Core Data Model Release Notes

Added value set for Type of Bill Codes to identify CMS Limited Data Set (LDS) Inpatient claims.

Added Payor Incurred Date fields to claims Natural Objects (and Semantic Mapping Templates).

Updated Capitation Member Summary Report Member-Months and Capitation Financial Transactions Natural Objects (removing Part A / B member premium amounts; adding some additional MSB fields; standardizing the order of fields; implementing the abbreviation of "Mandatory Supplemental Benefit" as msb in the column names); relatedly, updated a number of terms, especially to clarify that "Part C" amounts reflect the inclusion of Part A and B and MSB amounts, and added some for new MSB fields.

Added field Plan CMS Segment Number to Plans Natural Object and renamed field CMS Segment Number to Plan CMS Segment Number in MMR Member-Months and MMR Member-Month Transactions Natural Objects (and updated relevant Semantic Mapping Templates); these changes reflect a determination that different segments can represent distinct "plans" (under the Ursa Health definition), and so segment number, alongside contract number and PBP number, should be used to identify distinct plans.

Fixed bug in Data Mart for Claim Financials that was resulting in professional claim service line items that were part of multi-day claims being undercounted for intrinsically single-day Ursa Encounter Types (Home Health Visit Encounters, Clinician Office Visits, and Dialysis Facility Encounters); the overall impact of this bug was small (roughly 0.25% of claim records in the Data Mart for Claim Financials were affected in our synthetic test dataset; and aggregate financial figures -- agnostic of specific encounter type -- were not affected), but for analytics specific to the relevant encounter types the impact might be noticeable.

Updated Source Local Patient ID Crosswalk to Data Model Patient ID object's default patient mastering logic to improve stability of mastered Patient ID values. (The new logic now chooses the Source Local Patient ID with the earliest earliest data effective and documentation dates, rather than the earliest latest data effective and documentation dates; and also tie-breaks on the Source Local Patient ID value itself.)

Added Member Number to Patient-Plan Timelines of Plan Membership (both Natural Object and Semantic Mapping Template), and removed Subscriber Policy Number from same (as duplicative with Member Policy Number).

Added Is Disenrollment Transaction field to MMR Member-Month Transactions Natural Object and Semantic Mapping template; updated description of the MMR Member-Months Natural Object to clarify the object should not include member-months whose final action status is disenrolled.

On the Capitation Member Summary Report Member-Month Natural Object (and Semantic Mapping Template), added fields for post-sequestration CMS premium amounts, tweaked field names for fields related to the POP rate calculation, and reordered some financial fields. Migrated (recently created) CMS LISHIST Low Income Periods Natural Object from no_ursa_core_fin_024 to no_ursa_core_fin_025 to keep no_ursa_core_fin_024 available for the transactional counterpart to no_ursa_core_fin_023 (Capitation Member Summary Report Member-Months).

Added Body Site SNOMED CT fields EMR Encounter Diagnoses; added CMS LISHIST Low Income Periods Natural Object; added Patient MBI field to Patients Natural Object; added Is Accounting Activity Type Cash Flow Payment flag, and a number of benefit type flags (for, e.g., hearing, transportation, wellness, etc.) to Capitation Financial Transactions Natural Object; added Mandatory Supplemental Benefit fields for capitation revenue and expense, and Total Cash Flow Payment Amount field, to Capitation Member Summary Report Member-Months; added terms for these and related (finance-related) concepts.

Some field name tweaks and field additions to the Capitation Member Summary Report objects and templates.

2:10
Refinements to (slightly renamed) Capitation Member Summary Report Member-Months object / Semantic Mapping Template; removed CMS Premium Amount and Percent of Premium Fraction fields from Capitation Financial Transaction Fields (as insufficiently relevant, and now somewhat duplicative with those fields in the Capitation Member Summary Report Member-Months object).

Minor bug fixes to how qualifying EMR Encounter records are identified and retained in the Emergency Department Visit Parent Encounter Document Aggregator, Precursor 1 and Hospital Observation Stay Parent Encounter Document Aggregator, Precursor 1 objects.

