Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

Data Element
Adjudication Amount Type
Adjudication Date
Allowed Number of Units
Amount Paid by Patient
Care Team Role
Claim Adjusted from Identifier
Claim Adjusted to Identifier
Claim Amount Paid to Provider
Claim Attending Physician Name
Claim Attending Physician NPI
Claim Bill Facility Type Code
Claim Billing Provider Name
Claim Billing Provider NPI
Claim Billing Provider Contracting Status
Claim Diagnosis Related Group Version
Claim Discount Amount
Claim Frequency Code
Claim Identifier Type
Claim Identifier Type
Claim Inpatient Admission Type Code
Claim Inpatient Source Admission Code
Claim Non-covered Amount
Claim Operating Surgeon Name
Claim Operating NPI
Claim Other Payer Identifier(s)
Claim Other Payer Paid Amount
Claim Paid Date
Claim Payee
Claim Payee Type
Claim Payer Name
Claim Payer Identifier
Claim Received Date
Claim Total Submitted Amount
Claim Total Allowed Amount
Claim Payment Amount
Claim Payment Denial
Claim Payment Status Code
Claim Processing Status
Claim PCP name
Claim PCP NPI
Claim Performing Provider Name
Claim Performing Provider NPI
Claim Performing Provider Network Status
Claim Prescribing Physician Name
Claim Prescribing Provider NPI
Claim Prescriber Contracting Status
Claim Referring Physician Name
Claim Referring Physician NPI
Claim Referring Physician Network Status
Claim Supervising Physician Name
Claim Supervising Physician NPI
Claim Service Start Date
Claim Service End Date
Claim Service Classification Type Code
Claim Site of Service Network Status
Claim Type
Claim Sub Type
Co-insurance Liability Amount
Copay Amount
Compound Code
Diagnosis Code
Diagnosis Code Type
Diagnosis Code Type
Diagnosis Type
Modifier Code -4
Modifier Code -3
Modifier Code -2
Modifier Code -1
Procedure Type
Procedure Code Type
Procedure Code Type
Procedure Date
Procedure Code
Present on Admission
Line Amount Paid by Patient
Is E code
Line Copay Amount
Line Member Liability
Line Allowed Amount
Line Submitted Amount
Line Coinsurance Amount
Line Other Payer Paid Amount
Line Patient Deductible
Line Amount Paid to Provider
Line Allowed Amount
Drug Cost
Line Discount Amount
Line Payment Amount
Line Member Reimbursement
Line Noncovered Amount
Payment member explanation
Line Payment Denial Code
Benefit Payment Status
Quantity Qualifier Code
Quantity Dispensed
National Drug Code
Revenue Center Code
Place of Service Code
Type of Service
Service to Date
Line Number
Service (from) Date
Total Amount
Member Liability
Statement From Date
Member Paid Deductible
Member Reimbursement
Organization Identifier Type
Practitioner Identifier Type
Service Facility Address
Service Facility Name
Service Facility NPI
Plan Reported Brand-Generic Code
Prescription Origin Code
Refill Number
DAW Product Selection Code
RX Service Reference Number
Days Supply
Procedure Code Type
Statement Thru Date
Patient Discharge Status
Payer Claim Unique Identifier
Member Discharge Date
Member Admission Date

Comment

Submitted by NCQA on

NCQA USCDI v7 recommendation for Explanation of Benefit

Recommendation: Add Carin BB CPCDS elements related to explanation of benefits to USCDI v7 (currently Level 0 elements- Explanation of Benefits data class) to support exchange of adjudicated claims information without financial information, as proposed by Carin Alliance. The following are NCQA priorities based on use in HEDIS:

  • Claim Service Start Date
  • Claim Service End Date
  • Service (from) Date
  • Service to Date
  • Payer Claim Unique Identifier
  • Claim Type
  • Claim Sub Type
  • Statement From Date
  • Statement Thru Date
  • Claim Type of Bill Code
  • Place of Service Code
  • Revenue Center Code
  • National Drug Code
  • Quantity Dispensed
  • Days Supply
  • Diagnosis Code
  • Diagnosis Code Type
  • Procedure Code
  • Procedure Date
  • Modifier Code
  • Line Number

