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In-depth guides, tutorials, and best practices for database design, data architecture, and healthcare data modeling.
11 articles
Showing 1–6 of 11 posts
HCC risk adjustment determines how much revenue a health plan receives for each Medicare Advantage member. The data model behind it — from diagnosis code ingestion to RAF score calculation — is one of the most consequential schemas a payer data engineer will build.
Invalid NPI numbers in your provider table silently break claims routing, credentialing workflows, and CMS submissions. This guide covers validation approaches, NPPES enrichment patterns, and SQL queries for catching NPI data quality problems before they reach production.
HEDIS measure calculation is deceptively complex. NCQA technical specifications are hundreds of pages long, source data comes from four different systems, and one logic error can affect thousands of members. Here is how to build a pipeline that holds up to NCQA audit.
Prior authorization is one of the most operationally complex workflows in healthcare — and one of the most data-intensive. Here is the end-to-end data model, from PA request through appeal.
SDOH data is increasingly required for quality reporting, care management, and value-based contracts — but most warehouses treat it as an afterthought. Here is a practical data model that makes SDOH analytically useful.
Duplicate patient records, fragmented provider directories, and inconsistent plan data are MDM failures. Here is how to design MDM architecture for the three core healthcare domains.
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