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The United States Health Information Knowledgebase (USHIK) contains information from numerous healthcare-related initiatives. USHIK content includes administered items and other artifacts for CMS Quality Reporting Programs, All-Payer Claims Databases, Children's EHR Format, Draft Clinical Quality Measures available for feedback, AHRQ's Patient Safety / Common Formats, as well as standards for ASC X12, NCPDP, and HITSP.
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The United States Health Information Knowledgebase (USHIK) contains information from numerous healthcare-related initiatives. USHIK content includes administered items and other artifacts for CMS Quality Reporting Programs, All-Payer Claims Databases, Children's EHR Format, Draft Clinical Quality Measures available for feedback, AHRQ's Patient Safety / Common Formats, as well as standards for ASC X12, NCPDP, and HITSP.
Standards
The Standards portal provides specifications from ASC X12 (X12N 5010 Health Care Data Element Dictionary) and NCPDP (NCPDP October 2011 Data Dictionary). This portal provides an efficient interface for viewing and comparing standards artifacts.
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ASC X12
Data Elements
The Standards portal provides specifications from ASC X12 (X12N 5010 Health Care Data Element Dictionary) and NCPDP (NCPDP October 2011 Data Dictionary, NCPDP April 2014 Data Dictionary). This portal provides an efficient interface for viewing and comparing standards artifacts.
HITSP
The HITSP Portal contains data for health interoperability specifications and related constructs, such as C32, C80, C83, and C154. These specifications have been registered and structured to support research, analysis and comparison.
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C32: (CCD) Component
C80: Vocabularies & Terminologies
C83: CDA Content Modules
C154: Data Dictionary Component
The HITSP Portal contains data for health interoperability specifications and related constructs, such as C32, C80, C83, and C154. These specifications have been registered and structured to support research, analysis and comparison.
Common Formats
The Common Formats portal provides detailed information on the Data Elements required for Patient Safety Event reporting.
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The Common Formats portal provides detailed information on the Data Elements required for Patient Safety Event reporting.
Quality Reporting
The Quality Reporting portal contains specifications, artifacts, downloads, search tools, and other resources for Quality Reporting, including Clinical Quality Measures, Value Sets.
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The Quality Reporting portal contains specifications, artifacts, downloads, search tools, and other resources for Quality Reporting, including Clinical Quality Measures, Value Sets.
All-Payer Claims
The APCD portal offers a convenient set of tools for users to compare and download All-Payer Claims reporting specifications from single state and multiple states, as well as the APCD council core specification.
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The APCD portal offers a convenient set of tools for users to compare and download All-Payer Claims reporting specifications from single state and multiple states, as well as the APCD council core specification.
Draft Measures
Child EHR Format
The Children's EHR Format (the Format) is a set of child-specific requirements (and other requirements of special importance for children) that an EHR should meet to perform optimally for the particular health care needs of children. The Format is provided by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).
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View requirements by Topic Area:
Activity Clearance
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Patient Identifier
Patient Portals - PHR
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The Children's EHR Format (the Format) is a set of child-specific requirements (and other requirements of special importance for children) that an EHR should meet to perform optimally for the particular health care needs of children. The Format is provided by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).
Data Elements Related to Medical Rebate Data Submission Standard
Name:
Medical Rebate Data Submission Standard
Definition:
Provides a standardized format for health plans' rebate submissions to multiple manufacturers throughout the industry.
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Definition
Select 200070000
Adjudication Date
Date the claim or adjustment is processed.
Select 200093000
Allowed Amount
Allowable charges for covered services based on the specially negotiated fee between the provider and MCO.
Select 200189000
Billed Amount
Total reasonable and customary fee providers charge to provide the type of service received
Select 200236000
Claim Number
A unique identifier for a prescription and claim processor
Select 200307000
Contracting Organization (PMO) Contract Number
Contract number assigned by the contracting organization.
Select 200308000
Contracting Organization (PMO) ID Code
ID code assigned by the contracting organization.
Select 200309000
Contracting Organization (PMO) ID Qualifier
Indicates the type of data being submitted in the 'Contracting Organization (PMO) ID Code' (600-66) field.
