Mart review plan updates

dbt_doc_blocks/column_descriptions.md

@@ -1004,4 +1004,8 @@ Unique year-month of in the dataset computed from eligibility.
 
 {% docs zip_code %}
 The zip code of the record (e.g., facility location, patient, etc).
+{% enddocs %}
+
+{% docs member_month_key %}
+The unique combination of person_id, year_month, payer, plan, and data source.
 {% enddocs %}

models/claims_preprocessing/claims_enrollment/claims_enrollment__flag_claims_with_enrollment.sql

@@ -13,18 +13,13 @@ with claim_dates as(
         , member_id
         , payer
         , {{ quote_column('plan') }}
+        , data_source
         , coalesce(claim_line_start_date, claim_start_date, admission_date) as inferred_claim_start_date
-        , coalesce(claim_line_end_date, claim_end_date, discharge_date) as inferred_claim_end_date
         , case
             when claim_line_start_date is not null then 'claim_line_start_date'
             when claim_line_start_date is null and claim_start_date is not null then 'claim_start_date'
             when claim_line_start_date is null and claim_start_date is null and admission_date is not null then 'admission_date'
         end as inferred_claim_start_column_used
-        , case
-            when claim_line_end_date is not null then 'claim_line_end_date'
-            when claim_line_end_date is null and claim_end_date is not null then 'claim_end_date'
-            when claim_line_end_date is null and claim_end_date is null and discharge_date is not null then 'discharge_date'
-        end as inferred_claim_end_column_used
     from {{ ref('normalized_input__medical_claim') }}
 )
 
@@ -36,11 +31,9 @@ with claim_dates as(
         , member_id
         , payer
         , {{ quote_column('plan') }}
+        , data_source
         , inferred_claim_start_date
-        , inferred_claim_end_date
         , inferred_claim_start_column_used
-        , inferred_claim_end_column_used
-
         , {{ dbt.concat([
                 date_part('year', 'inferred_claim_start_date'),
                 dbt.right(
@@ -51,18 +44,6 @@ with claim_dates as(
                     2
                 )
             ]) }} as inferred_claim_start_year_month
-
-    , {{ dbt.concat([
-            date_part('year', 'inferred_claim_end_date'),
-            dbt.right(
-                dbt.concat([
-                    "'0'",
-                    date_part('month', 'inferred_claim_end_date'),
-                ]),
-                2
-            )
-        ]) }} as inferred_claim_end_year_month
-
 from claim_dates
 
 )
@@ -74,16 +55,15 @@ select distinct
     , claim.member_id
     , claim.payer
     , claim.{{ quote_column('plan') }}
+    , claim.data_source
+    , mm.member_month_key
     , claim.inferred_claim_start_year_month
-    , claim.inferred_claim_end_year_month
     , claim.inferred_claim_start_column_used
-    , claim.inferred_claim_end_column_used
     , cast('{{ var('tuva_last_run')}}' as {{ dbt.type_timestamp() }} ) as tuva_last_run
 from {{ ref('core__member_months')}} mm
 inner join claim_year_month claim
     on mm.person_id = claim.person_id
     and mm.member_id = claim.member_id
     and mm.payer = claim.payer
     and mm.{{ quote_column('plan') }} = claim.{{ quote_column('plan') }}
-    and mm.year_month >= claim.inferred_claim_start_year_month
-    and mm.year_month <= claim.inferred_claim_end_year_month
+    and mm.year_month = claim.inferred_claim_start_year_month

models/claims_preprocessing/claims_enrollment/claims_enrollment__flag_rx_claims_with_enrollment.sql

