Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
IMS HEALTH PharMetrics Plus Data Dictionary IMS LifeLink © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY Table of Contents Section I: PharMetrics Plus Overview This section provides general information about PharMetrics Plus, its source, and information about many of the highlights and attributes of claims data. Section II: File Details and Inventory This section contains a complete listing of all file fields and a brief description of their contents. A standard extract from Pharmetrics Plus consists of the following files: Claims detail (Claims) Patient level file of claim specific elements are from the detail record lines for all claims submitted to the health plan for payment, whether on a HCFA-1500, UB04, via a pharmacy claims system or PBM, or any other source. The file is sorted by patient id and date. Enrollment (Enroll) Patient level file of key demographics and eligibility information for patients in a dataset. The file consists of one record per member. Extended Enrollment (Enroll2) Patient level file of Benefit level indicators in a month to month format such as product and payer type; there are up to eight string formatted records per enrollee. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 2 Section III: Appendices to Pharmetrics Plus Files This section contains tables of names, codes and/or descriptions of standard or custom variables in the data. There are eight tables in this section: Admit Source Codes Admit Type Codes Dispensed as Written Codes Enrollee Relationship Codes Place of Service Codes Plan Payer Types Plan Product Types Provider Specialty Section IV: Clinical Code Reference Files NDC Reference – Reference information for all the NDC codes found in the extract. Diagnosis Reference – Reference information for all the ICD-9-CM diagnosis codes found in the extract. Procedure Code Reference – Reference information for all the CPT-4, HCPCS and ICD-9 procedure codes found in the extract. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 3 Section 1: PharMetrics Plus Overview IMS’ collaboration with Health Intelligence Company, which operates as Blue Health Intelligence, allows IMS’ bio-pharmaceutical clients sole access to one of the largest US health plan claims databases. The PharMetrics Plus claims database is comprised of adjudicated claims for more than 150 million unique patients across the United States, with approximately 40 million active in the most recent calendar year, 2011 with both pharmacy and medical coverage. Data are available from 2006 onwards; with a typical 3-4 month service date lag due to claims adjudication. PharMetrics Plus data has diverse representation of geography, employers, payers, providers and therapy areas. Patients in each 3-digit zip code and every Metropolitan Statistical Area of the US are included, with coverage of data from 90% of US hospitals, 80% of all US doctors, and representation from 85% of the Fortune 100 companies. In addition to standard fields such as inpatient and outpatient diagnoses and procedures, retail and mail order prescription records, PharMetrics Plus has detailed information on the pharmacy and medical benefit (copay/coinsurance amount, deductible), the inpatient stay (admission type and source, discharge status) and provider details (specialty, zip code, attending, referring, rendering, prescribing, primary care provider). All 3-digit zip codes in the US are covered and reported allowing more granular patient segmentation and comparisons by geography. Amounts allowed and paid by health plans are available for services rendered, as well as dates of service for all claims. Other data elements include demographic variables (age, gender, and geographic region), product type (e.g., HMO, PPO), payer type (e.g., commercial, Medicare-Risk), and start and stop dates of health-plan enrollment. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 4 Due to the broad reach of the data, records in the PharMetrics Plus database are representative of the national, commercially insured population in terms of age and gender. The data are also longitudinal, with approximately 20 million patients who have both medical and pharmacy coverage with 3 or more years of continuous enrollment. Data contributions are subjected to a series of quality checks to ensure a standardized format and to minimize error rates. All data are HIPAA compliant to protect patient privacy. