Core Data Model Terms

Accounting Activity Type

A classification system describing the type of accounting activity associated with a financial transaction. The four standard categories of Accounting Activity Type memorialized in the Capitation Financial Transactions Natural Object are "Capitation Revenue", "Capitation Expense", "Manual Adjustment", and "Cash Flow Payment"; though these may be amended as appropriate to align with local prevailing accounting conventions and nomenclature.

Accounting Activity Type Description

The natural language description of a financial record's Accounting Activity Type.

Linked Terms: Accounting Activity Type

Account Operational ID

The user-facing value used by staff used to uniquely identify the transaction's funding account in their administrative systems and/or day-to-day operations.

Active Ingredients Description

A natural language description of the medication's biologically active ingredient(s). For medications with multiple active ingredients, the active ingredients should be listed in alphabetical order.

Admit Date

The date the patient was admitted to a care facility; note that "admission" typically implies the initiation of inpatient status, but not always, so this term should not necessarily be interpreted in that way.

Admitting Diagnosis ICD-9-CM Code

The ICD-9-CM diagnosis code documented as the admitting diagnosis for an encounter.

Linked Terms: Diagnosis ICD-9-CM Code

Affiliated Health System ID

The health system ID for the parent health system the reference entity is affiliated with.

Linked Terms: Health System ID

Affiliated Program Entity

The program entity the reference patient or provider is affiliated with. Note that, in general, unless prohibited by the rules of the program, patients and providers may be concurrently affiliated with multiple program entities within the same program.

Linked Terms: Program Entity

Affiliated Program Entity ID

The internal database identifier (used, e.g., for joins and primary keys) for the affiliated program entity of the reference patient or provider.

Linked Terms: Affiliated Program Entity

Affiliated Provider Group

The provider group the individual provider is employed by or otherwise affiliated with.

Linked Terms: Provider Group

AHFS Pharmacologic-Therapeutic Classification System

A medication classification system maintained by the American Hospital Formulary Service (AHFS) that groups medications with similar pharmacologic, therapeutic, and/or chemical characteristics. The system has 4 tiers in total, expressed as an 8-digit code (with 2 digits representing each tier); but is commonly expressed as a 6-digit code, representing the first 3 (coarser-grained) tiers.

AHFS Therapeutic Class Code 6-Digit

The standard 6-digit AHFS Pharmacologic-Therapeutic Class Code, representing the first 3 tiers of the AHFS Pharmacologic-Therapeutic Classification system. The code is expressed as 6 numbers, without special characters delimiting the tiers, with leading and trailing zeros as needed.

Linked Terms: AHFS Pharmacologic-Therapeutic Classification System

AHFS Therapeutic Class Code 8-Digit

The standard 8-digit AHFS Pharmacologic-Therapeutic Class Code, representing all 4 tiers of the AHFS Pharmacologic-Therapeutic Classification system. The code is expressed as 8 numbers, without special characters delimiting the tiers, with leading and trailing zeros as needed.

Linked Terms: AHFS Pharmacologic-Therapeutic Classification System

AHFS Therapeutic Class Tier 1 Description

The natural language description of the first-tier category within the AHFS Therapeutic Classification System that the medication is assigned to.

Linked Terms: AHFS Pharmacologic-Therapeutic Classification System

AHFS Therapeutic Class Tier 2 Description

The natural language description of the second-tier category within the AHFS Therapeutic Classification System that the medication is assigned to.

Linked Terms: AHFS Pharmacologic-Therapeutic Classification System

AHFS Therapeutic Class Tier 3 Description

The natural language description of the third-tier category within the AHFS Therapeutic Classification System that the medication is assigned to.

Linked Terms: AHFS Pharmacologic-Therapeutic Classification System

Allergy / Intolerance List Entry

Documentation of a patient allergy or intolerance that is currently active, or was historically active. Typically, “allergy” refers to a patient’s propensity for immune system response to a substance and “intolerance” refers to a patient’s propensity for any other adverse reaction to a substance; but the precise distinction between these two concepts might differ from provider to provider.

Allowed Amount

The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively.

Linked Terms: Charge Amount, Contractual Adjustment Amount, Non-Contractual Adjustment Amount, Total Due Amount

Anesthesia Base Unit Count

The base units (or base factor) associated with the service documented on an anesthesia claim or bill.

Anesthesia Physical Status Unit Count

The numeric physical status units associated with the service documented on an anesthesia claim or bill, representing the patient's physical condition. (NB: not the same as, but often derived from, the physical status modifier, e.g., P1, P2, etc.)

Anesthesia Surgical HCPCS Code

The HCPCS code associated with the surgical procedure performed on a patient receiving anesthesia; sometimes included as a second HCPCS code on an anesthesia claim or bill.

Linked Terms: HCPCS Code

Anesthesia Surgical HCPCS Description

The natural language description of an anesthesia surgical HCPCS code.

Linked Terms: Anesthesia Surgical HCPCS Code

Anesthesia Time Unit Count

The time units associated with the service documented on an anesthesia claim or bill.

Appointment

A record describing the plan for a future, scheduled encounter. The appointment describes the plan for the encounter, not what actually happens in the encounter, apart from capturing whether the patient arrives and/or completes the encounter.

Linked Terms: Encounter

Appointment Created Date

The date the appointment record was created.

Linked Terms: Appointment

Appointment ID

The internal database identifier (used, e.g., for joins and primary keys) for the appointment.

