Interpreting Medical Claims Using the Optimized Service-Line Flagging Table

December 16, 2020; 12:00pm - 1:00pm ET

Presenter: Sofia Trogu, Health Data Analyst

Even the most experienced APCD users may look at a claim and wonder what each code indicates about the procedures and services provided to the patient. While using a thick CPT code manual or Onpoint’s reference tables to look up each code is one approach, many codes’ service descriptions often include specific medical jargon that can be difficult to decipher and understand.

To help simplify this complexity, Onpoint has developed a series of value-add flags that assign each medical claim service line to a broad service category. These assignments are based on the reported codes and provide yes/no answers that help resolve questions such as, “Does this service line belong to the Advanced Imaging category?” We deliver these flags using the Medical Claim Service-Line Flagging table, which enables end users to quickly see all of the value-added service-line flags associated with each service line in an extract. These flags also allow end users to pull specific services (e.g., preventive visits) for further research and analytics.

While this table previously was released on a limited basis, it is now part of Onpoint’s standard extract products. Given the acute relevance of the COVID-19 pandemic to APCD data, we recently enhanced this table with the addition of a COVID flag that highlights any services tied to the virus. This COVID flag supplements our telehealth flag, which is also of heightened interest during the pandemic.

This December webinar will provide background regarding the logic and determination of our service-line flagging and train end users in how to best incorporate the service-line flagging table into their queries and analytic practice.

Registration for this session has closed.