Code | Display | Definition |
claims-processing | Claim Processing | Request for data necessary from payers to support claims for services. |
risk-adjustment | Risk Adjustment | Request for data from payers to calculate differences in beneficiary-level risk factors that can affect quality outcomes or medical costs, regardless of the care provided. |
quality-metrics | Quality Metrics | Request for data used for aggregation, calculation and analysis, and ultimately reporting of quality measures. |
referral | Referral | Request for additional clinical information from referring provider to support performing the requested service. |
social-care | Social Care | Request for data from payers to support the non-medical social needs of individuals, especially the elderly, vulnerable or with special needs. |
authorization-other | Other Authorization | Request for data from payers for other authorization request not otherwise specified. |
care-coordination | Care Coordination | Request for data from payers to create a complete clinical record for each of their members to improve care coordination and provide optimum medical care. |
documentation-general | General Documentation | Request for data used from payers or providers for general documentation. |
orders | Orders | Request for additional clinical information from referring provider to support orders. |
patient-status | Patient Status | Requests for patient health record information from payers to support their payer member records. |
signature | Signature | Request for signatures from payers or providers on requested data. |
care-planning | Care Planning | Request for data from payers or providers to determine how to deliver care for a particular patient, group or community. |
social-risk | Social Risk | Request for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes. |
purpose-of-use | Purpose Of Use | Purpose of use for the requested data. |
signature-flag | Signature Flag | Flag to indicate whether the requested data requires a signature. |