Florida Healthy Kids



Florida Healthy Kids Program Utilization Reports by CountyMethods SummaryData Sources1. Enrollment database provided by the Florida Healthy Kids Program (FHKP) enrollment vendor.2. Claims and encounter data provided by each of the plans participating in the FHKP.Reporting Time PeriodJuly 1, 2010 – June 30, 2011Reports were run after the September 30, 2011 quarterly claims data submissions by the health plans were processed, allowing for a claims lag of at least 3 months.Base PopulationAll members enrolled at least one month during July 1, 2010 through June 30, 2011.Members missing the individual identifier needed to link between the enrollment and claims databases or who were missing the county identifier were excluded.Claims data from Simply Healthcare Plans was incomplete; however, this plan accounted for less than 1% of all FHKP enrollees.Utilization MeasurementOnly paid claims were reported.Inpatient was defined by UB Type of Bill 11X, 12X, 18X, 21X, 22X, 28X, 41X, 81X, 82X, or 84X or UB Revenue codes 0115, 0118, 0125, 0128, 0135, 0138, 0145, 0148, 0155, 0158, 019x, 0650, 0656, 0658, or 0659. One inpatient admission was defined as a unique combination of member ID and admission date - i.e., a member could have at most one inpatient admission the same day. ED visits were defined as CPT codes 99281-99285 or UB revenue code 045X, 0981 or CPT code 10040-69979 with place of service code 23. Visits that led to inpatient admissions were excluded. One member could have at most one ED visit the same day.Outpatient visits were defined as visits with any of the following : CPT code 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99420, 99429, 99432, 99461, 92002, 92004, 92012, 92014 or UB Revenue code: 051x, 0520-0523, 0526-0529, 0982, or 0983. One outpatient visit was defined as a unique combination of member ID, service date, and provider number - i.e., a member could have at most one visit with the same provider the same day. One prescription is defined as a unique combination of member ID, Rx fill date and NDC number with days supplied of 30 days or less. For prescriptions longer than 30 days, the number of prescriptions=(days supplied/30) and then rounded down (e.g., 100/30 = 3.33, so value=3). Only the primary diagnosis codes were used to identify the 25 most frequently occurring ICD diagnosis codes. ................
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