING

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

  • Medical_Claims.Claim_Line_Number

  • Type: INT64

  • Description: A specific line number within a claim, representing a distinct item or service billed.

Episode Dataset Specification

Medical Claims

  • Data Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which is used to categorize hospital cases for the purpose of Medicare reimbursement.

Medical_Claims.Diagnosis_Reorder

  • Data Type: BOOL

  • Description: A flag indicating whether the diagnosis was reordered during the claim process, important for claims processing and audits.

Medical_Claims.Diagnosis_Codes

  • Data Type: ARRAY

  • Description: A list of diagnosis codes associated with the claim, used for documenting and categorizing medical conditions treated.

Medical_Claims.Procedure_Codes

  • Data Type: ARRAY

  • Description: A list of procedure codes associated with the claim, detailing the medical procedures performed during the treatment.

Medical_Claims.Diagnosis_Category

  • Data Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes.

Medical_Claims.Stage

  • Data Type: STRING

  • Description: The stage of the claim within the treatment or billing cycle, indicating the claim's progression or status.

Admissions

Admissions

  • Data Type: ARRAY

  • Description: List of admissions related to the episode.

Admissions.Admission_ID

  • Data Type: STRING

  • Description: The unique identifier for each admission entry, used to track individual admissions throughout the healthcare system.

Admissions.Diagnosis_Category

  • Data Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes within the admission process.

Admissions.Stage

  • Data Type: STRING

  • Description: The stage of the patient's treatment or admission cycle at the time of the record, indicating the progress or status of care.

  • Data Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which categorizes hospital cases for the purpose of Medicare reimbursement and other billing purposes.

Prescription Claims (RX_Claims)

RX_Claims

  • Data Type: ARRAY

  • Description: List of prescription claims related to the episode.

RX_Claims.Claim_ID

  • Data Type: STRING

  • Description: The unique identifier for each prescription claim entry, used to track individual medication claims within the healthcare system.

RX_Claims.Time_Window_Months

  • Data Type: INT64

  • Description: The number of months over which the prescription claim is relevant, providing a timeframe for tracking medication usage and adherence.

RX_Claims.Episode_Score

  • Data Type: INT64

  • Description: A numerical score associated with the claim, reflecting the effectiveness or critical nature of the medication treatment within the episode of care.

RX_Claims.Specificity

  • Data Type: STRING

  • Description: A description of the specificity or targeting of the medication, indicating how closely the medication is tailored to treating specific conditions or patient groups.

General Episode Attributes

Type

  • Data Type: STRING

  • Description: Type of record or entry in the episode log.

Tenant

  • Data Type: STRING

  • Description: Tenant or organization associated with the episode data.

Active_Version

  • Data Type: BOOL

  • Description: Active version of the episode log record.

Date

  • Data Type: DATE

  • Description: Date associated with the episode log record.

Sequence

  • Data Type: INT64

  • Description: Sequence number or order of the episode log record.

Source_System_Name

  • Data Type: STRING

  • Description: Name of the source system for the episode data.

Source_Timestamp

  • Data Type: TIMESTAMP

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

Source_File_Name

  • Data Type: STRING

  • Description: Name of the source file for the episode data.

Schema_Version

  • Data Type: FLOAT64

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

Visibility_Level

  • Data Type: INT64

  • Description: Level of visibility or access control for the episode data.

Member_Partition

  • Data Type: INT64

  • Description: Partition or segment associated with the member data.

_updated

  • Data Type: STRING

  • Description: Indicator specifying if the episode log record has been updated.

Action

  • Data Type: STRING

  • Description: Action or operation performed on the episode log record (e.g., insert, update, delete).

Episode Table Schema

Member_ID

  • Data Type: STRING

  • Description: Unique alphanumeric patient identification number.

Episode_ID

  • Data Type: STRING

  • Description: Unique identifier for the episode.

From_Date

  • Data Type: DATE

  • Description: Start date of the episode.

To_Date

  • Data Type: DATE

  • Description: End date of the episode.

Days

  • Data Type: INT64

  • Description: The total number of days included in the episode record. This field is assigned using the first and last service dates within the episode (excluding drug claims). If the first and last service dates are the same, this is set to one.

Group_Code

  • Data Type: INT64

  • Description: The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

  • Data Type: STRING

  • Description: Summary code for the group of the episode.

Condition_Code

  • Data Type: STRING

  • Description: Code representing the condition associated with the episode.

Condition_Name

  • Data Type: STRING

  • Description: Name or description of the condition associated with the episode.

Condition_Chronic

  • Data Type: BOOL

  • Description: Indicator specifying if the condition is chronic or not.

Parent_Condition_Code

  • Data Type: STRING

  • Description: Code representing the parent condition, if applicable.

Parent_Condition_Name

  • Data Type: STRING

  • Description: Name or description of the parent condition, if applicable.

Condition_Confirmed

  • Data Type: BOOL

  • Description: Indicator specifying if the condition is confirmed or not.

High_Stage

  • Data Type: STRING

  • Description: The four-character numeric code identifying the highest stage of illness for an episode.

Severity_Code

  • Data Type: STRING

  • Description: Code representing the severity of the condition.

Severity_Description

  • Data Type: STRING

  • Description: Description of the severity of the condition.

Episode_Type_Description

  • Data Type: STRING

  • Description: Description of the type of episode.

Total_Episode_Scale

  • Data Type: FLOAT64

  • Description: Scale value for the episode.

Scale_Prediction_Error

  • Data Type: FLOAT64

  • Description: The one-character numeric value of the most intensive procedure submitted for the episode.\ Note: The Medical Claims input file, proc_code, is required for this output.

  • 0: None found

  • 1: Minor Diagnostic

  • 2: Minor Therapeutic

  • 3: Major Diagnostic

  • 4: Major Therapeutic

AHRQ_Procedure_Type

  • Data Type: INT64

  • Description: Type of procedure according to the AHRQ (Agency for Healthcare Research and Quality).

