Query Builders
Part A/B
Query Builder Part A and B is used to sort through patient data. Using the filters listed below, users may view patients with specific information, such as high claims or specific diagnoses.
To access Query Builder - Part A/B, click on 'Analytics' from the main menu and choose 'Query Builder-Part A/B' under the 'Analytics' menu.
There are a number of filter options to customize the Population Analytics Query Builder. Below is a list of basic Filters and the purpose of each one.
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1) Effective Period: This filter sets the time period for the patients you want to view
2) Divisions: This filter will allow for the selection of a specific division or multiple divisions within the ACO.
3) Practices: This filter will allow the selection of a specific practice, or all practices in the ACO.
4) TIN Number: This filter will return beneficiaries that are assigned to the associated TIN and have claims data.
5) Sub-TINs: This filter will allow for the selection of a specific Sub-TIN, or all Sub-TINs within the ACO.
6) NPI Number: This filter will return beneficiaries who have claims associated to the NPI (Facility and Individual).
7) Rendering/Attending Provider NPI: This filter will return beneficiaries who have claims where the selected NPI is listed as rendering service or attending the beneficiary.
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1) Date Range: By selecting the date range, the query will return data with a claim in the date range selected.
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2) Report Type: This filter is used to run a report based on specific needs. All queries require this field. Health Endeavors has pre-populated commonly requested reports.
A) High Claims: Query on all patients with high claims or by highest claims and associated diagnoses. When selecting the Highest Claims filter, a second dropdown bar will allow users to filters on the Top 100 Patients, Top 5%, Top 10%, Top 15%, and Top 20% of the population.
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Highest Claims
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Highest Claims with COPD
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Highest Claims with Diabetes
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Highest Claims with Heart Failure
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Highest Claims with IVD
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Highest Claims with CAD
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Highest Claims with Hypertension
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B) Diagnosis: Search claims data for patients who have a specific diagnosis.
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All patients with COPD
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All patients with Diabetes
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All patients with Heart Failure
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All patients with IVD
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All patients with CAD
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All patients with Hypertension
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C) Events: Search claims data for specific patients with events that are typically high in cost.
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All patients with MRI/MRA
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All patients with a Hospital Observation
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All Patients with an Emergency Visit
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All Patients with a CT Scan
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All Patients with a PET Scan
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D) All Patients: Choose this filter when your query does not need to account or any of the previous pre-populated reports.
Part A filters are specific to Part A claims, which pertain to Hospitals and other facilities.
1) The Date Type dropdown allows the following selections:
Effective Date: The data upon which the treatment was ordered to be performed.
Billing Date: The date upon which a bill was issued for treatment rendered.
Billing Date (DOS): The date upon which the treatment was performed.
2) The Part A Claim Type dropdown allows the following multiple selections:
HHA: Searches for population statistics based on claims involving a Home Health Agency.
Non Swing Bed SNF: Searches for population statistics based on claims that did not use swing bed Skilled Nursing Facilities.
Swing Bed SNF: Searches for population statistics based on claims that did use swing bed Skilled Nursing Facilities.
Outpatient: Searches for population statistics based on claims that involved medical treatment and did not require hospital admission.
Hospice: Searches for population statistics based on claims that used an extended care facility, which often involves a Skilled Nursing Facility.
Inpatient: Searches for population statistics based on claims that involved medical treatment and required hospital admission.
Inpatient Full-Encounter: Searches for population statistics based on claims that involved medical treatment that required hospital admission and extended treatments or observations usually lasting more than a day.
Part B Physician filters are specific to Part B claims. Part B claims are associated to Physicians and cover most redically necessary doctors' services, preventive care, laboratory tests, etc.
1) The Date Date of Service dropdown allows the following selections:
Effective Date: The data upon which the treatment was ordered to be performed.
Billing Date: The date upon which a bill was issued for treatment rendered.
Date of Service: The date upon which the treatment was performed.