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 5 Section 2: File Details and Inventory PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition adm_sc The source of admission identifies the place where the patient was identified as needing admission to a facility. Please refer to Appendices Section. Restrictions apply. * Admit Type Code adm_tc Priority of the inpatient admission. Information located on For example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. Please refer to Appendices Section. Restrictions apply. * Allowed Amount allowed The contracted reimbursable amount for covered medical services or supplies that the health plan agrees to pay to service providers. Attending Provider ID att_id When populated, NPI where available, else Plan Specific Provider ID will be on the claim. New att_spec Specialty of the Attending Provider. The attending provider’s primary specialty For physicians, this usually represents his/her board registered specialty. For non-physicians, specialty reflects the type of provider/facility. New bill_id When populated on medical and facility claims, NPI where available, else Plan Specific Provider ID. When populated on retail pharmacy records, NPI/NCPDP where available. New bill_spec The billing provider’s primary specialty. For physicians, this usually represents his/her board registered specialty. For non-physicians, specialty reflects the type of provider/facility. New Admit Source Code Attending Provider Specialty Code Billing Provider ID Billing Provider Specialty Code © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 6 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Bill Type billtype The bill type code indicates the status (complete bill, interim bill) of the facility bill. This field is not available for professional and pharmacy claims. Charge Amount charge This is the amount charged/billed for services provided by the servicing provider or facility. Claim Number claimno Claim line number assigned by the health plan adjudication system for internal tracking purposes. If a claim number is not submitted by the contributor, the field will be blank. New Coordination of Benefit Amount (COB Amount) cobamt The reduction in the amount paid to the provider to reflect adjustments as a secondary payer. New Medical Coinsurance Amount coinsamt Confinement Number conf_num Copayment copay The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%. The confinement is constructed by using the ‘frm_dt’ on the first room and board record and the ‘thru_dt’ on the last facility record in a series of facility records that have the same provider id and overlapping or contiguous dates. The confinement number is then assigned to all records that fall within that time frame. Confinement number is not unique within an extract. You must use pat_id and conf_num for uniqueness. Amount an insured individual pays directly to a provider at the time the services or supplies are rendered. Usually, copay will be a fixed amount per service, such as $15.00 per office visit. Amounts should include any sanction/penalty or copay form of insured noncompliance such as lack of prior authorizations. Also includes any amount paid as copayment or coinsurance for prescription medications. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New New 7 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition CPT Modifier cpt_mod Modifiers represent special circumstances related to the performance of the service. New Dispensed as Written daw Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. Refer to Appendices Section. New Days Supplied dayssup Estimated number of days the prescription will last or was prescribed. deductible The portion of this service that the member must pay which is applied to the total period deductible. Deductibles are usually applied over a specific time period, such as per calendar year, per benefit period, or per episode of illness. Admitting Diagnosis diag_admit Also considered the primary diagnosis code. ICD9-CM diagnosis code describing the condition chiefly responsible for a patient's admission to a facility. It may be different from the principal diagnosis, which is the diagnosis assigned after evaluation. Diagnosis Code diag1 diag11 Each record may include up to 11 ICD-9 (International Classification of Diseases, 9th revision). These codes describe the patient's condition or diagnosis. Deductible Dispensing Fee dispense_fee The dispensing fee paid. This amount is included in the Total Amount Paid. Represents a sum of any of one or more of the following: Ingredient Cost Paid, Dispensing Fee Paid, Flat Sales Tax Amount Paid, Percentage Sales Tax Amount Paid, Incentive Amount Paid, Professional Service Fee Paid, Other Amount Paid, less Patient Pay Amount and Other Payer Amount Recognized. