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This tool does not predict payer actions. It highlights statistical variance patterns that may warrant clearer documentation.
Module intelligence
Boundary Differential v1
State-border proxy for payment and volume differentials with DQ sensitivity labels. Use this page to confirm readiness, cross-state checks, and implementation fit. Readiness: Ready.
These metrics measure statistical consistency, not clinical appropriateness.
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Module: boundaryCross-state readiness check: PassedReadiness: ReadyProduction-ready: Yes
Maturity
Shipped
Readiness
Ready
Cross-state readiness
Passed
Coverage rows
82,310
Module details
This module ID is boundary, and the data package type is boundary_code_diff_v1.
The transform version is boundary-code-diff-v1, generated 2/18/2026, 5:17:39 PM.
The production-ready flag is Yes.
The primary buyers are State Medicaid directors, Managed care network teams.
The roadmap document is docs/prd/medicaid-intelligence-platform-breakthrough.md.
Release file path public/data/medicaid/derived/v1/latest/boundary_code_diff_v1_manifest.json
Published data path public/data/medicaid/derived/v1/latest/boundary_code_diff_v1.csv
Module API route /api/medicaid/intelligence/module/boundary.json
Data sample
| boundary_id | boundary_type | state_side_a | state_side_b | claim_month | hcpcs_code | window_miles | fragility_score | fragility_band | total_paid_side_a | total_paid_side_b | total_claims_side_a | total_claims_side_b | total_beneficiaries_side_a | total_beneficiaries_side_b | paid_per_claim_side_a | paid_per_claim_side_b | paid_per_claim_diff_pct | claim_volume_diff_pct | paid_total_diff_pct | source_rows_side_a | source_rows_side_b | dq_sensitivity | limitation | snapshot_id | dq_gate_version |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NC-VA | state_border | NC | VA | 2018-01 | 01916 | 30 | 21.0 | Sensitive | 511.26 | 2849.08 | 107.0 | 125.0 | 59.0 | 86.0 | 4.778131 | 22.79264 | 130.678313 | 15.517241 | 139.141873 | 3 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| AL-TN | state_border | AL | TN | 2018-01 | 0518F | 30 | 36.0 | Fragile | 0.0 | 0.0 | 229.0 | 103.0 | 189.0 | 101.0 | 0.0 | 0.0 | 0.0 | -75.903614 | 0.0 | 7 | 1 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| LA-TX | state_border | LA | TX | 2018-01 | 0518F | 30 | 36.0 | Fragile | 0.0 | 0.0 | 727.0 | 148.0 | 299.0 | 139.0 | 0.0 | 0.0 | 0.0 | -132.342857 | 0.0 | 3 | 7 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| TN-VA | state_border | TN | VA | 2018-01 | 0518F | 30 | 36.0 | Fragile | 0.0 | 0.0 | 103.0 | 490.0 | 101.0 | 252.0 | 0.0 | 0.0 | 0.0 | 130.522766 | 0.0 | 1 | 9 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| CA-OR | state_border | CA | OR | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.02 | 3065.0 | 105.0 | 2837.0 | 91.0 | 0.0 | 0.00019 | 200.0 | -186.750789 | 200.0 | 78 | 4 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| GA-NC | state_border | GA | NC | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 185.0 | 177.0 | 142.0 | 160.0 | 0.0 | 0.0 | 0.0 | -4.41989 | 0.0 | 2 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| GA-TN | state_border | GA | TN | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 185.0 | 292.0 | 142.0 | 220.0 | 0.0 | 0.0 | 0.0 | 44.863732 | 0.0 | 2 | 6 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IL-KY | state_border | IL | KY | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.01 | 136.0 | 674.0 | 130.0 | 568.0 | 0.0 | 1.5e-05 | 200.0 | 132.839506 | 200.0 | 1 | 12 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IL-MI | state_border | IL | MI | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 136.0 | 2728.0 | 130.0 | 2312.0 | 0.0 | 0.0 | 0.0 | 181.005587 | 0.0 | 1 | 18 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IL-WI | state_border | IL | WI | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 136.0 | 167.0 | 130.0 | 106.0 | 