2) The Part B Claim Type dropdown allows the following multiple selections:
RIC O Local Carrier non-DMEPOS / RIC O local carrier DMEPOS: Searches for DME/non-DME Part B claims that are processed by the MAC.
RIC M DMERC non-DMEPOS / RIC M DMERC DMEPOS: Searches for DME/non-DME part B Claims that are processed by the Durable Medical Equipment Regional Carrier.
Note: Part B DME queries can be run using the Part B DME Report Builder and therefore DMEPOS claims cannot be queried in the Population Analytics Query Builder.
1) CPT and HCPCS codes are numeric codes used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are over 8,000 codes available and there are many reference manuals available that cover these codes. To query the claims data for specific CPT/HCPCS codes, a Range of codes can be entered or a Comma Delimited string can be entered. The difference between these two queries is that by entering a Range, a user would be querying for all codes contained between the two values and the Comma Delimited would only query for the values entered.
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Users should note that an available option is to query with an AND/OR clause. The query will default to show all data that contains the values entered, otherwise known as "OR". By selecting "AND" the query will only return data if all values entered are present on a single claim.
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Users have the ability to Add CPT Sections for use in querying multiple ranges.
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2) ICD Codes are based on the World Health Organization's Ninth Revision of International Classification of Diseases
(ICD-9 / ICD-10). There are over 68,000 ICD codes available and there are many reference manuals available that cover these codes. To query the claims data for specific ICD codes, a Range of codes can be entered or a Comma Delimited string can be entered. YOu may select from either ICD-9 or ICD-10 by suing the ICD Version dropdown menu. The difference between the two queries is that by entering a Range, a user would be querying for all codes contained between the two values entered and a Comma Delimited would only query for the values entered.
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Users should note that an available option is to query with an And/Or clause. The query will default to show all data that contains the values entered, otherwise known as "OR." By selecting "AND" the query will only return data if all values entered are present on a single claim.
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Users have the ability to Add ICD Selections for use in querying multiple ranges.
Part A Claims Only: Diagnosis codes are commonly grouped together, known as DRGs, and can be queried if billed in a claim The filter DRG Watch will allow users to search one or more codes by selecting the associated check box.
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Note: There are 999 DRGs and the full listing can be found by clicking here.
A health related facility designed to provide custodial care for individuals unable to care for themselves because of mental or physical infirmity.
An institution providing medical and surgical treatment and nursing care for sick or injured people.
Skilled nursing facility is a setting for long term care, including other services and supports outside of an institution.
Home Health Agencies are primarily engaged in providing skilled or paraprofessional home health care to individuals in out -of-hospital settings (private, or boarding homes, hospices, shelters, etc...)
An extended care facility where religious beliefs prohibit conventional and unconventional medical care.
An extended care facility where religious beliefs prohibit conventional and unconventional medical care.
An independent unit that is approved to furnish outpatient maintenance dialysis services directly to ESRD patients.
Medical facilities that specialize in elective same-day or outpatient surgical procedures. Do not offer emergency care.
Part A Claims Only - Outpatient Service Type: Medical procedures or tests that can be done in a medical center without an overnight stay. Admission type codes are the codes that indicate the manner in which the patient was admitted to the health care facility. The Outpatient Service Type and Admission Type Code are queried by selecting one or more of the associated checkboxes. The different Outpatient Service Types and Admission Codes are shown in the image to the right.
Part A Claims Only: The Place of Service filters will allow a user to query the claims data for differing facilities types. The different facility types are shown in the image to the left.
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Note: Within each Facility Type, there are multiple Facility Classifications that can be queried to further drill down into the data. One or more classifications can be queried by selecting the associated check box.
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Part A Claims Only -Admission Source Codes are codes that indicate the source of admission to a facility. The Admission Source Codes can be queried by selecting one or more checkboxes. The different Admission Source codes can be found in the image to the left.
Part A Claims Only - Specialty Codes are codes used to indicate the specialty of a facility. The Specialty Codes can be queried by selecting one or more of the associated checkboxes. The different specialty codes are shown in the image to the right.