Select 200311000
Contracting Organization (PMO) Name
The name of the contracting organization.
Select 200343000
Data Level
The level of data being submitted.
Select 200344000
Data Provider ID Code
Code assigned to identify the data provider.
Select 200345000
Data Provider ID Qualifier
Identifies the type of data being submitted in the 'Data Provider ID Code' (601-32) field.
Select 200346000
Data Provider Name
Name of the data provider.
Select 200354000
Date Of Service
Identifies date the prescription was filled or professional service rendered or subsequent payer began coverage following Part A expiration in a long-term care setting only.
Select 200372000
Diagnosis Code
Code identifying the diagnosis of the patient.
Select 200374000
Diagnosis Code Qualifier
Code qualifying the 'Diagnosis Code' (424-DO).
Select 200479000
Encrypted Patient ID Code
Encrypted patient ID.
Select 200487000
Entity Country Code
Code of the country.
Select 200494000
Entity Zip/Postal Code
Code defining international postal code excluding punctuation of the entity indicated.
Select 200526000
Fill Number
The code indicating whether the prescription is an original or a refill.
Select 200543000
Formulary Code
Code assigned by PMO to identify the formulary used.
Select 200571000
Grand Total Quantity
The sum of the 'Total Quantity' (601-39) fields submitted within the 'UD' record type.
Select 200572000
Grand Total Requested Amount
The sum of the 'Requested Rebate Amount' (601-55) fields submitted within the 'UD' record type.
Select 200669000
J Code
A subset of the HCPCS Level II code set with a high-order value of "J" that has been used to identify certain drugs and other items
Select 200670000
J Code Modifier 1
Code specifying drug and other items
Select 200671000
J Code Modifier 2
Code specifying drug and other items
Select 200672000
J Code Modifier 3
Code specifying drug and other items
Select 200673000
J Code Modifier 4
Code specifying drug and other items
Select 200695000
Line Number
Unique number that identifies the record.
Select 200711000
Manufacturer (PICO) Contract Number
Contract number assigned by the manufacturer.
Select 200712000
Manufacturer (PICO) ID Code
Code assigned to identify the manufacturer.
Select 200713000
Manufacturer (PICO) ID Qualifier
Indicates the type of data being submitted in the 'Manufacturer (PICO) ID Code' (600-48) field.
Select 200715000
Manufacturer (PICO) Name
Name of the manufacturer.
Select 200752000
Medical Rebate Version Release Number
Version and release number of standard being submitted
Select 200930000
Patient Liability Amount
Amount of patient's out-of-pocket cost.
Select 201001000
Place of Service
Code identifying the place where a drug or service is dispensed or administered.
Select 201007000
Plan ID Code
ID assigned to identify the plan.
Select 201008000
Plan ID Qualifier
Identifies the type of data being submitted in the 'Plan ID Code' (600-94) field.
Select 201010000
Plan Name
The name of the plan.
Select 201011000
Plan Reimbursed Amount
Total amount the MCO pays to the provider (after removing the co-pay or deductible from the Allowable cost)
Select 201038000
Prescriber ID
ID assigned to the prescriber.
Select 201042000
Prescriber ID Qualifier
Code qualifying the 'Prescriber ID' (411-DB).
Select 201065000
Prescription/ Service Reference Number
Reference number assigned by the provider for the dispensed drug/product and/or service provided.
Select 201066000
Prescription/Service Reference Number Qualifier
Indicates the type of billing submitted.
Select 201067000
Prescription Type
Identifies the prescription as either a new/refill, an adjusted prescription or a reversal.
Select 201113000
Product Description
Description of product being submitted.
Select 201117000
Product/Service ID
ID of the product dispensed or service provided.
Select 201119000
Product/Service ID Qualifier
Code qualifying the value in 'Product/Service ID' (407-D7).
Select 201165000
Quarterly Member Indicator
Number indicating the number of times a member is billed in the billing period.
Select 201196000
Rebate Period End Date
Last day of the rebate period.
Select 201197000
Rebate Period Start Date
First day of the rebate period.
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