Linked Terms: Appointment

Appointment Slot

A period of time that is, was, or has some future potential to be available for booking an appointment for an encounter. Multiple appointment slots can be assigned to a single appointment; but the converse is not true (i.e., a single appointment slot cannot be associated with multiple appointments).

Linked Terms: Appointment, EMR Encounter

Appointment Slot ID

The internal database identifier (used, e.g., for joins and primary keys) for the appointment slot.

Linked Terms: Appointment Slot

APR-DRG Code

The standard 3-digit All Patient Refined Diagnosis Related Group code; APR-DRG codes should include leading zeros, and do not include the Severity of Illness or Risk of Mortality modifiers.

APR-DRG Description

The natural language description of a standard 3-digit All Patient Refined Diagnosis Related Group code.

Linked Terms: APR-DRG Code

APR-DRG Risk of Mortality Code

The standard 1-digit Risk of Mortality modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as ROM.

APR-DRG Severity of Illness Code

The standard 1-digit Severity of Illness modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as SOI.

Attending Provider

The individual provider identified as the attending provider for an encounter; typically considered to be the individual primarily responsible for the care provided during the encounter, even in cases where they did not themselves provider the care directly to the patient.

Linked Terms: Provider

Attending Provider Description

The natural language description of the attending provider; typically, the name of the provider.

Linked Terms: Attending Provider

Attending Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the attending provider.

Linked Terms: Attending Provider

Attending Provider NPI

The 10-digit National Provider Identifier for the attending provider.

Linked Terms: Attending Provider

Bad Debt Write-Off Amount

The amount of remaining balance on a billing or claim record that is considered unrecoverable. A positive amount indicates the presence of bad debt. Typically, the Bad Debt Write-Off Amount can be calculated by subtracting the Patient Paid Amount from the Patient Responsibility Amount.

Linked Terms: Patient Paid Amount, Patient Responsibility Amount

Benefit Type

A classification system describing the type of benefit associated with the given financial record, e.g., as the original funding source for services covered by a capitation transaction.

Benefit Type Description

The natural language description of the Benefit Type category.

Linked Terms: Benefit Type

Bill Any Plan Paid Amount

The total header-level Any Plan Paid Amount for the bill; for bills with an Any Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Plan Paid Amount

Bill Bad Debt Write-Off Amount

The total header-level Bad Debt Write-Off Amount for the bill; for bills with a Bad Debt Write-Off Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Bad Debt Write-Off Amount

Bill Charge Amount

The total header-level Charge Amount for the bill; for bills with a Charge Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Charge Amount

Bill Contractual Adjustment Amount

The total header-level Contractual Adjustment Amount for the bill; for bills with a Contractual Adjustment Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Contractual Adjustment Amount

Bill ID

The identifier for a professional or institutional bill header record; Bill ID values are consistent over the lifetime of a bill, including when a bill is adjusted. On a claim record, this field refers to the bill sent to the plan that originated the claim record.

Billing Provider

The provider, typically an organizational provider, that generated a bill, and to which resulting payments will be directed. For professional claims this is often a provider group; for institutional claims this is typically the facility where services were rendered, and for pharmacy claims this is typically the pharmacy.

Billing Provider Description

The natural language description of the billing provider.

Linked Terms: Billing Provider

Billing Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the billing provider.

Linked Terms: Billing Provider

Billing Provider NPI

The 10-digit National Provider Identifier for the billing provider.

Linked Terms: Billing Provider

Billing Provider TIN

The 9-digit federal Tax Identification Number for the billing provider.

Linked Terms: Billing Provider

Bill Non-Contractual Adjustment Amount

The total header-level Non-Contractual Adjustment Amount for the bill; for bills with a Non-Contractual Adjustment Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Non-Contractual Adjustment Amount

Bill Patient Paid Amount

The total header-level Patient Paid Amount for the bill; for bills with a Patient Paid Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Patient Paid Amount

Bill Patient Responsibility Amount

The total header-level Patient Responsibility Amount for the bill; for bills with a Patient Responsibility Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Patient Responsibility Amount

Bill Primary Plan Allowed Amount

The total header-level Primary Plan Allowed Amount for the bill; for bills with a Primary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Allowed Amount

Bill Primary Plan Paid Amount

The total header-level Primary Plan Paid Amount for the bill; for bills with a Primary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Plan Paid Amount

Bill Secondary Plan Allowed Amount

The total header-level Secondary Plan Allowed Amount for the bill; for bills with a Secondary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Allowed Amount

Bill Secondary Plan Paid Amount

The total header-level Secondary Plan Paid Amount for the bill; for bills with a Secondary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Plan Paid Amount

Bill Service Line Item Any Plan Paid Amount

The Any Plan Paid Amount for the bill service line item.

Linked Terms: Plan Paid Amount

Bill Service Line Item Bad Debt Write-Off Amount

The Bad Debt Write-Off Amount for the bill service line item.

Linked Terms: Bad Debt Write-Off Amount

Bill Service Line Item Charge Amount

The Charge Amount for the bill service line item.

Linked Terms: Charge Amount

Bill Service Line Item Contractual Adjustment Amount

The Contractual Adjustment Amount for the bill service line item.

Linked Terms: Contractual Adjustment Amount

Bill Service Line Item ID

The identifier for a service line item on an institutional or professional bill.

Bill Service Line Item Non-Contractual Adjustment Amount

The Non-Contractual Adjustment Amount for the bill service line item.

