Final Action Qualifying Diagnoses for CMS-HCC Calculations

Object Description

One record per distinct patient-final action diagnosis code-calendar date triple for records that are qualifying for use in calculating HCC/RAF score, either because they meet the claims or billing data standard or because they are associated with an allowed MAO-004 record. Includes patient-code-date triples with disallowed MAO-004 records if there is a diagnosis from a qualifying claim or bill present on that same date; this provides flexibility to downstream logic as to whether to use only allowed MAO-004 records or to cast a wider net (i.e., to include claims and/or billing data).

Metadata

• Table Name: ursa.so_ursa_hcc_cond_001
• Layer: SYNTHETIC_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
• Event Date: Diagnosis Effective Date
• Primary Key: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code