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New New 8 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Formulary Indicator formulary At the claim record level, value indicated whether the prescription drug was paid as included in the plan's formulary at the record level. Valid values are: F Formulary N Non-Formulary From Date from_dt Date on which services began for inpatient services or date of service for same day services, office visits, outpatient services, etc. ICD9 Procedure Code (Primary) icd9prc1 Principal medical procedure a patient received during inpatient stay. Current coding methods include: International Classification of Diseases Surgical Procedures (ICD-9). New ICD9 Procedure Code (Secondary) icd9prc2 icd9prc6 Additional ICD-9 procedure codes assigned to the inpatient claim. New Line Number linenum Line identification number that usually represents the number assigned in a source system for identification and processing. New National Drug Code (NDC) ndc The NDC is an eleven digit number that identifies the manufacturer, product name, and package size of each approved or repackaged prescription drug. These codes are assigned by the FDA. Paid Amount paid The dollar amount actually paid by the health plan to a provider for services rendered. Claim Paid Date paid_dt The date the claim was paid. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New 9 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Patient ID pat_id Encrypted unique patient identifier. Discharge Status patstat Patient’s status as of the discharge date for an facility stay. Patient status is only available for inpatient claims. New Primary Care Physician (PCP) ID pcp_id When populated NPI where available, else Plan Specific Provider ID on the claim. New Primary Care Physician (PCP) Specialty pcp_spec Specialty of the Primary Care Physician. New Claim Payment Status Place Of Service Procedure Code pmt_st_cd pos proc_cde Indicates whether the claim was paid or denied. P - Paid D - Denied New A HCFA standard variable identifying the location, or place, where medical services were rendered. Refer to Appendices Section. Procedure Code: A unique code identifying each procedure. These are either: CPT-4 Codes: AMA developed codes that describe medical, surgical, and diagnostic services performed by clinicians. HCPCS Codes: Codes developed by HCFA to describe the provision of supplies, injections, materials, services, durable medical equipment, and non-physician procedures. Revenue Center Codes: These codes are used to associate certain costs with specific revenue centers in a facility. Revenue codes will be present in the proc_cde field only when a HCPCS or CPT code was not present on the claim. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 10 PharMetrics Plus CLAIMS File Inventory Data Variable Description Place Of Service Procedure Code Data Variable Field Name pos proc_cde Data Variable Definition A HCFA standard variable identifying the location, or place, where medical services were rendered. Refer to Appendices Section. Procedure Code: A unique code identifying each procedure. These are either: CPT-4 Codes: AMA developed codes that describe medical, surgical, and diagnostic services performed by clinicians. HCPCS Codes: Codes developed by HCFA to describe the provision of supplies, injections, materials, services, durable medical equipment, and non-physician procedures. Revenue Center Codes: These codes are used to associate certain costs with specific revenue centers in a facility. Revenue codes will be present in the proc_cde field only when a HCPCS or CPT code was not present on the claim. Prescriber Provider ID prscbr_id When populated NPI or DEA where available, else Plan Specific Provider ID on the claim. New Prescriber Provider Specialty prscbr_spec When available, specialty of the Prescriber Provider. New Provider Type ptypeflg Quantity quan Provider Type: 0 Clinician 1 Facility 2 Other Quantity of drug dispensed expressed in metric decimal units as submitted by the pharmacy. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 11 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Record Type rectype Record Type: Each record is classified as one of the following six record types:(M)management(S)surgical (F)facility (A)ancillary (P)pharmacy (J) J record type is assigned to cost adjustments made for facility claims, if applicable. Referring Provider ID ref_id When populated, NPI where available, else Plan Specific Provider ID on the claim. New Referring Provider Specialty Code ref_spec When available specialty of the Referring Provider. New Rendering Provider ID rend_id When populated on medical and facility claims, NPI where available, else Plan Specific Provider ID on the claim. When populated on RX Claims, Pharmacy NPI/NCPDP. New Rendering Provider Specialty Code rend_spec When available, specialty of the Rendering Provider. New Revenue Center Code rev_code These codes are used to associate certain costs with specific revenue centers in a facility. New srv_unit The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. New Service Unit © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 12 PharMetrics Plus CLAIMS File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Submission Type Code sub_tp_cd This field identifies how the claim was submitted to the health plan by the provider/facility: EL - Electronic IN - Invalid PA - Paper SC - Scan UN - Unknown WB - Online To Date to_dt The final date of service delivery. The To Date is the same as From Date for same day services. tos_flag Type Of Service is assigned to facility claims. 