Linked Terms: Non-Contractual Adjustment Amount

Bill Service Line Item Patient Paid Amount

The Patient Paid Amount for the bill service line item.

Linked Terms: Patient Paid Amount

Bill Service Line Item Patient Responsibility Amount

The Patient Responsibility Amount for the bill service line item.

Linked Terms: Patient Responsibility Amount

Bill Service Line Item Primary Plan Allowed Amount

The Primary Plan Allowed Amount for the bill service line item.

Linked Terms: Allowed Amount

Bill Service Line Item Primary Plan Paid Amount

The Primary Plan Paid Amount for the bill service line item.

Linked Terms: Plan Paid Amount

Bill Service Line Item Secondary Plan Allowed Amount

The Secondary Plan Allowed Amount for the bill service line item.

Linked Terms: Allowed Amount

Bill Service Line Item Secondary Plan Paid Amount

The Secondary Plan Paid Amount for the bill service line item.

Linked Terms: Plan Paid Amount

Bill Service Line Item Tertiary Plan Allowed Amount

The Tertiary Plan Allowed Amount for the bill service line item.

Linked Terms: Allowed Amount

Bill Service Line Item Tertiary Plan Paid Amount

The Tertiary Plan Paid Amount for the bill service line item.

Linked Terms: Plan Paid Amount

Bill Service Line Item Total Due Amount

The Total Due Amount for the bill service line item.

Linked Terms: Total Due Amount

Bill Tertiary Plan Allowed Amount

The total header-level Tertiary Plan Allowed Amount for the bill; for bills with a Tertiary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Allowed Amount

Bill Tertiary Plan Paid Amount

The total header-level Tertiary Plan Paid Amount for the bill; for bills with a Tertiary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Plan Paid Amount

Bill Total Due Amount

The header-level Total Due Amount for the bill; for bills with a Total Due Amount listed for each service line item, this will typically be the sum of those line-level values.

Linked Terms: Total Due Amount

Calculated APR-DRG Mean Length of Stay in Calendar Days

Calculated from the data present in Ursa, the average length of stay experienced by a patient within a chosen APR-DRG.

Calculated MS-DRG Mean Length of Stay in Calendar Days

Calculated from the data present in Ursa, the average length of stay experienced by a patient within a chosen MS-DRG.

Campaign Description

The natural-language description of the broader communication campaign that the current instance of communication is a part of.

Campaign Operational ID

The "real-life" identifier for the broader communication campaign that the current instance of communication is a part of.

Capitation Expense

A fixed amount representing the cost of certain healthcare services provided to the patient over a given covered period, regardless of what services the patient actually receives. Equivalent to the sum of Medicare Part C and Medicare Part D Capitation Expense Amounts.

Capitation Revenue

A fixed payment to cover all qualifying healthcare services for a patient over a given covered period, regardless of what services the patient actually receives. Equivalent to the sum of the Medicare Part C and Medicare Part D capitation revenue amounts.

Cash Flow Payment

A cash payment; not considered to be Capitation Revenue.

Linked Terms: Capitation Expense

CCW Comorbidity Category

Categorizes the patient based on the number of distinct CCW conditions present as defined by the Chronic Condition Warehouse (CCW). Ranges informed by NIH publication; The impact of multiple chronic diseases on hospitalizations for ambulatory care sensitive conditions (2016).

CCW Type Category

A categorical grouper classifying the presence or absence of CCW Chronic Conditions and CCW Potentially Disabling Events into the following categories; [01] Zero Chronic Conditions or Disabling Events [02] Chronic Condition Only [03] Potentially Disabling Event Only [04] Both Chronic Condition & Potentially .

CDC CVX Code

The standard 2- or 3-digit CVX code developed and maintained by the CDC, identifying administered vaccine substances; e.g., 05 = Measles; 62 = HPV, quadrivalent; 118 = HPV, bivalent. CVX codes below 10 should include a leading zero.

CDC SVI Household / Disability Quintile Category

The CDC SVI Household/Disability Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable.

Linked Terms: CDC SVI Household / Disability Theme National Percentile

CDC SVI Household / Disability Theme National Percentile

Includes the four Census measures of (1) Percent aged 65 or older (2) Percent aged 17 or younger, (3) Percent with a disability (noninstitutionalized and older than age 5), and (4) Percent single parent households. Follows the same methodology as the overall SVI composite.

Linked Terms: CDC SVI Household / Disability Quintile Category, CDC SVI Overall National Percentile

CDC SVI Housing / Transportation Quintile Category

The CDC SVI Housing/Transportation Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable.

Linked Terms: CDC SVI Housing / Transportation Theme National Percentile

CDC SVI Housing / Transportation Theme National Percentile

Includes the five Census measures of (1) Percent housing structures with 10 or more units, (2) Percent mobile homes, (3) Percent households with more people than rooms, (4) Percent households with no vehicle available, (5) Percent living in group quarters (such as correctional facilities, nursing homes, college dorms, and military barracks). Follows the same methodology as the overall SVI composite.

Linked Terms: CDC SVI Housing / Transportation Quintile Category, CDC SVI Overall National Percentile

CDC SVI Minority / Language Quintile Category

The CDC SVI Minority/Language Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable.

Linked Terms: CDC SVI Minority / Language Theme National Percentile

CDC SVI Minority / Language Theme National Percentile

Includes the two Census measures of (1) Percent minority (all persons except white, non-Hispanic), (2) Percent who speak English "less than well" (persons age 5+). Follows the same methodology as the overall SVI composite.