Included

  • Data Type: BOOL

  • Description: This flag indicates if the episode was included in another episode during inclusion logic processing.

Preliminary_Group_Code

  • Data Type: INT64

  • Description: The preliminary episode group assigned before inclusion logics run.

Has_Inpatient_Claim

  • Data Type: BOOL

  • Description: If records grouped into the episode are completely outpatient, then false. If the records grouped into the episode have at least one inpatient claim, then true.

Inpatient_Allowed_Amount

  • Data Type: FLOAT64

  • Description: The admission portion of the amount allowed by the plan for payment on the episode.

Episode Dataset Specification

Inpatient Fields

Inpatient_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The inpatient portion of the allowed amount for payment on the episode.

  • This field is the sum of the allowed amount on all admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the allowed amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The inpatient portion of the amount submitted for the episode.

  • This field is the sum of the submitted charge amount on all admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the submitted charge amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The admissions portion of the net payment amount on the episode.

  • This field is the sum of the net payment amount on all admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the net payment amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Admission_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of admissions in the episode record.

  • When MEG is run with admission build, this field is the count of admissions built by the grouper that were included in the episode.

Outpatient Fields

Outpatient_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the amount allowed for payment on the episode.

  • This field is the sum of the allowed amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of allowed amounts on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the submitted or billed charge amount for the episode.

  • This field is the sum of the submitted charge amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the submitted charge amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the net payment amount for the episode.

  • This field is the sum of the net payment amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the allowed amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Admission_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the outpatient medical claims linked to the episode.

Medical Fields

Medical_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

Medical_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

Medical_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

Medical_Count

  • Required: YES

  • Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

Prescription Drug Fields

RX_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode.

  • This field is the sum of the allowed amount on all prescription drug claims linked to an episode.

RX_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode.

  • This field is the sum of the submitted charge amount on all prescription drug claims linked to the episode.

RX_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode.

  • This field is the sum of the net payment amount on all prescription drug claims linked to the episode.

RX_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total Fields

Total_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy allowed amounts.

Total_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount submitted for the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

Total_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net payment amount for the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

Total_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of claims in the episode.

  • If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple medical claims.

Total_EM_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of all E\&M claims in the episode.

Total_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed Care Fields

Managed_Care_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

Managed_Care_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

Managed_Care_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

Managed_Care_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Count

  • Required: YES

  • Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary Provider Fields

Primary_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

Primary_Provider_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Primary_Provider_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net payment amount associated with the primary provider summed from the medical claims input field.

Episode Dataset Specification

Episode Overview

This section captures detailed information about the entire patient care episode, providing a holistic view that integrates various aspects of healthcare delivery.

Fields

et_pay

  • Primary_Provider_RVU_Amount

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualification Flags

  • Qualified_Specific_Condition

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to "Condition Specific" rules. If the episode does not qualify, then this flag will be false.

  • Qualified_Generic

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified per the "Generic" rules. If the episode is not qualified according to any one of the Generic rules, then this flag will be false.

  • Qualified_History_And_Physical

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the "History and Physical" rules. If the episode is not qualified according to any one of the History and Physical rules, then this flag will be false.

  • Qualification_Sufficient

  • Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y. This flag will be N if the episode can be qualified.

    • Whenever this flag is Y, the qe_flag is always N.

    • When this flag is N, then the qe_flag can get a Y or N based on the other three flags: qe_cond_spec_flag, qe_his_and_phys_flag, or qe_generic_flag.

Completion Date

  • Completion_Date

  • Type: DATE

  • Description: The date on which the episode can be considered complete (not likely to include new claims).

Medical Claims Date Range

  • Medical_From_Date

  • Type: DATE

  • Description: The first date of a medical claim linked to the episode, based on the Medical Claims input label svc_date.

  • Medical_To_Date

  • Type: DATE

  • Description: The last date of a medical claim linked to the episode, based on the Medical Claims input label end_date.

Medical Claims

  • Medical_Claims

  • Type: ARRAY

  • Description: List of references to Medical claims included in the episode.

Medical Claims Fields

  • Claim_Type

  • Type: STRING

  • Description: Identifies the type of medical claim, such as inpatient, outpatient, or pharmacy, categorizing the nature of the medical service provided.

  • Claim_Type_Description

  • Type: STRING

  • Description: Provides a detailed description of the claim type, elaborating on the services covered under this claim category.

  • Claim_Number

  • Type: STRING

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

  • Claim_Line_Number

  • Type: INT64

  • Description: Represents a specific line within a claim, detailing an individual service or item billed within the broader claim.

  • Diagnosis_Related_Group

  • Type: STRING

  • Description: Refers to the DRG (Diagnosis Related Group) code, which is utilized to categorize hospital cases for the purpose of Medicare reimbursement and other insurance billing.

  • Diagnosis_Reorder

  • Type: BOOL

  • Description: Indicates whether the diagnosis was reordered for clarity or additional billing purposes during the claims processing.

  • Diagnosis_Codes

  • Type: ARRAY

  • Description: A list of diagnosis codes that detail the medical conditions diagnosed and treated during the episode covered by the claim.

  • Diagnosis_Code

    • Type: STRING

    • Description: Each string in this array represents a specific medical diagnosis code detailing conditions treated.

  • Procedure_Codes

  • Type: ARRAY

  • Description: A list of procedure codes that describe the medical procedures performed during the treatment associated with the claim.

  • Procedure_Code

    • Type: STRING

    • Description: Each string in this array represents a specific medical procedure code detailing treatments performed.

  • Diagnosis_Category

  • Type: STRING

  • Description: The category of the diagnosis, used to group similar medical conditions for analytical and billing purposes within healthcare management.

