Report Name
IVA Diagnosis Data
About This Report
This report offers all relevant Risk data for IVA projects to determine the status of members, chases, condition categories (CC), and diagnosis codes.
Project Type
IVA
Service Type
Full Service, Clinical Only
Intended User
Manager / Technical User
Best For
Receiving the detailed data of every enrollee in an issuer sample.
Using This Report
- Download the report and use within Excel
- Identify all the Chase IDs associated with an enrollee, the submission statuses of different condition categories for an enrollee, etc.
- Create pivot table to group values that aggregate the individual line items to discrete categories
What Information Can I Filter?
| Project |
| Measure |
| Enrollee ID |
| Member ID |
| Client Member ID |
| Claim ID |
| Chase ID |
| Stratum Level |
| Condition Category |
| Chase Status |
| Reported By EDGE |
What Do The Fields Mean?
| Field | Data Dictionary Definition |
| Total EDGE HCCs | (Original Measure: Total Edge Hccs) This is a distinct count of HCCs provided by EDGE for IVA |
| Total Chases | (Original Measure: Total Chases) Total number of IVA Chases for the project |
| Total Chases Retrieved | (Original Measure: Total Chases) Number of IVA Chases, in Workflow Status 'Chart QA' or later |
| Total Chases in Clinical Workflow Stages | (Original Measure: Clinical Total Chases) Number of IVA chases that are currently in a Clinical Workflow Stage ('Abstraction', 'Overread', or 'Overread2') |
| Total Enrollees with Diagnoses | (Original Measures: Total Members) This is a distinct count of members with valid diagnoses loaded into the database |
| Total Condition Categories | (Original Measure: Total Condition Categories) This is a distinct count of condition categories without hierarchy, whether substantiated or not |
| Total Unique RA Diagnoses | (Original Measure: Total Risk Adjustment Diagnoses) This is a unique count of diagnoses that map to a condition category |
| Total Unique RA Submittable Diagnoses | (Original Measure: Total RA Submittable Unique Diagnoses) This is a count of unique diagnoses by member that are considered risk adjustment (RA) submittable, meaning it is coded, validated, not pended, has a signature, and is associated with an HCC. |
| IVA Diagnosis Data (Table) | Provides all relevant risk data for IVA projects to determine the status of members, chases, condition categories (CC), and diagnosis codes. |
| HIOS | The Health Insurance Oversight System (HIOS) identifier assigned by CMS to a given health plan |
| Project ID | The internal identifier associated with a project |
| Project Name | The name associated with a project |
| Client ID | The internal identifier associated with a client |
| Client Name | The name of a client |
| Stratum Level | The stratum indicator of the stratum in which the enrollee was included. Strata 1-9 represent low, medium and high-risk enrollees with at least one (1) HCC or (1) RXC for each age model. Stratum 10 includes enrollees with no HCCs and no RXCs. Note: Only the adult RA model includes RXCs therefore only the adult strata 1-3 will include enrollees with RXCs |
| Enrollee ID | Government supplied identifier for a member, IVA only |
| Member ID | The internal identifier associated with a member |
| Full Name | The first and last name associated with a member |
| Client Member ID | The client identifier associated with a member |
| Date of Birth | The date of birth of the member |
| Gender | The gender of a member |
| Chase ID | The internal identifier associated with a chase |
| Sample Source Alias ID | The internal identifier associated with a client |
| Client Chase Key | The identifier provided by the client for a chase |
| Measure | Determines the type of an associated chase, which indicates what the coder is seeking to validate |
| Parent Chase ID | The chaseID of the original chase that spawned the (non-parent) chaseID associated |
| Parent Client Chase Key | The identifier provided by the client for a chase |
| Parent Measure Code | Determines the type of an associated parent chase, which indicates what the coder is seeking to validate in the original chase |
| Last Process Step | The current workflow state of a given chase |
| Current Chase Status | The current status of a chase |
| Pend Code | An internal identifier for the various reasons that a chase may be pended, awaiting further action/or info to collect or code a medical record |
| Pend Code Description | Description of a pend code |
| Pend Status ID | An internal identifier indicating the status of a given pend code |
| Pend Status Name | Description of a pend status ID |
| AID | Internal Address Identifier (AID) associated with a chase address that has been cleaned/combined and added to the master document source table |
| Document Source Alias ID | Data loaded (client provided) identifier for a chase location |
| Group Name | The name associated with an AID if available |
