PROV_PAYOR_DIAG_TABLE
This table provides monthly aggregate totals by individual provider, payor and diagnosis codes.
Queries that source from PROV_PAYOR_DIAG_TABLE table
What is in the PROV_PAYOR_DIAG_TABLE table?
Results are returned as a json, pySpark DataFrame, or pandas DataFrame (default).
| 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 |
| hcp_npi | Individual provider, identified via their National Provider Identifier (NPI). | 1306108402 |
| hcp_name | Name of the individual provider identified. | Mai Luu |
| hcp_specialty | Primary specialty of the individual provider. | Family Practice |
| hcp_zip | Primary zip code of the individual provider. | 87101 |
| hcp_state | Primary US State code code of the individual provider. | 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 |
Helper Function within the CareQuery API to help understand the underlying PROV_PAYOR_DIAG_TABLE dataset.
# import package
from care_query.care_query import CareQuery
# instantiate and connect
cq = CareQuery(email = "your-email",
token = "your-api-token")
# return details
print(cq.glossary.table_detail('PROV_PAYOR_DIAG_TABLE'))
Updated 10 months ago