0 Facility 1 Management/Surgery 2 Room and Board This field is not available for professional and pharmacy claims. Type of Service Flag © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New 13 PharMetrics Plus ENROLLMENT File Inventory Data Variable Description Data Variable Field Name Data Variable Definition Derived Sex der_sex If there is a sex listed on the enrollment record, it is used. Otherwise, the sex is derived from the claims file. Derived Year of Birth der_yob If there is a YOB listed on the enrollment record, it is used. Otherwise, the YOB is derived from the claims file. enr_rel This code is found in the common working file (CWF) and is used by CMS to verify a resident’s entitlement to and correct use of Medicare benefits. Please refer to Appendices Section. Enrollment String estring Months Covered Template in string format: A 252 character string of “X”s and “-”s. Each position in the ESTRING represents a single month. It begins as of January 1995. If a member is enrolled in a particular month, an “X” is placed in the appropriate position. If the member was not enrolled in that month, a “-” is in the position. First Claim Date clm_frst Date of patient's first claim. Group/NonGroup Coverage Indicator grp_indv_cd Specifies whether the contract is a group or individual: G - Group Coverage I - Individual Coverage U - Unknown New IMS Patient ID anon_ims_pat_id When populated, Patient identifier/key to other IMS Real World Evidence products – “allows ” patient linking”. New Enrollee Relationship Code © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New 14 PharMetrics Plus ENROLLMENT File Inventory Data Variable Description Name Data Variable Field Name Data Variable Definition Last Claim Date clm_last Date of patient's last claim. Last Date of Enrollment enr_last Last date of Enrollment. Modified to correspond with the date of complete claims data for the plan. Mental Health/Chemical Dependency Benefit Indicator MH_CD Specifies whether the enrollee/patient has mental health/chemical dependency benefits: Y - Yes MH/CD Benefit N - No MH/CD Benefit U - Unknown/Missing Mixed First Date of Enrollment mxce_fst First enrollment date where it exists, else, the first claim date. Mixed Last Date of Enrollment mxce_lst Last enrollment date where it exists, else, the last claim date. Patient ID pat_id Same patient ID as the claims file. Patient Region pat_region Patients are assigned to 1 of 4 U.S. Census regions based on residence. E - Northeast S - South MW - MidwestW - West Patient State pat_state State of residence for the enrollee/patient from the most recent enrollment record. New Patient Zip Code pat_Zip3 Zip code of the enrollee/patient is provided at the 3 digit level (###XX) from the most recent enrollment record. New Total Number of Claim Lines nbr_clm_lines Total Number of Claim Lines. Total Number of Months Enrolled mon_totl Total Number of Months Enrolled. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY New 15 PharMetrics Plus ENROLLMENT2 File Inventory Data Variable Description Patient ID Data Variable Field Name pat_id Data Variable Definition Encrypted unique patient identifier. Same as pat_id in claims and enrollment files. There are 8 strings in the same construct as the enrollment estring. Each position in a string represents a single month. It begins as of January 1995. Refer to each variable definition for specifics. In each month to month position values are reflective of: RX Benefit Indicator Pay Type Product Type Enrollment Eligibility Status* Hospital Benefit Indicator* Medical Benefit Indicator Medical Coordination of Benefits Indicator Pharmacy Coordination of Benefit Indicator *Not externally provided at this time. String Type Enrollment II Strings RX Benefit Indicator Pay Type ben_rx pay_type Y RX benefit N No RX Benefit C - Commercial K - State Children's Health Insurance Program (SCHIP) M - Medicaid R - Medicare Risk (presently known as Medicare Advantage) S - Self-Insured T - Medicare Cost (Medicare Supplemental) U - Unknown/Missing X - RX Only "-" - No Enrollment © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 16 PharMetrics Plus ENROLLMENT2 File Inventory Data Variable Description Data Variable Field Name Data Variable Definition prd_type H - Health Maintenance Organization I Indemnity/Traditional P - Preferred Provider Organization S - Point of Service D - Consumer Directed Health Care U - Unknown/Missing "-" - No Enrollment enr_type C - Cobra R - Retiree U - Unknown/Missing A - Active "-" No Enrollment Code is determined by the most span of data. Restrictions apply. * Hospital Benefit Indicator ben_hosp Y- Hospital benefit N - No Hospital Benefit U- Unknown/Missing Restrictions apply. * Medical Benefit Indicator ben_med Y - Medical benefit N - No Medical Benefit