| Address Grouping | Data loaded grouper to associate various address IDs into client-desired groups |
| Address1 | First line of a master chase (AID) address |
| Address2 | Second line of a master chase (AID) address |
| City | The city of a master chase (AID) address |
| State | The state associated with a master chase (AID) address |
| Postal Code | The zip code associated with a master chase (AID) address |
| Encounter Entity ID | The internal identifier assigned to an entity or associated data item recorded with a chase |
| Claim ID | The claim identifier provided at data load |
| Start Date | The start date associated with the time frame of the entire encounter |
| End Date | The end date associated with the time frame of the entire encounter |
| Enc Source Type Name | Identifies whether the associated diagnosis code was part of the data load (Client) or added by a Coder |
| Enc Acceptable Signature | Indicates whether there is an acceptable signature associated with a chase |
| Signature Deficiency | Indicates that a VRC 51 is associated with the relevant diagnosis code, which means that there is no valid signature associated with the medical record |
| Encounter Found | Indicates whether the coder found the data load encounter in the medical chart |
| Encounter Face to Face | Indicates whether the encounter reviewed qualifies as a face to face visit |
| Encounter Service Provider Name | Full name for the encounter provider |
| Enc Service Provider Source Alias ID | Data load identifier for the encounter provider |
| Source Type Name | Identifies whether the associated diagnosis code was part of the data load (Client) or added by a Coder |
| Diag Start Date | The start date associated with the time frame of the diagnosis |
| Diag End Date | The end date associated with the time frame of the diagnosis |
| Diag Entity ID | The internal identifier assigned to an entity or associated data item recorded with a chase |
| ICD Code | Diagnosis code- international classification of diseases (ICD) |
| Validation Reason Code | The reason provided by the coder as to whether or not the diagnosis code is represented within the medical chart |
| Diag Service Provider Name | Full name for the diagnosing provider |
| Service Provider NPI | National Provider Identifier (NPI) for the diagnosing provider |
| Service Provider Source Alias ID | Data load identifier for the diagnosing provider |
| Service Provider Specialty | The specialty of the diagnosing provider |
| Diagnosis Submit Result | Indicates whether the diagnosis is valid given the circumstances of the associated chase: if the chase has an active pend, or the diagnosis code has a VRC that is not '00', '103', '105', then unsubmittable if the diagnosis code has no matching condition category (CC), has an acceptable VRC, and an acceptable signature then NON-RA submittable if the diagnosis code has a matching condition category (CC), has an acceptable VRC, and an acceptable signature then RA submittable if the diagnosis code has no matching condition category (CC), has an acceptable VRC, and has no acceptable signature then NON-RA conditional if the diagnosis code has a matching condition category (CC), has an acceptable VRC, and has no acceptable signature then RA conditional if the diagnosis code is not acceptable, then unsubmittable and if the diagnosis code does not fall into a category above, then pending |
| Diagnosis Validated | This determines if the diagnosis code was coded and supported within the chart |
| Model ID | Internal identification number assigned to each condition model loaded into the database |
| Model Name | The official name of the model software/tables loaded to represent the model |
| Condition Category | Numerical identifier associated with the condition within a given condition model, a.k.a condition code |
| CC Description | The description of a condition category |
| EDGE HCC Flag | Determines if a given condition category is an HCC recognized by CMS for IVA |
| Highest Level HCC | Indicates whether the condition category is a hierarchical condition category: it is the highest applicable and substantiated condition category after hierarchy is applied |
| Edge Hcc | The list provided by the government of recognized HCCs for a given enrollee in IVA |
| Special Handling Code | Client provided chase instructions |
| Service Facility Type Code | A code that identifies where the service was rendered |
| Service Code | A Procedure Code that identifies the service rendered: CPT or HCPC |
| RA Eligible Flag | Indicates whether the medical claim is RA eligible or not |
| RXC Eligible Flag | Indicates whether the medical claim is RXC eligible or not |
| Absolute Cc Submission Status | Provides the highest available submission status for an HCC given the aggregation level |
| Absolute Cc Position | Provides the highest available position for an HCC given the aggregation level |