Comparison of definitions for identifying urgent care centers in health insurance claims

The objective of this study is to describe and validate two claims-based UCC definitions. We used FAIR Health insurance claims from 444,263 organization National Provider Identifiers (NPIs) with at least 10 claims, January 2016 –March 2019 and merged this data with National Plan and Provider Enumeration System data. The first definition required (1) a UCC place of service code (POS), (2) ≥ 10% Current Procedure Terminology (CPT) codes specific to UCCs, or (3) a UCC taxonomy code in the primary field. The second def inition relaxed these criteria. A random sample of 5% of NPIs identified as UCCs were validated through internet searches. Prevalence and positive predictive value (PPV) were calculated for both definitions. The first definition identified 6669 (1.5%) of NPIs as UCCs resulting in a PPV of 92%. The s econd definition identified 8261 (1.9%) of NPIs as UCCs and had a PPV of 87%. Out of NPIs identified under the first definition, 96% were identified using POS codes, 50% were identified using taxonomy codes, and 46% using CPT codes, with 62% of NPIs meeting multiple criteria. Findings suggest that t hese methods may be used by researchers to identify UCCs in studies of cost or utilization in different healthcare settings.
Source: Health Services and Outcomes Research Methodology - Category: Statistics Source Type: research

Related Links:

Source: Surgery - Category: Surgery Source Type: research
Source: Surgery - Category: Surgery Source Type: research
Source: Surgery - Category: Surgery Source Type: research
Source: Surgery - Category: Surgery Source Type: research
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
ConclusionsThe prevalence of OCI observed in our study is consistent with previous literature, and we confirm that it is more frequently retrieved in women. Longitudinal research is warranted to elucidate the evolution, while knowledge about the disorder is needed to raise the awareness of rheumatologists and radiologists and to properly identify and report the condition.Key Points• OCI may mimic sacroiliitis and is a major differential diagnosis of radiographic axial spondyloarthritis.• Prevalence of OCI in our sample is 1.0%, in line with previous literature.• OCI predominantly affects women, and our study...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
AbstractLong-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure ...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
The five-bedroom, five-bathroom home was listed this week for $3.7 million. The owners have moved just two houses down.
Source: bizjournals.com Health Care:Pharmaceuticals headlines - Category: Pharmaceuticals Authors: Source Type: news
Source: Journal of Molecular Diagnostics - Category: Pathology Source Type: research
More News: Health Insurance | Insurance | Internet | Statistics | Study