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This tool does not predict payer actions. It highlights statistical variance patterns that may warrant clearer documentation.
Module intelligence
Code Substitution Edges v1
Event-window substitution edges that track post-change volume migration. 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: code-substitutionCross-state readiness check: PassedReadiness: ReadyProduction-ready: Yes
Maturity
Shipped
Readiness
Ready
Cross-state readiness
Passed
Coverage rows
N/A
Module details
This module ID is code-substitution, and the data package type is N/A.
The transform version is code-substitution-edges-v1, generated 2/18/2026, 6:39:23 PM.
The production-ready flag is Yes.
The primary buyers are Payer policy teams, State Medicaid directors.
The roadmap document is docs/prd/medicaid-intelligence-platform.backlog.md.
Release file path public/data/medicaid/derived/v1/latest/code_substitution_edges_v1_manifest.json
Published data path public/data/medicaid/derived/v1/latest/code_substitution_edges_v1.csv
Module API route /api/medicaid/intelligence/module/code-substitution.json
Data sample
| event_id | event_code | effective_month | window_months | to_code | cohort_npi_count | pre_claims | post_claims | delta_claims | delta_claims_pct | pre_paid | post_paid | delta_paid | delta_paid_pct | reimbursement_change_pct | event_source | event_type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 3 | 1288Z | 1 | 3813.0 | 4029.0 | 216.0 | 0.056648 | 51449.55 | 53805.1 | 2355.55 | 0.045784 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 3 | 1291Z | 1 | 846.0 | 1028.0 | 182.0 | 0.21513 | 12378.38 | 12356.53 | -21.85 | -0.001765 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 3 | 1300Z | 1 | 0.0 | 91.0 | 91.0 | 0.0 | 8228.16 | 8228.16 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy | ||
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 6 | 1300Z | 1 | 0.0 | 161.0 | 161.0 | 0.0 | 21941.76 | 21941.76 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy | ||
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 12 | 1530P | 1 | 1493.0 | 1933.0 | 440.0 | 0.294709 | 362720.0 | 451860.0 | 89140.0 | 0.245754 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_1286Z_201902 | 1286Z | 2019-02 | 12 | 1300Z | 1 | 0.0 | 286.0 | 286.0 | 0.0 | 45026.32 | 45026.32 | 0.940304 | observed_paid_per_claim_shift | rate_change_proxy | ||
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0100 | 921 | 4267283.0 | 5003670.0 | 736387.0 | 0.172566 | 84461231.6 | 157925268.21 | 73464036.61 | 0.869796 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0110 | 921 | 907273.0 | 1121218.0 | 213945.0 | 0.235811 | 5782459.36 | 5530890.18 | -251569.18 | -0.043506 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | S0215 | 921 | 1703068.0 | 1884593.0 | 181525.0 | 0.106587 | 37204001.17 | 42818517.95 | 5614516.78 | 0.150912 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | T2003 | 921 | 1219550.0 | 1391592.0 | 172042.0 | 0.14107 | 17553341.6 | 22668516.27 | 5115174.67 | 0.291407 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0120 | 921 | 857246.0 | 1013156.0 | 155910.0 | 0.181873 | 11776802.24 | 12829417.38 | 1052615.14 | 0.08938 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0090 | 921 | 826478.0 | 899442.0 | 72964.0 | 0.088283 | 9260642.83 | 10384738.52 | 1124095.69 | 0.121384 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | T2005 | 921 | 41876.0 | 86227.0 | 44351.0 | 1.059103 | 5138486.63 | 6211287.88 | 1072801.25 | 0.208778 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | T2049 | 921 | 13706.0 | 46001.0 | 32295.0 | 2.356267 | 591301.45 | 549789.07 | -41512.38 | -0.070205 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0390 | 921 | 7245.0 | 26681.0 | 19436.0 | 2.682678 | 224010.04 | 1348944.68 | 1124934.64 | 5.021805 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0425 | 921 | 1241763.0 | 1260608.0 | 18845.0 | 0.015176 | 25087976.73 | 24516718.03 | -571258.7 | -0.02277 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0080 | 921 | 98680.0 | 106998.0 | 8318.0 | 0.084293 | 2131067.29 | 2477775.89 | 346708.6 | 0.162692 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0170 | 921 | 27873.0 | 32697.0 | 4824.0 | 0.173071 | 237812.34 | 315995.34 | 78183.0 | 0.328759 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | 96153 | 921 | 32806.0 | 37373.0 | 4567.0 | 0.139212 | 3455956.93 | 3719100.71 | 263143.78 | 0.076142 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | A0427 | 921 | 87243.0 | 90558.0 | 3315.0 | 0.037997 | 16018632.76 | 16323388.94 | 304756.18 | 0.019025 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | 96152 | 921 | 20529.0 | 23613.0 | 3084.0 | 0.150227 | 3122186.06 | 3547154.33 | 424968.27 | 0.136112 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | T1020 | 921 | 21796.0 | 24413.0 | 2617.0 | 0.120068 | 4698570.49 | 5284872.13 | 586301.64 | 0.124783 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | S0209 | 921 | 436382.0 | 438981.0 | 2599.0 | 0.005956 | 8427336.61 | 8497295.82 | 69959.21 | 0.008301 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | T1019 | 921 | 19810.0 | 22245.0 | 2435.0 | 0.122918 | 1957593.69 | 1993143.01 | 35549.32 | 0.01816 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
| obsppc_A0130_201902 | A0130 | 2019-02 | 3 | S5102 | 921 | 5888.0 | 8125.0 | 2237.0 | 0.379925 | 542779.25 | 600041.43 | 57262.18 | 0.105498 | 0.082826 | observed_paid_per_claim_shift | rate_change_proxy |
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