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