Rationale: NCQA continues to recommend that the Carin BB CPCDS elements be added to USCDI to support exchange of adjudicated claims information (without financial information), as proposed by Carin Alliance. The CMS Interoperability and Prior Authorization Final Rule requires payers to share patient claims and encounter data with in-network providers with whom the patient has a treatment relationship. This requirement provides a direct scenario where EHRs may begin to accept, store and use Carin BB CPCDS elements. Adding CPCDS elements under the Explanation of Benefits data class (Level 0 in ONDEC) to USCDI aligns requirements across payers and health IT and will improve data sharing abilities across health plans and providers. Information sharing reduces redundancy in data collection, can improve the patient experience, and can support record location. 

Submitted by NCQA on

NCQA Recommendations for USCDI v6- Carin BB CPCDS Elements

Carin Blue Button (BB) Common Payer Consumer Data Set (CPCDS) elements: 

Recommendation type: Add new USCDI elements.

Recommendation: Add Carin BB CPCDS elements related to explanation of benefits to USCDI v6 to support exchange of adjudicated claims information (without financial information), as proposed by Carin Alliance.

Rationale: The CMS Interoperability and Prior Authorization Final Rule requires payers to share patient claims and encounter data with in-network providers with whom the patient has a treatment relationship. This requirement provides a direct scenario where EHRs may begin to accept, store and use Carin BB CPCDS elements. Adding CPCDS elements under the Explanation of Benefits data class to USCDI aligns requirements across payers and health IT, and will improve data sharing abilities across health plans and providers. Information sharing reduces redundancy in data collection, can improve the patient experience, and can support record location. 

Submitted by markaroberts85 on

CPCDS - USCDI - USCDI +Class and Data Elements Mapping

As part of our comment to USCDI+ Quality, CARIN developed a CPCDS - USCDI - USCDI+ Class and Data Element crosswalk that maps the various Data Classes and Data Elements between CPCDS - USCDI - USCDI+. Of note, it does not map to all the USCDI and USCDI+ Classes and Data Elements, only to those related to CPCDS. We hope this is helpful and are happy to provide a walk through of the crosswalk, if helpful.

Here is a link to the comment: https://oncprojectracking.healthit.gov/support/projects/USCDIQ/issues/USCDIQ-50?filter=allissues

Mapping is attached.

Thank you again for providing the opportunity to comment on these data elements. We appreciate your consideration and if you have any questions or additional follow-up, please contact a member of our administrative team at mark.roberts@leavittpartners.com or ryan.howells@leavittpartners.com.  

CPCDS - USCDI - USCDI +Class and Data Elements 063023 Submitted.xlsx

Submitted by markaroberts85 on

CARIN Alliance Submission to USCDI

The CARIN Alliance, a multi-sector group of stakeholders representing numerous hospitals, thousands of physicians, and millions of consumers, individuals, and caregivers would like to thank you and the ONC staff for reviewing the data classes and data elements submitted by the CARIN Alliance in September 2021 and April 2022. As part of this submission, we again want to make a recommendation to include the Explanation of Benefit (EOB) data classes and data elements associated with the CARIN IG for Blue Button as part of USCDI version 3.

 

CARIN Alliance Comments on USCDI v4 093022.pdf

Submitted by markaroberts85 on

Additional comment

Additionally, the names for US Core Data for Interoperability (USCDI) and the aligning HL7 US Core FHIR are misleading. The true scope of USCDI is focused largely on EHR interoperabilty and ONC certification of EHRs. However, “US Core” implies core data for the US in general, not the narrow focus on EHRs. For instance, public health and payer use cases are not well represented.

Suggest renaming US Core to something more appropriate to it’s scope, such as US Core for EHR exchange, or expand the scope and make it truly encompassing of the chosen name. At a minimum clearly delineate the scope of USCDI, especially what is not in “US Core” that actually is a core need for the US (in a pandemic, how can public health not be considered core).

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