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Classification Level Data Class Data Class Description Data Element Data Element Description Applicable Standards Submitter Name Submitter Organization Submission Date
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Claim Service Start Date

Date on which services began.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Drug Cost

Price paid for the drug excluding mfr discounts. It is the sum of the following components:ingredient cost, dispensing fee, sales tax, and vaccine administration fee.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Line Amount Paid by Patient

Medical: The amount paid by the member at the point of service.
Pharmacy: Amount that is calculated by the processor and returned to the pharmacy as the total amount to be paid by the patient to the pharmacy; the patient’s total cost share, including copayments, amounts applied to deductible, over maximum amounts, penalties, etc

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Laboratory

Analysis of clinical specimens to obtain information about the health of a patient.

 Test Kit Unique Device Identifier Uniquely identifies the type of test (at minimum by using test name and manufacturer (similar to the make and model of a car)) that was used to obtain the Test Result Value. It is a device identifier and should be referenced using Device Identifiers (DI), when available. The DI is contained within the unique device identifier (UDI), created by manufacturer (Manufacturer requests UDI issuance, then provides DI, or can be pulled from GUDID database (https://accessgudid.nlm.nih.gov/) Riki Merrick Association of Public Health Laboratories
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Line Discount Amount

The amount of the discount.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Line Payment Amount

The amount sent to the payee from the health plan. This amount is to exclude any member cost sharing. It should include the total of member and provider payments.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Compound Code

The code indicating whether or not the prescription is a compound. NCPDP field # 406-D6

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Benefit Payment Status

Indicates the in network or out of network payment status of the claim.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Quantity Qualifier Code

The unit of measurement for the drug. (gram, ml, etc.).

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Pregnancy Information Pregnancy Intention Screening

Screening patient for their desire to become pregnant in the next 12 months in order to determine which reproductive health services may be relevant to offer the patient in that encounter.

Pregnancy Intention Screening Question: Pregnancy intention in the next year - Reported
LOINC:86645-9
Example answer list:
Answer
Yes, I want to become pregnant; LA26438-4
I'm OK either way; LA26439-2
No, I don't want to become pregnant; LA26440-0
Unsure; LA14072-5

SNOMEDCT response option value set OID: 2.16.840.1.113762.1.4.1166.22

 Emily Decker Upstream USA
Level 0 Travel Information Purpose of Travel

Purpose of travel (business, tourism, etc.)

HL7 FHIR: US Public Health Travel History profile (Observation.component)

HL7 CDA: Purpose of Travel Observation template

SNOMED: 280147009 "Travel Purpose"

PHIN VADS Value Set: PHVS_TravelPurpose_CDC

 Nedra Garrett CDC
Level 0 Travel Information Transportation Details

Information about transportation details such as the type of transport along with any associated information (e.g., name of cruise ship, flight number, airport, seat number, cabin number).

HL7 FHIR: US Public Health Transportation Details profile

HL7 CDA: Transportation Details Organizer/Transportation Details Observation templates

VSAC Value Set: Transport vehicle type

 Nedra Garrett CDC
Level 0 Social Determinants of Health Self-Identified Need for Contraception (SINC)

Self-Identified Need for Contraception screening tool for primary care settings.

Self-Identified Need for Contraception (SINC) LOINC: 98076-3
Example answer list:
Yes (qualifier value) LA33-6
No - I do not want to talk about contraception today because I am here for something else; LA32389-1
No - This question does not apply to me/I prefer not to answer; LA32390-9
No - I am already using contraception; LA32393-3
No - I am unsure or don't want to use contraception; LA32391-7
No - I am hoping to become pregnant in the near future; LA32392-5

 Dr. Christine Dehlendorf Person-Centered Reproductive Health Program, Family and Community Medicine, University of California, San Francisco
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Quantity Dispensed

Quantity dispensed for the drug.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Place of Service Code

Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Nutrition and Diet Eating/drinking assistive device External devices that are designed, made, or adapted to assist a person with eating and/or drinking

HL7 Version 2 – ODS – Dietary orders, supplements, and preferences (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=185) HL7 Version 3 Standard: Orders; Diet and Nutrition, Release 1 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=317) HL7 FHIR NutritionOrder (https://www.hl7.org/fhir/nutritionorder.html) In addition, many there are many nutrition-related terms in SNOMED CT. Many of these terms have been put in value sets in VSAC or through HL7 terminology. Here are some examples: Diet Type (OID 2.16.840.1.113883.4.642.3.385) – HL7 terminology Nutrient Modifier (OID 2.16.840.1.113883.4.642.3.386) – HL7 terminology Nutrition Supplement (OID 2.16.840.1.113883.4.642.3.390) – HL7 terminology Enteral Nutrition Type (OID 2.16.840.1.113883.4.642.3.391) – HL7 terminology Enteral Nutrition Additive (OID 2.16.840.1.113883.4.642.3.392) – HL7 terminology Food Allergies and Intolerance (OID 2.16.840.1.113762.1.4.1186.3) - VSAC Feeding Device Grouping (OID 2.16.840.1.113762.1.4.1095.87) - VSAC

 Becky Gradl Academy of Nutrition and Dietetics
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Service to Date

Date on which services ended. Located on CMS 1500 (Form Locator 24A)

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Type of Service

High level classification of services into logical grouping.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 Allowed Number of Units

The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners
Level 0 Explanation of Benefit

Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

 National Drug Code

National Drug Code (NDC), or if the prescription is a compound, the value 'Compound'

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

 Mark Roberts Leavitt Partners