Part B Claims Only - Rendering TIN designates the location where the Part B claim has taken place. Then Rendering Provider Type Codes are used to identify the type of provider furnishing the service for the line item on the claim. The Rendering Provider Type Code can be queried by selecting one or more of the associated checkboxes. The different Rendering Provider Type Codes are shown in the image to the right.
Part B Claims Only - Place of Service Codes are two-digit codes placed on Part B Physician claims to indicate the setting in which a service was provided. The Place of Service codes can be queried by selecting one or more of the associated checkboxes. The different Place of Service codes can be found in the image to the left.
Part B Claims Only - Specialty Codes reference a physician's primary taxonomy code. Specialty codes are designed to categorize the type, classification, and/or specialization of health care providers. These codes can be queried by selecting one or more of the associated checkboxes.
Patient Demographics can be queried to show data as it relates to your population and the groups within it. The available Patient Demographics fields are:
Attribution: Attributed, Non-Attributed or Both
HICN: Search by unique patient identifier
MBI: Search by unique patient Medicare Beneficiary Identifier.
Last Name: Search by Patient Last Name.
First Name: Search by Patient First Name.
Gender: Female, Male or Both
Age: Search by age ranges in years
DOB: Search by patients Date of Birth.
Living/Deceased: Living only, Deceased only or Both
State: Search by claims with a specific state
Zip Code: Search for claims with a specific zip code
Beneficiary Race Code: White, Black, Other, Asian, Hispanic, North American Native and Unknown
Beneficiary Medicare Status Code indicates how a beneficiary currently qualifies for Medicare. The Beneficiary Medicare Status Code can be queried by selecting one or more of the associated checkboxes.
Aged without ESRD: Searches for patients over the age of 65 who do not have End State Renal Disease.
Aged with ESRD: Searches for patients over the age of 65 who have End Stage Renal Disease.
Disabled without ESRD: Searches for patients with a diagnosed disability who do not have End State Renal Disease.
Disabled with ESRD: Searches for patients with a diagnosed disability who have End Stage Renal Disease.
ESRD Only: Searches for patients who have End Stage Renal Disease regardless of other attributes.
Dual Eligibility Code indicates individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit. The Dual Eligible Codes can be queried by selecting one or more of the associated checkboxes. The filter options for Dual Eligible Codes are:
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Not Medicare enrolled for the month: Searches for patients with no Medicare enrollment information for the month.
QMB Only: Searches for patients under the Qualified Medicare Beneficiary Program.
QMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Qualified Medicare Beneficiary program with Medicaid benefits.
SLMB only: Searches for patients under the Service Limited Medicare Beneficiary program.
SLMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Service Limited Medicare Beneficiary program with Medicaid benefits.
QDWI: Searches for patients under the Qualified Disabled Working Individuals Program.
Qualifying Individuals: Searches for patients, under the Qualifying Individuals program.
Other Dual Eligibility (Non-QMB, SLMB, QDWI, or QI) w/ Medicaid Coverage in Rx: Searches for patients who are dual categorized in a program that is not QMB, SLMB, QDWI, or QI but contains Medicaid Coverage.
Other Dual Eligible but without Medicaid coverage: Searches for patients who are categorized in a program that is not QMB, SLMB, QDWI or QI and do not have Medicaid coverage.
Non-Medicaid: Searches for patients who do not have Medicaid coverage.
Once the report has been configured using the above filters, click the Search button to run the report. Alternatively, you may enter a New Custom Report Title and click Save Search to retain this specific report configuration for the future. Saved reports may be edited, run or deleted as necessary. You may also click Reset Form to remove all filters and start over.