0.0 | 0.0 | 0.0 | 20.462046 | 0.0 | 1 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| KY-OH | state_border | KY | OH | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.01 | 0.0 | 674.0 | 3744.0 | 568.0 | 3029.0 | 1.5e-05 | 0.0 | -200.0 | 138.976913 | -200.0 | 12 | 41 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| KY-TN | state_border | KY | TN | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.01 | 0.0 | 674.0 | 292.0 | 568.0 | 220.0 | 1.5e-05 | 0.0 | -200.0 | -79.089027 | -200.0 | 12 | 6 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| MI-OH | state_border | MI | OH | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 2728.0 | 3744.0 | 2312.0 | 3029.0 | 0.0 | 0.0 | 0.0 | 31.396786 | 0.0 | 18 | 41 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| MI-WI | state_border | MI | WI | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 2728.0 | 167.0 | 2312.0 | 106.0 | 0.0 | 0.0 | 0.0 | -176.925734 | 0.0 | 18 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| NC-TN | state_border | NC | TN | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 177.0 | 292.0 | 160.0 | 220.0 | 0.0 | 0.0 | 0.0 | 49.040512 | 0.0 | 3 | 6 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| NJ-NY | state_border | NJ | NY | 2018-01 | 1000F | 30 | 34.0 | Fragile | 0.0 | 0.0 | 334.0 | 7642.0 | 287.0 | 7196.0 | 0.0 | 0.0 | 0.0 | 183.249749 | 0.0 | 7 | 161 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| MI-OH | state_border | MI | OH | 2018-01 | 1003F | 30 | 56.0 | Fragile | 0.0 | 0.0 | 667.0 | 136.0 | 578.0 | 133.0 | 0.0 | 0.0 | 0.0 | -132.254047 | 0.0 | 6 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| NC-TN | state_border | NC | TN | 2018-01 | 1003F | 30 | 56.0 | Fragile | 0.0 | 0.0 | 143.0 | 117.0 | 139.0 | 96.0 | 0.0 | 0.0 | 0.0 | -20.0 | 0.0 | 3 | 3 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IN-OH | state_border | IN | OH | 2018-01 | 1006F | 30 | 47.0 | Fragile | 0.0 | 0.0 | 175.0 | 246.0 | 108.0 | 198.0 | 0.0 | 0.0 | 0.0 | 33.729216 | 0.0 | 6 | 8 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| LA-TX | state_border | LA | TX | 2018-01 | 1006F | 30 | 47.0 | Fragile | 0.0 | 0.0 | 335.0 | 320.0 | 174.0 | 252.0 | 0.0 | 0.0 | 0.0 | -4.580153 | 0.0 | 6 | 8 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IL-KY | state_border | IL | KY | 2018-01 | 1055F | 30 | 97.0 | Fragile | 0.06 | 0.0 | 111.0 | 108.0 | 29.0 | 106.0 | 0.000541 | 0.0 | -200.0 | -2.739726 | -200.0 | 2 | 4 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| AL-TN | state_border | AL | TN | 2018-01 | 1090F | 30 | 21.0 | Sensitive | 0.0 | 0.0 | 137.0 | 343.0 | 130.0 | 257.0 | 0.0 | 0.0 | 0.0 | 85.833333 | 0.0 | 2 | 8 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| AZ-CA | state_border | AZ | CA | 2018-01 | 1090F | 30 | 21.0 | Sensitive | 0.0 | 0.01 | 305.0 | 420.0 | 221.0 | 408.0 | 0.0 | 2.4e-05 | 200.0 | 31.724138 | 200.0 | 6 | 19 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IN-KY | state_border | IN | KY | 2018-01 | 1090F | 30 | 21.0 | Sensitive | 0.0 | 0.0 | 119.0 | 146.0 | 42.0 | 116.0 | 0.0 | 0.0 | 0.0 | 20.377358 | 0.0 | 2 | 2 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
| IN-OH | state_border | IN | OH | 2018-01 | 1090F | 30 | 21.0 | Sensitive | 0.0 | 0.0 | 119.0 | 209.0 | 42.0 | 142.0 | 0.0 | 0.0 | 0.0 | 54.878049 | 0.0 | 2 | 7 | high | State-border proxy (v1). No provider geocoordinates or 30-mile bilateral attribution in this release. | 2026-02-18__210410Z | 1.0.0 |
Method and limitations
- This tool does not predict payer actions. It highlights statistical variance patterns that may warrant clearer documentation.
- Statistical consistency context; not payer prediction, not clinical appropriateness.
- Availability and cross-state checks are data-readiness indicators, not clinical or payer outcomes.
- All data samples are aggregate-only and must not be interpreted as provider-level adjudication evidence.
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Page updated: 2026-02-16