Claims Data Dictionary

Table Name

Column Name

Data Type

notes

INPATIENT_EVENTS

UTILIZATION_ID

String

Equivalent of claim ID

INPATIENT_EVENTS

VISIT_ID

String

INPATIENT_EVENTS

VISIT_TYPE

String

INPATIENT_EVENTS

PATIENT_ID

String

Hashed unique patient identifier

INPATIENT_EVENTS

ADMIT_DATE

Date

Admission dates for inpatient procedures

INPATIENT_EVENTS

DISCHARGE_DATE

Date

Discharge date for inpatient procedures

INPATIENT_EVENTS

CLAIM_FROM_DATE

Date

INPATIENT_EVENTS

CLAIM_THROUGH_DATE

Date

INPATIENT_EVENTS

TOTAL_LOS

Integer

Total length of inpatient stay

INPATIENT_EVENTS

DRG_CODE

String

DRG code - usually only available for acute inpatient care

INPATIENT_EVENTS

DRG_CODE_DESCRIPTION

String

DRG code Description

INPATIENT_EVENTS

DRG_CODE_TYPE

String

MS-DRG vs APR-DRG

INPATIENT_EVENTS

DRG_CODE_VERSION

String

Version of DRG code

INPATIENT_EVENTS

DRG_CODE_IMPUTATION_FLAG

Boolean

Flag to determine imputation status of DRG code

INPATIENT_EVENTS

MDC_CODE

String

Three digit numeric code that groups beneficiary diagnosis codes into broad categories based on condition type and body region. a higher level grouping on MS-DRG

INPATIENT_EVENTS

MDC_DESCRIPTION

String

MDC code description

INPATIENT_EVENTS

ADMIT_SOURCE_CODE

String

INPATIENT_EVENTS

ADMIT_TYPE_CODE

String

INPATIENT_EVENTS

DISCHARGE_STATUS_CODE

String

Discharge status code

INPATIENT_EVENTS

ACUTE_SUBACUTE

String

Acute Inpatient vs Sub-acute Inpatient

INPATIENT_EVENTS

UTILIZATION_CATEGORY

String

Sub categories under Acute Inpatient & Sub-acute Inpatient

INPATIENT_EVENTS

ADMISSION_DIAGNOSIS_CODE

String

ICD 10 Dx code

INPATIENT_EVENTS

PRIMARY_DIAGNOSIS_CODE

String

ICD 10 Dx code

INPATIENT_EVENTS

SECONDARY_DIAGNOSIS

_CODES

Array

ICD 10 Dx code

INPATIENT_EVENTS

ICD_PCS_CODES

Array

ICD PCS codes from all service line for the claims collected as array

INPATIENT_EVENTS

CPT_HCPCS_CODES

Array

HCPCS & CPT codes from all service line for the claims collected as array

INPATIENT_EVENTS

REVENUE_CODES

Array

Revenue codes from all service line for the claims collected as array

INPATIENT_EVENTS

BILL_TYPE_CODE

String

Bill type code. First digit is facility type code. Second digit is facility class code. Third digit is claim frequency code

INPATIENT_EVENTS

FACILITY_TYPE_CLASS_CODE

_DESC

String

Description of the first & second digit of the bill type code

INPATIENT_EVENTS

FACILITY_NPI

String

NPI of the facility or the laboratory in which the services were rendered for Institutional Claim;

INPATIENT_EVENTS

FACILITY_NPI_CLASSIFICATION

String

Classification based on the NUCC taxonomy code for that NPI

INPATIENT_EVENTS

FACILITY_NPI_SPECIALIZATION

String

Specialization of the primary taxonomy code

INPATIENT_EVENTS

BILLING_NPI

String

Facility that is submitting the institutional claim or the human provider who rendered the care and is submitting the professional claim

INPATIENT_EVENTS

BILLING_NPI_CLASSIFICATION

String

INPATIENT_EVENTS

BILLING_NPI_SPECIALIZATION

String

INPATIENT_EVENTS

BILLING_NPI_SPECIALTY

String

Specialization of the Billing NPI

INPATIENT_EVENTS

ATTENDING_NPI

String

The human provider that was the attending physician in a hospital setting in which the services were rendered.