Linked Terms: CDC SVI Minority / Language Quintile Category, CDC SVI Overall National Percentile

CDC SVI Overall National Percentile

Social Vulnerability Index is a composite score maintained by the Center for Disease Control and Prevention using data from the U.S. Census of Population and Housing. The score is a composite of 15 measures, with all directed so that higher values indicate more vulnerability. The composite finds the percentile ranking of each component value, sums the percentile rankings, and then finds the percentile ranking of the sums. Percentile ranks are found with the formula: Percentile Rank = (Rank-1) / (N-1). If any component is missing, then the composite is also recoded as missing. Measures are organized into the four themes of Socioeconomic Status, Household Composition & Disability, Minority Status & Language, and Housing Type & Transportation, and composites for these themes are constructed with the same methodology. SVI is reported at the Census Tract level. Tracts aim to include about 4000 people each. On average, there are about 4 Census Block groups for each Census Tract, so the SVI has less geographic resolution than the ADI. Ursa stores the 2018 version of the SVI, which was released on 01/31/2020 and is the most recent as of 02/02/22.

Linked Terms: CDC SVI Overall Quintile Category

CDC SVI Overall Quintile Category

The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.

CDC SVI Socioeconomic Quintile Category

The CDC SVI Socioeconomic Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable.

Linked Terms: CDC SVI Socioeconomic Theme National Percentile

CDC SVI Socioeconomic Theme National Percentile

Includes the five Census measures of (1) Percent below 150% poverty, (2) Unemployment rate, (3) Per-capita income, and (4) Percent with no high school diploma, (5) percent uninsured. Follows the same methodology as the overall SVI composite.

Linked Terms: CDC SVI Socioeconomic Quintile Category, CDC SVI Overall National Percentile

Charge Amount

The initial list price of a service or product set by the provider.

Child Patient Communication Sequence Number

The sequence number, in chronological order, of the instance of communication associated with the current record within the context of the parent communication instance.

Linked Terms: Parent Patient Communication ID, Patient Communication ID

Claim

A collection of records representing an invoice for health care products or services as received and interpreted by a payor.

In our terminology, bills and claims are different, but closely related, concepts. A provider generates a bill; if that bill is sent to a payor, it generates a claim. A single bill may identify multiple payors, which may generate multiple claims. When a payor receives a bill but declines to pay, that denial is also considered a claim (and retained in the data as documentation of services rendered to a patient).

Claims (and bills) cover three claim classes: institutional, professional, and pharmacy. Institutional and professional claims – sometimes referred to collectively as medical claims – have a hierarchical structure, with a one-to-many relationship between claim headers and service line items as a central feature; in contrast, each pharmacy claim only describes a single dispensation of medication, so no such parent-child structure is required. Institutional claims additionally include a collection of ICD-10-CM codes (representing discharge diagnoses) and a collection of ICD-10-PCS codes (representing significant procedures performed); both collections are directly subordinate to the header, and therefore peers to the service line items. Professional claims do not include ICD-10-PCS codes, and their ICD-10-CM diagnosis codes are subordinate to each service line item rather than to the header, meaning different professional services on a single claim may have different diagnosis codes.

A claim represents this collection of information over its lifetime of potential reversals and adjustments. That is, each transaction modifies the claim, it does not close out the claim and generate a new one.

Claim Adjustment Group Code

The standard 2-character Claim Adjustment Group Code; e.g., CO = Contractual Obligation, OA = Other Adjustment, etc.

Claim Adjustment Reason Code

The standard 1-, 2- or 3-character Claim Adjustment Reason Code (CARC); e.g., 1 = Deductible amount, 253 = Sequestration reduction in federal payment, B4 = Late filing penalty, etc.

Claim Adjustment Reason Description

The natural language description of the Claim Adjustment Reason Code (CARC).

Linked Terms: Claim Adjustment Reason Code

Claim Allowed Amount

The amount determined by the payor to be the maximum allowed amount for all the billed services on a claim, often representing a negotiated contractual amount.

Linked Terms: Claim

Claim Calendar Month Start Date

The start date of the calendar month (e.g., January 1, February 1, etc.) containing the Claim Covered Start Date.

Linked Terms: Claim Covered Start Date

Claim Calendar Quarter Start Date

The start date of the calendar quarter (e.g., January 1, April 1, etc.) containing the Claim Covered Start Date.

Linked Terms: Claim Covered Start Date

Claim Calendar Year Start Date

The start date of the calendar year (i.e., January 1) containing the Claim Covered Start Date.

Linked Terms: Claim Covered Start Date

Claim Charge Amount

The amount charged for this claim on the original bill, before any contractual adjustments or other discounts were applied.

Claim Class Category

Identifies a record as associated with a professional, institutional, or pharmacy claim.

Claim COB Paid Amount

The amount paid for all services on a claim by other insurance plans as part of a "coordination of benefit" (COB) arrangement.

Claim Covered End Date

The end date of services covered by a claim.

Claim Covered Start Date

The start date of services covered by a claim.

Claim Dispensing Fee Allowed Amount

The portion of the allowed amount associated with the pharmacy's dispensing fee.

Linked Terms: Claim Allowed Amount

Claim ID

The internal database identifier (used, e.g., for joins and primary keys) for the claim.

Linked Terms: Claim

Claim Ingredient Cost Allowed Amount

The portion of the allowed amount associated with the cost of the medication's ingredients.