All patients have medical benefit New ben_mcob P - Primary M - Secondary to Medicare S - Secondary to other commercial payer N - No medical coverage "-" - No Enrollment New ben_pcob P - Primary M - Secondary to Medicare S - Secondary to other commercial payer N - No medical coverage "-" - No Enrollment New Product Type Enrollment Eligibility Status Medical Coordination of Benefits Indicator Pharmacy Coordination of Benefit Indicator © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 17 Section 3: Appendices to PharMetrics Plus Files Table I: Admit Source Codes Admit Source Code Value Admit Source Code Description Admit Source Code Definition 1 Physician Referral The patient was admitted to this facility upon the recommendation of his or her personal physician. 2 Clinic Referral The patient was admitted to this facility upon recommendation of this facility’s clinic physician. 3 HMO Referral The patient was admitted to this facility upon the recommendation of a health maintenance organization physician. 4 Transfer from a Hospital The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient. 5 Transfer from a Skilled Nursing Facility The patient was admitted to this facility as a transfer from a skilled nursing facility where he or she was an inpatient. 6 The patient was admitted to this facility as a transfer from a health care facility other than an acute care facility or a Transfer from Another Health Care skilled nursing facility. This includes transfers from nursing homes, long term care facilities and skilled nursing facility Facility patients that are at a non-skilled level of care. 7 Emergency Room The patient was admitted to this facility upon the recommendation of this facility's emergency room physician. 8 Court/Law Enforcement The patient was admitted to this facility upon the direction of a court of law, or upon the request of a law enforcement agency representative. 9 Information Not Available The means by which the patient was admitted to this hospital is not known © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 18 Admit Source Code Value Admit Source Code Description Admit Source Code Definition A Transfer from a Critical Access Hospital The patient was admitted to this facility as a transfer from a Critical Access Hospital where he or she was an inpatient. B Transfer from Another Home Health Agency The patient was admitted to this home health agency as a transfer from another home health agency. C Readmission to Same Home Health Agency The patient was readmitted to this home health agency within the existing 60-day payment. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 19 Table II: Admit Type Codes Admit Type Code Admit Type Code Description Admit Type Code Definition Value Emergency The patient requires immediate medical intervention as a result of severe, life threatening or potentially disabling conditions. Generally, the patient is admitted through the emergency room. Urgency The patient requires immediate attention for the care and treatment of a physical or mental disorder. Generally the patient is admitted to the first available and suitable accommodation. Elective The patient's condition permits adequate time to schedule the availability of a suitable accommodation. Newborn Use of this code necessitates the use of special Source of Admission codes - see Form Locator 20. Trauma Center Visit to a trauma center/hospital as licensed or designated by the state or local government authority authorized to do so, or as verified by the American College of Surgeons <u>and</u> involving a trauma activation. Info NA Information Not Available. 1 2 3 4 5 9 © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 20 Table III: Dispensed As Written Codes Dispensed As Written Code Value 01 Dispensed as Written Code Description Brand product is 'medically necessary' and therefore no substitution is allowed by the prescriber. This would be used when a brand name drug has consistently received better results than a generic version and so a specific brand name version is deemed required. This must be dispensed exactly as written. 02 Substitution allowed- patient requested product dispensed. This means the patient chose the specific brand being dispensed. This is used when generic substitution is allowed, but the patient wants the brand name version. 03 Substitution allowed- pharmacist selected product dispensed. This means the pharmacist chose which brand of a drug to provide, even though a generic product option is available. 04 Substitution allowed- generic drug not in stock. This means a brand name was dispensed instead of a generic version, because the generics were all out of stock. 05 Substitution allowed- Brand dispensed as pharmacy's generic. This means that the pharmacy used a "Branded Generic." This happens when the generic isn't stocked by the pharmacy and they use a brand name instead. 