INPATIENT_EVENTS

ATTENDING_NPI_SPECIALTY

String

Specialty of the Attending NPI

INPATIENT_EVENTS

OPERATING_NPI

String

The human provider that was the operating physician when operating physician data is required on the institutional claim

INPATIENT_EVENTS

OPERATING_NPI_SPECIALTY

String

Specialty of the Operating NPI

INPATIENT_EVENTS

NETWORK_STATUS

String

INPATIENT_EVENTS

ENCOUNTER_TYPE

String

INPATIENT_EVENTS

CLAIM_PAYER_NAME_PRIMARY

String

INPATIENT_EVENTS

CLAIM_INSURANCE_GROUP

_PRIMARY

String

INPATIENT_EVENTS

CLAIM_INSURANCE_SEGMENT

_PRIMARY

String

INPATIENT_EVENTS

CLAIM_PAYER_NAME

_SECONDARY

String

INPATIENT_EVENTS

CLAIM_INSURANCE_GROUP

_SECONDARY

String

INPATIENT_EVENTS

CLAIM_INSURANCE_SEGMENT

_SECONDARY

String

INPATIENT_EVENTS

PATIENT_INSURANCE_GROUP

String

INPATIENT_EVENTS

PATIENT_INSURANCE

_SEGMENT

String

INPATIENT_EVENTS

PAYMENT_MODEL

String

Payment model of the claim

INPATIENT_EVENTS

PROVIDER_ZIP

String

Provider zip code

INPATIENT_EVENTS

PATIENT_ZIP

String

First three digits of the patient zip code

INPATIENT_EVENTS

PROVIDER_STATE

String

INPATIENT_EVENTS

PATIENT_STATE

String

INPATIENT_EVENTS

SERVICE_AREA_TYPE

String

INPATIENT_EVENTS

TOTAL_PROVIDER_BILLED

_AMOUNT_ORIGINAL

Float

INPATIENT_EVENTS

TOTAL_PLAN_ALLOWED

_AMOUNT_ORIGINAL

Float

INPATIENT_EVENTS

TOTAL_PLAN_PAID_AMOUNT

_ORIGINAL

Float

INPATIENT_EVENTS

TOTAL_PATIENT

_RESPONSIBILITY_ORIGINAL

Float

INPATIENT_EVENTS

ESTIMATED_ALLOWED_AMNT

Float

Komodo Health estimated total allowed amount

NON_INPATIENT

_EVENTS

UTILIZATION_ID

String

Equivelant of claim ID

NON_INPATIENT

_EVENTS

LINE_NUMBER

Integer

Equivelent of claim service line number

NON_INPATIENT

_EVENTS

VISIT_ID

String

NON_INPATIENT

_EVENTS

VISIT_TYPE

String

NON_INPATIENT

_EVENTS

PATIENT_ID

String

Hashed unique patient identifier

NON_INPATIENT

_EVENTS

CLAIM_TYPE_CODE

String

Claim type code

NON_INPATIENT

_EVENTS

SERVICE_DATE

Date

Service From Date

NON_INPATIENT

_EVENTS

SERVICE_TO_DATE

Date

Service To Date

NON_INPATIENT

_EVENTS

REVENUE_CODE

String

Revenue code

NON_INPATIENT

_EVENTS

PROCEDURE_CODE

String

Procedure code

NON_INPATIENT

_EVENTS

MODIFIERS

Array

Procedure code modifier

NON_INPATIENT

_EVENTS

UNITS

Float

Cleaned unit

NON_INPATIENT

_EVENTS

IMPUTED_UNIT_FLAG

Boolean

If unit is imputed or normalized

NON_INPATIENT

_EVENTS

UNIT_TYPE

String

NON_INPATIENT

_EVENTS

NDC11

String

NDC 11

NON_INPATIENT

_EVENTS

UTILIZATION_TYPE

String

KH Utilization Classification L1; related to Payment model

NON_INPATIENT

_EVENTS

SERVICE_CATEGORY

String

KH Utilization Classification L2, related to type of service

NON_INPATIENT

_EVENTS

SERVICE_SUBCATEGORY

String

KH Utilization Classification L3, realted to type of service

NON_INPATIENT

_EVENTS

PLACE_OF_SERVICE

String

Place of service code; usually provided only for claim type code ='P'

NON_INPATIENT

_EVENTS

BILL_TYPE_CODE

String

Bill type code; usually provided only for claim type code ='I'

NON_INPATIENT

_EVENTS

FACILITY_TYPE_CLASS

_CODE_DESC

String

Description of the first and second digit of the bill type code

NON_INPATIENT

_EVENTS

APC_CODE

String

Imputed APC code

NON_INPATIENT

_EVENTS

APC_DESCRIPTION

String

Imputed APC code description

NON_INPATIENT

_EVENTS

PRIMARY_DIAGNOSIS

_CODE_ARRAY

Array

Primary diagnosis code; For facility claims, this is primary diagnosis code from header, size will be 1; For professional claims, this is the diagnosis codes that the service line was pointed to, size can be greater than 1;