Renamed newly created Capitation Financial Report Member-Months object / template to Capitated Member Summary Report Member-Months, and made some tweaks to the field names; made a number of small changes to the fields in the Capitation Financial Transaction Fields for consistency with the new object and to improve clarity (e.g., now using Increase to Net Paid Amount and Resulting Net Paid Amount instead of Increase to Account Balance Amount and Resulting Transaction Family Increase to Account Balance Amount).

Added new Natural Object / Semantic Mapping Template: Capitation Financial Report Member-Months

Added terms.

Minor / cosmetic changes: removed an object that was errantly included in URSA-CORE; tweaked the name of a newly added value set; removed from a Synthetic Object some unused fields that might have been misleading.

In MMR Member-Month Transactions Natural Object (and Semantic Mapping Template), created "Increase to" and "Resulting" fields for the following fields: CMS MMR Part A Monthly Rate for Payment or Adjustment, CMS MMR Part B Monthly Rate for Payment or Adjustment, CMS MMR Part D Monthly Rate for Payment or Adjustment, CMS MMR Medication Therapy Management Add-On Amount, CMS MMR Part A MSP Reduction Amount, CMS MMR Part B MSP Reduction Amount.

Added ICD-9-CM code fields to the EMR Encounter Diagnoses and EMR Encounter Service Line Items Natural Objects; mapped in these newly added ICD-9-CM code fields to Universal Patient Document Aggregator, and also mapped in some LOINC, SNOMED CT, and service description fields (which already existed upstream but were just errantly unmapped); updated data diagnostics measure URSA-CORE-922 (Documents with Conflicting Encounter Types) to additionally cover Dialysis Facility Encounters; made significant changes to the Type of Bill Code MEDICARE PART B value set (based largely on new empirical review of institutional claims data).

Fixed a bug related to the calculation of continuous episodes of primary payor membership; bug details: in cases where the patient switched between different primary payors without any gap, we were treating that as a single continuous membership episode, but should have been starting new episodes whenever the patient switched to a new primary payor; the most notable impact of this bug was on the Continuous Primary Payor Membership Episode fields in the Patient Timelines Master for URSA-CORE Concepts object.

Updated Provider Contract assets to rename some provider fields to clarify that they represent values for the provider as written in the contract.

2:10
Added Provider Contracts Natural Object (and Semantic Mapping Template); renamed Provider Contract fields in several Natural / Synthetic Objects to use "Plan Attributee Provider Contract" nomenclature (to clarify which provider the contract is for); removed Provider Contract ID fields from MMR and MAO-004 Natural Objects (not sufficiently relevant to those concepts); published Primary Plan Attributee Provider Contract ID in Patient Timelines Master for URSA-CORE Concepts.

Added Primary Billing TIN to Providers Natural Object (and Semantic Mapping Template).

Tweaks to the published fields and field names of the MAO-004 Natural Objects.

Formally set the three Dialysis Facility Encounter precursor objects to be dedicated precursors.

Add Transaction Paid Date to all financial transaction Natural Objects (and Semantic Mapping Templates).

Added some fields to the Claim Transactions and Billing Transactions Natural Objects (and Semantic Mapping Templates).

Removed errant Place of Service Code = 10 entry from URSA SETTING TIER 1 = UNCLASSIFIABLE value set.

Addition of two frequently requested CMS Revenue Center Code value sets; INPATIENT PSYCHIATRIC FACILITY SETTING and CRITICAL ACCESS HOSPITAL FACILITY SETTING

Significant updates to Home Health Care Visit encounter objects (to better capture professional claims / bills related to home health, and to generate home health visits when there is only a professional bill / claim); added new encounter type: Dialysis Facility Encounter; updated downstream encounter infrastructure and analytic fields to reflect this new encounter type.

Tweaks to Capitation Financial Transaction field names; added Provider Contract ID field to Patient Timelines of Plan Membership Natural Object (and select downstream objects).

