See Filters tab for sample filters.Data Element Name Years Requested Filters Applied Justification Notes

Member Monthspersonkey Unique person identifier 2010-2015 Needed as a linkage variablepatid Encrypted patient ID 2010-2015 Needed as a linkage variableeffdate Effective date 2010-2015 Needed to create enrollment periods for patients/beneficiaries termdate Termination date 2010-2015 Needed to create enrollment periods for patients/beneficiaries payer APAC Payer 2010-2015 Needed to partition member months into payer categoriesprod Product code 2010-2015 Needed to separate members enrolled in HMO plansmedflag Medical coverage flag 2010-2015 Needed to identify whether medical services are covered (as opposed to just not used)rxflag Pharmacy coverage flag 2010-2015 Needed to identify whether pharmacy services are covered (as opposed to just not used)pebb PEBB flag 2010-2015 Plan type vairable needed to construct comparison groupsoebb OEBB flag 2010-2015 Plan type vairable needed to construct comparison groupsAge Member age (years) 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsgender Member gender 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsRace Member race 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsEthn Member ethnicity 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsLang Primary spoken language 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsZip Member ZIP code of residence 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectscounty Member county of residence 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsMsa MSA 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsyear Calendar year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectstpa_or_pbm_duplicate_mm Third party administrator or

pharmacy benefit manager duplicate flag

2010-2015 Needed to deduplicate member months

yob Member year of birth 2010-2015 Needed to precisely calculate age as required for specific quality measuresmedicaid Type of Medicaid coverage (FFS,

MC)2010-2015 Custom field created by OHA using CCO ID variable; in combination with Payer and Prod variables, allows partition

of member months into payer categoriesmedicare Type of Medicare coverage (MED,

ADV, MED FFS)2010-2015 Custom field created by OHA using A.PAYER_LOB; in combination with Payer and Prod variables, allows partition of

member months into payer categoriesDual Indicator for dual coverage

(enrolled in Medicaid and Medicare during the same month)

2010-2015 Custom field created by OHA; in combination with Medicaid and Medicare variables, allows identification of dual eligible members for subgroup analysis

NonElg Eligible for Medicaid 2010-2015 Custom field created by OHA; in combination with Payer and Prod, allows identification of Medicaid membersSNP Indicator for enrollment in Duals

Special Needs Plan (SN3)2010-2015 Custom field created by OHA; in combination with Payer and Prod, allows identification of members in dual eligible

special needs plans for subgroup analysisPayer ID Unique identifier for each payer that

submits to APAC 2010-2015 Needed to filter out certain payers identified by OHA as having problematic data

Carrier name Name of health insurance carrier associated with Payer ID (a Payer-ID-to-carrier-name crosswalk may be provided)

2010-2015 Needed to filter out certain payers identified by OHA as having problematic data

All Medical 2010-2015clmid Claim ID 2010-2015 Needed to de-duplicate claim linesline Claim line 2010-2015 Needed to de-duplicate claim linesclmstatus Claim status 2010-2015 Needed to de-duplicate claim linescob COB status 2010-2015 Y/N flag Needed to adjust for individuals with coverage from multiple planspaytype Payer type 2010-2015 Needed to provide additional granularity on differences in patient populations and utilization across payersprod Product code 2010-2015 Needed for analysis separating individuals covered under HMO plans vs. individuals covered in PPO planspayer APAC Payer 2010-2015 Needed to account for different payment ratesmedflag Medical coverage flag 2010-2015 Y/N flag Needed to identify individuals with medical coverage only, rx coverage only, or both (e.g., to exclude individuals with

medical coverage only in analyses of total cost)rxflag Pharmacy coverage flag 2010-2015 Y/N flag See line 13; allows for inclusion/exclusion criteria (e.g., individuals without rx coverage could be included in analyses

of hospitalizations in order to improve power but excluded from analyses of total cost due to missing data)

pebb PEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupsoebb OEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupspatid Encrypted patient ID 2010-2015 Needed to de-duplicate claim linespersonkey Unique person identifier 2010-2015 Needed to de-duplicate claim linesgender Gender 2010-2015 F, M, or U Needed as an independent variable in statistical models to account for person-level demographic effectsyob Birth year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsrace Race 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsethn Ethnicity 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effects

Indicate data elements requested. Use extract column name for elements from

limited data sets. Use data element format AA### for elements from the Data Elements Collected by APAC

section of the APAC Data User Guide.Indicate the name of each element

requested.

