Creating a computerized database from administrative claims data

The creation of a computerized database from Medicaid administrative claims data for research purposes is described. Researchers should consult with computer experts at their institution befor e selecting software for data manipulation and conversion. It is essential to have an accurate layout of the file record before attempting to convert raw claims data into data sets or other data formats. The location of data elements within the claim will vary depending on whether the record comes f rom a provider, an institution, or a pharmacy. Each claim contains a common header, a variable header, and a claim detail section. The difficulty in a nalyzing data elements within a claim detail lies in locating the starting point of the claim detail section. So that data elements not in character o r numeric formats can be converted, the file record layout must describe th e exact format of each data element and its COBOL notation. A data element dictionary is necessary for translating data element ceding into usable dat a. Data elements not necessary for any planned analysis must be eliminated. The data are then "cleaned" to remove any denied or reversed claims and cl aims that contain incomplete or erroneous data. Regardless of the format data are obtained in, an accurate file record layo ut and a data element dictionary are essential to the conversion of adminis trative claims data into a computerized database far data analysis and rese arch purposes.