06 Override DAW Code. This is the all-purpose override code and is used whenever an override is needed. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 21 Table IV: Enrollee Relationship Codes Enrollee Relationship Code Value 01 04 05 07 10 15 17 18 19 20 21 22 23 24 29 32 33 36 39 40 41 43 53 G8 Enrollee Relationship Code Description Spouse Grandfather Or Grandmother Grandson Or Granddaughter Nephew Or Niece Foster Child Ward Stepson Or Stepdaughter Self Child Employee Unknown Handicapped Dependent Sponsored Dependent Dependent Of A Minor Dependent Significant Other Mother Father Emancipated Minor Organ Donor Cadaver Donor Injured Plaintiff Child Where Insured Has No Financial Responsibility Life Partner Other Relationship NOTE: It is not possible to detect whether patients are related within the database. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 22 Table V: Place of Service of Codes: Place of Service Code Value 01 02 11 12 21 22 23 24 25 26 31 32 33 34 41 42 50 51 52 53 54 55 56 62 61 65 71 72 81 99 00 XX ZZ Place of Service Description Unspecified Inpatient code Unspecified Outpatient Code Office Patient's Home Inpatient Hospital Outpatient Hospital Emergency Room-Hospital Ambulatory Surgical Center Birthing Center Military Treatment Facility Skilled Nursing Facility Nursing Facility Custodial Care Facility Hospice Ambulance-Land Ambulance-Air or Water Federally Qualified Health Center Inpatient Psychiatric Hospital Psych. Facility Partial Hospital Community Mental Health Center Intermediate Care Facility/Mentally Retarded Residential Substance Abuse Treatment Facility Psych Residential Treatment Center Comprehensive OP Rehab Facility Comprehensive IP Rehab Facility End Stage Renal Disease Treatment Facility State or Local Pub Health Clinic Rural Health Clinic Independent Lab Other Unlisted Facility Pharmacy Other Unknown © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 23 Table VI: Payer Type Codes Plan Payer Type Value C Plan Payer Type Description Plan Payer Type Table Definition Commercial Plan Commercial Plan: Commercial plans are primarily employer based. The health plan assumes the risk of insuring the enrolled members. K State Children's Health Insurance Program (SCHIP) A Medicaid variant, primarily earmarked for children. It has been segmented as often this population exhibits less enrollment variation, but generally can be considered identical to the Medicaid category. M Medicaid Medicaid, a state and federal health insurance program for qualifying low income individuals, contracts in some cases with private health insurers to manage the health care for Medicaid enrollees. The health plan assumes the financial risk of insuring the enrollees and typically manages the plan like an HMO. R Medicare Risk Medicare, a federal health plan for senior individuals and individuals with selected disabilities, contracts in some cases with private health insurers to manage the health care for Medicare enrollees. The health plan assumes the financial risk of insuring the enrollees and typically manages the plan like an HMO. Medicare Risk plans typically cover more services, including drugs, than traditional Medicare insurance, although the choice of providers and access to providers is more limited than traditional Medicare insurance. T Medicare Cost Medicare Cost (also known as Medicare Gap or Medicare Supplemental) insurance is insurance purchased by individuals to cover services not covered by traditional Medicare insurance. Patients submit claims to either Medicare or the Medicare Cost insurer depending on the services consumed. Only the data submitted to the Medicare Cost insurer is in the health plan database. Medicare Cost plans are structured similarly to indemnity plans. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 24 Table VII: Product Type Codes Plan Product Type Values D Plan Product Type Description Consumer Directed Health Care H Health Maintenance Organization I Indemnity Plan S Point Of Service P Preferred Provider Organization U Other or Unknown Plan Product Type Definition A self-identified plan option, thought to be similar to a commercial plan, but with underlying benefit plan design changes. These options can show a high degree of variation, but are thought to be highdeductible/high co-insurance plans. Historically, HMO coverage is associated with lower premiums, lower patient contributions (through relatively modest co-payments and deductibles), tightest provider network management controls, most restrictions on choice of providers and the most restrictions on the ability to self-refer. Over time, however, many HMO plans have changed to offer more choice and greater access to providers. Indemnity insurance is traditional health insurance. Typically, indemnity insurance has the highest premiums and greatest patient choice of providers and very few restrictions on self-referral. Patients typically pay 20% of fees paid to providers