Linked Terms: Claim Allowed Amount

Claim Operational ID

The identifier for an institutional, professional, or pharmacy claim used to identify a record in an operational or administrative system; i.e., the "real life" identifier for the record that might be used by staff or other operators.

Claim or Billing Transaction

A financial record representing the creation, modification, or reversal of a bill or claim header or service line item.

Linked Terms: Claim

Claim or Billing Transaction Detail

A financial record providing detailed information about a claim or billing transaction, often represented by a Claim Adjustment Reason Code (CARC) and/or Remittance Advice Remark Code (RARC). A single Transaction record may have multiple Transaction Detail records associated with it.

Linked Terms: Claim or Billing Transaction, Claim Adjustment Reason Code, Remittance Advice Remark Code

Claim Paid Date

The date the claim was paid by the payor.

Claim Patient Paid Amount

The amount paid by the patient for all services on a claim.

Claim Patient Responsibility Amount

The amount determined by a plan to be owed by the patient for all services on a claim.

Claim Payment Processing Status Category

Identifies the claim as Paid, Denied, Open, or Status Unknown.

Linked Terms: Is Claim Processed Status Open, Is Claim Processed Status Denied, Is Claim Processed Status Paid

Claim Plan Paid Amount

The amount paid by an insurance plan for all services on a claim.

Claim Received Date

The date the claim was originally received for processing by the payor.

Claim Sales Tax Allowed Amount

The portion of the allowed amount associated with the sales tax on the fill.

Linked Terms: Claim Allowed Amount

Claim Service Line Item Allowed Amount

The amount determined by the payor to be the maximum allowed amount for all the a claim service line item, representing, for example, negotiated contractual amounts.

Claim Service Line Item Charge Amount

The amount charged for this claim service line item on the original bill, before any contractual adjustments or other discounts were applied.

Claim Service Line Item COB Paid Amount

The amount paid for a claim service line item by other insurance plans as part of a "coordination of benefit" (COB) arrangement.

Claim Service Line Item ID

The identifier for a service line item on an institutional or professional claim.

Claim Service Line Item Operational ID

The identifier for an institutional or professional claim service line item used to identify a record in an operational or administrative system; i.e., the "real life" identifier for the record that might be used by staff or other operators.

Claim Service Line Item Patient Paid Amount

The amount paid by the patient for a claim service line item.

Claim Service Line Item Patient Responsibility Amount

The amount determined by a plan to be owed by the patient for a claim service line item.

Claim Service Line Item Plan Paid Amount

The amount paid by an insurance plan for a claim service line item.

Claims Expense Amount

The amount reflecting the expense to a risk-bearing entity associated with health care services captured in claims data. In the context of Medicare Advantage program, this is equivalent to the sum of Medicare Part C and D Claims Expense Amounts.

Clinical Note

A broad category of document, written by a provider, describing the clinical status of the patient and/or clinical activities related to the patient’s care.

Clinical Note ID

The internal database identifier (used, e.g., for joins and primary keys) for the Clinical Note.

Linked Terms: Clinical Note

Clinician Office Visit

An encounter in which the patient received in-person care from a clinical provider, including non-physicians, in an office or clinic setting; operationally defined by the presence of one or more of the following: (1) a qualifying HCPCS code on a professional claim or bill service line item, or on an EMR encounter service line item; (2) a qualifying HCPCS or revenue center code on an institutional claim or bill service line item associated with a claim or bill with a qualifying type of bill code; or (3) an EMR encounter record flagged as a clinician office visit (i.e., Is Encounter Type Clinician Office Visit = 1). Qualifying records are considered to be part of the same encounter if they share the same patient, service date, and service provider, billing provider, or provider group.

Linked Value Sets: CLINICIAN OFFICE VISIT (URSA-CORE HCPCS), CLINIC SETTING (URSA-CORE CMS_REVENUE_CENTER_CODE), VALUES CONSISTENT WITH CLINICIAN OFFICE VISIT (URSA-CORE CMS_TYPE_OF_BILL_CODE)

CMS Admission Type Code

The standard CMS 1-digit Admission Type code; 1 = Emergency, 2 = Urgent, etc.

CMS Admission Type Description

The natural language description of a CMS Admission Type code

Linked Terms: CMS Admission Type Code

CMS Admit Source Code

The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.

CMS Admit Source Description

The natural language description of a standard CMS Admit Source code.

Linked Terms: CMS Admit Source Code

CMS Admit Type Code

The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.

CMS Admit Type Description

The natural language of a standard CMS Admit Type or Type of Admission Code; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.

Linked Terms: CMS Admit Type Code

CMS Chronic Condition Warehouse (CCW)

The CMS Chronic Conditions Data Warehouse (CCW) provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across the continuum of care. The CCW includes common chronic conditions and other chronic or potentially disabling conditions, which identify additional chronic health, mental health, and substance abuse conditions. These reference only ICD-10 diagnosis codes and have modified look-back periods, qualifying claims, and codes. See more at: https://www2.ccwdata.org/

CMS Claim Type Category

A classification of claims, based on the CMS claim types: Inpatient, Outpatient, Skilled Nursing Facility, Home Health Agency, Hospice, Carrier and Durable Medical Equipment; these categories are also used by CMS to group claims into the Standard Analytic Files (SAF) of the Limited Data Set (LDS) extract. Note that this classification should not be mistaken as describing setting, necessarily, since the CMS rules for submitting claims sometimes involve unexpected mappings of actual setting to claim type (e.g., TOB 12x, typically used for Part B services delivered in an inpatient setting, are submitted using the Outpatient claim type).

