How to populate payer_plan_period.payer_concept_id based on plan type in the source

[burrowse]

How to populate payer_plan_period.payer_concept_id based on plan type in the source

CDM or THEMIS convention?

Themis

Table or Field level?

Field

Is this a general convention?

No

Summary of issues

• There are outstanding questions on the forum on how to populate payer_concept_id based on plan type.
• For example, this forum post asks the question if concept_id 327 (“Private Health Insurance” the parent of commercial claims) or 328 (“Private Health Insurance - Managed Care”) should be used instead of 0 for "commercial claim and encounter" datasets where "plan type" blank.
• Another post asks about specific guidance for:
  • Plan types of "Point of Service" and "Point of Service with capitation" mapping to 331 "Commercial Managed Care - Point of Service"
  • Commercial Claims and Encounters and Medicare datasets mapping to 284 "Medicare Point of Service"

Summary of answer

• Based on the forum, there doesn't appear to be general guidance on how these should be mapped for the payer_concept_id
• There could be general guidance provided on how to populate payer_plan_period.pay_concept_is based on the plan_type and/or the dataset type

Related links

• Forum post about commercial claim and encounter datasets where plan type is blank: https://forums.ohdsi.org/t/concept-for-payer-in-payer-plan-period-where-type-of-plan-is-undefined/10385
• Additional forum post about specific plan types and datasets: https://forums.ohdsi.org/t/concepts-for-payer-and-plan-on-cdm-payer-plan-period-table/8535

Other comments/notes

• This topic needs more discussion to provide guidance to the community.

[MelaniePhilofsky]

Archiving this issue. Please reopen this issue if there are still questions.