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Data sources for validations

Suggest edit Updated on August 31, 2021

The SCE performs data validations on the following codes against the appropriate supporting table. Information on populating the tables can be found in the code set management documentation for the Pega Foundation for Healthcare (PFHC).

The SCE switches between ICD-9 and ICD-10 codes based on the coding format identified on the claim.

CodeTableClass
Tooth codesPr_PegaHC_Data_ToothCodesPegaHC-Data-ToothCodes
ICD-9 Procedure codesProcedureCodePegaHealth-Codes-Data-Procedure-ICD9
ICD-10 Procedure codesICD10PcsPegaHealth-Codes-Data-Procedure-ICD10
HCPCS Procedure codesHCPCS_CODESPegaHealth-Codes-Data-HCPCS
CPT Procedure codesCPT_CODESPegaHealth-Codes-Data-CPT
CDT Procedure codespr_PegaHealth_Codes_Data_CDTPegaHealth-Codes-Data-CDT
Revenue codesREVENUE_CODESPegaHealth-Codes-Data-Revenue
NDC CodesNDC_PACKAGEPegaHealth-Codes-Data-NDC-Package
ICD-9 Diagnosis codesDIAGNOSISPegaHealth-Codes-Data-Diagnosis-ICD9
ICD-10 Diagnosis codesICD10DxPegaHealth-Codes-Data-Diagnosis-ICD10
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