| Field | Description |
|---|---|
| Parent Organization | High-level rollup of organizations that makes it easier to filter and group NPIs. These can represent large hospital systems, ownership groups, groups of facilities, and more. Note this can be separate from NPPES data and NPPES organizations should be used in conjunction with the Parent Organization in getting correct NPIs for analysis. |
| Organization | Indicates the healthcare organization or facility. Note there can be multiple NPIs per organization. |
| Billing NPI | Represents the National Provider Identifier, a unique 10-digit number assigned to healthcare providers from which the claim was submitted. |
| Facility NPI | Represents the National Provider Identifier, a unique 10-digit number assigned to healthcare providers where the services on the claim was performed. This is not always populated from claims data sources and may not match the Billing NPI (ex. Organization bills through a separate NPI from which the facility where the service is performed). |
| State | Indicates the U.S. state where the Billing NPI is registered in NPPES. |
| County | Indicates the U.S. county where the Billing NPI is registered in NPPES. |
| Zip Code | Indicates the U.S zip code where the Billing NPI is registered in NPPES. |
| City | Indicates the U.S. city where the Billing NPI is registered in NPPES. |
| Taxonomy Grouping | Represents the categorization of healthcare providers based on their specialties and services. |
| Taxonomy Display Name | User-friendly name to describe a provider’s specialty or service category. This is the display name of the Taxonomy Code. |
| Taxonomy Classification | Offers a detailed categorization of the provider’s area of expertise. |
| Taxonomy Specialization | Indicates a further level of specialization within a broader taxonomy classification. |
| Class of Trade | Provides a high-level grouping of related healthcare services to segment and analyze data across broad service domains (for example, Home Health and Hospice). This field is is commonly used for macro-level filtering to isolate relevant NPIs. |
| Trade Type | Additional layer of specificity within a trade category by describing the general nature of the services delivered (for example, in-home nursing care services). |
| Trade Subtype | The most granular classification within Trade Categories & Types, identifying the specific service focus within a trade type. |
| Field | Description |
|---|---|
| Channel | Commercial, Medicare, Medicaid, or Dual/Other |
| Payer Name | Identifies the insurance provider or entity responsible for reimbursement. |
| Field | Description |
|---|---|
| Claim Type | Refers to the classification of billing codes based on service type or specialty. This field represents if a rate is Professional or Institutional. Note that the use of this field by individual Payers can be different based on their interpretation of CMS rules. |
| Procedure Code Type | Defines the type of billing code, such as CPT, HCPCS, or ICD. |
| Procedure Code Category | Groups billing codes into broader categories based on service or procedure characteristics to more easily identify services for analysis. |
| Procedure Code Subcategory | Provides a more detailed classification within a broader billing code category to further identify specific services or sets of services. |
| Procedure Code | The standardized code representing a specific medical service or procedure. |
| Procedure Code Description | Provides a descriptive name associated with the billing code. |
| Procedure Code Modifier | Adds additional context or specificity to a billing code, often indicating variations of a service. This can be additive to the original service or represent a different service variant depending on the code and payer. |
| Procedure Code Modifier Description | Additional description for the respective Procedure Code Modifier to provide more context on the modifier |
| Setting | High-level grouping of services for Inpatient, Outpatient, or Office |
| Place of Service Code | Codes that identify the physical location where the service was provided, such as an outpatient clinic or hospital. This field represents the actual codes as they show in the data. |
| Place of Service | Provides the descriptive name(s) corresponding to the place of service code(s). |
| Field | Description |
|---|---|
| Total Claims | Number of claims submitted (from 837) |
| Total Remits | Count of remittance records (from 835). |
| Average Remit | Average allowed amount per remit. This is weighted by the # of units. |
| Attributed Charge Amount | Sum of charges across all claim submissions from the 837 for the given scope of filters & dimensions. |
| Attributed Total Units | Total number of billed units at the line-item level. Note: Codes can be billed multiple times on a single claim depending on the code type. |
| Average Claim Amount | Calculated as Attributed Charge Amount / Attributed Total Units. |
| Attributed Claim Count | This is the count of claims submitted per given scope of the data. This field is used to determine the "Total Claims" metric when viewing aggregates. |
| Min Per Unit Allowed | The lowest allowed amount observed for a single billed unit across all remittance records in the selected scope. Represents the lower bound of payer reimbursement at the unit level. |
| Max Per Unit Allowed | The highest allowed amount observed for a single billed unit across all remittance records in the selected scope. Represents the upper bound of payer reimbursement at the unit level. |
| Avg Per Unit Allowed | The average of allowed amounts per billed unit across all remittance records for given scope. This is often used in analysis to account for the impact of outliers and variation in reimbursements. |
| Median Per Unit Allowed | The median of allowed amounts per unit for the given scope. This is often used in conjunction with the Average Per Unit Allowed to better understand the variance of allowed amounts. |
| Count of Units | Total number of units reported on remittance records. |
| Total Claim Count | Count of remittance records (from 835). |