EDGE_PAYOR_TABLE
Monthly aggregation of provider referrals and the procedures performed by the referred provider, both explicitly stated on the claim and inferred via patient pathways.
Table Description
feature | description | example |
|---|---|---|
year | Year in which the primary encounter occured | 2023 |
month | Month in which the primary encounter occured | 2 |
ref_npi | National Provider Identifier (NPI) of the referring provider | 1447546585 |
ref_name | Full name of the referring provider | kellen benes |
ref_specialty | Primary specialty of the referring provider | therapy - physical medicine |
npi | National Provider Identifier (NPI) of the referred provider | 1003221029 |
name | Full name of the referred provider | gabriel jefferson |
specialty | Primary specialty of the referred provider | physician assistant |
inferred | Binary indicator of whether the relationship total was inferred.
| 1 |
payor | Name of the primary payor on each encounter. | United Healthcare |
payor_channel | Payor channel-of-business, line-of-business, or plan type. | Medicare Advantage |
diag_subcategory | Sub-category of the ICD-10 diagnosis code given to patient within the encounter | thiamine deficiency |
diag_category | Category of the ICD-10 diagnosis code given to the patient within the encounter | endocrine, nutri, and metabolic diseases/immunity disorders |
num_patients | Number of unique patients referred within the explicit or inferred context of the relationship. | 4 |
num_encounters | Number of unique encounters referred within the explicit or inferred context of the relationship. | 14 |
total_line_charges | Total line-item provider charges for procedures rendered submitted to insurers by the referred provider (NPI). | 834.18 |
total_claim_charges | Line-item provider and facility charge for procedures and revenue codes rendered and submitted to insurers. | 1,250.39 |
total_smart_allowed | Total smart allowed made by the referred provider within the inferred context of the relationship. Smart Allowed is the line-item estimate of allowed amount, utilizing proprietary ML on actual adjudicated amounts to provide estimates, within an average of 5% variance from actuals. | 902.06 |
Updated about 1 month ago