You may request any of the data elements APAC collects, including any data elements in the limited data sets, and any listed in the Data Elements Collected by APAC section of the APAC Data User Guide. Complete columns A-E for all data elements requested. Provide any optional notes in column F. Direct identifiers such as patient name, address, or exact dates of service are only released under special circumstances that comply with HIPAA requirements, and may require specific approvals such as Institutional Review Board (IRB) approval and patient consent, and review by the Department of Justice.

Custom Data Set

Please Note: Only complete this tab if you are requesting a custom data set instead of a limited data set.

Provide any notes about the data elements requested, if applicable.

OHA recommends certain data elements for all requests depending on claim type, as they are necessary to properly interpret duplicate claim lines. These elements are pre-populated in the table below. Requesters should still fill out columns C and D for these elements. If you do not wish to receive a pre-populated element, delete the entire row.

If requesting a custom data set, you must also complete the Payers tab.

See Instructions tab for further instructions and information about pre-populated elements.

Indicate year(s) for each element

requested.

Specify filters for each element requested, if applicable.

Justify why each element requested is necessary.

Data Element Name Years Requested Filters Applied Justification Noteslang Primary spoken language 2010-2015 Code set available from the NISO

web siteNeeded as an independent variable in statistical models to account for person-level demographic effects

msa Member MSA code 2010-2015 See United States Census Bureau web site

Needed as an independent variable in statistical models to account for person-level demographic effects

state Member state 2010-2015 Standard two character abbreviation

Needed as an independent variable in statistical models to account for person-level demographic effects

zip Member zip code 2010-2015 Freely available in the public domain

Needed to develop metrics for distance to provider (access proxy)

fromdate From date 2010-2015 YYYY-MM-DD Needed to understand utilization patterns (e.g. whether office visit was before or after hospitalization)todate To date 2010-2015 YYYY-MM-DD See line 27paid Total payment 2010-2015 Needed to track expenditures (primary dependent variable)copay Co-payment 2010-2015 Needed to provide granularity on patient out-of-hospital expensescoins Co-insurance 2010-2015 Needed to provide granularity on patient out-of-hospital expensesdeduct Deductible 2010-2015 Needed to provide granularity on patient out-of-hospital expensesoop Patient pay amount 2010-2015 Required if deductible, co-pay, or

co-insurance are missing.Needed to assess changes over time when comparing Medicaid with Commercial or other other coverage

tob Type of bill 2010-2015 Needed to categorize claims by service setting and typepos Place of service code 2010-2015 Needed to categorize claims by service setting and typerevcode Revenue code 2010-2015 See NUBC web site Needed to categorize claims by service setting and typeqty Quantity 2010-2015 Needed to analyze utilizationhcg HCG code 2010-2015 Needed to categorize claims by service setting and typedx1 Principal diagnosis 2010-2015 See current ICD documentation

from CMSNeeded for episode grouper, as well as identification of specific patient populations and co-morbidities. For example, patients with mental health conditions are a focus of our study and ICD-9 codes allow us to create that cohort as well as to stratify by all mental illness and serious mental illness. ICD-9 Codes are also necessary for quality measures (including AHRQ Prevention Quality Indicators) that are part of the study

dx2 Diagnosis 2 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx3 Diagnosis 3 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx4 Diagnosis 4 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx5 Diagnosis 5 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx6 Diagnosis 6 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx7 Diagnosis 7 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx8 Diagnosis 8 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx9 Diagnosis 9 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx10 Diagnosis 10 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx11 Diagnosis 11 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx12 Diagnosis 12 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx13 Diagnosis 13 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

poa1 POA code 1 2010-2015 Needed for quality measures (e.g., AHRQ Prevention Quality Indicators)poa2 POA code 2 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa3 POA code 3 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa4 POA code 4 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa5 POA code 5 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa6 POA code 6 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa7 POA code 7 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa8 POA code 8 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa9 POA code 9 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa10 POA code 10 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa11 POA code 11 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa12 POA code 12 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa13 POA code 13 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpx1 Principal inpt procedure 2010-2015 See current ICD documentation

from CMSNeeded for quality measures (e.g., AHRQ Prevention Quality Indicators)

px2 Procedure 2 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px3 Procedure 3 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px4 Procedure 4 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