while the plan typically pays the remaining 80%. Patients also pay deductibles, typically higher than HMO plans, on selected services such as Emergency Room visits and Inpatient Admissions. POS plans are a hybrid of HMO and Indemnity plans. If a patient stays within the provider network and does not self-refer, patient contributions are structured like an HMO (i.e. relatively modest co-payments and deductibles) but the patient may elect to self refer and pay standard 20% coinsurance rates and typically higher deductibles. PPO plans are a hybrid of managed-care-like plans and indemnity plans. Patient contributions are structured like an indemnity plan (i.e. patient typically pay 20% coinsurance rates and deductibles on selected services), but if the patient stays within the network, the fees paid to providers are discounted. Like traditional indemnity plans, there are very few restrictions on self-referral. Product type is unknown. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 25 Table VIII: Provider Specialty Table Provider Specialty Type Value ALLERGY ANESTH ASC CARDIOL CHIRO COLON_SR CT_SRG DENTIST DERMATOL DME_HH ENDOCRIN ENT ER_PHYS GASTRO GENETICS GERIATRC GP_FP HAND_SRG HEMATOL HEM_ONC HOSPITAL INF_DIS INTERN MHSA_FAC MIDWIFE NEONAT NEPHROL NEUR_SRG NEUROL --no cpi-N/A NRS_ANES NRS_PRCT OB_GYN OCC_THER OPHTHAL OPTOMTRY ORTH_SRG ORTHO Provider Specialty Type Description Allergy and Immunology Anesthesiology Ambulatory Surgery Center Cardiology Chiropractic Colon-Rectal Surgery Cardio-Thoracic Surgery Dentist Dermatology Durable Medical Equipment/Home Health Endocrinology ENT Emergency Medicine Physician Gastroenterology Medical Genetics Geriatrics General Practice/Family Practice Hand Surgery Hematology Hematology/Oncology Hospital Infectious Disease Internal Medicine Mental Health/Substance Abuse Facility Midwife Neonatology Nephrology Neurosurgery Neurology The record doesn’t group to a cluster, therefore no specialty is assigned. Not Available Nurse Anesthetist Nurse Practitioner Obstetrics and Gynecology Occupational Therapy Ophthalmology Optometry Orthopedic Surgery Orthopedics © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 26 Provider Specialty Type Value Provider Specialty Type Description OSTOPATH Osteopath OTHER OTHR_FAC OTHR_SPC OTHR_SRG PATHOL PED PHYS_AST PHYS_MED PLST_SRG PODIATRY PSYCHIAT PSYCHOL PT PULMONAR RADIOL RAD_ONC RHEUM RN SOC_WORK SNF SURGERY URG_FAC URGENT UROLOGY VAS_SRG Other Other Facility Other Specialty Other Surgeon Pathology Pediatrics Physician Assistant Physical Medicine and Rehabilitation Plastic Surgery Podiatry Psychiatry Psychology Physical Therapy Pulmonology Radiology Radiation Oncology Rheumatology Registered Nurse Social Work Skilled Nursing Facility/Long Term Care General Surgery Urgent Care Facility Urgent Care Medicine Urology Vascular Surgery © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 27 Section 3: Clinical Code Reference Files NDC Reference File Variable Description Ahfscc The American Hospital Formulary Service (AHFS) publishes the AHFSCC Pharmacologic-Therapeutic Classification Compilation codes which are used throughout the health care industry as a means for drug classification. It is less specific than both the GPI therapeutic classification and the USC therapeutic classification system. Brand_indicator The brand indicator identifies whether a product is trademark, generic or branded generic (gen_brand). Branded generics are: • generally a generic drug product • more than one company manufactures this drug product • the manufacturer can be a research and development company or a generic company • sold under a branded generic or a generic name Brand_name The Brand or Trademark name Dosage_form The Dosage Form indicates the form (solid, liquid, or gas) in which the drug product is dispensed. The “C6” refers to the sixth subset of the GPI which generally represents the Dosage Form (for example, the GPI for Furosemide Tab 20 mg, 37 20 00 30 00 03 05, has an “03” in the C6 position designating the Dosage Form “TAB”). © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 28 NDC Reference File Variable Description Drug_class The first four digits (second subset) of the GPI code represent the Drug Class which identifies specific therapeutic drug classes designed to accommodate more detailed market research. The Drug Class also serves as the structural base for most therapeutic drug monitoring applications (such as dosage screening and disease contraindication monitoring). For example, Drug Group 37, DIURETICS, includes the following Drug Classes: 37-00-00-00-00 *DIURETICS* 37-10-00-00-00 *Carbonic Anhydrase Inhibitors** 37-20-00-00-00 *Loop Diuretics** 37-30-00-00-00 *Mercurial Diuretics** 37-40-00-00-00 *Osmotic Diuretics** 37-50-00-00-00 *Potassium Sparing Diuretics** 37-60-00-00-00 *Thiazides** 37-90-00-00-00 *Miscellaneous Diuretics** 37-99-00-00-00 *Combination