SUMMARY

DDOD use case to verify the accuracy of data obtained from the HealthCare Finder API after a user identified potential data quality issues.

WHAT IS A USE CASE?

A “Use Case” is a request that was made by the user community because there were no available datasets that met their particular needs. If this use case is similar to your needs, we ask that you add your own requirements to the specifications section.

The concept of a use case falls within the Demand-Driven Open Data (DDOD) program and gives you a formalized way to identify what data you need. It’s for anyone in industry, research, media, nonprofits or other government agencies. Each request becomes a DDOD use case, so that it can be prioritized and worked on.

Use Cases also provide a wealth of insights about existing alternative datasets and tips for interpreting and manipulating data for specific purposes.

PURPOSE

Clarity is needed around how completeness of the data via the HealthFinder API.

• Is it intended to be a complete data set? e.g., does it have every on- and off-exchange plan available in the country?


• If it is not intended to be a complete data set, what fields (eg, plans, issuers, scenarios) are systematically missing in the data?


• Why are there specific cases of known plans that are missing in the data (eg, no Carefirst/BCBS plans in Virgina)?

VALUE

In order for the HealthCare Finder API to be useful, it must be a trusted source and accurate; if there are data gaps, those must be clearly documented. The API is critical in assisting the users to find the best healthcare plans.

USE CASE SPECIFICATIONS & SOLUTION

Information about this use cases is maintained in a wiki: http://hhs.ddod.us/wiki/Use_Case_28:_Verify_accuracy_of_healthcare.gov_P...

It serves as a knowledge base.

USE CASE DISCUSSION FORUM

All communications between Data Users, DDOD Administrators and Data Owners are logged as discussions within GitHub issues: https://github.com/demand-driven-open-data/ddod-intake/issues/28

It aims to provide complete transparency into the process and ensure the same message gets to all participants.

CASE STATUS

Closed. PlanFinder is intended for off-exchange (off FFM) plans only. PlanFinder is not meant to be a comprehensive list of every plan available; it is only intended to display the potential options for consumers looking to purchase insurance off the exchange. While there is some overlap where many on-exchange plans appear in the dataset, this does not guarantee a comprehensive list of every plan.

The PlanFinder API and website return the same data.

On-exchange plans are also available on data.healthcare.gov under the term "QHP" (Qualified Health Plan).

A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related Groups (DRG)

SUMMARY

DDOD use case to link Centers for Medicare and Medicaid Services (CMS) Open Payments dataset to a physician's National Provider Identifier (NPI).

WHAT IS A USE CASE?

A “Use Case” is a request that was made by the user community because there were no available datasets that met their particular needs. If this use case is similar to your needs, we ask that you add your own requirements to the specifications section.

The concept of a use case falls within the Demand-Driven Open Data (DDOD) program and gives you a formalized way to identify what data you need. It’s for anyone in industry, research, media, nonprofits or other government agencies. Each request becomes a DDOD use case, so that it can be prioritized and worked on.

Use Cases also provide a wealth of insights about existing alternative datasets and tips for interpreting and manipulating data for specific purposes.

PURPOSE

Linking the Open Payments dataset to NPI would allow for matching to other datasets which use NPI.

VALUE

A common physician identifier across all datasets would allow for provider cost and quality analytics across datasets.

USE CASE SPECIFICATIONS & SOLUTION

Information about this use cases is maintained in a wiki: http://hhs.ddod.us/wiki/Use_Case_29:_Link_Open_Payments_dataset_to_NPI

It serves as a knowledge base.

USE CASE DISCUSSION FORUM

All communications between Data Users, DDOD Administrators and Data Owners are logged as discussions within GitHub issues: https://github.com/demand-driven-open-data/ddod-intake/issues/29

It aims to provide complete transparency into the process and ensure the same message gets to all participants.

CASE STATUS

Closed, as the legislation that made Open Payments possible explicitly forbids reporting of the NPI.

This reference provides significant summary information about health expenditures and the Centers for Medicare & Medicaid Services' (CMS) programs. The information presented was the most current available at the time of publication. Significant time lags may occur between the end of a data year and aggregation of data for that year.

Decisions of the Departmental Appeals Board's Medicare Appeals Council involving claims for entitlement to Medicare and individual claims for Medicare coverage and payment filed by beneficiaries or health care providers/suppliers.

Decisions of the Departmental Appeals Board's Medicare Appeals Council involving claims for entitlement to Medicare and individual claims for Medicare coverage and payment filed by beneficiaries or health care providers/suppliers.

Decisions issued by Administrative Law Judges of the Departmental Appeals Board's Civil Remedies Division concerning fraud and abuse determinations by the Office of the Inspector General (OIG) or the Centers for Medicare & Medicaid Services (CMS); provider/supplier enforcement and certification determinations by CMS; terminations of or refusal to grant or continue federal funding for alleged civil rights violations; Program Fraud Civil Remedies Act determinations; civil money penalty determinations by Social Security Administration (SSA); and Equal Access to Justice Act determinations relating to OIG proceedings.