Unlocking the Potential of Claims Data Insights in Healthcare data solutions in Microsoft Fabric

As part of the continuous innovation within healthcare data solutions in Microsoft Fabric, we are excited to introduce our CMS Claims data transformations capability. This feature specifically tailored to handle CMS CCLF formats. By ingesting, CMS Claims data into healthcare data solutions enables customers to assess the effectiveness of their care management programs, monitor population-level trends and utilization, also and measure their performance against benchmarks to reduce overall claim expenses and improve patient care. 

Leveraging the Medallion Lakehouse architecture, this feature allows healthcare organizations to seamlessly integrate claims data into the unified data platform provided in Microsoft Fabric. This solution supports scalable data ingestion and transformation workflows that convert claims data into tabular shapes, promoting efficient healthcare delivery and decision-making. 

The Medallion Lakehouse for Claims Data  

The Medallion Lakehouse architecture for claims data is built on the foundational layers of Microsoft Fabric’s healthcare data solutions. This architecture is designed to support the ingestion, transformation, and analysis of healthcare claims data. It comprises three fundamental layers: 

• Bronze (Raw Zone): The first layer stores raw claims data in its original CCLF format. This raw zone acts as a staging area where files are ingested directly into the Lakehouse, maintaining the data’s original integrity. It supports native and compressed file types of the claims format, ensuring compatibility and flexibility in data processing. 

• Silver (Enriched Zone): This intermediate layer focuses on processing and enriching the raw claims data by transforming it into structured formats based on the FHIR specifications. It leverages data transformation tools to parse and map the claims data into FHIR financial resources, storing the transformed data in a format optimized for querying and analysis. 

• Gold (Curated Zone): The final layer aggregates the enriched data to create a highly curated dataset, optimized for reporting and analytics. In this zone, the data is further transformed into OMOP CDM (Observational Medical Outcomes Partnership Common Data Model) or a custom data model. The mapping ensures compatibility with various analytical and machine-learning models that healthcare organizations might deploy for deeper insights.  

Conceptual architecture 

The volume and complexity of claims data often require robust solutions to manage and extract valuable insights efficiently. Microsoft Fabric’s Medallion Lakehouse provides a comprehensive approach to handling these needs, offering three distinct ingestion patterns based on organizational requirements and existing data infrastructure: 

Conceptual architecture and ingestion patterns of the claims data transformations

End to End execution steps 

Step 1: Create a workspace and add health solutions capability. 

Creation of healthcare solution in Fabric workspace

Step 2: Setup healthcare data solutions on your Fabric workspace. Follow the guidance from the deployment wizard and add sample data if needed. 

Step 3: Select the CMS claims data transformations capability and click on Deploy.

Deployment of Claims data transformation

Step 4: Upload the CCLF files in following folder structure Ingest\Claims\CCLF\<namespace> 

Ingest folder structure to upload the CCLF files

Step 5: Run the claims data pipeline to transform the data from the Bronze Lakehouse to Silver Lakehouse. 

Data pipeline run from Bronze to Silver Lakehouse

Step 6: To validate the ingested and transformed data, check the ExplanationOfBenefits table to view the data 

The CMS claims data transformations capability within Microsoft Fabric’s Medallion Lakehouse architecture offers a powerful and scalable solution for healthcare organizations to integrate, manage, and analyse claims data effectively. By transforming raw claims data into FHIR, healthcare data solutions in Microsoft Fabric enables seamless interoperability and supports advanced analytics, providing a robust foundation for enhanced healthcare delivery and operational efficiency. 

For further details and documentation, Overview of CMS claims data transformations(preview)

FHIR® is a registered trademark of Health Level Seven International, registered in the U.S. Trademark Office, and is used with their permission.   

Medical device disclaimer: Microsoft products and services (1) are not designed, intended or made available as a medical device, and (2) are not designed or intended to be a substitute for professional medical advice, diagnosis, treatment, or judgment and should not be used to replace or as a substitute for professional medical advice, diagnosis, treatment, or judgment. Customers/partners are responsible for ensuring solutions comply with applicable laws and regulations.