Once you have hit the Search or Save Search buttons, a patient list will display below the filters. From left to right, the columns in the list show the claim Source, patient HICN, patient MBI, First Name, Last Name, Sex, Date of Birth, Living Status, assigned Practice, Sub-TIN, Division, Total Claims, and Total of Claims. If both Part A and Part B were selected for claims, each patient will have two separate rows if there are claims data for both. At the bottom of the list, the Totals for both Total claims and Total of Claims for all listed patients will be displayed. Each patient has detailed claims and medical information accessible from the patient list by clicking on the Details button at the end of the patient row. By clicking on the icon under the Action column, a window will open with the patient's medical and claims data.
The Excel Export button in the upper left corner of the table may be used to save the information viewed in the patient list to an excel spreadsheet.
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After running the query, a new option will also be available beside the confirmation buttons called Export Full Results. This option will create a report with full claims data for all entries on the patient list. The full export results are limited to a maximum of 250,000 individual claims. If the patient list generated by the query includes more claims than this, not all claims data will be exported. For reports that require full results for over 250,000 claims, please use Submit a Request for further assistance. Once the export is completed, it will be available on the Population Analytics Query Builder page directly below the patient list. The report link will only be available for a limited time after the export is complete.
Part D
Query Builder Part D is used to create customized reports using criteria related to Medicare Part D claims. Using the filters listed below, users may view patients with specific information, such as specific drug codes or names.
To access Query Builder - Part D, click on 'Analytics' from the main menu and choose 'Query Builder-Part D' under the 'Analytics' menu.
There are a number of filter options to customize the Population Analytics Query Builder Part D. Below is a list of basic Filters and the purpose of each one.
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1) Effective Period: This filter sets the time period for the patients you want to view
2) Divisions: This filter will allow for the selection of a specific division or multiple divisions within the ACO.
3) Practices: This filter will allow the selection of a specific practice, or all practices in the ACO.
4) TIN Number: This filter will return beneficiaries that are assigned to the associated TIN and have claims data.
5) Sub-TINs: This filter will allow for the selection of a specific Sub-TIN, or all Sub-TINs within the ACO.
6) NPI Number: This filter will return beneficiaries who have claims associated to the NPI (Facility and Individual).
7) Rendering/Attending Provider NPI: This filter will return beneficiaries who have claims where the selected NPI is listed as rendering service or attending the beneficiary.
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8) Report Type: This filter is used to run a report based on specific needs. All queries require this field. Choose Highest Claims or All Patients from the drop down depending on your needs.
9) If Highest Claims is selected: You will see a second dropdown to filter on Top 100, Top 5%, Top 10%, Top 15% or Top 20% of the population.
10) Date Range: By selecting the date range, the query will return data with a claim in the date range selected.
Patient Demographics can be queried to show data as it relates to your population and the groups within it. The available Patient Demographics fields are:
Attribution: Attributed, Non-Attributed or Both
HICN: Search by unique patient identifier
MBI: Search by unique patient Medicare Beneficiary Identifier.
Last Name: Search by Patient Last Name.
First Name: Search by Patient First Name.
Gender: Female, Male or Both
Age: Search by age ranges in years
DOB: Search by patients Date of Birth.
Living/Deceased: Living only, Deceased only or Both
State: Search by claims with a specific state
Zip Code: Search for claims with a specific zip code
Beneficiary Race Code: White, Black, Other, Asian, Hispanic, North American Native and Unknown
Beneficiary Medicare Status Code indicates how a beneficiary currently qualifies for Medicare. The Beneficiary Medicare Status Code can be queried by selecting one or more of the associated checkboxes.
Aged without ESRD: Searches for patients over the age of 65 who do not have End State Renal Disease.
Aged with ESRD: Searches for patients over the age of 65 who have End Stage Renal Disease.
Disabled without ESRD: Searches for patients with a diagnosed disability who do not have End State Renal Disease.
Disabled with ESRD: Searches for patients with a diagnosed disability who have End Stage Renal Disease.
ESRD Only: Searches for patients who have End Stage Renal Disease regardless of other attributes.
Dual Eligibility Code indicates individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit. The Dual Eligible Codes can be queried by selecting one or more of the associated checkboxes. The filter options for Dual Eligible Codes are:
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Not Medicare enrolled for the month: Searches for patients with no Medicare enrollment information for the month.