NON_INPATIENT

_EVENTS

DIAGNOSIS_CODES

Array

All diagnosis code assigned with the claim; primary diagnosis code will be part of the array

NON_INPATIENT

_EVENTS

ICD_PCS_CODES

Array

All ICD PCS codes that are associated with the claim

NON_INPATIENT

_EVENTS

ATTENDING_NPI

String

The human provider that was the attending physician in a hospital setting in which the services were rendered.

NON_INPATIENT

_EVENTS

ATTENDING_NPI_SPECIALTY

String

Specialty of the Attending NPI

NON_INPATIENT

_EVENTS

OPERATING_NPI

String

The human provider that was the operating physician when operating physician data is required on the institutional claim

NON_INPATIENT

_EVENTS

OPERATING_NPI_SPECIALTY

String

Specialty of the Operating NPI

NON_INPATIENT

_EVENTS

BILLING_NPI

String

NON_INPATIENT

_EVENTS

BILLING_NPI_CLASSIFICATION

String

NON_INPATIENT

_EVENTS

BILLING_NPI_SPECIALIZATION

String

NON_INPATIENT

_EVENTS

FACILITY_NPI

String

NPI of the facility or the laboratory in which the services were rendered for Institutional Claim;

NON_INPATIENT

_EVENTS

FACILITY_NPI_CLASSIFICATION

String

NON_INPATIENT

_EVENTS

FACILITY_NPI_SPECIALIZATION

String

Specialty of the Facility NPI

NON_INPATIENT

_EVENTS

RENDERING_NPI

String

The provider directly rendering the care, or in the case that a mid-level provider is rendering the care, this is the supervising provider, only found on an Professional Claim or on an outpatient facility claims; this is distinct for each service line.

NON_INPATIENT

_EVENTS

RENDERING_NPI_SPECIALTY

String

Specialty of the Rendering NPI

NON_INPATIENT

_EVENTS

REFERRING_NPI

String

The provider ordering a laboratory test or a specialty pharmacy product that is covered under the medical benefit.

NON_INPATIENT

_EVENTS

REFERRING_NPI_SPECIALTY

String

Specialty of the Reffering NPI

NON_INPATIENT

_EVENTS

NETWORK_STATUS

String

NON_INPATIENT

_EVENTS

ENCOUNTER_TYPE

String

NON_INPATIENT

_EVENTS

CLAIM_PAYER_NAME_PRIMARY

String

NON_INPATIENT

_EVENTS

CLAIM_INSURANCE_GROUP

_PRIMARY

String

NON_INPATIENT

_EVENTS

CLAIM_INSURANCE_SEGMENT

_PRIMARY

String

NON_INPATIENT

_EVENTS

CLAIM_PAYER_NAME

_SECONDARY

String

NON_INPATIENT

_EVENTS

CLAIM_INSURANCE_GROUP

_SECONDARY

String

NON_INPATIENT

_EVENTS

CLAIM_INSURANCE_SEGMENT

_SECONDARY

String

NON_INPATIENT

_EVENTS

PATIENT_INSURANCE_GROUP

String

Payer channel

NON_INPATIENT

_EVENTS

PATIENT_INSURANCE

_SEGMENT

String

Payer channel

NON_INPATIENT

_EVENTS

PAYMENT_MODEL

String

Name of cost function

NON_INPATIENT

_EVENTS

PROVIDER_ZIP

String

Provider zip code

NON_INPATIENT

_EVENTS

PATIENT_ZIP

String

First three digits of the patient zip code

NON_INPATIENT

_EVENTS

PROVIDER_STATE

String

NON_INPATIENT

_EVENTS

PATIENT_STATE

String

NON_INPATIENT

_EVENTS

SERVICE_AREA_TYPE

String

NON_INPATIENT

_EVENTS

PROVIDER_BILLED_AMOUNT

_ORIGINAL

Float

NON_INPATIENT

_EVENTS

PLAN_ALLOWED_AMOUNT

_ORIGINAL

Float

NON_INPATIENT

_EVENTS

PLAN_PAID_AMOUNT

_ORIGINAL

Float

NON_INPATIENT

_EVENTS

ESTIMATED_ALLOWED

_AMNT

Float

Estimated total allowed amount