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Background
Healthcare claims data are an important source of information for activities to improve the quality and value of healthcare. Because there is wide variation in how claims are submitted by different providers and stored by different health insurers, converting claims into consistent information for analysis presents challenges. The Health Innovation Program (HIP) has developed internal standards for processing claims data to support the creation of analytic files.
Who should use this toolkit?
This toolkit is intended for healthcare analysts.
What does the toolkit contain?
The toolkit contains a list of standards for processing healthcare claims data.
How should these tools be used?
The materials in this toolkit can be used to:
- Combine health insurance claims from different sources
- Process health insurance claims to produce analytic files
A copy of the standards is available in this PDF file.
Development of this toolkit
The HIP Claims Data Processing Standards Toolkit was developed by healthcare analysts at the Health Innovation Program at the University of Wisconsin-Madison.
This project was supported by the University of Wisconsin School of Medicine and Public Health’s Health Innovation Program (HIP), the Wisconsin Partnership Program, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 9 U54 TR000021 from the National Center for Advancing Translational Sciences (previously grant 1 UL1 RR025011 from the National Center for Research Resources). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.
Please send questions, comments and suggestions to HIPxChange@hip.wisc.edu
References
ResDAC provide information on the use of Medicare claims data. www.resdac.org
Toolkit citation
Health Innovation Program. HIP Claims Data Processing Standards Toolkit. University of Wisconsin-Madison. Madison, WI; 2019.
About the Developer
The HIP Claims Data Processing Standards Toolkit was built by staff at the Health Innovation Program at the University of Wisconsin – Madison School of Medicine & Public Health. The mission of the Health Innovation Program is to transform healthcare delivery and population health across the state and nation through health systems research that partners University of Wisconsin faculty with healthcare and community organizations.