QMB Only: Searches for patients under the Qualified Medicare Beneficiary Program.
QMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Qualified Medicare Beneficiary program with Medicaid benefits.
SLMB only: Searches for patients under the Service Limited Medicare Beneficiary program.
SLMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Service Limited Medicare Beneficiary program with Medicaid benefits.
QDWI: Searches for patients under the Qualified Disabled Working Individuals Program.
Qualifying Individuals: Searches for patients, under the Qualifying Individuals program.
Other Dual Eligibility (Non-QMB, SLMB, QDWI, or QI) w/ Medicaid Coverage in Rx: Searches for patients who are dual categorized in a program that is not QMB, SLMB, QDWI, or QI but contains Medicaid Coverage.
Other Dual Eligible but without Medicaid coverage: Searches for patients who are categorized in a program that is not QMB, SLMB, QDWI or QI and do not have Medicaid coverage.
Non-Medicaid: Searches for patients who do not have Medicaid coverage.
Select a filter option:
Part D: To view all Part D claims
Drug Code: To search for claims for a specific drug code
Drug name: To search for claims for a specific drug name
1) CPT and HCPCS codes are numeric codes used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are over 8,000 codes available and there are many reference manuals available that cover these codes. To query the claims data for specific CPT/HCPCS codes, a Range of codes can be entered or a Comma Delimited string can be entered. The difference between these two queries is that by entering a Range, a user would be querying for all codes contained between the two values and the Comma Delimited would only query for the values entered.
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Users should note that an available option is to query with an AND/OR clause. The query will default to show all data that contains the values entered, otherwise known as "OR". By selecting "AND" the query will only return data if all values entered are present on a single claim.
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Users have the ability to Add CPT Sections for use in querying multiple ranges.
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2) ICD Codes are based on the World Health Organization's Ninth Revision of International Classification of Diseases
(ICD-9 / ICD-10). There are over 68,000 ICD codes available and there are many reference manuals available that cover these codes. To query the claims data for specific ICD codes, a Range of codes can be entered or a Comma Delimited string can be entered. YOu may select from either ICD-9 or ICD-10 by suing the ICD Version dropdown menu. The difference between the two queries is that by entering a Range, a user would be querying for all codes contained between the two values entered and a Comma Delimited would only query for the values entered.
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Users should note that an available option is to query with an And/Or clause. The query will default to show all data that contains the values entered, otherwise known as "OR." By selecting "AND" the query will only return data if all values entered are present on a single claim.
​
Users have the ability to Add ICD Selections for use in querying multiple ranges.
Once the report has been configured using the above filters, click the Search button to run the report. Alternatively, you may enter a New Custom Report Title and click Save Search to retain this specific report configuration for the future. Saved reports may be edited, run or deleted as necessary. You may also click Reset Search to remove all filters and start over.
Once you have hit the Search or Save Search buttons, a patient list will display below the filters. From left to right, the columns in the list show the claim patient HICN, patient MBI, First Name, Last Name, Sex, Date of Birth, Living Status, Practice, Sub-TIN, Division, Total Claims, and Total of Claims. At the bottom of the list, the Totals for both Total claims and Total of Claims for all listed patients will be displayed. By clicking on the icon under the Action column, a window will open with the patient's medical and claims data.
The Excel Export button in the upper left corner of the table may be used to save the information viewed in the patient list to an excel spreadsheet.
After running the query, a new option will also be available beside the confirmation buttons called Export Full Results. This option will create a report with full claims data for all entries on the patient list. The full export results are limited to a maximum of 250,000 individual claims. If the patient list generated by the query includes more claims than this, not all claims data will be exported. For reports that require full results for over 250,000 claims, please use Submit a Request for further assistance. Once the export is completed, it will be available on the Population Analytics Query Builder page directly below the patient list. The report link will only be available for a limited time after the export is complete.