Data Element Name Years Requested Filters Applied Justification Notespx5 Procedure 5 2010-2015 See current ICD documentation

from CMSSee line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px6 Procedure 6 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px7 Procedure 7 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px8 Procedure 8 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px9 Procedure 9 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px10 Procedure 10 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px11 Procedure 11 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px12 Procedure 12 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px13 Procedure 13 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

proccode CPT or HCPCS procedure code 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

Needed to identify primary care provider visits, emergency department visits, and to separate claims by Berenson-Eggers Type of Service (BETOS) codes)

mod1 Prodcure code modifier 1 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

mod2 Prodcure code modifier 2 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

mod3 Prodcure code modifier 3 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

mod4 Prodcure code modifier 4 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

dstatus Discharge status 2010-2015 Needed to determine where patients are discharged (home, transfer, died)los Length of stay 2010-2015 Needed to analyze utilization measure (dependent variable)msdrg MS-DRG 2010-2015 See current MS-DRG

documentation from CMSNeeded to analyze utilization measure (dependent variable)

attid Attending provider ID 2010-2015 Needed to compare utlization/access across patients and payer groupsspec Attending provider specialty 2010-2015 See provider taxonomy from

NUCC web siteNeeded to compare utlization/access across patients and payer groups

billid Billing provider ID 2010-2015 Needed to compare utlization/access across patients and payer groupsentity Billing provider entity name 2010-2015 Needed to compare utlization/access across patients and payer groupsicdver ICD version 2010-2015 The U.S. transitioned from ICD-9 to ICD-10 codes in October 2015. This element is needed to identify diagnosis and

procedure codes under the new system.Year Calendar year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsPayer ID Payer ID 2010-2015 Unique identifier for each payer that submits to APAC; in combination with Carrier Name, needed to identify payers

with data issues Bill prov lname fac cw Hospital Facility ID 2010-2015 Needed to analyze hospital-related outcomesADM DATE/MC018 Admission date 2010-2015 Needed to analyze hospital-related outcomesDIS DATE/MC070 Discharge date 2010-2015 Needed to analyze hospital-related outcomesMC204 Admission source 2010-2015 Needed to analyze hospital-related outcomesCarrier name Carrier name 2010-2015 Name of health insurance carrier associated with Payer ID (a Payer-ID-to-carrier-name crosswalk may be provided);

in combination with Carrier Name, needed to identify payers with data issuesCCO ID Unique identifier for each CCO 2010-2015 Needed to report results by CCO IDMCO18 admission date 2010-2015 Needed to analyze hospital-related outcomesMCO70 discharge date 2010-2015 Needed to analyze hospital-related outcomesptstatus discharge status 2010-2015 Needed to analyze hospital-related outcomesAll Pharmacyclmid Claim ID 2010-2015 Needed to de-duplicate claim linesline Claim line 2010-2015 Needed to de-duplicate claim linesclmstatus Claim status 2010-2015 Needed to de-duplicate claim linescob COB status 2010-2015 Y/N flag Needed to adjust for individuals with coverage from multiple planspaytype Payer type 2010-2015 Needed to provide additional granularity on differences in patient populations and utilization across payersprod Product code 2010-2015 Needed for analysis separating individuals covered under HMO plans vs. individuals covered in PPO planspayer APAC Payer 2010-2015 Needed to account for different payment ratesmedflag Medical coverage flag 2010-2015 Y/N flag Needed to identify individuals with medical coverage only, rx coverage only, or both (e.g., to exclude individuals with

medical coverage only in analyses of total cost)rxflag Pharmacy coverage flag 2010-2015 Y/N flag See line 13; allows for inclusion/exclusion criteria (e.g., individuals without rx coverage could be included in analyses

of hospitalizations in order to improve power but excluded from analyses of total cost due to missing data)

