QA UDS Table 4

This section describes relevant logic that is used to identify or categorize data for this table. The logic is broken down by section.

Income as Percent of Poverty Guideline

• There is no significant logic used determine this section. Data from patient Quickview (see below) is bucketed per HRSA specification.

Principal Third-Party Medical Insurance

• The patient age is calculated, as of December 31st of the program year, based on the patient date of birth.

• The principal third-party insurance is defined as the primary insurance on the date of the last UDS visit during the reporting year. We calculate this the same way we do in Patients by Zip:

  • The principal third-party insurance is defined as the primary medical insurance patients had at the time of their last visit regardless of whether that insurance was billed or paid for any or all of the visit services. We calculate this the same way we do in Patients by Zip, using the patient's primary insurance listed in their registration at the time of the visit. If you see an inaccurate patient insurance in Patients by Zip or Table 4, you can update the Expiration date for that insurance to a date before the visit.

  • If you see an inaccurate patient insurance in Patients by Zip or Table 4, you can update the Expiration date for that insurance to a date before the visit.

• To view the patient insurance navigate to the “Insurances” section of the patient Quickview. If the insurance information has changed since the last UDS visit you can view previous insurances by clicking “View cancelled insurances”

Managed Care Utilization

• athenaOne does not capture the data necessary to support this section.

Special Populations

• There is no significant logic used determine this section. Data from patient Quickview or department designations (see below) is bucketed per HRSA specification.

This section describes the data sources for this table and where you can view that data within athenaOne.

Income as Percent of Poverty Guideline

• This data comes from the “Income Level” field in the “Financial” section of the patient Quickview, if your organization uses the income range field. Please contact the CSC to set up the income range field if you choose to use it as your data capture option. On the Main Menu, click Support > Success Community > Contact Client Support Center.

• This data is calculated based on the “Income” and “Family size” fields in the “Financial” section of the patient Quickview, if your organization uses these fields to capture income.

Principal Third-Party Medical Insurance

• The patient age is calculated based on the “DOB” field in the “Identification/Provider” section of Quickview.

• The principal third-party insurance is defined as the primary insurance on the date of the last UDS visit during the reporting year. As stated above, we look at the claim and appointment, and we trust those values if they’re not Self Pay. If they are Self Pay, we look to the patient insurance as defined in Quickview. If there are multiple active primary insurances, we will pick one at random. To view the patient insurance, navigate to the “Insurances” section of the patient Quickview. If the insurance information has changed since the last UDS visit you can view previous insurances by clicking “View cancelled insurances”

Managed Care Utilization

• athenaOne does not capture the data necessary to support this section.

Special Populations

• The agricultural worker status data comes from the “Agricultural worker” field in the “Financial” section of the patient Quickview.

• Selecting “Yes” will trigger a dropdown menu where you can choose “Migratory” or “Seasonal”.

• The homeless status data comes from the “Homeless status” field in the “Financial” section of the patient Quickview.

• Selecting “Yes” will trigger a dropdown menu where you can choose a more granular homeless status based on the available choices in this table.

• The veteran status data comes from the “Veteran status” filed in the “Financial” section of the patient Quickview.

• The school-based health center patient and public housing site patient counts are determined by the Department settings for your FQHC departments.

This section provides examples of how to trace pieces of data from the Rolled Up report back to athenaOne.

Income as Percent of Poverty Guideline

 

athenaOne action:

• Beginning with the Rolled Up report, we will trace the counts in the highlighted income level fields back to their source.
  

You can:

• Filter the Filtered Data by Patient report in excel to match the Rolled Up report using the UDS_PATIENT_INCOMELEVEL column. Note that columns have been removed from the screenshot below to fit into this document.
  Note: For example, this report also includes the username who last updated the patient's income and when. See the PATIENT_INCOME_LASTMODIFIEDBY and PATIENT_INCOME_LASTMODIFIED columns.
  

• Use the PATIENT_ID field from the Filtered Data by Patient report to find a patient in athenaOne. In Quickview, scroll down to the “Identification/Provider” section and the “Demographics” section.
  

Principal Third-Party Medical Insurance

 

athenaOne action:

• Beginning with the Rolled-Up report, we will trace the counts in the highlighted principal third-party medical insurance field fields back to their source.
  

You can:

• Filter the Filtered Data by Patient report in excel to match the Rolled Up report using the UDS_PRI_INS_PACKAGECATEGORY column and UDS_AGE_BUCKET column. Note that rows and columns have been removed from the image below to fit into this document.
  

• Use the CLAIM_ID field to navigate to the claim and view the “Primary payer” (and Secondary payer, if necessary) field. If the “Primary payer” field is Self Pay, navigate to the patient Quickview page to view their primary insurance. According to the logic above, if their insurance has changed, you can view historical insurances by clicking “View cancelled insurances” on the Quickview page.
  

Special Populations

 

athenaOne action:

• Beginning with the Rolled Up report, we will trace the counts in the highlighted special populations field back to their source.
  

You can:

• Filter the Filtered Data by Patient report in excel to match the Rolled Up report using the PATIENT_AGRICULTURAL column. Note that rows and columns have been removed from the screenshot below to fit into this document. Depending on the special population counts that you are tracing, you may need to use the PATIENT_HOMELESS, PATIENT_VETERAN, UDS_PUBLICHOUSING_DEPT, or UDS_SCHOOLBASED_DEPT columns.
  

• Use the PATIENT_ID field from the Filtered Data by Patient report to find a patient in athenaOne. In Quickview, scroll down to the “Financial” section to view the “Agricultural worker” field.
  

You know your data best, so here are some questions to ask about your data to help you be confident about its accuracy.

1. "In the income as percent of poverty guideline section, does the total number of patients at each income level seem reasonable? Are there an unexpected number of “Unknown” patients that may indicate data is not being captured?"

2. "In the principal third-part medical insurance section, do the total number of patients in each insurance category make sense compared to our overall patient population? If there appears to be an unexpected number of patients in one of the insurance categories, trace some examples to identify potentially miscategorized insurances."

3. "Can I trace the patients from a single field from the Rolled-Up data report back through the Filtered Data report and use the PATIENT_ID to find and confirm the data for those patients?"