CMS DRG Arithmetic Mean LOS

The arithmetic mean length of stay (ALOS) is the average length of stay experienced by a patient within a chosen DRG.

Linked Terms: CMS DRG Geometric Mean LOS

CMS DRG Geometric Mean LOS

The geometric mean length of stay or (GMLOS) is the national mean length of stay for each diagnostic related grouper (DRG) as determined and published by CMS. The geometric mean reduces the effect of very high or low values, which might bias the mean if a straight average (arithmetic mean) is used.

Linked Terms: CMS DRG Arithmetic Mean LOS

CMS Dual Status Code

The standard 2-character CMS Dual Status Code, which identifies the patient's most recent entitlement status for Medicaid and other qualifying non-Medicare programs; e.g., 01 = QMB only, 02 = QMB + full Medicaid, etc.

CMS Medicare Beneficiary Status Code

The standard 2-digit CMS code Beneficiary Status Code, which identifies the reason for a beneficiary's entitlement to Medicare benefits as of a particular date; e.g.,10 = Aged without ESRD, 11 = Aged with ESRD, 20 = Disabled without ESRD, 21 = Disabled with ESRD, 31 = ESRD only.

CMS MMR Adjustment Reason Code

The standard 2-digit Adjustment Reason Code (ARC) developed and maintained by CMS, and used to identify the reason for a revision to a patient's MMR information; e.g., 01 = Notification of Death of Beneficiary; 02 = Retroactive Enrollment; etc. This field contains the same values as the CMS MMR "Adjustment Reason Code (ARC)" field, which the CMS documentation defines as: "This is populated with a valid ARC for adjustments. For prospective payment components, it is populated with 00".

CMS MMR Cleanup ID

This field contains the same values as the CMS MMR "Cleanup ID" field, which the CMS documentation defines as: "The Cleanup ID field is used in the event of a cleanup or a RAS overpayment run. It is used to uniquely identify the cleanup with which the record is associated. It is usually the Ticket number for the cleanup or overpayment run. The field will be blank when the record reports: A prospective payment; A non-cleanup adjustment; Any payment or adjustment prior to August 2011".

CMS MMR Default Risk Factor Code

This field contains the same values as the CMS MMR "Default Risk Factor Code" field, which the CMS documentation defines as: "Indicator that a Default Risk Adjustment Factor (RAF) was used for calculating this payment or adjustment. A Default Risk Adjustment Factor (score) is used only if the RASS system did not provide MARx risk scores for this beneficiary. In these cases MARx assigns a default score based upon 'demographics' of the beneficiary. 1 = Default Enrollee - Aged/Disabled; 2 = Default Enrollee - ESRD dialysis; 3 = Default Enrollee - ESRD Kidney Transplant - Month 1; 4 = Default Enrollee - ESRD Kidney Transplant - Months 2-3; 5 = Default Enrollee - ESRD Post Graft - Months 4-9; 6 = Default Enrollee - ESRD Post Graft - 10+ Months; 7 = Default Enrollee Chronic Care SNP".

CMS MMR ESRD MSP Code

This field contains the same values as the CMS MMR "ESRD MSP Flag" field, which the CMS documentation defines as: "Indicator that Medicare is a Secondary Payer due to ESRD. As of January 2011: T = MSP due to Transplant/Dialysis; P = MSP due to Post Graft"; with NULL = "ESRD MSP not applicable".

CMS MMR LIS Premium Subsidy Amount

This field contains the same values as the CMS MMR "LIS Premium Subsidy" field, which the CMS documentation defines as: "Low Income Premium Subsidy Amount for the beneficiary".

CMS MMR Low-Income Subsidy Cost-Sharing Amount

This field contains the same values as the CMS MMR "Low-Income Subsidy Cost-Sharing Amount" field, which the CMS documentation defines as: "The low-income subsidy cost-sharing amount included in the payment".

CMS MMR Medication Therapy Management Add-On Amount

This field contains the same values as the CMS MMR "Medication Therapy Management (MTM) Add On" field, which the CMS documentation defines as: "The total Medication Therapy Management (MTM) Add-On for the beneficiary".

CMS MMR Monthly Risk-Adjusted Part A Amount

This field contains the same values as the CMS MMR "Monthly Risk Adjusted Amount Part A" field, which the CMS documentation defines as: "Monthly Part A portion of the payment or adjustment dollars".

CMS MMR Monthly Risk-Adjusted Part B Amount

This field contains the same values as the CMS MMR "Monthly Risk Adjusted Amount Part B" field, which the CMS documentation defines as: "Monthly Part B portion of the payment or adjustment dollars".

CMS MMR MSP Reduction Factor

This field contains the same values as the CMS MMR "MSP Reduction Factor" field, which the CMS documentation defines as: "MSP secondary payer reduction factor used in this payment or adjustment calculation"; with NULL = "Not applicable".

CMS MMR PACE Cost Sharing Add-on Amount

This field contains the same values as the CMS MMR "PACE Cost Sharing Add-on" field, which the CMS documentation defines as: "Total Part D PACE Cost Sharing Add-on amount".

CMS MMR PACE Premium Add-On Amount

This field contains the same values as the CMS MMR "PACE Premium Add On" field, which the CMS documentation defines as: "Total Part D PACE Premium Add-on amount".