Diuretics** The number “99” found in the second or third subset in some GPIs is used in Facts and Comparisons' TCS to identify combination drug products. Fd_drug_name GPI Generic Name. Identifies the product represented by the GPI which includes generic name, strength and dosage form. Gen_nm Generic Name/Active Ingredient Gpi The 14-character GPI (generic product indicator) consists of a hierarchy of seven subsets, each providing increasingly more specific information about drug products. These subsets are structured and identified below: GPI Record 12-xx-xx-xx-xx-xx-xx Drug Group *MISC. ENDOCRINE* 12-34-xx-xx-xx-xx-xx Drug Class *Posterior Pituitary** 12-34-56-xx-xx-xx-xx Drug Subclass *Vasopressin*** 12-34-56-78-xx-xx-xx Drug Name Desmopressin 12-34-56-78-90-xx-xx Drug Name Acetate 12-34-56-78-90-12-xx Dosage Form Tablet 12-34-56-78-90-12-34 Strength 0.1MG Last_chg_dt The Last Change Date identifies the most recent date any field in the drug file was changed. © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 29 NDC Reference File Variable Description Manufacturer_name The Manufacturer’s (Labeler) Name indicates the manufacturer, distributor, and/or division whose name is included on the label. Drug products are identified and reported using an 11-digit, 3segment number called the National Drug Code (NDC), which is a universal product identifier for human drugs. The NDC code identifies the labeler, product, and trade package size. The first segment (5-digits), the labeler code, is assigned by the FDA. A labeler is any firm that manufactures (including repackers or relabelers), or distributes (under its own name) the drug. The second segment (4-digits), the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment (2-digits), the package code, identifies package sizes and types. Both the product and package codes are assigned by the firm. The NDC code is reported in the following configuration: 5-4-2. Ndc Route_admin Rx_group Rx_otc The Route of Administration indicates how the medication's dosage form is administered to the patient. Examples are: ORAL (OR) Taken by mouth RECTAL (RE) Administered into the rectum SUBCUTANEOUS (SC) Injection through the skin into the loose subcutaneous tissue under the skin INHALATION (IN) Drug administration into the lungs (either during a drawn or forced breath) INJECTION (IJ) A set of one or more injectable routes or the route of injection is not specified INTRAMUSCULAR (IM) Injection into a muscle group Drug Group The two-character Drug Group (first two digits and first subset of the GPI code) classifies general drug products. Examples are: 01-00-00-00-00 *PENICILLINS* 25-00-00-00-00 *CONTRACEPTIVES* 27-00-00-00-00 *ANTIDIABETIC* 36-00-00-00-00 *ANTIHYPERTENSIVE* 86-00-00-00-00 *OPHTHALMIC* Indicates whether the product is available only by prescription (Rx) or over-the-counter (OTC). © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 30 NDC Reference File Variable Strength Tee_code Unit Usc_code Usc_description Variable DX Diag_description Description The Strength is present for products with a single active ingredient. For combination products, the strength is designated as zero. The “C7” refers to the seventh subset of the GPI which generally represents the product Strength (for example, the GPI for Furosemide Tab 20 mg, 37 20 00 30 00 03 05, has an “05” in the C7 position designating the product Strength 20mg) A two-character code indicating the FDA rating of the therapeutic equivalence of a drug product with other pharmaceutically equivalent drug products, as published in the Orange Book. Use of the TEE Code with the GPI enables the end-user to have a list of bioequivalent, substitutable drug products sharing the same active ingredients including the same route, strength, and dosage form. The Strength Unit of Measure, when combined with the Strength represents the dosage strength as provided by the manufacturer. For example: Drug Product: Indocin Strength: 25 Strength Unit of Measure: MG Interpreted Strength: Indocin 25 mg The Uniform System of Classification (USC) is a therapeutic classification system created by IMS America and the Pharmaceutical Marketing Research Group. This system is marketoriented and is unique to the United States. The USC Classification System is more specific than the American Hospital Formulary Service (AHFS) Therapeutic Classification System and less specific than Medi-Span’s Therapeutic Classification System. One USC Code can be applied to multiple GPI’s while a GPI will have only one USC code. Not all GPIs have a USC Code. Text description of the USC code. Diagnosis Reference File Description Alpha-numeric code for the ICD-9-CM Diagnosis Code Short version of the text description for the code © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 31 THIS PAGE IS INTENTIONALLY BLANK © IMS HEALTH INCORPORATED OR ITS AFFILIATES. ALL RIGHTS RESERVED. CONFIDENTIAL AND PROPRIETARY 32