  • Stage

  • Type: STRING

  • Description: Indicates the stage of treatment or the billing cycle that the claim is documenting, reflecting the progression or status of the medical case.

Admissions

  • Admissions

  • Type: ARRAY

  • Description: List of references to Admissions included in the episode.

Admissions Fields

  • Admission_ID

  • Type: STRING

  • Description: The unique identifier for each admission entry, used to track individual admissions throughout the healthcare system.

  • Diagnosis_Category

  • Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes within the admission process.

  • Stage

  • Type: STRING

  • Description: The stage of the patient's treatment or admission cycle at the time of the record, indicating the progress or status of care.

  • Diagnosis_Related_Group

  • Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which categorizes hospital cases for the purpose of Medicare reimbursement and other billing purposes.

RX Claims

  • RX_Claims

  • Type: ARRAY

  • Description: List of references to RX claims included in the episode.

RX Claims Fields

  • Claim_ID

  • Type: STRING

  • Description: The unique identifier for each prescription claim entry, used to track individual medication claims within the healthcare system.

  • Time_Window_Months

  • Type: INT64

  • Description: The number of months over which the prescription claim is relevant, providing a timeframe for tracking medication usage and adherence.

  • Episode_Score

  • Type: INT64

  • Description: A numerical score associated with the claim, reflecting the effectiveness or critical nature of the medication treatment within the episode of care.

  • Specificity

  • Type: STRING

  • Description: A description of the specificity or targeting of the medication, indicating how closely the medication is tailored to treating specific conditions or patient groups.

General Episode Metadata

  • Type

  • Type: STRING

  • Description: Type of episode.

  • Tenant

  • Type: STRING

  • Description: Tenant identifier.

  • Active_Version

  • Type: BOOL

  • Description: Active version of the dataset.

  • Date

  • Type: DATE

  • Description: Date of the dataset entry.

  • Sequence

  • Type: INT64

  • Description: Sequence number.

  • Source_System_Name

  • Type: STRING

  • Description: Name of the source system.

  • Source_Timestamp

  • Type: TIMESTAMP

  • Description: Timestamp of the source data.

  • Source_File_Name

  • Type: STRING

  • Description: Name of the source file.

  • Schema_Version

  • Type: FLOAT64

  • Description: Version of the schema.

  • Visibility_Level

  • Type: INT64

  • Description: Level of visibility of the episode data.

  • Member_Partition

  • Type: INT64

  • Description: Partition identifier for the member.

  • _updated

  • Type: STRING

  • Description: Indicator specifying if the entry was updated.

Episode Dataset Specification

Overview

The episode dataset contains records of hospital admissions during the patient care episode. This information helps in tracking the patient's journey through different stages of care, ensuring that all interactions and interventions are documented.

Pharmacy Claims Data (RX Claims)

This part of the dataset focuses on the medication usage associated with the patient care episode. It includes detailed claims data, which is essential for analyzing treatment patterns and medication management within the episode.

Table Content

Table Name

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique alphanumeric patient identification number.

Episode_ID

YES

STRING

Unique identifier for the episode.

From_Date

YES

DATE

Start date of the episode.

To_Date

YES

DATE

End date of the episode.

Days

NO

ARRAY

The total number of days included in the episode record. This field is assigned using the first and last service dates within the episode (excluding drug claims). If the first and last service dates are the same, this is set to one.

Group_Code

YES

INT64

The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

YES

STRING

Summary code for the group of the episode.

Condition_Code

YES

STRING

Code representing the condition associated with the episode.

Condition_Name

YES

STRING

Name or description of the condition associated with the episode.

Condition_Chronic

YES

BOOL

Indicator specifying if the condition is chronic or not.

Parent_Condition_Code

YES

STRING

Code representing the parent condition, if applicable.

Parent_Condition_Name

YES

STRING

Name or description of the parent condition, if applicable.

Condition_Confirmed

YES

BOOL

Indicator specifying if the condition is confirmed or not.

High_Stage

YES

STRING

The four-character numeric code identifying the highest stage of illness for an episode.

Severity_Code

YES

STRING

Code representing the severity of the condition.

Severity_Description

YES

STRING

Description of the severity of the condition.

Episode_Type_Description

YES

STRING

Description of the type of episode.

Total_Episode_Scale

YES

FLOAT64

Scale value for the episode.

Scale_Prediction_Error

YES

FLOAT64

The one-character numeric value of the most intensive procedure submitted for the episode. NOTE: The Medical Claims input file, proc_code, is required for this output. Possible values:
0 (None found)
1 (Minor Diagnostic)
2 (Minor Therapeutic)
3 (Major Diagnostic)
4 (Major Therapeutic)

AHRQ_Procedure_Type

YES

INT64

Type of procedure according to the AHRQ (Agency for Healthcare Research and Quality).

Included

YES

BOOL

This flag indicates if the episode was included in another episode during inclusion logic processing.

Preliminary_Group_Code

YES

INT64

The preliminary episode group assigned before inclusion logic is run.

Has_Inpatient_Claim

YES

BOOL

If records grouped into the episode are completely outpatient, then false. If the records grouped into the episode have at least one inpatient claim, then true.

Inpatient_Allowed_Amount

YES

FLOAT64

The admission portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the allowed amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Submitted_Amount

YES

FLOAT64

The inpatient portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the submitted charge amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Net_Amount

YES

FLOAT64

The admissions portion of the net payment amount on the episode. This field is the sum of the net payment amount on all admission records within the episode. When MEG is run with admission build, this field is the sum of the net payment amount from all admissions built and included in the episode, as well as any medical input records with an inpatient record type that did not become part of an admission.

Inpatient_Admission_Count

YES

INT64

The total count of admissions in the episode record. When MEG is run with admission build, this field is the count of admissions built by the grouper that were included in the episode.