Part B DME
Query Builder Part B DME is used to create customized reports using criteria related to Medicare Part B Durable Medical Equipment claims. Using the filters listed below, Users may view patients with specific information, such as specific type of service code and place of codes.
To access Query Builder - Part B DME, click on 'Analytics' from the main menu and choose 'Query Builder-Part D' under the 'Analytics' menu.
There are a number of filter options to customize the Population Analytics Query Builder Part B DME. Below is a list of basic Filters and the purpose of each one.
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1) Effective Period: This filter sets the time period for the patients you want to view
2) Divisions: This filter will allow for the selection of a specific division or multiple divisions within the ACO.
3) Practices: This filter will allow the selection of a specific practice, or all practices in the ACO.
4) TIN Number: This filter will return beneficiaries that are assigned to the associated TIN and have claims data.
5) Sub-TINs: This filter will allow for the selection of a specific Sub-TIN, or all Sub-TINs within the ACO.
6) NPI Number: This filter will return beneficiaries who have claims associated to the NPI (Facility and Individual).
7) Rendering/Attending Provider NPI: This filter will return beneficiaries who have claims where the selected NPI is listed as rendering service or attending the beneficiary.
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8) Report Type: This filter is used to run a report based on specific needs. All queries require this field. Choose Highest Claims or All Patients from the drop down depending on your needs.
9) If Highest Claims is selected: You will see a second dropdown to filter on Top 100, Top 5%, Top 10%, Top 15% or Top 20% of the population.
10) Date Range: By selecting the date range, the query will return data with a claim in the date range selected.
Patient Demographics can be queried to show data as it relates to your population and the groups within it. The available Patient Demographics fields are:
Attribution: Attributed, Non-Attributed or Both
HICN: Search by unique patient identifier
MBI: Search by unique patient Medicare Beneficiary Identifier.
Last Name: Search by Patient Last Name.
First Name: Search by Patient First Name.
Gender: Female, Male or Both
Age: Search by age ranges in years
DOB: Search by patients Date of Birth.
Living/Deceased: Living only, Deceased only or Both
State: Search by claims with a specific state
Zip Code: Search for claims with a specific zip code
Beneficiary Race Code: White, Black, Other, Asian, Hispanic, North American Native and Unknown
Beneficiary Medicare Status Code indicates how a beneficiary currently qualifies for Medicare. The Beneficiary Medicare Status Code can be queried by selecting one or more of the associated checkboxes.
Aged without ESRD: Searches for patients over the age of 65 who do not have End State Renal Disease.
Aged with ESRD: Searches for patients over the age of 65 who have End Stage Renal Disease.
Disabled without ESRD: Searches for patients with a diagnosed disability who do not have End State Renal Disease.
Disabled with ESRD: Searches for patients with a diagnosed disability who have End Stage Renal Disease.
ESRD Only: Searches for patients who have End Stage Renal Disease regardless of other attributes.
Dual Eligibility Code indicates individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit. The Dual Eligible Codes can be queried by selecting one or more of the associated checkboxes. The filter options for Dual Eligible Codes are:
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Not Medicare enrolled for the month: Searches for patients with no Medicare enrollment information for the month.
QMB Only: Searches for patients under the Qualified Medicare Beneficiary Program.
QMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Qualified Medicare Beneficiary program with Medicaid benefits.
SLMB only: Searches for patients under the Service Limited Medicare Beneficiary program.
SLMB and Medicaid coverage including Rx: Searches for patients who are dual categorized under the Service Limited Medicare Beneficiary program with Medicaid benefits.
QDWI: Searches for patients under the Qualified Disabled Working Individuals Program.
Qualifying Individuals: Searches for patients, under the Qualifying Individuals program.
Other Dual Eligibility (Non-QMB, SLMB, QDWI, or QI) w/ Medicaid Coverage in Rx: Searches for patients who are dual categorized in a program that is not QMB, SLMB, QDWI, or QI but contains Medicaid Coverage.