pebb PEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupsoebb OEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupspatid Encrypted patient ID 2010-2015 Needed to de-duplicate claim lines (key field)personkey Unique person identifier 2010-2015 Needed to de-duplicate claim lines (key field)gender Gender 2010-2015 F, M, or U Needed as an independent variable in statistical models to account for person-level demographic effectsyob Birth year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsrace Race 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsethn Ethnicity 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectslang Primary spoken language 2010-2015 Code set available from the NISO

web siteNeeded as an independent variable in statistical models to account for person-level demographic effects

msa Member MSA code 2010-2015 See United States Census Bureau web site

Needed as an independent variable in statistical models to account for person-level demographic effects

Data Element Name Years Requested Filters Applied Justification Notesstate Member state 2010-2015 Standard two character

abbreviationNeeded as an independent variable in statistical models to account for person-level demographic effects

zip Member zip code 2010-2015 Freely available in the public domain

Used to develop metrics for distance to provider (access proxy)

paid Total payment 2010-2015 Needed to track expenditures (primary dependent variable)copay Co-payment 2010-2015 Needed to provide granularity on patient out-of-hospital expensescoins Co-insurance 2010-2015 Needed to provide granularity on patient out-of-hospital expensesdeduct Deductible 2010-2015 Needed to provide granularity on patient out-of-hospital expensesoop Patient pay amount 2010-2015 Required if deductible, co-pay, or

co-insurance are missing.Needed to assess changes over time when comparing Medicaid with Commercial or other other coverage

tob Type of bill 2010-2015 Needed to categorize claims by service setting and typepos Place of service code 2010-2015 Needed to categorize claims by service setting and typehcg HCG code 2010-2015 Needed to categorize claims by service setting and typefilldate Fill date 2010-2015 YYYY-MM-DD Needed to understand utilization patterns (e.g. whether a prescription for drug X occurred after a diagnosis of Y)

ndc NDC 2010-2015 Link to the NDC database Needed to stratify by drug class and substancerxclass NDC therapeutic class 2010-2015 Needed to stratify by drug class and substancebrand Brand status 2010-2015 Needed to stratify by drug class and substancerxcompound Compound drug indicator 2010-2015 1=no; 2=yes Needed to stratify by drug class and substanceqtydisp Quantity dispensed 2010-2015 Needed as a utilization measure (dependent variable)rxdays Days supply 2010-2015 Needed as a utilization measure (dependent variable)daw Dispense as written code 2010-2015 Needed to characterize prescribing practicesPROV NPI Provider NPI 2010-2015 Needed to characterize prescribing practicesprescribing provider NPI 2010-2015 In combination with other provider identifiers, needed to associate claims to clinics through providers for analyses

involving clinics and clinic characteristicsentity Pharmacy name 2010-2015 Needed to compare utlization/access across patients and payer groupsYear Calendar year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsPayer ID Payer ID 2010-2015 Unique identifier for each payer that submits to APAC; in combination with Carrier Name, needed to identify payers

with data issues generic Generic drug name 2010-2015 Needed to analyze utilization among dual eligiblesprovid Prescribing provider ID 2010-2015 Needed as a linkage variableCarrier name Carrier name 2010-2015 Name of health insurance carrier associated with Payer ID (a Payer-ID-to-carrier-name crosswalk may be provided);

in combination with Carrier Name, needed to identify payers with data issues2010-2015

Episodes of Care 2010-2015clmid Claim ID 2010-2015 Needed to de-duplicate claim linesline Claim line 2010-2015 Needed to de-duplicate claim linesclmstatus Claim status 2010-2015 Needed to de-duplicate claim linescob COB status 2010-2015 Y/N flag Needed to adjust for individuals with coverage from multiple planspaytype Payer type 2010-2015 Needed to provide additional granularity on differences in patient populations and utilization across payersprod Product code 2010-2015 Needed for analysis separating individuals covered under HMO plans vs. individuals covered in PPO planspayer APAC Payer 2010-2015 Needed to account for different payment ratesmedflag Medical coverage flag 2010-2015 Y/N flag Needed to identify individuals with medical coverage only, rx coverage only, or both (e.g., to exclude individuals with