Outpatient_Allowed_Amount

YES

FLOAT64

The outpatient portion of the amount allowed for payment on the episode. This field is the sum of the allowed amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of allowed amounts on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Submitted_Amount

YES

FLOAT64

The outpatient portion of the submitted or billed charge amount for the episode. This field is the sum of the submitted charge amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of the submitted charge amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Net_Amount

YES

FLOAT64

The outpatient portion of the net payment amount for the episode. This field is the sum of the net payment amount on all non-admission records within the episode. When MEG is run with admission build, this field is the sum of the allowed amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Episode Dataset Specification

Episode Fields

Outpatient Admission Count

  • Column Name: Outpatient_Admission_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of the outpatient Medical Claims linked to the episode.

Medical Allowed Amount

  • Column Name: Medical_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

Medical Submitted Amount

  • Column Name: Medical_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

Medical Net Amount

  • Column Name: Medical_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

Medical Count

  • Column Name: Medical_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

Prescription Drug Allowed Amount

  • Column Name: RX_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all prescription drug claims linked to an episode.

Prescription Drug Submitted Amount

  • Column Name: RX_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all prescription drug claims linked to the episode.

Prescription Drug Net Amount

  • Column Name: RX_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode. This field is the sum of the net payment amount on all prescription drug claims linked to the episode.

Prescription Drug Count

  • Column Name: RX_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total Allowed Amount

  • Column Name: Total_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode. This field is the sum of the inpatient, outpatient, and pharmacy allowed amounts.

Total Submitted Amount

  • Column Name: Total_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total amount submitted for the episode. This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

Total Net Amount

  • Column Name: Total_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total net payment amount for the episode. This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

Total Count

  • Column Name: Total_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of claims in the episode. If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple Medical Claims.

Total E\&M Count

  • Column Name: Total_EM_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total count of all E\&M claims in the episode.

Total RVU Amount

  • Column Name: Total_RVU_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed Care Provider ID

  • Column Name: Managed_Care_Provider_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

Managed Care Provider Type

  • Column Name: Managed_Care_Provider_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

Managed Care Allowed Amount

  • Column Name: Managed_Care_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed Care Submitted Amount

  • Column Name: Managed_Care_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

Managed Care Net Amount

  • Column Name: Managed_Care_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed Care Count

  • Column Name: Managed_Care_Count

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary Provider ID

  • Column Name: Primary_Provider_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

Primary Provider Type

  • Column Name: Primary_Provider_Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

Primary Provider Allowed Amount

  • Column Name: Primary_Provider_Allowed_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

Primary Provider Submitted Amount

  • Column Name: Primary_Provider_Submitted_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Primary Provider Net Amount

  • Column Name: Primary_Provider_Net_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The total net pay amount associated with the primary provider summed from the Medical Claims Input field, net_pay.

Primary Provider RVU Amount

  • Column Name: Primary_Provider_RVU_Amount

  • Is Nullable: YES

  • Data Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualified Specific Condition

  • Column Name: Qualified_Specific_Condition

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified according to “Condition Specific” rules. If the episode does not qualify, then this flag will be false.

Qualified Generic

  • Column Name: Qualified_Generic

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified per the “Generic” rules. If the episode is not qualified according to any one of the Generic rules then this flag will be false.

Qualified History and Physical

  • Column Name: Qualified_History_And_Physical

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the “History and Physical” rules. If the episode is not qualified according to any one of the his_and_phy rules, then this flag will be false.

Qualification Sufficient

  • Column Name: Qualification_Sufficient

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y. This flag will be N if the episode can be qualified. Whenever this flag is Y, the qe_flag is always N, and when this flag is N, then the qe_flag can get a Y or N based on the other three flags: qe_cond_spec_flag, qe_his_and_phys_flag, or qe_generic_flag.

Completion Date

  • Column Name: Completion_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The date on which the Episode can be considered complete (not likely to include new claims).

Medical From Date

  • Column Name: Medical_From_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The first date of a medical claim linked to the episode, based on the Medical Claims input label, svc_date.

Medical To Date

  • Column Name: Medical_To_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: The last date of a medical claim linked to the episode, based on the Medical Claims input label, end_date.

Visibility Level

  • Column Name: Visibility_Level

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Level of visibility or access control for the episode data.

Table Content

Member ID

  • Column Name: Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique alphanumeric patient identification number.

Episode ID

  • Column Name: Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the episode.

Admissions Admission ID

  • Column Name: Admissions_Admission_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the admission record.

Admissions Diagnosis Category

  • Column Name: Admissions_Diagnosis_Category

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Category of diagnosis related to the admission.

Admissions Stage

  • Column Name: Admissions_Stage

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Stage related to the admission.

Episode Dataset Specification

Table Content

Table Name

Column Name

Is Nullable

Data Type

Description

Admissions_Diagnosis_Related_Group

YES

STRING

Diagnosis-related group (DRG) associated with the admission, which categorizes patients by diagnosis, procedure, and other factors for billing and management purposes.

Prescription Claims

Table Content

Table Name

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique alphanumeric patient identification number.

Episode_ID

YES

STRING

Unique identifier for the episode.

RX_Claims_Claim_ID

YES

STRING

Unique identifier for the prescription claim.

RX_Claims_Time_Window_Months

YES

INT64

Time window in months for the prescription claim.

RX_Claims_Episode_Score

YES

INT64

Score related to the prescription claim within the episode.

RX_Claims_Specificity

YES

STRING

Specificity of the prescription claim within the episode.

Medical Claims

Table Content

Table Name

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique alphanumeric patient identification number.

Episode_ID

YES

STRING

Unique identifier for the episode.

Medical_Claims_Claim_Type

YES

STRING

Claim type code: "PROF" or "INST".