Other Dual Eligible but without Medicaid coverage: Searches for patients who are categorized in a program that is not QMB, SLMB, QDWI or QI and do not have Medicaid coverage.
Non-Medicaid: Searches for patients who do not have Medicaid coverage.
Users have the option to also filter down to a specific Type of Service Code and/or Place of Service Code. Select options from the drop downs to narrow down your results to a specific code.
CPT and HCPCS codes are numeric codes used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are over 8,000 codes available and there are many reference manuals available that cover these codes. To query the claims data for specific CPT/HCPCS codes, a Range of codes can be entered or a Comma Delimited string can be entered. The difference between these two queries is that by entering a Range, a user would be querying for all codes contained between the two values and the Comma Delimited would only query for the values entered.
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Users have the ability to Add CPT Sections for use in querying multiple ranges.
Users have the option to also filter down to a specific Primary Payer Code, Carrier Payment Denial Code, and/or Processing Indicator Code. Select from the drop downs to narrow down your results to a specific code.
Once the report has been configured using the above filters, click the Search button to run the report. Alternatively, you may enter a New Custom Report Title and click Save Search to retain this specific report configuration for the future. Saved reports may be edited, run or deleted as necessary. You may also click Reset Search to remove all filters and start over.
Once you have hit the Search or Save Search buttons, a patient list will display below the filters. From left to right, the columns in the list show the claim patient HICN, patient MBI, First Name, Last Name, Sex, Date of Birth, Living Status, Practice, Sub-TIN, Division, Total Claims, and Total of Claims. At the bottom of the list, the Totals for both Total claims and Total of Claims for all listed patients will be displayed. By clicking on the icon under the Action column, a window will open with the patient's medical and claims data.
The Excel Export button in the upper left corner of the table may be used to save the information viewed in the patient list to an excel spreadsheet.
After running the query, a new option will also be available beside the confirmation buttons called Export Full Results. This option will create a report with full claims data for all entries on the patient list. The full export results are limited to a maximum of 250,000 individual claims. If the patient list generated by the query includes more claims than this, not all claims data will be exported. For reports that require full results for over 250,000 claims, please use Submit a Request for further assistance. Once the export is completed, it will be available on the Population Analytics Query Builder page directly below the patient list. The report link will only be available for a limited time after the export is complete.
Commercial
Commercial Query Builder is used to sort through your commercial or non-medicare patient data. Using the filters listed below, users may view patients with specific information, such as high claims or specific diagnoses.
To access Commercial Query Builder, click on 'Analytics' from the main menu and choose 'Commercial Query Builder' under the 'Analytics' menu.
There are a number of filter options to customize the Population Analytics Query Builder. Below is a list of basic Filters and the purpose of each one.
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Practices: This filter will allow the selection of a specific practice, or all practices in the ACO.
Divisions: This filter will return beneficiaries who have claims associated to the selected division
Primary Care Physicians Name: This filter will return beneficiaries who have claims associated to the entered Primary Care Physician.
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1) Date Range: By selecting the date range, the query will return data with a claim in the date range selected.
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2) Report Type: This filter is used to run a report based on specific needs. All queries require this field. Health Endeavors has pre-populated commonly requested reports.
A) Highest Claims: highest claims and associated diagnoses. When selecting the Highest Claims filter, a second dropdown bar will allow users to filters on the Top 100 Patients, Top 5%, Top 10%, Top 15%, and Top 20% of the population.
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Highest Claims
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Highest Claims with COPD
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Highest Claims with Diabetes
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Highest Claims with Heart Failure
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Highest Claims with IVD
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Highest Claims with CAD
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Highest Claims with Hypertension ​
For the next set of filters click on either Claims or Prescriptions.
Claims filters:
CPT and HCPCS codes are numeric codes used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are over 8,000 codes available and there are many reference manuals available that cover these codes. To query the claims data for specific CPT/HCPCS codes, a Range of codes can be entered or a Comma Delimited string can be entered. The difference between these two queries is that by entering a Range, a user would be querying for all codes contained between the two values and the Comma Delimited would only query for the values entered.
