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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?

Your [data files] just saved me a lot of aggravation. MG, Texas

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