The Teus Classifier™ is a system that categorizes each claim and claim-line of a health insurance medical claims dataset along several dimensions. The system is transparent, easily modifiable, and compatible with open-source databases and analytic tools. The Classifier’s multi-dimensional approach comprehensively describes a claim, including “who” (provider type), “what” (type of service), and “where” (site of service). The classifications can be easily customized to meet an organization’s specific analytic needs.
CMS publishes CMS-HCC risk adjustment software in the form of SAS scripts. Running the scripts requires an expensive SAS license. We have rewritten CMS-HCC scripts in R, which is free and open source. Our R code exactly reproduces the SAS output. We also have the reference tables and the scripts necessary to select the claims whose diagnoses can be used for risk adjustment, per the instructions of Chapter 7 of the Medicare Managed Care Manual, and to generate the input tables used by the (SAS or R) software.
Health insurance claims data is presented via codes – diagnosis codes, procedure codes, and many others. The codes are meaningless to human readers without code descriptions. Teus Health has developed a comprehensive set of tables that provide descriptions for health insurance claim codes. In the language of information technology, these tables are known as “reference tables.” Our reference tables have been designed specifically to meet the needs of health insurance claims data analysis teams.