What is H1 Claims Data?
- Understanding medical claims data is an extremely powerful tool for understanding HCP/HCO treatment focus, patient volumes and the direction of your therapeutic area.
- H1’s claims data is the aggregation of 2 billion medical encounters with an HCP that are submitted for reimbursement to health insurance payers in the United States. This data includes all the diagnoses the HCP gives as well as the procedures they do to treat those diseases/symptoms.
Where does H1 source its Claims Data?
- H1 has done the research to find and curate the best medical claims data available across all therapeutic areas. This data is sourced from LexisNexis and covers almost all public and private payers. While it does not cover all payers as there are many tiny players across the country, this data is the most comprehensive source and is representative of all the procedures and diagnoses in the country.
How often is the Claims Data updated?
- H1 updates it’s medical claims data on a quarterly basis and displays data going on year back on a one-quarter delay.
- Example: As of April 1st, 2020, H1 is displaying data from January 2019 to December 2019.
Which and What Types of HCPs does this data cover?
- H1 Medical Claims data covers HCPs of all specialties as it covers any HCP with an NPI Number.
What is not covered in H1 claims data?
- While H1’s data covers all products used in an in-patient setting, it does not include prescriptions that are taken by a patient and sourced at a pharmacy. H1’s claims data also currently covers the United States but is looking to expand to the EU in 2022.
Medical Claims Terminology
Procedure Code / CPT Code / HCPCS Code
Procedure codes are assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services. They are used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer for that service. Since everyone uses the same codes to mean the same thing, they ensure uniformity.
Common Procedural Technology (CPT codes) are that agreed-upon standard (in most cases) and maintained and copyrighted by the AMA (American Medical Association). As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes discarded. Thousands of codes are in use and updated annually.
While not exactly the same as CPT codes, Healthcare Common Procedure Coding System (HCPCS) is used by Medicare in the United States.
Diagnosis Code / ICD Code
Diagnosis codes are identifiers that are found on patient paperwork, including hospital records, medical charts, visit summaries and bills that correspond to the specific disease or symptom a patient has.
The ICD or International Classification of Diseases codes are the agreed-upon codes in the medical community and are maintained by the World Health Organization (WHO) and distributed in countries across the globe. In the United States, ICD codes are overseen by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).
The 10th version of the code, in use since 2015, is called the ICD-10 and contains more than 70,000 disease codes.1 These codes ensure that you get proper treatment and are charged appropriately for any medical services you receive.
The ICD receives annual updates in between revisions, which is sometimes reflected in the code title. For example, the 2020 updated version is the ICD-10-CM. The ICD-11 was approved by the WHO in 2019 and goes into effect in 2022.
How to Filter On Claims:
All filters can be found on the left-hand side of the H1 platform. The claims filter sits directly below the "Payments" filter option. Filtering on claims follows the same filtering rules as the other H1 platform filters which are further explained in the "Understanding Search" article.
Step 1: Users are able to filter by Diagnosis Codes ( ICD-9 ) and Procedure Codes (HCPCS or CPT). The claims filter function works the same for both procedure codes and Diagnosis codes.
Step 2: Click on the “Claims” filter to view the two filter options Diagnosis Codes (ICD-9) and Procedure Codes (HCPCS or CPT). Enter the relevant code into the corresponding search option. NOTE: Do not include any punctuation within the search. Ex. The diagnosis code (ICD 9) for Renal Cell Carcinoma is C64. 9, however, when typed into the search it must be typed as C649.
Step 3: Apply the code of interest by typing it in the search bar and hitting enter. In the below example the diagnosis code for Renal Cell Carcinoma was applied. Applying the claims filter will automatically cause the results to Sort By: Total Diagnosis Code.
*Tip* Users are able to filter by multiple codes in one search. Filtering by multiple diagnosis codes will work as an “or” function. For example, as seen below, you can apply the ICD code C649 for Renal Cell Carcinoma as well as the ICD code for Renal Mass N2889 and the results that will occur are HCPs that have done a diagnosis of either Renal Cell Carcinoma OR Renal Mass.
If you need help determining the relevant codes to your product/therapeutic area, please refer to the Cheat Sheet providing during training or contact email@example.com