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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
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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 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 Prior Authorization Transfer
Name:
Prior Authorization Transfer
Definition:
Transferring existing prior authorization data between payer/processors when transitioning clients, performing system database or platform changes.
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Definition
Select 200056000
Additional Message Information
Free text message.
Select 200095000
Alternate ID Number
Alternate ID number assigned to the cardholder or family member.
Select 200174000
Batch Number
A number generated by the sender to uniquely identify this batch from others, especially when multiple batches may be sent in one day.
Select 200180000
Benefit Amount
Represents the amount of the overridden amount to be applied in place of the standard plan benefit.
Select 200181000
Benefit Amount Time Period
Defines how the Benefit Amount Type override is to be applied during a time period and corresponds to the plan's benefit accrual period.
Select 200182000
Benefit Amount Type
Represents which of the benefit accumulation types is being overridden and also has an option to override all benefit amounts. This amount is usually set to an amount outside of the normal plan benefit coverage level.
Select 200183000
Benefit Amount Used To-Date
Indicates the aggregated amount of benefit used to date against a previously approved override amount.
Select 200208000
Cardholder ID
Insurance ID assigned to the cardholder or identification number used by the plan.
Select 200233000
Claim Cost Ceiling Override Amount
Represents either the specific copay Gross Amount Due or the Gross Amount Due Ceiling that the prior authorization is overriding.
Select 200237000
Claim Origination
From the plan's perspective, the method/system/application by which the payer received the claim.
Select 200244000
Client Name
Name of client.
Select 200286000
Compound Indicator
Code indicating if the prior authorization applies to compounded products only.
Select 200315000
Copay/Coinsurance Override Amount
Represents either the specific copay dollar amount or coinsurance rate that is defined in the prior authorization and is qualified by the Copay/Coinsurance Override Type (A08).
Select 200316000
Copay/Coinsurance Override Type
Indicator used to represent whether or not the override is defined as a flat dollar amount or as a percentage, and is usually outside of the normal plan benefit coverage level. Percentage may be considered a coinsurance amount.
Select 200317000
Copay Conjunction Sequence
The sequence in which a multi-tiered copay structure should be applied.
Select 200335000
Creation Date
Date the file was created.
Select 200336000
Creation Time
Time the file was created.
Select 200351000
Date Of Birth
Date of birth of patient.
Select 200359000
Days Supply
Estimated number of days the prescription will last.
Select 200362000
Days Supply Used to Date
Accumulated authorized amount of days supply used to date
Select 200386000
Dispense As Written (DAW) Difference
Indicator to determine where the cost differential of the DAW difference should be shifted.
Select 200398000
Dosage Per Day
The dosage per day that is approved by the prior authorization and is usually over or under the normal plan limits or clinical guidelines.
Select 200441000
Drug Type
Code to indicate the type of drug dispensed.
Select 200524000
File Type
Code identifying whether the file contained is test or production data.
Select 200528000
Fills/Refills Used To-Date
Indicates the number of fills or refills used to date by a patient against an existing Annual Fill or Annual Refill override.
Select 200532000
First Name
First name.
Select 200577000
Group ID
ID assigned to the cardholder group or employer group.
Select 200688000
Last Name
Last name.
Select 200778000
Middle Initial
Individual middle initial.
Select 200918000
Patient First Name
Individual first name.
Select 200919000
Patient Gender Code
Code indicating the gender of the individual.
Select 200920000
Patient ID
ID assigned to the patient.
Select 200926000
Patient ID Qualifier
Code qualifying the 'Patient ID' (332-CY).
Select 200929000
Patient Last Name
Individual last name.
Select 200938000
Patient Relationship Code
Code indicating relationship of patient to cardholder.
Select 200981000
Person Code
Code assigned to a specific person within a family.
Select 201038000
Prescriber ID
ID assigned to the prescriber.
Select 201042000
Prescriber ID Qualifier
Code qualifying the 'Prescriber ID' (411-DB).
Select 201046000
Prescriber Override Type
The override's inclusion or exclusion parameters as it applies to the prescriber network for a plan.
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 201068000
Previous Date of Fill
Date prescription was previously filled.
Select 201080000
Prior Authorization Create Date
The date the prior authorization record was created in sender's system.
Select 201082000
Prior Authorization Effective Date
Date the prior authorization became effective.
Select 201083000
Prior Authorization Expiration Date
Date the prior authorization ends.
Select 201084000
Prior Authorization Number-Assigned
Unique number identifying the prior authorization assigned by the processor.
Select 201085000
Prior Authorization Number of Fills Authorized
The number of fills allowed to be covered by the prior authorization and is usually over or under the normal plan limitations.
Select 201086000
Prior Authorization Number Of Refills Authorized
Number of refills authorized by the prior authorization.
Select 201087000
Prior Authorization Number Submitted
Number submitted by the provider to identify the prior authorization.
Select 201089000
Prior Authorization Quantity
Amount authorized expressed in metric decimal units.
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