Refinements to Capitation Financial Transactions concept / assets.

Modest overhaul to Capitation Revenue Transactions Natural Objects (and associated assets) to be more expansive Capitation Financial Transactions; this represents a design decision to model both revenue and expense (and other) capitation-style financial transactions in one Natural Object, rather than two.

Refinements to new MAO-004 Diagnosis Transactions object.

Added MAO-004 Diagnosis Transactions Natural Object (including precursor); updated MAO-004 Diagnosis Fields Semantic Mapping Template to include additional fields used for this new object.

Updated Universal Patient Document Aggregator to include MAO-004 Diagnosis records.

Added fields related to provider contract to MAO-004 Natural Object and Semantic Mapping Template; added some additional fields to the MAO-004 Semantic Mapping Template that are useful for integration (but are not published to the Natural Object).

Added Natural Objects and Semantic Mapping Template for MAO-004 Diagnoses

Minor field tweaks to MMR Natural Objects.

Further refinements to MMR Member-Months and MMR Member-Month Transactions concepts (both Natural Objects and Semantic Mapping Templates)

Added MMR Member-Months Natural Object (and Semantic Mapping Template); renamed MMR Records object (and SM Template) to MMR Member-Month Transactions.

Rebranded "Contract" as "Provider Contract" for clarity (affecting Natural Objects and Semantic Mapping Templates)

Added new Natural Object (and Semantic Mapping Template): MMR Records; updated Patient-Plan Timelines of Plan Membership Natural Object (and SM Template) to be consistent with new MMR Records fields -- specifically: updated fields for LTI status and OREC, and added field for RAF Type code -- and made the necessary changes to downstream objects.

Submitting updated DM for URSA-CORE Patient Timelines to reflect changes made to the SO Patient Timelines Master for URSA-CORE Concepts which rebuilt some long column names (in context of recent increase to column name max length for non-Postgres DBMS).

Added Contract ID to Pre-Calculated Measure Results natural object; tweaked Professional Bill Service Line Items and Patient Timelines Master for URSA-CORE Concepts to rebuild some very long column names (in context of recent increase to column name max length for non-Postgres DBMS).

Made some tweaks to the Capitation Revenue Transaction object (and Semantic Mapping Template), reflecting a new, finer grain size for the object (i.e., each transaction now only covers a single revenue type, e.g., part A, part B, etc.). Added and/or updated terms related to this.

Significant update to how financial / transaction information is modeled in the existing billing natural objects; added two new objects to capture transactions on the claims side: Claim Transactions and Claim Transaction Details (analogous to the two existing billing transaction objects); added a third natural object, Capitation Revenue Transactions, to capture information about payments for patients in a capitated arrangement.

Added a new field, "CMS DRG Weight", to the Data Mart for Hospital Inpatient Admission Encounters (ursa.dm_ursa_core_002) to enable the calculation of CMI. Added several new DRG and MDC related fields to the Data Mart for SNF Encounters (ursa.dm_ursa_core_007).

Updated Claim Aggregator object to use (recently updated) CMS Type of Bill Code Reference to obtain Ursa Setting Tier 1 values, rather than (now outdated) Lookup Table URSA SETTING TIER 1 DESCRIPTION, which is now retired and no longer in the URSA-CORE namespace.

Modifications to the new Home Health Care Visit objects: fixed some bugs; added logic to generate primary HCPCS procedure; no longer using Attending provider as a backup for Service provider.

Several modifications and additions related to adding a new Ursa encounter type: Home Health Care Visits; including:

• New value sets to identify home health care services;
• New encounter document aggregator and encounter objects for home health care visit encounters;
• Updates to the standard Ursa Core encounter objects (Encounter Aggregator for All URSA-CORE Encounter Types, Universal Encounter Document Aggregator, Data Mart for URSA-CORE Encounters), including updating the Ursa Encounter Type Tier 1 Category and Ursa Encounter Type Tier 2 Category fields to include a new category;
• Updates to the data diagnostic measure, URSA-CORE-922 (Documents with Conflicting Encounter Types) to additionally check for conflicts with home health care visit encounters.