medical coverage only in analyses of total cost)rxflag Pharmacy coverage flag 2010-2015 Y/N flag See line 13; allows for inclusion/exclusion criteria (e.g., individuals without rx coverage could be included in analyses

of hospitalizations in order to improve power but excluded from analyses of total cost due to missing data)

pebb PEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupsoebb OEBB flag 2010-2015 0/1 flag Plan type vairable needed to construct comparison groupspatid Encrypted patient ID 2010-2015 Needed to de-duplicate claim linespersonkey Unique person identifier 2010-2015 Needed to de-duplicate claim linesgender Gender 2010-2015 F, M, or U Needed as an independent variable in statistical models to account for person-level demographic effectsyob Birth year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsrace Race 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsethn Ethnicity 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectslang Primary spoken language 2010-2015 Code set available from the NISO

web siteNeeded as an independent variable in statistical models to account for person-level demographic effects

msa Member MSA code 2010-2015 See United States Census Bureau web site

Needed as an independent variable in statistical models to account for person-level demographic effects

state Member state 2010-2015 Standard two character abbreviation

Needed as an independent variable in statistical models to account for person-level demographic effects

zip Member zip code 2010-2015 Freely available in the public domain

Used to develop metrics for distance to provider (access proxy)

fromdate From date 2010-2015 YYYY-MM-DD Dates of service allow us to understand utilization patterns (e.g. whether office visit was before or after hospitalization)

todate To date 2010-2015 YYYY-MM-DD Same as abovepaid Total payment 2010-2015 Needed to track expenditures (primary dependent variable)copay Co-payment 2010-2015 Needed to provide granularity on patient out-of-hospital expensescoins Co-insurance 2010-2015 Needed to provide granularity on patient out-of-hospital expensesdeduct Deductible 2010-2015 Needed to provide granularity on patient out-of-hospital expensesoop Patient pay amount 2010-2015 Required if deductible, co-pay, or

co-insurance are missing.Needed to assess changes over time when comparing Medicaid with Commercial or other other coverage

tob Type of bill 2010-2015 Needed to categorize claims by service setting and typepos Place of service code 2010-2015 Needed to categorize claims by service setting and typerevcode Revenue code 2010-2015 See NUBC web site Needed to categorize claims by service setting and typeqty Quantity 2010-2015 Needed to analyze utilizationhcg HCG code 2010-2015 Needed to categorize claims by service setting and typedx1 Principal diagnosis 2010-2015 See current ICD documentation

from CMSNeeded for episode grouper, as well as identification of specific patient populations and co-morbidities. For example, patients with mental health conditions are a focus of our study and ICD-9 codes allow us to create that cohort as well as to stratify by all mental illness and serious mental illness. ICD-9 Codes are also necessary for quality measures (including AHRQ Prevention Quality Indicators) that are part of the study

Data Element Name Years Requested Filters Applied Justification Notesdx2 Diagnosis 2 2010-2015 See current ICD documentation

from CMSSee line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx3 Diagnosis 3 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx4 Diagnosis 4 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx5 Diagnosis 5 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx6 Diagnosis 6 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx7 Diagnosis 7 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx8 Diagnosis 8 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx9 Diagnosis 9 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx10 Diagnosis 10 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx11 Diagnosis 11 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx12 Diagnosis 12 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

dx13 Diagnosis 13 2010-2015 See current ICD documentation from CMS

See line 39; while not all diagnosis codes are populated for every claim, codes from dx2 through dx13 improve accuracy of episode grouper output where populated

poa1 POA code 1 2010-2015 Needed for quality measures (e.g., AHRQ Prevention Quality Indicators)poa2 POA code 2 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa3 POA code 3 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa4 POA code 4 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa5 POA code 5 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa6 POA code 6 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa7 POA code 7 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa8 POA code 8 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa9 POA code 9 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa10 POA code 10 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa11 POA code 11 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa12 POA code 12 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpoa13 POA code 13 2010-2015 See line 52; while not all POA codes are populated for every claim, codes from poa 2 through poa 13 are useful for

analyzing utilization and quality where populatedpx1 Principal inpt procedure 2010-2015 See current ICD documentation