@@ -0,0 +1,47 @@
+{{ config(
+     enabled = var('claims_preprocessing_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))
+ | as_bool
+   )
+}}
+
+
+with claim_dates as(
+    select
+        claim_id
+        , claim_line_number
+        , person_id
+        , member_id
+        , payer
+        , {{ quote_column('plan') }}
+        , data_source
+        , {{ dbt.concat([
+                date_part('year', 'paid_date'),
+                dbt.right(
+                    dbt.concat([
+                        "'0'",
+                        date_part('month', 'paid_date'),
+                    ]),
+                    2
+                )
+            ]) }} as paid_year_month
+    from {{ ref('normalized_input__pharmacy_claim') }}
+)
+
+select distinct
+     claim.claim_id
+    , claim.claim_line_number
+    , claim.person_id
+    , claim.member_id
+    , claim.payer
+    , claim.{{ quote_column('plan') }}
+    , claim.data_source
+    , mm.member_month_key
+    , claim.paid_year_month
+    , cast('{{ var('tuva_last_run')}}' as {{ dbt.type_timestamp() }} ) as tuva_last_run
+from {{ ref('core__member_months')}} mm
+inner join claim_dates claim
+    on mm.person_id = claim.person_id
+    and mm.member_id = claim.member_id
+    and mm.payer = claim.payer
+    and mm.{{ quote_column('plan') }} = claim.{{ quote_column('plan') }}
+    and mm.year_month = claim.paid_year_month

models/claims_preprocessing/claims_preprocessing_models.yml

@@ -26,6 +26,10 @@ models:
         description: Name of the payer.
       - name: plan
         description: Name of the plan.
+      - name: data_source
+        description: '{{ doc("data_source") }}'
+      - name: member_month_key
+        description: '{{ doc("member_month_key") }}'
       - name: inferred_claim_start_year_month
         description: |
           The claim start date year and month.  If claim line start date is missing then the following column will be used, 
@@ -39,6 +43,35 @@ models:
       - name: inferred_claim_end_column_used
         description: The name of the column used to populated inferred_claim_start_column_used.
 
+  - name: claims_enrollment__flag_rx_claims_with_enrollment
+    description: This table contains pharmacy claims with matching enrollment
+    config:
+      schema: |
+        {%- if var('tuva_schema_prefix',None) != None -%}{{var('tuva_schema_prefix')}}_claims_preprocessing
+        {%- else -%}claims_preprocessing{%- endif -%}
+      alias: flag_rx_claims_with_enrollment
+      tags:
+        - claims_preprocessing
+      materialized: table
+    columns:
+      - name: claim_id
+        description: Unique identifier for each claim.
+      - name: claim_line_number
+        description: >
+          Indicates the line number for the particular line of the claim.
+      - name: person_id
+        description: Unique identifier for each patient in the dataset.
+      - name: payer
+        description: Name of the payer.
+      - name: plan
+        description: Name of the plan.
+      - name: data_source
+        description: '{{ doc("data_source") }}'
+      - name: member_month_key
+        description: '{{ doc("member_month_key") }}'
+      - name: paid_year_month
+        description: the year and month of the date the pharmacy claim was paid.
+
 
 
 ###   Normalized Claim Input Layer

models/core/core_models.yml

@@ -611,6 +611,8 @@ models:
       description: '{{ doc("in_network_flag") }}'
     - name: enrollment_flag
       description: '{{ doc("enrollment_flag") }}'
+    - name: member_month_key
+      description: '{{ doc("member_month_key") }}'
     - name: data_source
       description: '{{ doc("data_source") }}'
     - name: tuva_last_run
@@ -711,6 +713,10 @@ models:
       - core
       materialized: table
     columns:
+    - name: member_month_key
+      description: '{{ doc("member_month_key") }}'
+      tests:
+        - not_null
     - name: person_id
       description: '{{ doc("person_id") }}'
       tests:
@@ -990,6 +996,10 @@ models:
         description: '{{ doc("deductible_amount") }}'
       - name: in_network_flag
         description: '{{ doc("in_network_flag") }}'
+      - name: enrollment_flag
+        description: '{{ doc("enrollment_flag") }}'
+      - name: member_month_key
+        description: '{{ doc("member_month_key") }}'
       - name: data_source
         description: '{{ doc("data_source") }}'
       - name: tuva_last_run

models/core/final/core__member_months.sql

@@ -29,7 +29,6 @@ inner join month_start_and_end_dates b
   and a.enrollment_end_date >= b.month_start_date
 ),
 