In the Patient Timelines for CCW Conditions [ursa.so_ursa_core_pat_007] individual conditions are grouped into system categories. The field "Is CCW Hyperlipidemia" has been added to the category "Is CCW System Endocrine/Metabolic". Previously it was in the "Cardiovascular" system category.

• Fixed a bug in the Primary Care Providers object that was resulting in preventive care visits only being counted for one provider per encounter, even for encounters where multiple providers participated in the encounter in some capacity; the intended logic -- now implemented correctly -- is that any provider participating in a preventive care visit should receive "credit" for that participation when calculating the share of each provider's visits that are preventive care visits.

• Added a number of terms related to the Ursa Hospital Admission Condition-Treatment Type classification system.

• Updated data diagnostic measures to include payor ID as an analytic field.

• Update of ZIP Code Reference object to include census boundary coordinates data to power choropleths.

• In the Emergency Department Visit Parent Encounter Document Aggregator, Precursor 1 (Qualifying Non-Inpatient Documents) object, made the following changes to the EMR Encounter stack (to better prevent duplicate qualifying records and improve consistency with how we’re dealing with claims data): (1) we now keep at most a single qualifying record from among an EMR Encounter or its children EMR Encounter Service Line Item records; (2) we set the qualifying document to be the EMR Encounter ID if the encounter type or setting is qualifying, else we use the service line item record; (3) whether it is qualifying or not, we now use the EMR Encounter record as the master document.

• In the Universal Patient Document Aggregator object, updated the logic for Medication Dispense documents to use a coalesce of Dispensed Date, Administered Date, and Encounter Start Date when populating the Document Effective Date, Document Effective Start Date, and Document Effective End Date fields.

• Set Medication Dispenses, Precursor 1 (All Source Records) to be dedicated precursor;
• Updated Medication Orders, Medication List Entries, and Pharmacy Claims natural objects to use new Medi-Span GPI Code 14-Digit field name; updated logic in Universal Patient Document Aggregator to expect the new name where appropriate. (These changes should now complete the transition to using the new nomenclature across the data model.)

• Rebrand of “Medication Dispensing” (object and field names) as “Medication Dispense”;
• Added Order ID, Medication Dispense ID, Ordering Provider ID, Dispensing Provider ID, Is Document Type Medication Dispense flag, RxNorm Code, Medication SNOMED CT Code, and CDC CVX Code to Universal Patient Document Aggregator to better incorporate Medication Dispense information;
• Updated Universal Patient Document Aggregator mappings for Pharmacy Claims and Patient Observations to also populate some of these new fields (e.g., Order ID) as appropriate;
• Updated Semantic Mapping Templates for Pharmacy Claims, Medications, Medication List Entries, Medication Orders, Medication Dispenses to renamed Medi-Span GPI 14-Digit to Medi-Span GPI Code 14-Digit, for consistency with other code field names; and updated term;
• Updated Medication Dispenses and Medications Natural Objects to use Medi-Span GPI Code 14-Digit field name.

• In Patient-Plan Timeline of Plan Membership Fields Semantic Mapping Template, corrected data type of Is Dual Medicare-Medicaid Enrolled to be integer
• Added new Natural Object (and Semantic Mapping Template) for Medication Dispensing

• Update of CPT and HCPCS Reference object to include additional fields related to Restructured BETOS Classification System and to remove fields classifying CPT and HCPCS codes by setting (which was determined to be too unreliable)
• Removed an errantly added field on the Patient Communications object.
• Added Provider Description as an input to the Provider mastering object and updated the logic to publish a reconciled Provider Description in the final output of the object.

Added some terms related to the recently added CMS status fields.

Added Is CMS Aged Status, Is CMS Long-Term Institutionalized Status, and Is CMS New Enrollee Status fields to Patient-Plan Timelines of Plan Membership natural object (and related Semantic Mapping Template); this supports new development related to calculating HCC/RAF scores.

Initial release of URSA-CORE v3