Healthcare Data & File Services
YEI provides medical coding and claims processing data with ongoing updates. We continually monitor all data sources so that you don't have to, and we accuracy-check every line of data before it reaches you. Data is provided with a one year subscription so that you receive all updates and changes throughout your subscription year.
Why YEI Data and Libraries?
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, knowing that our success depends on their success.
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 standard flat-file delimited and XML formats, compatible with any commercial database system. Custom HL7, X12, and other proprietary formats are also available to meet your unique requirements. File format changes, as needed, are also provided at no additional charge to our clients. 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 form below, and standard formats can be directly ordered via the Order link below for use within a single physical site. For multi-site use or for deployment to third parties and clients, contact us at support@YostEngineering.com or 888-395-9029 for a redistribution license. 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 service.
Data Files for medical necessity are compatible with 3rd party systems, such as CPSI, Epic Systems, Fletcher-Flora (FFlex eSuite, LabPak), Iatrics (MNO, LAB e-Laborate), MediTech, and other vendors. They are also available in custom formats for homegrown systems, for claims scrubbing systems, and for historical purposes.
Available Content Areas Include:
- Medical Necessity Libraries (Medicare, Private Payer, and Custom)
- Coding Files (including CPT, HCPCS, ICD, Dental, NDC, modifiers, PQRI, POS, BETOS)
- Facility Coding (APC, DRG, Revenue Codes, MDC, CPT to APC crosswalks, DRG-MDC-ICD crosswalk)
- Medicare Fee Schedules (Physician, RBRVS, Laboratory, PEN, DEM, ambulance, ambulatory surgery, Part B drugs, anesthesia)
- Custom Fee Schedules
- Correct Coding (CCI, NCCI/OCE, MUE)
- Zip Codes (US, Canada)
Download a summary of available data files and libraries organized by general content areas.
Delivery and Updates
Our standard data delivery service is via a secure website that clients can log into and download their latest files. Email notices are provided to alert you to updated files when they are posted. For licensed distributors, data may also be dropped or loaded directly into a third-party system via FTP or secure login, acquired via web-based query service, TCP/IP query service, or accessed through components embedded within other software. Updates are made on an ongoing basis, with data posted as frequently as daily, depending on how frequently Medicare and other content sources are making changes.
- 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
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 only 11 error corrections per year for the past 3 years
- Data updated DAILY
- Over 2.8 million unique medical necessity linkages across over eight thousand CPT and HCPCS codes. The most comprehensive, detailed, and documented data in the entire industry.
More Information
Contact us for more information or to get a quote on the data you need.
Standard Files for Direct Order
Direct order is available for the data you need.
For any questions regarding the purchase of data files, please contact our office at 888-395-9029 or support@YostEngineering.com
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 | CIGNA | 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 |