Medical_Claims_Claim_Type_Description

YES

STRING

Description of the medical claim type.

Medical_Claims_Claim_Number

YES

STRING

Number of the medical claim.

Medical_Claims_Claim_Line_Number

YES

INT64

Claim’s item line number.

Medical_Claims_Diagnosis_Related_Group

YES

STRING

Diagnosis-related group (DRG) related to the medical claim.

Medical_Claims_Diagnosis_Reorder

YES

BOOL

Reorder indicator for the diagnosis related to the medical claim.

Medical_Claims_Diagnosis_Codes

NO

ARRAY

Codes associated with the diagnosis in the medical claim.

Medical_Claims_Procedure_Codes

NO

ARRAY

Codes associated with procedures in the medical claim.

Medical_Claims_Diagnosis_Category

YES

STRING

Category of the diagnosis in the medical claim.

Episode Details

Table Content

Table Name

Column Name

Is Nullable

Data Type

Description

Member_ID

YES

STRING

Unique alphanumeric patient identification number.

Episode_ID

YES

STRING

Unique identifier for the episode.

From_Date

YES

DATE

Start date of the episode.

To_Date

YES

DATE

End date of the episode.

Days

YES

INT64

Duration of the episode in days.

Group_Code

YES

INT64

The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

YES

STRING

Code summarizing the group information for the episode.

Condition_Code

YES

STRING

Condition Code based on Group Code.

Condition_Name

YES

STRING

Human-readable name of the condition related to the episode.

Condition_Chronic

YES

BOOL

Chronic Condition Indicator.

Parent_Condition_Code

YES

STRING

Parent Condition Code based on Group Code.

Parent_Condition_Name

YES

STRING

Parent condition human-readable name.

Condition_Confirmed

YES

BOOL

Indicator confirming the diagnosis of the condition.

High_Stage

YES

STRING

The four-character numeric code identifying the highest stage of illness for an episode.

Severity_Code

YES

STRING

Condition severity code.

Severity_Description

YES

STRING

Condition severity name.

Episode_Type_Description

YES

STRING

Episode Type Description.

Total_Episode_Scale

YES

FLOAT64

The episode cost scale prediction error.

Scale_Prediction_Error

YES

FLOAT64

Scale value for expected allowed payments, where 1.00 is average.

AHRQ_Procedure_Type

YES

INT64

The one-character numeric value of the most intensive procedure submitted for the episode.

Included

YES

BOOL

This flag indicates if the episode was included in another episode during inclusion logic processing.

Preliminary_Group_Code

YES

INT64

The preliminary episode group assigned before inclusion logic is run.

Has_Inpatient_Claim

YES

BOOL

If records grouped into the episode are completely outpatient, then false. If the records grouped into the episode have at least one inpatient claim, then true.

Inpatient_Allowed_Amount

YES

FLOAT64

The admission portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all admission records within the episode.

Inpatient_Submitted_Amount

YES

FLOAT64

The inpatient portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all admission records within the episode.

Inpatient_Net_Amount

YES

FLOAT64

The admissions portion of the net payment amount on the episode. This field is the sum of the net payment amount on all admission records within the episode.

Inpatient_Admission_Count

YES

INT64

The total count of admissions in the episode record. When MEG is run with admission build, this field is the count of admissions built by the grouper that were included in the episode.

Episode Dataset Specification

Outpatient Fields

Outpatient_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the amount allowed for payment on the episode.

  • This field is the sum of the allowed amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of allowed amounts on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the submitted or billed charge amount for the episode.

  • This field is the sum of the submitted charge amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the submitted charge amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the net payment amount for the episode.

  • This field is the sum of the net payment amount on all non-admission records within the episode.

  • When MEG is run with admission build, this field is the sum of the allowed amount on all medical input records within an episode that were not part of an admission and did not have an inpatient record type.

Outpatient_Admission_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the outpatient medical claims linked to the episode.

Medical Fields

Medical_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

Medical_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

Medical_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

Medical_Count

  • Required: YES

  • Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

Prescription Drug (RX) Fields

RX_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode.

  • This field is the sum of the allowed amount on all prescription drug claims linked to an episode.

RX_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode.

  • This field is the sum of the submitted charge amount on all prescription drug claims linked to the episode.

RX_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode.

  • This field is the sum of the net payment amount on all prescription drug claims linked to the episode.

RX_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total Fields

Total_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy allowed amounts.

Total_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount submitted for the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

Total_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net payment amount for the episode.

  • This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

Total_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of claims in the episode.

  • If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple medical claims.

Total_EM_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of all E\&M claims in the episode.

Total_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed Care Fields

Managed_Care_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

Managed_Care_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

Managed_Care_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

Managed_Care_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Count

  • Required: YES

  • Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary Provider Fields

Primary_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

Primary_Provider_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Primary_Provider_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net pay amount associated with the primary provider summed from the medical claims input field, net_pay.

Primary_Provider_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualification Flags

Qualified_Specific_Condition

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to "Condition Specific" rules.

  • If the episode does not qualify, then this flag will be false.

Qualified_Generic

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified per the "Generic" rules.

  • If the episode is not qualified according to any one of the Generic rules, then this flag will be false.

Qualified_History_And_Physical

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the "History and Physical" rules.

  • If the episode is not qualified according to any one of the his_and_phy rules, then this flag will be false.

Qualification_Sufficient

  • Required: YES

  • Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y.

  • This flag will be N if the episode can be qualified.

  • Whenever this flag is Y, the qe_flag is always N.

Episode Dataset Specification

Episode Fields

Completion_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date when the episode was completed.

Medical_From_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Start date for medical services related to the episode.

Medical_To_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: End date for medical services related to the episode.

Medical_Claims

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: List of medical claims related to the episode.

