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

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

npi

National Provider Identifier (NPI) of individual and/or
organizational provider(s) that appear on the encounter.

Any Valid NPI

payor

Health Insurance Payor name

values available

payor_channel

Health Insurance Payor channel-of-business or line-of-business

values available

proc_code

CPT or HCPCS procedural code performed within the encounter

values available

proc_category

Category of the CPT or HCPCS
procedure performed within the encounter

values available

proc_subcategory

Sub-category of the CPT or HCPCS
procedure performed within the encounter

values available

proc_greedy

Boolean indicator for 'AND' or 'OR' when multiple
procedure parameters specified - helps users offer various
levels of specificity without confusing and/or logic

True or False

taxonomy_code

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

values available

specialty

Specialty of the organization or individual provider(s), specific focus of a provider by patient population, disease, skill or philosophy

values available

specialty_category

Specialty category of the organization or individual provider(s), broad focus of a provider by patient population, disease, skill or philosophy

values available

subspecialty

Specialty subcategory of the organization or individual
provider(s), hyper-specific focus of a provider by patient
population, disease, skill or philosophy

values available

taxonomy_greedy

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

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 providerPayorProcAggs query returns the PROV_PAYOR_PROC_TABLE for all aggregate totals that meet the criterion specified within the query.

featuredescriptionexample
yearYear in which the aggregated values are calculated.2022
monthInteger indicator for the month of the year in which the aggregated values are calculated5
hcp_npiOrganizational provider, identified via their National Provider Identifier (NPI).1306108402
hcp_nameName of the individual provider identified.Mai Luu
hcp_specialtyPrimary specialty of the individual provider.Family Practice
hcp_zipPrimary zip code of the individual provider.87101
hcp_statePrimary US State code code of the individual provider.NM
payorName of the primary payor on each encounter.Centers for Medicare & Medicaid Services (CMS)
payor_channelPayor channel-of-business, line-of-business, or plan type.Medicare
proc_codeProcedure code performed within encounter(s). Designated by a CPT or HCPCS code.99457
proc_descDescription of the procedure performed within the encounter(s).Management using the results of remote vital sign monitoring per calendar month, first 20 minutes
proc_subcategoryProcedural sub-category related to the procedure performed.Eval. and Mgmt. - Special Eval. and Mgmt. Services
proc_categoryProcedural category related to the procedure performed.Evaluation and Management
num_patientsTotal number of patients seen within the aggregation period.25
num_visitsTotal number of visits within the aggregation period.32
num_encountersTotal number of encounters within the aggregation period.41
total_line_chargesSum of line item charges within the aggregation period. Line item charges are directly related to the procedure performed.$5,729.18
total_claim_chargesSum of the claim item charges within the aggregation period. Claim charges include the procedure charge and related facility charges.$9,103.40
total_smart_allowedSum 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_chargeAverage line item charge at the line itemwithin the aggregation period. Line item charges are directly related to the procedure performed.$139.73
mean_claim_chargeAverage 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_allowedAverage 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