from CMSNeeded for quality measures (e.g., AHRQ Prevention Quality Indicators)

px2 Procedure 2 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px3 Procedure 3 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px4 Procedure 4 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px5 Procedure 5 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px6 Procedure 6 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px7 Procedure 7 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px8 Procedure 8 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px9 Procedure 9 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px10 Procedure 10 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px11 Procedure 11 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px12 Procedure 12 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

px13 Procedure 13 2010-2015 See current ICD documentation from CMS

See line 65; while not all procedure codes are populated for every claim, codes from px2 through px13 are useful for analyzing utilization and quality where populated

proccode CPT or HCPCS procedure code 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

Needed to identify primary care provider visits, emergency department visits, and to separate claims by Berenson-Eggers Type of Service (BETOS) codes)

mod1 Prodcure code modifier 1 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

Data Element Name Years Requested Filters Applied Justification Notesmod2 Prodcure code modifier 2 2010-2015 See CMS web site for HCPCS

codes; CPT codes are proprietarySee line 78; procedure code modifiers are needed to analyze utilization and quality

mod3 Prodcure code modifier 3 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

mod4 Prodcure code modifier 4 2010-2015 See CMS web site for HCPCS codes; CPT codes are proprietary

See line 78; procedure code modifiers are needed to analyze utilization and quality

megcode MEG code 2010-2015 Illness classification/episode classification needed to stratify or conduct separate analyses (e.g., understanding how CCO transformation affects cost of epidsodes of hypertension w/o complication)

megdesc MEG description 2010-2015 See line 85; needed to provide clarity on type of episode, which will be used to stratify/separate analysesmegbodysys MEG body system 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegstage MEG stage 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegtype MEG type of care description 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegcomplete MEG episode completion 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegnum MEG episode number 2010-2015 Needed as episode ID to link claims, analyze claims, and compare costs across treatment episodesmegdays MEG episode duration in days 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegprorate MEG prorated episode count 2010-2015 Along with megcode and megbodysys, needed to carry out analyses involving medical episode groupermegoutlier MEG outlier indicator 2010-2015 Needed to excludemeglow MEG low outlier indicator 2010-2015 Needed to excludemeghigh MEG high outlier indicator 2010-2015 Needed to excludendc NDC 2010-2015 Link to the NDC database National Drug Code needed to identify specific drugs (e.g., publicly available crosswalks allow for identification of all

"mental health" drugs through NDC)rxclass NDC therapeutic class 2010-2015 Therapeutic class needed to identify specific drug classes (utilization measure)qtydisp Quantity dispensed 2010-2015 Needed as an adherence/utilization measurerxdays Days supply 2010-2015 Needed as an adherence/utilization measuredaw Dispense as written code 2010-2015 Needed as a utilization measuredstatus Discharge status 2010-2015 Needed to identify source of patients dischargeslos Length of stay 2010-2015 Needed as a utilization measure (dependent variable)msdrg MS-DRG 2010-2015 See current MS-DRG

documentation from CMSNeeded as a utilization measure (dependent variable)

attid Attending provider ID 2010-2015 Needed to compare utlization/access across patients and payer groupsspec Attending provider specialty 2010-2015 See provider taxonomy from

NUCC web siteNeeded to compare utlization/access across patients and payer groups

billid Billing provider ID 2010-2015 Needed to compare utlization/access across patients and payer groupsentity Billing provider entity name 2010-2015 Needed to compare utlization/access across patients and payer groupsicdver ICD version 2010-2015 The U.S. transitioned from ICD-9 to ICD-10 codes in October 2015. This element is needed to identify diagnosis and

procedure codes under the new system.Year Calendar year 2010-2015 Needed as an independent variable in statistical models to account for person-level demographic effectsPayer ID Payer ID 2010-2015 Unique identifier for each payer that submits to APAC; in combination with Carrier Name, needed to identify payers

with data issues Carrier name Carrier name 2010-2015 Name of health insurance carrier associated with Payer ID (a Payer-ID-to-carrier-name crosswalk may be provided);

in combination with Carrier Name, needed to identify payers with data issues

Mark each payer you are requesting with "X".

Justify why each payer requested is necessary.

