Healthcare Payments Data (HPD) Services Report

This dataset contains data for the Healthcare Payments Data (HPD) Services report. The term "Services" refers to individual procedures reported on the service lines of healthcare claims in California, categorized using the Restructured Berenson-Eggers Type of Services (BETOS) Classification System (RBCS) from the Centers for Medicare & Medicaid Services (CMS). The data in the report includes three main metrics: Total services, the total member count, and the service rate per 1,000 members. Total services represents the total number of services received by members during the reporting year. The member count reports the total number of unique individuals who received at least one service during the reporting year. The service rate per 1,000 members is calculated by dividing the total number of services during the reporting year by the total sum of monthly member enrollments (provided in the data) and multiplying the result by 12,000. The metrics can be grouped by year, age, sex (assigned at birth), county of residence (including an option for Los Angeles Service Planning Areas, or SPAs), Covered California Region, and payer. Users can choose to view the data at two different levels. The most aggregate level groups the data by the eight main RBCS categories: Anesthesia, Durable Medical Equipment (DME), Evaluation and Management (E&M), Imaging, Procedure, Test, Treatment and Other. The second level breaks the eight aggregate RBCS categories into more specific subcategories. Data files are provided for each choice.

This dataset contains data for the Healthcare Payments Data (HPD) Services report. The term "Services" refers to individual procedures reported on the service lines of healthcare claims in California, categorized using the Restructured Berenson-Eggers Type of Services (BETOS) Classification System (RBCS) from the Centers for Medicare & Medicaid Services (CMS). The data in the report includes three main metrics: Total services, the total member count, and the service rate per 1,000 members. Total services represents the total number of services received by members during the reporting year. The member count reports the total number of unique individuals who received at least one service during the reporting year. The service rate per 1,000 members is calculated by dividing the total number of services during the reporting year by the total sum of monthly member enrollments (provided in the data) and multiplying the result by 12,000. The metrics can be grouped by year, age, sex (assigned at birth), county of residence (including an option for Los Angeles Service Planning Areas, or SPAs), Covered California Region, and payer. Users can choose to view the data at two different levels. The most aggregate level groups the data by the eight main RBCS categories: Anesthesia, Durable Medical Equipment (DME), Evaluation and Management (E&M), Imaging, Procedure, Test, Treatment and Other. The second level breaks the eight aggregate RBCS categories into more specific subcategories. Data files are provided for each choice.