Medical_Claims Fields

  • Claim_Type

  • Data Type: STRING

  • Description: The type of medical claim, such as inpatient, outpatient, pharmacy, etc., categorizing the nature of the claim.

  • Claim_Type_Description

  • Data Type: STRING

  • Description: A detailed description of the claim type, providing additional context about the services covered under this claim type.

  • Claim_Number

  • Data Type: STRING

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

  • Claim_Line_Number

  • Data Type: INT64

  • Description: A specific line number within a claim, representing a distinct item or service billed within the claim.

  • Diagnosis_Related_Group

  • Data Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which is used to categorize hospital cases for the purpose of Medicare reimbursement.

  • Diagnosis_Reorder

  • Data Type: BOOL

  • Description: A flag indicating whether the diagnosis was reordered during the claim process, important for claims processing and audits.

  • Diagnosis_Codes

  • Data Type: ARRAY

  • Description: A list of diagnosis codes associated with the claim, used for documenting and categorizing medical conditions treated.

  • Procedure_Codes

  • Data Type: ARRAY

  • Description: A list of procedure codes associated with the claim, detailing the medical procedures performed during the treatment.

  • Diagnosis_Category

  • Data Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes.

  • Stage

  • Data Type: STRING

  • Description: The stage of the claim within the treatment or billing cycle, indicating the claim's progression or status.

Admissions

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: List of admissions related to the episode.

Admissions Fields

  • Admission_ID

  • Data Type: STRING

  • Description: The unique identifier for each admission entry, used to track individual admissions throughout the healthcare system.

  • Diagnosis_Category

  • Data Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes within the admission process.

  • Stage

  • Data Type: STRING

  • Description: The stage of the patient's treatment or admission cycle at the time of the record, indicating the progress or status of care.

  • Diagnosis_Related_Group

  • Data Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which categorizes hospital cases for the purpose of Medicare reimbursement and other billing purposes.

RX_Claims

  • Is Nullable: NO

  • Data Type: ARRAY

  • Description: List of prescription claims related to the episode.

RX_Claims Fields

  • Claim_ID

  • Data Type: STRING

  • Description: The unique identifier for each prescription claim entry, used to track individual medication claims within the healthcare system.

  • Time_Window_Months

  • Data Type: INT64

  • Description: The number of months over which the prescription claim is relevant, providing a timeframe for tracking medication usage and adherence.

  • Episode_Score

  • Data Type: INT64

  • Description: A numerical score associated with the claim, reflecting the effectiveness or critical nature of the medication treatment within the episode of care.

  • Specificity

  • Data Type: STRING

  • Description: A description of the specificity or targeting of the medication, indicating how closely the medication is tailored to treating specific conditions or patient groups.

Type

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Type of record or entry in the episode log.

Tenant

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Tenant or organization associated with the episode data.

Active_Version

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Active version of the episode log record.

Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Date associated with the episode log record.

Sequence

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Sequence number or order of the episode log record.

Source_System_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Name of the source system for the episode data.

Source_Timestamp

  • Is Nullable: YES

  • Data Type: TIMESTAMP

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

Source_File_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Name of the source file for the episode data.

Schema_Version

  • Is Nullable: YES

  • Data Type: FLOAT64

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

Visibility_Level

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Level of visibility or access control for the episode data.

Member_Partition

  • Is Nullable: YES

  • Data Type: INT64

  • Description: Partition or segment associated with the member data.

_updated

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Indicator specifying if the episode log record has been updated.

Action

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Action or operation performed on the episode log record (e.g., insert, update, delete).

Table Content

Member_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique alphanumeric patient identification number.

Episode_ID

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Unique identifier for the episode.

From_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: Start date of the episode.

To_Date

  • Is Nullable: YES

  • Data Type: DATE

  • Description: End date of the episode.

Days

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The total number of days included in the episode record. This field is assigned using the first and last service dates within the episode (excluding drug claims). If the first and last service dates are the same, this is set to one.

Group_Code

  • Is Nullable: YES

  • Data Type: INT64

  • Description: The four-character numeric code identifying the DRG for the episode.

Summary_Group_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Summary code for the group of the episode.

Condition_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Code representing the condition associated with the episode.

Condition_Name

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Name or description of the condition associated with the episode.

Condition_Chronic

  • Is Nullable: YES

  • Data Type: BOOL

  • Description: Indicator specifying if the condition is chronic or not.

Parent_Condition_Code

  • Is Nullable: YES

  • Data Type: STRING

  • Description: Code representing the parent condition associated with the episode.

Episode Dataset Specification

Parent Condition Details

Parent Condition Code

  • Field Name: Parent_Condition_Code

  • Required: YES

  • Type: STRING

  • Description: Code representing the parent condition, if applicable.

Parent Condition Name

  • Field Name: Parent_Condition_Name

  • Required: YES

  • Type: STRING

  • Description: Name or description of the parent condition, if applicable.

Condition Confirmed

  • Field Name: Condition_Confirmed

  • Required: YES

  • Type: BOOL

  • Description: Indicator specifying if the condition is confirmed or not.

Illness Stage and Severity

High Stage

  • Field Name: High_Stage

  • Required: YES

  • Type: STRING

  • Description: The four-character numeric code identifying the highest stage of illness for an episode.

Severity Code

  • Field Name: Severity_Code

  • Required: YES

  • Type: STRING

  • Description: Code representing the severity of the condition.

Severity Description

  • Field Name: Severity_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the severity of the condition.

Episode Type and Scale

Episode Type Description

  • Field Name: Episode_Type_Description

  • Required: YES

  • Type: STRING

  • Description: Description of the type of episode.

Total Episode Scale

  • Field Name: Total_Episode_Scale

  • Required: YES

  • Type: FLOAT64

  • Description: Scale value for the episode.