-
 add_attribution_fields as (
 select
     a.person_id
@@ -56,6 +55,34 @@ and a.year_month = b.year_month
 and a.payer = b.payer
 and a.{{ quote_column('plan') }} = b.{{ quote_column('plan') }}
 and a.data_source = b.data_source
+),
+
+final_with_sk as (
+select 
+    dense_rank() over (
+      order by 
+        person_id
+      , year_month
+      , payer
+      , {{ quote_column('plan') }}
+      , data_source
+  ) as member_month_key
+  , person_id
+  , member_id
+  , year_month
+  , payer
+  , {{ quote_column('plan') }}
+  , data_source
+  , tuva_last_run
+  , payer_attributed_provider
+  , payer_attributed_provider_practice
+  , payer_attributed_provider_organization
+  , payer_attributed_provider_lob
+  , custom_attributed_provider
+  , custom_attributed_provider_practice
+  , custom_attributed_provider_organization
+  , custom_attributed_provider_lob
+from add_attribution_fields
 )
 
-select * from add_attribution_fields
+select * from final_with_sk

models/core/staging/core__stg_claims_medical_claim.sql

@@ -104,6 +104,7 @@ select
         when enroll.claim_id is not null then 1
             else 0
     end as int) as enrollment_flag
+    , enroll.member_month_key
     , cast(med.data_source as {{ dbt.type_string() }} ) as data_source
     , cast('{{ var('tuva_last_run')}}' as {{ dbt.type_timestamp() }} ) as tuva_last_run
 from {{ ref('normalized_input__medical_claim') }} as med
@@ -116,4 +117,8 @@ inner join all_encounters as x
   and med.claim_line_number = x.claim_line_number
 left join {{ ref('claims_enrollment__flag_claims_with_enrollment') }} as enroll
   on med.claim_id = enroll.claim_id
-  and med.claim_line_number = enroll.claim_line_number
+  and med.claim_line_number = enroll.claim_line_number
+  and med.person_id = enroll.person_id
+  and med.payer = enroll.payer
+  and med.{{ quote_column('plan') }} = enroll.{{ quote_column('plan') }}
+  and med.data_source = enroll.data_source

