Term: Medical Services / Medical Claims Data

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Glossary Definition

Last Updated: 2014-06-24

Definition:

The Medical Services / Medical Claims data is an administrative health database consisting of medical (hospital/physician) claims for physician visits in offices, hospitals, and outpatient departments; fee-for-service components for tests such as lab and x-ray procedures performed in offices and hospitals; and payments for on-call agreements. In Manitoba, fee-for-service providers must submit claims to Manitoba Health for reimbursement and a small proportion of salaried physicians also submit evaluation claims (shadow billing).

For more information on Medical Services data, see the:

• Medical Services Data Description that contains a brief summary of the content of the data set and information on the Source Agency, Purpose, Years, Type, Size, Data Level, Components, Scope, Data Collection Method, Data Highlights, Data Cautions, Access Requirements, More Information, and Last Updated date;
  
  
• MCHP Metadata Repository - Medical Services - [Internal Access Only] - for technical and programming related information, including an Overview, Data Model, Data Quality, Data Dictionary, Documents and Reports, and Blog.

NOTE: In MCHP research, the Medical Services data has also been referred to as: Physician Claims data, the Medical Services Database, the Medical Claims File, and the Physician Claims File.

Related concepts 

• Adjusted Clinical Group® (ACG®) - Relative Cost Weights
• Adjusted Clinical Groups® (ACG®) - Overview
• Adult Immunizations
• Age as a Research Variable - Known Discrepancies
• Ambulatory Care Sensitive (ACS) Conditions
• Ambulatory Visits
• Arthritis - Measuring Prevalence
• Asthma - Measuring Prevalence
• Attention-Deficit Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder (ASD) - Measuring Treatment Prevalence
• Breast Cancer Screening / Mammography
• Cancer Diagnoses Validity / Agreement In Administrative Health Data
• Cataract Surgery
• Cervical Cancer Screening (Pap test)
• Charlson Comorbidity Index
• Chlamydia - Method of Identification
• Computed Tomography (CT) Imaging
• Conduct Disorder
• Congenital Anomalies
• Congestive Heart Failure (CHF)
• Costing - Low Birth Weight Infants Project
• Costing Methods: An Overview of Costing Health Services in Manitoba
• Costing Using the 1999 Cost List for Manitoba Health Services
• Dementia - Measuring Prevalence
• Dental Surgeries / Dental Extractions to Treat Severe-Early Childhood Caries (S-ECC) in Preschool Children
• Depression - Defining in Administrative Data
• Diabetes - Measuring Prevalence
• Diabetes in Pregnancy - Differentiating Between Maternal Pre-Gestational Diabetes and Gestational Diabetes
• Disability - Data Sources for Measuring Prevalence
• Discrepancies Between MCHP and Manitoba Health Published Reports
• Double Counting
• Elixhauser Comorbidity Index
• Fractures: Case Definitions Using Administrative Data
• Full Time Equivalent (FTE) Physicians - Calculations
• Gonorrhea - Method of Identification
• Human Immunodeficiency Virus (HIV) - Method of Identification
• Hypertension - Measuring Prevalence
• Identifying Obstructive Sleep Apnea (OSA) and Non-OSA Matched Cohorts
• Inflammatory Bowel Disease (IBD) - Defining in Administrative Data
• Intellectual Disability (ID) (Mental Retardation) / Developmental Disability (DD) / Developmental Disorders / Intellectual or Developmental Disability (IDD)
• International Classification of Disease (ICD) Coding in MCHP Data
• Irritable Bowel Syndrome (IBS) - Defining in Administrative Data
• Ischemic Heart Disease (IHD) / Coronary Heart Disease (CHD) - Measuring Prevalence
• Measuring Majority of Care
• Mental Disorder / Mental Health Disorder / Mental Health Illness Classification
• Mood and Anxiety Disorders - Measuring Prevalence
• Morbidity Classification System in Children
• Osteoporosis - Measuring Prevalence
• Patient Allocation Algorithm: Assigning Patients to Physicians, Physician Groups or Clinics
• Physician / Hospital Claims
• Physician Consultation Visits
• Physician Price Index
• Postal Codes and Coding Methods in Manitoba Health Claims Data
• Prenatal Care Visits (PCV) / Prenatal Care (PNC) Visits
• Referral Rates for Primary Care Physicians to Specialists
• Regular Source of Care (RSOC)
• Renal Failure
• Revised-Graduated Prenatal Care Utilization Index (R-GINDEX)
• Routine Electrocardiography - Electrocardiogram (ECG or EKG)
• Service Types, Physician Visits
• Stroke - Measuring Prevalence
• Suicide and Attempted Suicide (Intentional Self Inflicted Injury)
• Syphilis - Method of Identification
• Total Respiratory Morbidity (TRM) - Measuring Prevalence
• Tuberculosis (TB) - Method of Identification
• Undercounting Hospital Visits
• Virtual or Telephone Physician Visits
• Waiting Times for Surgery
• Waiting Times for Surgery - Update to 2007

Related terms 

• Ambulatory Visits - Physician
• Cancer Diagnoses Agreement
• Fee-For-Service (FFS)
• Magnetic Resonance Imaging (MRI) Scans
• Medical Claims
• Physician Claims
• Physician Resource Database
• Shadow Billing
• Specialist Physicians (SP)
• Tariff Rates and Descriptions Data

Links 

• MCHP Data Repository - Medical Services Data Description

References 

• Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I, McDougall C, Boriskewich E. Understanding the Health System Use of Ambulatory Care Patients. Winnipeg, MB: Manitoba Centre for Health Policy, 2013. [Report] [Summary] (View)

Term used in 

• Chateau D, Enns M, Ekuma O, Koseva I, McDougall C, Kulbaba C, Allegro E. Evaluation of the Manitoba IMPRxOVE Program. Winnipeg, MB: Manitoba Centre for Health Policy, 2015. [Report] [Summary] (View)
• Fransoo R, Martens P, The Need to Know Team, Prior H, Burchill C, Koseva I, Bailly A, Allegro E. The 2013 RHA Indicators Atlas. Winnipeg, MB: Manitoba Centre for Health Policy, 2013. [Report] [Summary] [Additional Materials] (View)
• Fransoo R, Martens P, The Need to Know Team, Prior H, Burchill C, Koseva I, Rajotte L. Who is in our Hospitals.and why? Winnipeg, MB: Manitoba Centre for Health Policy, 2013. [Report] [Summary] [Additional Materials] (View)
• Katz A, Chateau D, Bogdanovic B, Taylor C, McGowan K-L, Rajotte L, Dziadek J. Physician Integrated Network: A Second Look. Winnipeg, MB: Manitoba Centre for Health Policy, 2014. [Report] [Summary] [Updates and Errata] (View)
• Martens P, Nickel N, Forget E, Lix L, Turner D, Prior H, Walld R, Soodeen RA, Rajotte L, Ekuma O. The Cost of Smoking: A Manitoba Study. Winnipeg, MB: Manitoba Centre for Health Policy, 2015. [Report] [Summary] [Updates and Errata] [Additional Materials] (View)