Scale Prediction Error

  • Field Name: Scale_Prediction_Error

  • Required: YES

  • Type: FLOAT64

  • Description: The one-character numeric value of the most intensive procedure submitted for the episode.

  • Note: The Medical Claims input file, proc_code, is required for this output.

  • Values:

    • 0: None found

    • 1: Minor Diagnostic

    • 2: Minor Therapeutic

    • 3: Major Diagnostic

    • 4: Major Therapeutic

AHRQ Procedure Type

  • Field Name: AHRQ_Procedure_Type

  • Required: YES

  • Type: INT64

  • Description: Type of procedure according to the AHRQ (Agency for Healthcare Research and Quality).

Episode Inclusion Details

Included

  • Field Name: Included

  • Required: YES

  • Type: BOOL

  • Description: This flag indicates if the episode was included in another episode during inclusion logic processing.

Preliminary Group Code

  • Field Name: Preliminary_Group_Code

  • Required: YES

  • Type: INT64

  • Description: The preliminary episode group assigned before inclusion logics run.

Has Inpatient Claim

  • Field Name: Has_Inpatient_Claim

  • Required: YES

  • Type: BOOL

  • Description:

  • If records grouped into the episode are completely outpatient, then false.

  • If the records grouped into the episode have at least one inpatient claim, then true.

Financial Details

Inpatient Allowed Amount

  • Field Name: Inpatient_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The admission portion of the amount allowed by the plan for payment on the episode. This field is the sum of the allowed amount on all admission records within the episode.

Inpatient Submitted Amount

  • Field Name: Inpatient_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The inpatient portion of the amount submitted for the episode. This field is the sum of the submitted charge amount on all admission records within the episode.

Inpatient Net Amount

  • Field Name: Inpatient_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The admissions portion of the net payment amount on the episode. This field is the sum of the net payment amount on all admission records within the episode.

Inpatient Admission Count

  • Field Name: Inpatient_Admission_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of admissions in the episode record.

Outpatient Allowed Amount

  • Field Name: Outpatient_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the amount allowed for payment on the episode. This field is the sum of the allowed amount on all non-admission records within the episode.

Outpatient Submitted Amount

  • Field Name: Outpatient_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the submitted or billed charge amount for the episode.

Outpatient Net Amount

  • Field Name: Outpatient_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The outpatient portion of the net payment amount for the episode.

Outpatient Admission Count

  • Field Name: Outpatient_Admission_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the outpatient medical claims linked to the episode.

Medical Allowed Amount

  • Field Name: Medical_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the allowed amount for the episode.

Medical Submitted Amount

  • Field Name: Medical_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the amount submitted for the episode.

Medical Net Amount

  • Field Name: Medical_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The medical portion of the net payment amount for the episode.

Medical Count

  • Field Name: Medical_Count

  • Required: YES

  • Type: INT64

  • Description: The count of the inpatient and outpatient records linked to the episode.

Prescription Drug Allowed Amount

  • Field Name: RX_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount allowed by the plan for payment on the episode.

Prescription Drug Submitted Amount

  • Field Name: RX_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the amount submitted for the episode.

Prescription Drug Net Amount

  • Field Name: RX_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The prescription drug portion of the net payment amount for the episode.

Prescription Drug Count

  • Field Name: RX_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of the prescription drug claims linked to the episode.

Total Allowed Amount

  • Field Name: Total_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount allowed by the plan for payment on the episode.

Episode Dataset Specification

Fields

Total_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total amount submitted for the episode. This field is the sum of the inpatient, outpatient, and pharmacy submitted charge amounts.

Total_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net payment amount for the episode. This field is the sum of the inpatient, outpatient, and pharmacy net payment amounts.

Total_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of claims in the episode. If admission build is also run, each admission will count as one claim. The admission is usually constructed from multiple medical claims.

Total_EM_Count

  • Required: YES

  • Type: INT64

  • Description: The total count of all E\&M claims in the episode.

Total_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total RVUs for all claims in the episode.

Managed_Care_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest number of E\&M claims associated with this episode.

Managed_Care_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: The provider type for the provider with the highest number of E\&M claims.

Managed_Care_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The E\&M portion of the amount submitted for the episode.

Managed_Care_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The managed care portion of the net amount for the episode.

Managed_Care_Count

  • Required: YES

  • Type: INT64

  • Description: The number of E\&M visits in the episode.

Primary_Provider_ID

  • Required: YES

  • Type: STRING

  • Description: The provider ID for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Type

  • Required: YES

  • Type: STRING

  • Description: Provider type for the provider with the highest sum of RVUs for the claims in the episode.

Primary_Provider_Allowed_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for an episode.

Primary_Provider_Submitted_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Primary_Provider_Net_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The total net pay amount associated with the primary provider summed from the medical claims input field, net_pay.

Primary_Provider_RVU_Amount

  • Required: YES

  • Type: FLOAT64

  • Description: The primary physician portion of the amount submitted for the episode.

Qualified_Specific_Condition

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to “Condition Specific” rules. If the episode does not qualify, then this flag will be false.

Qualified_Generic

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified per the “Generic” rules. If the episode is not qualified according to any one of the Generic rules, then this flag will be false.

Qualified_History_And_Physical

  • Required: YES

  • Type: BOOL

  • Description: This flag will be true if the episode is qualified according to the “History and Physical” rules. If the episode is not qualified according to any one of the his_and_phy rules, then this flag will be false.

Qualification_Sufficient

  • Required: YES

  • Type: BOOL

  • Description: If the episode cannot be qualified when looking at the details of the episode, then this flag will be Y. This flag will be N if the episode can be qualified. Whenever this flag is Y, the qe_flag is always N, and when this flag is N, then the qe_flag can get a Y or N based on the other three flags: qe_cond_spec_flag, qe_his_and_phys_flag, or qe_generic_flag.