See Filters tab for sample filters. Payer Type Payer notes

Payer Requested Justification Filters Applied Payer Notes

XComparison between payers on access, costs and quality All Payers

All Payers includes Medicaid, Medicare Advantage, and Private Commercial Insurance (includes OEBB/PEBB).

Medicaid

REQUESTERS MAY NOT REQUEST MEDICAID DATA ONLY. For those that only want Medicaid data, APAC is not the appropriate data source. Please contact OHA.HealthAnalyticsRequest@state.or.us for further instruction.

Medicare AdvantagePrivate Commercial Insurance (includes OEBB/PEBB)OEBB/PEBB Select if requesting OEBB/PEBB data onlyMedicare FFS Medicare FFS data will only be given to projects in which OHA is funding and directing.

PayersThe following payers are available for request. You may request all payers, or one or more specific payer. Requesters must provide a justification for each payer requested.

Specify filters for each element requested, if

APPROVAL OF SUBMISSION

May 25, 2017 Dear Investigator:

On 5-25-2017, the IRB reviewed the following submission:

IRB ID: IRB00011844 MOD or CR ID: CR00002203 Type of Review: Continuing Review

Title of Study: Assessing the Potential for a State Medicaid Reform Model to Reduce Disparities

Title of modification Principal Investigator: Kenneth McConnell

Funding: Name: DHHS NIH Natl Inst on Minority Hlth & Hlth Disp, PPQ #: 1008418, Funding Source: MD011212

IND, IDE, or HDE: None Documents Reviewed: • RHEC Interview Guide

• Information Sheet - RHEC • Telephone Script • Information Sheet • Interview Guide • Email Script • Recruitment Letter -RHEC • Grant application • Follow-up Phone Script -RHEC • Brief Project Description • Data Elements.xlsx • Grant • Protocol • WoA

The IRB granted final approval on 5/25/2017. The study is approved until 5/24/2018.

Review Category: Expedited Category # 5 and 7

Copies of all approved documents are available in the study's Final Documents (far right column under the documents tab) list in the eIRB. Any additional documents that require

Version Date: 06/30/2016 Page 1 of 2

an IRB signature (e.g. IIAs and IAAs) will be posted when signed. If this applies to your study, you will receive a notification when these additional signed documents are available.

Ongoing IRB submission requirements:

• Six to ten weeks before the expiration date, you are to submit a continuing review to request continuing approval.

• Any changes to the project must be submitted for IRB approval prior to implementation.

• Reportable New Information must be submitted per OHSU policy. • You must submit a continuing review to close the study when your research is

completed.

Guidelines for Study Conduct

In conducting this study, you are required to follow the guidelines in the document entitled, "Roles and Responsibilities in the Conduct of Research and Administration of Sponsored Projects," as well as all other applicable OHSU IRB Policies and Procedures.

Requirements under HIPAA

If your study involves the collection, use, or disclosure of Protected Health Information (PHI), you must comply with all applicable requirements under HIPAA. See the HIPAA and Research website and the Information Privacy and Security website for more information.

IRB Compliance

The OHSU IRB (FWA00000161; IRB00000471) complies with 45 CFR Part 46, 21 CFR Parts 50 and 56, and other federal and Oregon laws and regulations, as applicable, as well as ICH-GCP codes 3.1-3.4, which outline Responsibilities, Composition, Functions, and Operations, Procedures, and Records of the IRB.

Sincerely,

The OHSU IRB Office

Version Date: 06/30/2016 Page 2 of 2

Although CHSE will reuse commercial data received under the waiver evaluation BAA for purposes stated in this DUA, we will not reuse Medicare FFS data. Medicare FFS data for the waiver evaluation will be saved in a separate location from our regular extracts on CHSE’s storage drive. Furthermore, data management and analysis will be conducted as separate processes from our regular “staging” of APAC/Medicaid data, and output (analytic) datasets will be saved in a separate, project‐specific location that the rest of the group does not access. All staff will be notified that Medicare FFS data are only for use in the waiver evaluation and no other projects. In addition, CHSE will restrict permissions on access to data elements as allowed in the DUA. These restrictions will be set in the context of an SQL relational database, with settings set per user and field.