CMS TEAM Data Readiness Suite
Executive Overview: Data-Driven Transformation
The Transforming Episode Accountability Model (TEAM) requires hospitals to accept financial accountability for specific surgical episodes. Success depends on accurately extracting data from EDI 837 (Claims) and EDI 835 (Remittance) files to reconcile payments, identify anchor stays, and track quality metrics. This dashboard highlights the critical data categories required for participation.
Episode Mix Distribution
Requires extraction of 'Principal Diagnosis' & 'Procedure Code'
Claim Cost Components
Requires extraction of 'Allowed Amt' (AMT Segment) & 'Line Item Charge' (Loop 2400)
Capture Patient MBI and Admission Date from Loop 2010BA/2300 to anchor episodes.
Use Attending Provider NPI (Loop 2310A) to attribute costs to specific surgeons.
Match Claim Control Numbers (CLN) between 837 submissions and 835 payments.
EDI 837I Data Element Dictionary
A comprehensive map of the specific EDI X12 segments needed for TEAM reporting. Use the filters below to locate specific data elements within the complex 837 Institutional file structure.
Episode Definitions & Trigger Logic
TEAM episodes are triggered by specific MS-DRGs and Procedure codes found in the Loop 2300 HI Segment (Principal Diagnosis) and Loop 2400 SV1 Segment (Procedures). Select an episode type to see the data requirements.
Implementation Checklist
Track your organization's progress in extracting and validating the necessary fields.