Completion_Date

  • Required: YES

  • Type: DATE

  • Description: The date on which the episode can be considered complete (not likely to include new claims).

Medical_From_Date

  • Required: YES

  • Type: DATE

  • Description: The first date of a medical claim linked to the episode, based on the medical claims input label, svc_date.

Medical_To_Date

  • Required: YES

  • Type: DATE

  • Description: The last date of a medical claim linked to the episode, based on the medical claims input label, end_date.

Medical_Claims

  • Required: NO

  • Type: ARRAY

  • Description: List of references to medical claims included in the episode.

Medical_Claims.Claim_Type

  • Type: STRING

  • Description: Identifies the type of medical claim, such as inpatient, outpatient, or pharmacy, categorizing the nature of the medical service provided.

Medical_Claims.Claim_Type_Description

  • Type: STRING

  • Description: Provides a detailed description of the claim type, elaborating on the services covered under this claim category.

Medical_Claims.Claim_Number

  • Type: STRING

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

Medical_Claims.Claim_Line_Number

  • Type: INT64

  • Description: Represents a specific line within a claim, detailing an individual service or item billed within the broader claim.

Medical_Claims.Diagnosis_Related_Group

  • Type: STRING

  • Description: Refers to the DRG (Diagnosis Related Group) code, which is utilized to categorize hospital cases for the purpose of Medicare reimbursement and other insurance billing.

Medical_Claims.Diagnosis_Reorder

  • Type: BOOL

  • Description: Indicates whether the diagnosis was reordered for clarity or additional billing purposes during the claims processing.

Medical_Claims.Diagnosis_Codes

  • Type: ARRAY

  • Description: A list of diagnosis codes that detail the medical conditions diagnosed and treated during the episode covered by the claim.

Medical_Claims.Diagnosis_Codes.Diagnosis_Code

  • Type: STRING

  • Description: Each string in this array represents a specific medical diagnosis code detailing conditions treated.

Medical_Claims.Procedure_Codes

  • Type: ARRAY

  • Description: A list of procedure codes that describe the medical procedures performed during the treatment associated with the claim.

Medical_Claims.Procedure_Codes.Procedure_Code

  • Type: STRING

  • Description: Each string in this array represents a specific medical procedure code detailing treatments performed.

Medical_Claims.Diagnosis_Category

  • Type: STRING

  • Description: The category of the diagnosis, used to group similar medical conditions for analytical and billing purposes within healthcare management.

Medical_Claims.Stage

  • Type: STRING

  • Description: Indicates the stage of treatment or the billing cycle that the claim is documenting, reflecting the progression or status of the medical case.

Episode Dataset Specification

Admissions

Admissions

  • Type: NO

  • Data Type: ARRAY

  • Description: List of references to Admissions included in the episode.

Admissions.Admission_ID

  • Type:

  • Data Type: STRING

  • Description: The unique identifier for each admission entry, used to track individual admissions throughout the healthcare system.

Admissions.Diagnosis_Category

  • Type:

  • Data Type: STRING

  • Description: The category of the diagnosis, used to group similar conditions for analytical and billing purposes within the admission process.

Admissions.Stage

  • Type:

  • Data Type: STRING

  • Description: The stage of the patient's treatment or admission cycle at the time of the record, indicating the progress or status of care.

  • Type:

  • Data Type: STRING

  • Description: The DRG (Diagnosis Related Group) code, which categorizes hospital cases for the purpose of Medicare reimbursement and other billing purposes.

RX Claims

RX_Claims

  • Type: NO

  • Data Type: ARRAY

  • Description: List of references to RX claims included in the episode.

RX_Claims.Claim_ID

  • Type:

  • Data Type: STRING

  • Description: The unique identifier for each prescription claim entry, used to track individual medication claims within the healthcare system.

RX_Claims.Time_Window_Months

  • Type:

  • Data Type: INT64

  • Description: The number of months over which the prescription claim is relevant, providing a timeframe for tracking medication usage and adherence.

RX_Claims.Episode_Score

  • Type:

  • Data Type: INT64

  • Description: A numerical score associated with the claim, reflecting the effectiveness or critical nature of the medication treatment within the episode of care.

RX_Claims.Specificity

  • Type:

  • Data Type: STRING

  • Description: A description of the specificity or targeting of the medication, indicating how closely the medication is tailored to treating specific conditions or patient groups.

Episode Metadata

Type

  • Type: YES

  • Data Type: STRING

  • Description: Type of episode.

Tenant

  • Type: YES

  • Data Type: STRING

  • Description: Tenant identifier.

Active_Version

  • Type: YES

  • Data Type: BOOL

  • Description: Active version of the dataset.

Date

  • Type: YES

  • Data Type: DATE

  • Description: Date of the dataset entry.

Sequence

  • Type: YES

  • Data Type: INT64

  • Description: Sequence number.

Source_System_Name

  • Type: YES

  • Data Type: STRING

  • Description: Name of the source system.

Source_Timestamp

  • Type: YES

  • Data Type: TIMESTAMP

  • Description: Timestamp of the source data.

Source_File_Name

  • Type: YES

  • Data Type: STRING

  • Description: Name of the source file.

Schema_Version

  • Type: YES

  • Data Type: FLOAT64

  • Description: Version of the schema.

Visibility_Level

  • Type: YES

  • Data Type: INT64

  • Description: Level of visibility of the episode data.

Member_Partition

  • Type: YES

  • Data Type: INT64

  • Description: Partition identifier for the member.

_updated

  • Type: YES

  • Data Type: STRING

  • Description: Indicator specifying if the entry was updated.

Related Articles
Condition Dataset Specification
Rx Claim Dataset Specification
Risk Score Dataset Specification
Admission Dataset Specification
Medical Claim Dataset Specification
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