models/core/staging/core__stg_claims_pharmacy_claim.sql

@@ -10,36 +10,49 @@
 
 select
     {{ dbt.concat([
-        "cast(claim_id as " ~ dbt.type_string() ~ ")",
+        "cast(pharm.claim_id as " ~ dbt.type_string() ~ ")",
         "'-'",
-        "cast(claim_line_number as " ~ dbt.type_string() ~ ")",
+        "cast(pharm.claim_line_number as " ~ dbt.type_string() ~ ")",
         "'-'",
-        "cast(data_source as " ~ dbt.type_string() ~ ")"
+        "cast(pharm.data_source as " ~ dbt.type_string() ~ ")"
          ]) }} as pharmacy_claim_id
-       , cast(claim_id as {{ dbt.type_string() }} ) as claim_id
-       , cast(claim_line_number as integer ) as claim_line_number
-       , cast(person_id as {{ dbt.type_string() }} ) as person_id
-       , cast(member_id as {{ dbt.type_string() }} ) as member_id
-       , cast(payer as {{ dbt.type_string() }} ) as payer
-       , {{ quote_column('plan') }}
-       , cast(prescribing_provider_id as {{ dbt.type_string() }} ) as prescribing_provider_id
-       , cast(prescribing_provider_name as {{ dbt.type_string() }} ) as prescribing_provider_name
-       , cast(dispensing_provider_id as {{ dbt.type_string() }} ) as dispensing_provider_id
-       , cast(dispensing_provider_name as {{ dbt.type_string() }} ) as dispensing_provider_name
-       , cast(dispensing_date as date ) as dispensing_date
-       , cast(ndc_code as {{ dbt.type_string() }} ) as ndc_code
-       , cast(ndc_description as {{ dbt.type_string() }} ) as ndc_description
-       , cast(quantity as integer ) as quantity
-       , cast(days_supply as integer ) as days_supply
-       , cast(refills as integer ) as refills
-       , cast(paid_date as date ) as paid_date
-       , cast(paid_amount as {{ dbt.type_numeric() }}) as paid_amount
-       , cast(allowed_amount as {{ dbt.type_numeric() }} ) as allowed_amount
-       , cast(charge_amount as {{ dbt.type_numeric() }} ) as charge_amount
-       , cast(coinsurance_amount as {{ dbt.type_numeric() }} ) as coinsurance_amount
-       , cast(copayment_amount as {{ dbt.type_numeric() }} ) as copayment_amount
-       , cast(deductible_amount as {{ dbt.type_numeric() }} ) as deductible_amount
-       , cast(in_network_flag as int ) as in_network_flag
-       , cast(data_source as {{ dbt.type_string() }} ) as data_source
+       , cast(pharm.claim_id as {{ dbt.type_string() }} ) as claim_id
+       , cast(pharm.claim_line_number as integer ) as claim_line_number
+       , cast(pharm.person_id as {{ dbt.type_string() }} ) as person_id
+       , cast(pharm.member_id as {{ dbt.type_string() }} ) as member_id
+       , cast(pharm.payer as {{ dbt.type_string() }} ) as payer
+       , pharm.{{ quote_column('plan') }}
+       , cast(pharm.prescribing_provider_id as {{ dbt.type_string() }} ) as prescribing_provider_id
+       , cast(pharm.prescribing_provider_name as {{ dbt.type_string() }} ) as prescribing_provider_name
+       , cast(pharm.dispensing_provider_id as {{ dbt.type_string() }} ) as dispensing_provider_id
+       , cast(pharm.dispensing_provider_name as {{ dbt.type_string() }} ) as dispensing_provider_name
+       , cast(pharm.dispensing_date as date ) as dispensing_date
+       , cast(pharm.ndc_code as {{ dbt.type_string() }} ) as ndc_code
+       , cast(pharm.ndc_description as {{ dbt.type_string() }} ) as ndc_description
+       , cast(pharm.quantity as integer ) as quantity
+       , cast(pharm.days_supply as integer ) as days_supply
+       , cast(pharm.refills as integer ) as refills
+       , cast(pharm.paid_date as date ) as paid_date
+       , cast(pharm.paid_amount as {{ dbt.type_numeric() }}) as paid_amount
+       , cast(pharm.allowed_amount as {{ dbt.type_numeric() }} ) as allowed_amount
+       , cast(pharm.charge_amount as {{ dbt.type_numeric() }} ) as charge_amount
+       , cast(pharm.coinsurance_amount as {{ dbt.type_numeric() }} ) as coinsurance_amount
+       , cast(pharm.copayment_amount as {{ dbt.type_numeric() }} ) as copayment_amount
+       , cast(pharm.deductible_amount as {{ dbt.type_numeric() }} ) as deductible_amount
+       , cast(pharm.in_network_flag as int ) as in_network_flag
+       , cast(
+       case
+           when enroll.claim_id is not null then 1
+              else 0
+       end as int) as enrollment_flag
+       , enroll.member_month_key
+       , cast(pharm.data_source as {{ dbt.type_string() }} ) as data_source
        , '{{ var('tuva_last_run')}}' as tuva_last_run
-from {{ ref('normalized_input__pharmacy_claim') }}  pharm
+from {{ ref('normalized_input__pharmacy_claim') }}  pharm
+left join {{ ref('claims_enrollment__flag_rx_claims_with_enrollment') }} as enroll
+  on pharm.claim_id = enroll.claim_id
+  and pharm.claim_line_number = enroll.claim_line_number
+  and pharm.person_id = enroll.person_id
+  and pharm.payer = enroll.payer
+  and pharm.{{ quote_column('plan') }} = enroll.{{ quote_column('plan') }}
+  and pharm.data_source = enroll.data_source

models/data_quality/dqi/mart_review/final/mart_review__claims_with_enrollment.sql

@@ -8,20 +8,24 @@ with enrollment_stage as(
 SELECT
     mc.data_source,
     mc.year_month,
+    mc.payer,
+    mc.{{ quote_column('plan') }},
     SUM(CASE WHEN mm.person_id IS NOT NULL THEN 1 ELSE 0 END) AS claims_with_enrollment,
     COUNT(*) AS claims
 FROM {{ ref('mart_review__stg_medical_claim') }} mc
 LEFT JOIN {{ ref('core__member_months')}} mm
-    ON mc.person_id = mm.person_id
-    AND mc.data_source = mm.data_source
-    AND mc.year_month = mm.year_month
+    ON mc.member_month_key = mm.member_month_key
 GROUP BY mc.data_source
 , mc.year_month
+, mc.payer
+, mc.{{ quote_column('plan') }}
 )
 
 select
     data_source
     , year_month
+    , payer
+    , {{ quote_column('plan') }}
     , claims_with_enrollment
     , claims
     , cast(claims_with_enrollment / claims as {{ dbt.type_numeric()}} ) AS percentage_claims_with_enrollment