HHSRiskScoreRequestPatient

Request ID is assigned by client to distinguish their patients or to keep track of their requests. Unique request ID must be used per patient. Client patient ID can be used as request ID. You will see an error message if there are duplicate request IDs in the request.

Date of birth in 'yyyy-MM-dd' format. Used to calculate age at diagnosis for MCE (Medicare Code Edits) diagnosis code age edits (age = date of service - date of birth).

Enrollee's gender (either Male or Female)

Enrollee’s metal level. Plans in the Health Insurance Marketplace are presented in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. (“Catastrophic” plans are also available to some people.) Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care.

The adult models include enrollment duration factors for months enrolled when an enrollee’s enrollment period in an issuer’s plans is less than 12 months. Enrollment duration in months in benefit year; used in Adult model to create 11 mutually-exclusive enrollment duration in months (ED_1 through ED_11) that indicate partial year enrollment.

Enrollees who qualify for cost-sharing reductions or those enrolled in premium assistance Medicaid alternative plans will be assigned CSR_INDICATOR1-CSR_INDICATOR13. Non-CSR recipients and enrollees with unknown CSR status are assigned CSR_INDICATOR0.

Collection of diagnosis codes with service date used for Medicare claims/encounters

Collection of NDC or HCPCS codes used for Prescription Drugs. Only NDCs or/and HCPCSs from pharmacy claims filled in the benefit year or inpatient claims with discharges in the benefit year should be included. All other NDCs or/and HCPCSs do not map to an RXC and are not used to calculate risk scores.