payorDiagAggs
Query to specify payor, channel and diagnoses aggregated at a monthly, quarterly, yearly or entire period basis.
Get Started with payorDiagAggs
If you have already setup CareQuery, run the below code to get started with your first payorDiagAggs query.
Example:
Humana's Medicare Advantage obesity aggregates in Wichita in Q4-2023
# 1) import
from care_query.care_query import CareQuery
# 2) instantiate and connect
cq = CareQuery(email = "your-email",
token = "your-api-token",
sftp_key = "path/to/your/company.PEM")
# 3) build query
query_name = cq.payorDiagAggs(diag_subcategory = 'obesity',
min_date = "2023-10-01",
max_date = "2024-01-01",
payor = 'humana inc.',
payor_channel = 'medicare advantage',
metro = 'wichita, ks',
limit = 25000)
# 4A) submit query to return data
sample_data = query_name.sample()
# 4B) submit query to return data
size_estimate = query_name.estimate()
# 4C) submit query to return data
result_data = query_name.execute()
Query Parameters
The following a parameters are available within the payorDiagAggs query, including details on the parameter values.
| parameter | description | options |
|---|---|---|
min_date | Lower threshold date within the date range of interest, observational start date | Date String |
max_date | Upper threshold date within the date range of interest, observational end date | Date String |
payor | Health Insurance Payor name | values available |
payor_channel | Health Insurance Payor channel-of-business or line-of-business | values available |
diag_code | ICD-10 diagnosis code given to the patient within the encounter | values available |
short_diag_code | First three digits of the ICD-10 diagnosis code given to the patient within the encounter | values available |
diag_subcategory | Sub-category of the ICD-10 diagnosis code given to patient within the encounter | values available |
diag_category | Category of the ICD-10 diagnosis code given to the patient within the encounter | values available |
diag_greedy | Boolean indicator for 'AND' or 'OR' when multiple diagnosis parameters specified - helps users offer various levels of specificity without confusing and/or logic | True or False |
state | US State residence of the query patient population | values available |
division | Nine distinct US State groupings as defined by the US Census Bureau | values available |
region | Four major US State groupings as defined by the US Census Bureau | values available |
metro | Metropolitan and micropolitan statistical areas according to the US Census Bureau | values available |
short_zip | First three digits the zip code of the query patient population specified | First 3 digits of zip code(s) |
limit | Number of rows returned in the data request | Integer or False |
show | Binary indicator as to whether you'd like query to be printed for review upon it's creation | True or False |
Query Return Data
The orgPayorDiagAggs query returns the PAYOR_DIAG_TABLE for all aggregate totals that meet the criterion specified within the query.
| feature | description | example |
|---|---|---|
| year | Year in which the aggregated values are calculated. | 2022 |
| month | Integer indicator for the month of the year in which the aggregated values are calculated | 5 |
| short_zip | First three digits of the primary patient zip code | 871 |
| state | US State of the primary patient location | NM |
| payor | Name of the primary payor on each encounter. | Centers for Medicare & Medicaid Services (CMS) |
| payor_channel | Payor channel-of-business, line-of-business, or plan type. | Medicare |
| diag_code | Diagnosis code performed within the encounters in consideration, as designated by ICD-10 codes. | E512 |
| diag_desc | Description of the diagnosis code performed. | Wernicke's encephalopathy |
| diag_subcategory | Sub-category related to the diagnosis performed. | thiamine deficiency |
| diag_category | Category related to the diagnosis performed. | endocrine, nutri, and metabolic diseases/immunity disorders |
| num_patients | Total number of patients seen within the aggregation period. | 25 |
| num_visits | Total number of visits within the aggregation period. | 32 |
| num_encounters | Total number of encounters within the aggregation period. | 41 |
| total_line_charges | Sum of line item charges within the aggregation period. Line item charges are directly related to the procedure performed. | $5,729.18 |
| total_claim_charges | Sum of the claim item charges within the aggregation period. Claim charges include the procedure charge and related facility charges. | $9,103.40 |
| total_smart_allowed | Sum of allowed amount estimates within the aggregation period. Smart Allowed® values are derived from multiple sources to estimate the final adjudicated amount at the line-item level. | $3,958.01 |
| mean_line_charge | Average line item charge at the line itemwithin the aggregation period. Line item charges are directly related to the procedure performed. | $139.73 |
| mean_claim_charge | Average claim item charge at the line item within the aggregation period. Claim charges include the procedure charge and related facility charges. | $222.03 |
| mean_smart_allowed | Average allowed amount at the line item within the aggregation period. Smart Allowed® values are derived from multiple sources to estimate the final adjudicated amount at the line-item level. | $96.50 |
| mean_smart_allowed | Average allowed amount at the line item within the aggregation period. Smart Allowed® values are derived from multiple sources to estimate the final adjudicated amount at the line-item level. | $96.50 |
Updated 10 months ago