​
Users should note that an available option is to query with an AND/OR clause. The query will default to show all data that contains the values entered, otherwise known as "OR". By selecting "AND" the query will only return data if all values entered are present on a single claim.
​
Users have the ability to Add CPT Sections for use in querying multiple ranges.
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ICD Codes are based on the World Health Organization's Ninth Revision of International Classification of Diseases
(ICD-9 / ICD-10). There are over 68,000 ICD codes available and there are many reference manuals available that cover these codes. To query the claims data for specific ICD codes, a Range of codes can be entered or a Comma Delimited string can be entered. YOu may select from either ICD-9 or ICD-10 by suing the ICD Version dropdown menu. The difference between the two queries is that by entering a Range, a user would be querying for all codes contained between the two values entered and a Comma Delimited would only query for the values entered.
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Users should note that an available option is to query with an And/Or clause. The query will default to show all data that contains the values entered, otherwise known as "OR." By selecting "AND" the query will only return data if all values entered are present on a single claim.
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Users have the ability to Add ICD Selections for use in querying multiple ranges.
DRG Watch allows users to search one or more codes by selecting the associated check box.
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Note: There are 999 DRGs and the full listing can be found by clicking here.
Place of Service filters allow a user to query the claims data for differing facilities types.
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Enter Provider in the provider field to filter for a specific provider.
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Enter Vendor in the vendor field to filter for a specific vendor.
Prescriptions filters:
Drug Code: Enter a drug code or click on the 'Drug Code Lookup' button to search for a specific code.
Drug Name: Enter a drug name to search claims for a specific drug name.
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Pharmacy name: Enter a Pharmacy name to view claims from a specific pharmacy
Patient Demographics can be queried to show data as it relates to your population and the groups within it. The available Patient Demographics fields are:
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Member No.: Search by patient Member ID number.
Last Name: Search by Patient Last Name.
First Name: Search by Patient First Name.
Gender: Female, Male or Both
Age: Search by age ranges in years
DOB: Search by patients Date of Birth or Date of Birth Range
Living/Deceased: Living only, Deceased only or Both
State: Search by claims with a specific state
Zip Code: Search for claims with a specific zip code
Employer Group ID: Enter an Employer Group ID to search for a specific ID
Employer Group Name: Enter an Employer Group Name to search for a specific name
Population: Choose population from drop down. You may select more than one population if applicable.
Population Grouping: Choose a population grouping from the drop down if applicable.
Once the report has been configured using the above filters, click the Search button to run the report. Alternatively, you may enter a New Custom Report Title and click Save Search to retain this specific report configuration for the future. Saved reports may be edited, run or deleted as necessary. You may also click Reset Form to remove all filters and start over.
Once you have hit the Search or Save Search buttons, a patient list will display below the filters. From left to right, the columns in the list show the claim Source, patient MemberNo, First Name, Last Name, Sex, Date of Birth, Living Status, assigned Practice, Population, Number of Claims and Total of Claims. At the bottom of the list, the Totals for both Total claims and Total of Claims for all listed patients will be displayed. Each patient has detailed claims and medical information accessible from the patient list by clicking on the Details button at the end of the patient row. By clicking on the icon under the Action column, a window will open with the patient's medical and claims data.
The Excel Export button in the upper left corner of the table may be used to save the information viewed in the patient list to an excel spreadsheet.
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After running the query, a new option will also be available beside the confirmation buttons called Export Full Results. This option will create a report with full claims data for all entries on the patient list. The full export results are limited to a maximum of 250,000 individual claims. If the patient list generated by the query includes more claims than this, not all claims data will be exported. For reports that require full results for over 250,000 claims, please use Submit a Request for further assistance. Once the export is completed, it will be available on the Population Analytics Query Builder page directly below the patient list. The report link will only be available for a limited time after the export is complete.