Report Name
EDGE HCC Performance Summary
About This Report
This report gives a high level summary view of how the IVA audit is progressing.
Project Type
IVA
Service Type
Full Service, Clinical Only
Intended User
Manager / Technical User
Best For
Program managers to understand how their programs performed based on the original EDGE sample.
Using This Report
- Identify how many EDGE HCCs became validated and how many did not
- Measure the validation rate of each HCC
- Determine areas for provider education by recognizing HCCs with low validation rates
What Information Can I Filter?
| Condition Category |
What Do The Fields Mean?
| Field | Data Dictionary Definition |
| Project Name | The name associated with a project |
| Category Code | Numerical identifier associated with the condition within a given condition model |
| Category Name | The description of a condition category |
| Total EDGE HCCs | Distinct count of member EDGE/RADVDE HCCs combinations |
| Substantiated EDGE HCC Count | Count of unique Enrollee ID/CC combinations that are substantiated and are an EDGE provided HCC |
| Unsubstantiated EDGE HCC Count | Count of unique Enrollee ID/CC combinations that are unsubstantiated and are an EDGE provided HCC |
| Percent EDGE HCCs Substantiated | Percentage of EDGE HCCs that are validated/substantiated |
| Submittable EDGE HCC Count | Count of EDGE HCCs that can be submitted to the Government |
| Conditional EDGE HCC Count | Count of EDGE HCCs that are valid, subject to a condition |
| Pending EDGE HCC Count | Count of EDGE HCCs that are pending/in progress. “Pending” in this situation means the chart wasn’t coded. Either because we didn’t get the chart, something held up coding, or we stopped work due to time constraints. |
| Unsubmittable EDGE HCC Count | Count of EDGE HCCs that cannot be submitted to the Government |