Member Utilization

Admission Date

This field identifies the date and time of the encounter admission, formatted as 'MM/DD/YYYY HH:MM:SS'.

Discharge Date

This field identifies the date and time of the encounter discharge, formatted as 'MM/DD/YYYY HH:MM:SS'.

Encounter Type

This field contains the setting of the encounter.

Valid values are:

• Emergency

• Inpatient

Encounter Status

This field contains the status of the encounter.

Valid values are:

• Currently Hospitalized - Value-add field built by HealthInfoNet to identify encounter records that do not have a discharge date or discharge disposition code and are within 30 days of the admission date. If the encounter records are later updated with a discharge disposition code, the reporting will update with the latest source value; if the encounter records are not updated with a discharge disposition code within 30 days of the admission date, the records will be assumed as discharged.

• Assumed Discharged - Value-add field built by HealthInfoNet to identify encounter records that are 30 days past the admission date and do not have a discharge date or discharge disposition code. If encounter records are later updated with a discharge disposition code, the reporting will update with the latest source value.

• Home - Provided as discharge disposition code

• Facility - Provided as discharge disposition code

• Inpatient Admission - Provided as discharge disposition code

• Swing Bed - Provided as discharge disposition code

• Expired - Provided as discharge disposition code

• Law Enforcement - Provided as discharge disposition code

Readmission/Return Risk

This field contains a risk class identifying the member’s chance for being readmitted to the Inpatient setting or returning to the Emergency Department setting in the next 30 days based on the last 30 days' worth of encounter information.

Valid values are:

• Low

• Moderate

• High

• Very High

For more information on HealthInfoNet’s readmission/return predicted risk models, see the section on Predictive Risk Modeling.

Medicaid ID

This field contains an ID that identifies a unique Medicaid member. Note: This is the ID referred more commonly by MaineCare as the 'A' number or the Member Secondary ID.

Member Name

This field contains the first and last names of the member.

Rendering Facility Name

This fields contains the name of the facility where the member's encounter occurred.

PCP Name

This field contains the name of the member's attributed Primary Care Provider (PCP).

Chief Complaint

This field contains the member's chief complaint reported on the encounter.

Diagnosis Type

This field contains indication of whether the primary diagnosis code reported on the member’s encounter is classified as Emergent or Non-Emergent.

Valid values are:

• Emergent

• Non-Emergent

Note: This field uses an ICD-10 value set identified by MaineCare under “Section 45 Non-Emergent Use of Emergency Department: ICD-10 Codes,” effective October 1, 2015, as "Non-Emergent" diagnosis codes.

Primary Diagnosis Code

This field contains the member's primary ICD-10 diagnosis code reported on the encounter. 

Primary Diagnosis Description

This field contains the member's primary ICD-10 diagnosis code description reported on the encounter. 

Secondary Diagnosis Code

This field contains the member's secondary ICD-10 diagnosis code reported on the encounter. 

Secondary Diagnosis Description

This field contains the member's secondary ICD-10 diagnosis code description reported on the encounter. 

Attribution Type

View our section onAttribution Selection from more information.

For more information on HealthInfoNet’s attribution methodologies, see the section on Member & Organizational Attribution.

Attribution Level

View our section onAttribution Selection from more information.

Attribution Entity

View our section onAttribution Selection from more information.

Admission Date Period

The defined range of admission dates corresponding to a member’s encounters.

Options for this filter allow users to configure the report based on either a rolling-period basis (e.g., last 90 days) or on a calendar-period basis (e.g., last full quarter).

Encounter Type

The type of encounter setting (i.e., Inpatient or Emergency Department).

Encounter Status

The indication of whether a member’s encounter is considered currently hospitalized or whether it has been discharged and, if so, to which setting.

For more information on HealthInfoNet’s encounter status methodology, see the section on Encounter Status.

Rendering Facility Name

The facility where the encounter was rendered by the member.

Medicaid ID

The ID that identifies a unique Medicaid member. Note: This is the ID referred more commonly by MaineCare as the 'A' number or the Member Secondary ID.

Readmission/Return Risk

The risk class identifying a member’s chance for being readmitted to the Inpatient setting or returning to the Emergency Department setting in the next 30 days based on the last 30 days' worth of encounter information.

For more information on HealthInfoNet’s condition-based predicted risk models, see the section on Predictive Risk Modeling.

Diagnosis Type

The indication of whether the primary diagnosis code reported on a member’s encounter is classified as Emergent or Non-Emergent.

This filter uses an ICD-10 value set identified by MaineCare under “Section 45 Non-Emergent Use of Emergency Department: ICD-10 Codes,” effective October 1, 2015, as "Non-Emergent" diagnosis codes.

Chief Complaint

This identification of the chief complaint reported on a member’s encounter.

Chronic Condition

The identification of encounters only for members with a present chronic condition.

Chronic conditions are identified by whether a member has a score of ‘100’ for any of the available condition predicted risk models.

For more information on HealthInfoNet’s condition-based predicted risk models, see the section on Predictive Risk Modeling.

Attribution Type

View our section onAttribution Selection from more information.

Retrieves encounter data per members' attribution to organization(s) based on their encounter histories.

Attribution Level

View our section onAttribution Selection from more information.

Retrieves encounter data on all levels of organizations that are affiliated with members' attributed organization(s) based on their encounter histories.

Attribution Entity

View our section onAttribution Selection from more information.

Retrieves encounter data on all organizations that are affiliated with members' attributed organization(s) based on their encounter histories.

Admission Date Period

Last 30 Days

Retrieves encounter data based on admission dates from the last 30 days (from today).

Encounter Type

Inpatient

Retrieves both Inpatient and Emergency Department encounter data.

Encounter Status

All

Retrieves encounter data for all encounter statuses (i.e., currently hospitalized and discharged).

Rendering Facility Name

All

Retrieves encounter data for all rendering facilities.

Medicaid ID

All

Retrieves encounter data for all eligible members.

Readmission/Return Risk

All

Diagnosis Type

All

Retrieves encounter data for all types of primary diagnosis codes (i.e., emergent and non-emergent).

Chief Complaint

All

Retrieves encounter data for all chief complaints.

Chronic Condition

All

Retrieves encounter data for all members regardless of whether they have a chronic condition.