providerPayorProcAggs
Query to specify individual provider, procedure and payor aggregations at a monthly, quarterly, yearly or entire period basis.
Get Started with providerPayorProcAggs
If you have already setup CareQuery, run the below code to get started with your first providerPayorProcAggs query.
Example:
Provider commercial surgical procedure volumes by payor in North Platte, NE in Q1 of 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.providerPayorProcAggs(proc_subcategory = ['surgery - cardiovascular system',
'surgery - digestive system',
'surgery - general'],
min_date = "2023-01-01",
max_date = "2023-03-31",
metro = "north platte, ne",
payor_channel = "commercial")
# 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 providerPayorProcAggs query, including details on the parameter values.
parameter | description | options |
|---|---|---|
| Lower threshold date within the date range | Date String |
| Upper threshold date within the date range | Date String |
| National Provider Identifier (NPI) of individual and/or | Any Valid NPI |
| Health Insurance Payor name | |
| Health Insurance Payor channel-of-business or line-of-business | |
| CPT or HCPCS procedural code performed within the encounter | |
| Category of the CPT or HCPCS | |
| Sub-category of the CPT or HCPCS | |
| Boolean indicator for 'AND' or 'OR' when multiple | True or False |
| Taxonomy of the organization or individual provider, 10-digit code that used to identify the type, classification, and area of specialization of an individual or organizational healthcare provider | |
| Specialty of the organization or individual provider(s), specific focus of a provider by patient population, disease, skill or philosophy | |
| Specialty category of the organization or individual provider(s), broad focus of a provider by patient population, disease, skill or philosophy | |
| Specialty subcategory of the organization or individual | |
| Boolean indicator for 'AND' or 'OR' when multiple taxonomy or specialty parameters specified - helps users offer various levels of specificity without confusing and/or logic | True or False |
| US State residence of the query patient population | |
| Nine distinct US State groupings as defined by the US Census Bureau | |
| Four major US State groupings as defined by the US Census Bureau | |
| Metropolitan and micropolitan statistical | |
| First three digits the zip code of the | First 3 digits of zip code(s) |
| Number of rows returned in the data request | Integer or False |
| Binary indicator as to whether you'd like | True or False |
Query Return Data
The providerPayorProcAggs query returns the PROV_PAYOR_PROC_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 |
| hcp_npi | Organizational 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 |
| proc_code | Procedure code performed within encounter(s). Designated by a CPT or HCPCS code. | 99457 |
| proc_desc | Description of the procedure performed within the encounter(s). | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes |
| proc_subcategory | Procedural sub-category related to the procedure performed. | Eval. and Mgmt. - Special Eval. and Mgmt. Services |
| proc_category | Procedural category related to the procedure performed. | Evaluation and Management |
| 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 |
Updated 5 months ago