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Healthcare Data & File Services

We provide a wealth of healthcare data for use by payers, providers, claims processors, software vendors, and other healthcare industry firms. Data is delivered in a variety of delimited flat files or formats compatible with any commercial database system, and custom formats are available at no additional cost to meet unique or proprietary formats. All data elements and components can be mixed and matched to support your specific need. Data may also be accessed via several web-based protocols, in both batch and transaction modes.

Why YEI?

Yost Engineering is a leading provider of data services and back-end processing services for healthcare clients of every size. In addition to our competitive pricing and rigorous quality controls, we are fully dedicated to serving the needs of our clients. We are not a competitor to our software and other third-party clients, and therefore support them knowing that our success depends on them.

We provide expertise and assistance for all the data that we provide, and help clients through all phases of data usage, including:

implementation of data sets
interpretation and appropriate use of data content
programming and database logic
workarounds for legacy systems
content changes during migration and upgrades

Formats and Content

Our data is generated and published in a variety of flat-file delimited formats, compatible with any commercial database system. Custom, HL7, X12, and XML formats are also available at no additional cost to meet your unique or proprietary formats. File format changes, as needed, are also provided at no additional charge to our clients, and can be usually be accomodated with a 24-hour turn-around.

Data files can be provided in ready-to-use reference file formats, or in files to be used to import the data into third party systems or databases.

Commonly requested content and data elements are listed in the table below. All data elements and components can be mixed and matched to support your specific needs, and additional filtering to include or exclude certain types of data is also available as part of our basic service.

Data Files for medical necessity are compatible with 3rd party systems, such as CPSI, Epic Systems, Fletcher-Flora (FFlex eSuite, LabPak), MediTech, and other vendors. They are also available in custom formats for homegrown systems, for claims scrubbing systems, and for historical purposes.

Delivery and Updates

We also offer flexible delivery methods. Data may be dropped or loaded directly into a third-party system, acquired via web-based query service, TCP/IP query service, or accessed through ActiveX components embedded within other software. Data may be purchased on a one-time basis, or with a subscription service that keeps the data current. Data updates are made via automated or manual web download or via FTP and may be scheduled as frequently as daily. And we can customize the delivery method and update schedule to suit your requirements.

updated data made available on a daily (Monday through Friday) basis
ready-to-use formats to copy to your system
ready-to-load formats that you upload or import into your system
files that you redistribute or push to your clients
files that we redistribute or push to your clients for you

Data sets are typically provided as a yearly subscription, but can also be purchased on a one-time basis. Subscriptions are available for facility and in-house use, as well as for redistribution to clients and use within claims processing systems.

Web-Based Query and Batch Services

In addition to files, we also offer web-based query systems, so that clients can completely avoid data maintenance issues. Web-based services can be custom-developed, or put together on a mix-and-match basis using popular components such as these:

custom web interfaces and utilities, hosted by us or through your servers
ActiveX components for easy integration of coding tools and reference data
AJAX-based client web service (for a desktop application look and feel)
TCP-IP-based query service
Data validation services (batch and transaction modes)
Full claims scrubbing systems (batch and transaction modes)

All solutions can be branded according to your specifications, and seamlessly integrated into your existing services.

Quality Data

In order to maintain accurate and continually updated records for the entire United States and territories, we monitor an extensive list of primary sources. Data is compiled and validated from these primary sources, and extensively audited, using both certified coders and proprietary artificial intelligence systems. Our automated and manual auditing systems consistently correct errors from the original data, and we work with the source organizations in verifying and correcting their incorrect or inconsistent data. All data and systems are maintained in-house by our employees, and no work is outsourced.

