Healthcare Data Guides

EDI Transactions Overview

837, 835, 270/271 healthcare EDI standards with database schemas and SQL.

EDI 837 Claims Guide

837P vs 837I, staging DDL, Snowflake schema, dbt models, and denial SQL.

EDI 835 Remittance Guide

ERA staging DDL, CARC/RARC lookup tables, and payment reconciliation SQL.

EDI 270/271 Eligibility Guide

Real-time eligibility staging DDL, response parsing, and Snowflake schema.

EDI 277 Claim Status Guide

Claim status staging DDL, 837-to-277 reconciliation SQL, dbt models.

Claims Adjudication

Claims processing logic, payment workflows, and adjudication database design.

Medical Billing & Revenue Cycle

Claims processing, revenue cycle management, and billing data standards.

Prior Authorization

Authorization approval workflows, data models, and utilization management.

Carrier Payment Data Standards

Carrier payment data standards, remittance, and payer data models.

ICD-10 Codes

ICD-10-CM diagnosis codes, database design, code structure, and billing integration.

CPT Codes

CPT codes, modifiers, RVUs, database design, and healthcare billing standards.

DRG Codes

Diagnosis Related Groups, hospital payment, MS-DRG weights, and case mix.

LOINC Codes

Laboratory and clinical observation codes, database design, and integration.

SNOMED CT

Clinical terminology standard, concept hierarchy, and database integration.

RxNorm

Medication terminology, drug naming standards, and pharmacy data integration.

NDC Codes

National Drug Code structure, FDA integration, and drug product identification.

NPI Guide

National Provider Identifier, database design, taxonomy, and lookup methods.

Provider Credentialing

Provider verification, enrollment, credentialing data models, and workflows.

EHR Systems

Electronic health records architecture, data standards, and integration patterns.

EMR vs EHR

Electronic medical vs health records comparison, data models, and migration.

Epic Clarity Data Model

Clarity vs Chronicles vs Cogito, key tables, SQL patterns, dbt models, and Snowflake integration.

Closed System Transfer Devices

CSTD standards, pharmacy safety data, and device tracking models.

HCC Risk Adjustment

Hierarchical Condition Categories, RAF scores, and Medicare Advantage payment.

Medicare STAR Ratings

CMS star ratings, quality measures, bonus payments, and MA plan performance.

Medicare & Medicaid

Payer data models, eligibility, enrollment, and government program standards.

HEDIS Measures

Quality metrics, NCQA reporting, measure logic, and data requirements.

IBNR & Claims Reserves

Incurred but not reported claims, actuarial reserves, and data models.

Pharmacy Benefits (PBM)

Formulary management, PBM data standards, and pharmacy benefit analytics.

Dispensing Data Standards

Pharmacy dispensing data, prescription records, and medication fulfillment.

Medication Decision Support

Clinical decision support for medications, drug interactions, and allergy alerts.

HL7 FHIR

Healthcare interoperability standard, FHIR resources, APIs, and data exchange.

HIPAA Compliance

Privacy and security standards, PHI/PII handling, and compliance data models.

Product Identification Standards

NDC, UPC, GTIN standards for medical product data and supply chain.

Healthcare Analytics

Data warehouse design, BI architecture, and analytics for healthcare data teams.

Dimensional Modeling for Healthcare

Star schema, fact and dimension tables, SCD Type 2, conformed dimensions, and dbt patterns for healthcare data warehouses.

Snowflake for Healthcare Data

HIPAA-compliant schema design, PHI security controls, virtual warehouse sizing, data sharing, and dbt patterns.

dbt for Healthcare Data Engineering

Project structure, staging models, HEDIS measure logic, PHI handling, ISO-11179 naming, and production deployment patterns.

Databricks for Healthcare Data

Unity Catalog PHI governance, Delta Lake, medallion architecture, HIPAA compliance, and dbt integration patterns.

Care Management

Care plans, patient coordination, case management data models, and analytics.

Social Determinants of Health

SDOH data standards, screening tools, and population health data integration.