Dataset: California Independent Medical Review Dataset

About this Dataset

California Independent Medical Review Dataset

This data is from the California Department of Managed Health Care (DMHC). It contains all decisions from Independent Medical Reviews (IMR) administered by the DMHC since January 1, 2001. An IMR is an independent review of a denied, delayed, or modified health care service that the health plan has determined to be not medically necessary, experimental/investigational or non-emergent/urgent. If the IMR is decided in an enrollee's favor, the health plan must authorize the service or treatment requested.

Data Description

Field Name	Description	Data type
Reference ID	Unique identifier for the case	Plain Text
Report Year	Year the case was reported	Number
Diagnosis Category	The main diagnosis category	Plain Text
Diagnosis Sub Category	The secondary diagnosis category	Plain Text
Treatment Category	The main treatment category	Plain Text
Treatment Sub Category	The secondary treatment category	Plain Text
Determination	Indicates if the determination was upheld or overturned	Plain Text
Type	Indicates the type of case (Experimental/Investigational, Urgent Care, Medical Necessity)	Plain Text
Age Range	The age of the patient	Number
Patient Gender	The gender of the patient	Plain Text
Findings	A summary of the case findings	Plain Text

Image Credit - Moondance from Pixabay

Tables

Independent Medical Reviews

@kaggle.prasad22_ca_independent_medical_review.independent_medical_reviews

9.57 MB
19245 rows
11 columns


CREATE TABLE independent_medical_reviews (
  "reference_id" VARCHAR,
  "report_year" BIGINT,
  "diagnosis_category" VARCHAR,
  "diagnosis_sub_category" VARCHAR,
  "treatment_category" VARCHAR,
  "treatment_sub_category" VARCHAR,
  "determination" VARCHAR,
  "type" VARCHAR,
  "age_range" VARCHAR,
  "patient_gender" VARCHAR,
  "findings" VARCHAR
);