Administrative Claims Databases

Claims systems are an important source for service utilization data, offering large sample sizes across a geographically dispersed population, identifiable at the state, county, and postal zip code level. Health insurance claims databases may also capture eye care services provided outside the scope of ophthalmology and optometry, such as services provided by general practitioners, pediatricians, and other specialists, or services provided in emergency department or inpatients settings. However, a fundamental limitation of claims data is that these are principally payment records and are based on diagnostic coding that may be driven by reimbursement concerns, thus may or may not always accurately reflect the true medical condition. For more information, please visit the Review of Claims and Registries Report [PDF – 870 KB].

Administrative claims databases include insurance claims and payment information. VEHSS plans to include the following five claims databases:

Highlighted Coverage Area
Coverage areas for Administrative Claims Databases
Medicare Medicaid MarketScan VSP Military Health System
Nationally Representative Partial No No No No
Geographic Representation
State Representation Yes Yes Partial Yes Partial
County Representation Yes Yes Partial Partial Partial
Patient Groups
Age 0-65 Partial Yes Yes Yes Yes
Age 65+ Yes Partial Partial Yes Partial
Undiagnosed Patients No No No No No
Uninsured Patients No No No Partial No
Care Type and Setting
Vision Services No Partial No Yes Yes
Eye Care Yes Yes Yes Partial Yes
Other Medical Yes Yes Yes No Yes
All Medical Diagnoses Yes Yes Yes No Yes
Risk Factors Yes Yes Yes Partial Yes
Uncorrected Acuity No No No No Partial
Corrected Acuity No No No Partial Partial