Our compulsive attention to quality control and data accuracy is documented by audited results that include:

99.99%+ accuracy rate
Average of 9 error corrections per year for the past 4 years
Data updated DAILY

Available Data Content

MEDICAL NECESSITY DICTIONARIES, TABLES AND DATABASES
Procedure/Diagnosis matching			Policy names
Date specific coverage at policy and diagnosis level			Policy numbers
Links directly to the policy			Limited coverage rules
Non-coverage rules			Permissive edits
All 50 states plus territories			Medicare NCDs (CMS)
Medicare LCDs - Fiscal Intermediaries (FIs, Part A, Hospitals)			Medicare DME
Medicare LCDs - Carriers (Part B, physicians)			Medicaid
Private Payers	Aetna	Anthem		Blue Cross/Blue Shield
	CareFirst	Empire		Excellus
	Highmark	Horizon		Premera
	Regence	United Healthcare		Wellmark
	Wellpoint
	Call to check on other payers

ICD-9 CODE FILES AND DATABASES
ICD-9 diagnosis codes and descriptions	Short, medium, long descriptors
ICD-9 procedure codes and descriptions	ICD-9 guidelines
ICD-9 hierarchy	Search tools
Keyword index

CPT AND HCPCS CODE FILES AND DATABASES
CPT and HCPCS procedure codes	Procedure descriptions
Short, medium, long descriptors	CPT Guidelines
CPT Hierarchy	HCPCS Hierarchy
Keyword index	Search tools
PQRI codes (Physician Quality Reporting Initiative)

PHARMACEUTICAL CODES
NDC (National Drug Codes) numbers	Drug names
Dosages, forms, packaging	Administration route
Active ingredients	FDA approval numbers
Manufacturer name, address	Manufacturer product codes
RX (prescription only) designation	OTC (over the counter) designation

ANCILLARY CODES
CPT Modifiers	HCPCS Modifiers
Place of Service Codes	Physical Status Codes

USAGE WARNINGS AND GUIDELINES
Frequency restrictions	Situational coverage
Age restrictions	Gender restrictions
Maternity designations	Add-on code designations
Inpatient-only restrictions	Truncated code designations
Primary code designation	Secondary code designation
Conscious / moderate sedation designation

CORRECT CODING INFORMATION
CCI (Correct Coding Initiative)	NCCI (National Correct Coding)
OCE (Outpatient Code Editor)	Non-reportable codes
Mutually exclusive codes	Components
Modifier over-rides

REIMBURSEMENT AND PAYMENT DATA
Revenue Codes	DRG (Diagnostic Related Groups)
DRG-MDC-ICD-9 crosswalks	MDC (Major Diagnostic Categories)
OPPS data (Outpatient Prospective Payment System)	Primary ICD-9 based DRG/MDC grouper
APC categories (Ambulatory Payment Classifications)	Medicare Status Codes
Global Surgery Days	Multiple Procedure Payment
Bilateral Surgery Allowed	Assistant at Surgery Allowed
Co-Surgeons Allowed	Team Surgery Allowed
ESRD file sets	Medicare Manuals
UB-04 formats and instructions (also UB-92)	UB-04 help files (also UB-92)
UB-04 billing manual content (also UB-92)	UB-04 help utilities (also UB-92)
CMS-1500 formats and instructions (also HCFA-1500)	CMS-1500 help files (also HCFA-1500)
CMS-1500 billing manual content (also HCFA-1500)	CMS-1500 help utilities (also HCFA-1500)

CLAIM PROCESSING DATA
Claim Adjustment Reason Codes (CARC)	Taxonomy codes
Remittance Advice Remark Codes (RARC)	Claim status codes

FEE CALCULATION DATA
RVUs (Relative Value Units)	Physician fee schedule (RBRVS)
Pre, Intra, and Post-Op allowances and percentages	Clinical Laboratory fee schedule
PEN (Parenteral and Enteral Nutrition) supply fee schedule	DME/DMERC/DMEPOS fee schedule
Ambulance fee schedule	Ambulatory Surgery fee schedule
Anesthesia fee schedule and base units	Part B Drug fee schedule
Custom fee schedules

ZIP CODE VERIFICATION
US zip code validation	Canadian zip code validation
City and state verification	Zip code look-up utilities
Zip code statistical & demographic data

CUSTOM DATA SERVICES
Custom dataset compilations	Data conversions
Management and maintenance of proprietary data	Legacy system interfaces and crosswalks

Healthcare Division

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