CMS MMR Part A Monthly Rate for Payment or Adjustment

This field contains the same values as the CMS MMR "Part A Monthly Rate for Payment or Adjustment" field, which the CMS documentation defines as: "The Part A State and County Rate used in the payment or adjustment calculation. Payments = Rate in effect for payment period; Adjustments = Rate in effect for adjustment period i.e. the updated rate in effect for the adjustment period".

CMS MMR Part A MSP Reduction Amount

This field contains the same values as the CMS MMR "MSP Reduction Amount Part A" field, which the CMS documentation defines as: "MSP reduction amount Part A; Reported as a POSITIVE AMT, is actually a NEGATIVE AMT".

CMS MMR Part A RAF Score

This field contains the same values as the CMS MMR "Risk Adjustment Factor A" field, which the CMS documentation defines as: "Part A Risk Adjustment Factor used for the Payment Calculation".

CMS MMR Part B Monthly Rate for Payment or Adjustment

This field contains the same values as the CMS MMR "Part B Monthly Rate for Payment or Adjustment" field, which the CMS documentation defines as: "The Part B State and County Rate used in the payment or adjustment calculation. Payments = Rate in effect for payment period; Adjustments = Rate in effect for adjustment period i.e. the updated rate in effect for the adjustment period".

CMS MMR Part B MSP Reduction Amount

This field contains the same values as the CMS MMR "MSP Reduction Amount Part B" field, which the CMS documentation defines as: "MSP reduction amount Part B; Reported as a POSITIVE AMT, is actually a NEGATIVE AMT".

CMS MMR Part B RAF Score

This field contains the same values as the CMS MMR "Risk Adjustment Factor B" field, which the CMS documentation defines as: "Part B Risk Adjustment Factor used for the Payment Calculation".

CMS MMR Part C Basic Premium Part A Amount

This field contains the same values as the CMS MMR "Part C Basic Premium – Part A Amount" field, which the CMS documentation defines as: "The premium amount for determining the MA payment attributable to Part A".

CMS MMR Part C Basic Premium Part B Amount

This field contains the same values as the CMS MMR "Part C Basic Premium – Part B Amount" field, which the CMS documentation defines as: "The premium amount for determining the MA payment attributable to Part B".

CMS MMR Part C Frailty Factor

This field contains the same values as the CMS MMR "Part C Frailty Factor" field, which the CMS documentation defines as: "Part C Frailty Factor used in this payment or adjustment calculation. Used for PACE, FIDE SNPs, and some MMPs"; with NULL = "Not applicable".

CMS MMR Part D Basic Premium Amount

This field contains the same values as the CMS MMR "Part D Basic Premium Amount" field, which the CMS documentation defines as: "Plan’s Part D premium amount".

CMS MMR Part D Coverage Gap Discount Amount

This field contains the same values as the CMS MMR "Part D Coverage Gap Discount Amount" field, which the CMS documentation defines as: "Amount of the Coverage Gap Discount Amount included in the payment".

CMS MMR Part D Direct Subsidy Amount

This field contains the same values as the CMS MMR "Part D Direct Subsidy Amount" field, which the CMS documentation defines as: "Total Part D Direct subsidy amount for the beneficiary".

CMS MMR Part D Low-Income Multiplier

This field contains the same values as the CMS MMR "Part D Low-Income Multiplier" field, which the CMS documentation defines as: "The Part D low-income multiplier used in the calculation of the payment or adjustment".

CMS MMR Part D LTI Indicator Code

This field contains the same values as the CMS MMR "Part D Long Term Institutional Indicator" field, which the CMS documentation defines as: "Indicator of beneficiary Long Term Institutional (LTI) status for the Part D payment or adjustment. A = LTI (aged); D = LTI (disabled)"; with NULL = "No LTI".

CMS MMR Part D LTI Multiplier

This field contains the same values as the CMS MMR "Part D Long Term Institutional Multiplier" field, which the CMS documentation defines as: "Part D LTI multiplier used in the calculation of the payment or adjustment".

CMS MMR Part D Monthly Rate for Payment or Adjustment

This field contains the same values as the CMS MMR "Part D Monthly Rate for Payment or Adjustment" field, which the CMS documentation defines as: "The Part D rate used in the payment or adjustment calculation. Payments = Rate amount in effect for payment period; Adjustments = Rate amount in effect for adjustment period".

CMS MMR Part D RAF Score

This field contains the same values as the CMS MMR "Risk Adjustment Factor D" field, which the CMS documentation defines as: "Part D Risk Adjustment Factor used for the Payment Calculation".

CMS MMR Payment Date

The monthly period, expressed as text in YYYYMM format, in which any new or updated financial calculations in the current MMR record actually contributed to the amount paid by CMS to the Medicare Advantage organization. This field contains the same values as the CMS MMR "Payment Date" field, which the CMS documentation defines as: "Payment month for the report (YYYYMM)" (Note that we use the word "date" in the field name here -- even though the field does not, strictly speaking, contain a date -- for consistency with the official MMR field name.)

Linked Terms: Covered Month Start Date

CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount

This field contains the same values as the CMS MMR "Rebate for Other Part A Mandatory Supplemental Benefits" field, which the CMS documentation defines as: "The amount of the rebate allocated to providing Part A Supplemental benefits".

CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount

This field contains the same values as the CMS MMR "Rebate for Other Part B Mandatory Supplemental Benefits" field, which the CMS documentation defines as: "The amount of the rebate allocated to providing Part B Supplemental benefits".

CMS MMR Rebate for Part A Cost Sharing Reduction Amount

This field contains the same values as the CMS MMR "Rebate for Part A Cost Sharing Reduction" field, which the CMS documentation defines as: "The amount of the rebate allocated to reducing the beneficiary Part A cost-sharing".

CMS MMR Rebate for Part B Cost Sharing Reduction Amount

This field contains the same values as the CMS MMR "Rebate for Part B Cost Sharing Reduction" field, which the CMS documentation defines as: "The amount of the rebate allocated to reducing the beneficiary Part B cost-sharing".

CMS MMR Rebate for Part B Premium Reduction Part A Amount

This field contains the same values as the CMS MMR "Rebate for Part B Premium Reduction – Part A Amount" field, which the CMS documentation defines as: "The Part A amount of the rebate that is allocated to reducing the beneficiary Part B premium. This amount is subtracted from payments for one of two reasons: 1. The beneficiary has ESRD status. 2. The beneficiary is enrolled in an Employer Group Plan and is neither Hospice nor ESRD (Effective 01/01/2020). For all other beneficiaries, this field is informational".

CMS MMR Rebate for Part B Premium Reduction Part B Amount

This field contains the same values as the CMS MMR "Rebate for Part B Premium Reduction – Part B Amount" field, which the CMS documentation defines as: "The Part B amount of the rebate that is allocated to reducing the beneficiary Part B premium. This amount is subtracted from payments for one of two reasons: 1. The beneficiary has ESRD status. 2. The beneficiary is enrolled in an Employer Group Plan and is neither Hospice nor ESRD (Effective 01/01/2020). For all other beneficiaries, this field is informational".

CMS MMR Rebate for Part D Basic Premium Reduction Amount

This field contains the same values as the CMS MMR "Rebate for Part D Basic Premium Reduction" field, which the CMS documentation defines as: "Amount of the rebate allocated to reducing the beneficiary basic Part D premium".

CMS MMR Rebate for Part D Supplemental Benefits Part A Amount

This field contains the same values as the CMS MMR "Rebate for Part D Supplemental Benefits – Part A Amount" field, which the CMS documentation defines as: "Part A Amount of the rebate allocated to providing Part D supplemental benefits".

CMS MMR Rebate for Part D Supplemental Benefits Part B Amount

This field contains the same values as the CMS MMR "Rebate for Part D Supplemental Benefits – Part B Amount" field, which the CMS documentation defines as: "Part B Amount of the rebate allocated to providing Part D supplemental benefits".

CMS MMR Reinsurance Subsidy Amount

This field contains the same values as the CMS MMR "Reinsurance Subsidy Amount" field, which the CMS documentation defines as: "The amount of reinsurance subsidy included in the payment".

CMS MMR Risk Adjustment Age Group Code

That standard 4-digit CMS Risk Adjustment Age Group (RAAG) Code, describing the age category of the patient as used to calculate RAF scores. This field contains the same values as the CMS MMR "Risk Adjustment Age Group (RAAG)" field, which the CMS documentation defines as: "The Risk Adjustment Age Group for the beneficiary (BBEE). In general it is based upon the age as of February 1 of payment year. BB = Beginning Age; EE = Ending Age".

CMS MMR Run Date

The date on which the contents of the current MMR record were generated from the original CMS source data. This field contains the same values as the CMS MMR "Run Date" field, which the CMS documentation defines as: "Date the file was produced"

CMS MMR State and County Code

This field contains the same values as the CMS MMR "State & County Code" field, which the CMS documentation defines as: "Beneficiary State and County Code".

CMS MMR Total MA Payment Part A Amount

This field contains the same values as the CMS MMR "Total MA Payment or Adjustment Part A" field, which the CMS documentation defines as: "The total Part A portion of the MA payment".

CMS MMR Total MA Payment Part B Amount

This field contains the same values as the CMS MMR "Total MA Payment or Adjustment Part B" field, which the CMS documentation defines as: "The total Part B portion of the MA payment".

CMS MMR Total MA Payment Part C Amount

This field contains the same values as the CMS MMR "Total MA Part C Payment or Adjustment" field, which the CMS documentation defines as: "The total MA Part C A/B payment".

CMS MMR Total Payment Part D Amount

This field contains the same values as the CMS MMR "Total Part D Payment or Adjustment" field, which the CMS documentation defines as: "The total Part D payment or adjustment for the beneficiary".

CMS Original Reason for Entitlement Code

The standard CMS 1-digit code, commonly abbreviated OREC, identifying the original reason the patient was entitled to Medicare; 0 = Old Age and Survivor's Insurance, 1 = Disability Insurance Benefit, 2 = ESRD, 3 = Both Disability and ESRD, 9 = None of the Above.

CMS Part D Default Risk Factor Code

This field contains the same values as the CMS MMR "Part D Default Risk Factor Code" field, which the CMS documentation defines as: "The code that indicates the type of Part D Default Risk Factor for beneficiaries with less than 12 months of Medicare Part A entitlement: 1 = Not ESRD, Not Low Income, Not Originally Disabled; 2 = Not ESRD, Not Low Income, Originally Disabled; 3 = Not ESRD, Low Income, Not Originally Disabled; 4 = Not ESRD, Low Income, Originally Disabled; 5 = ESRD, Not Low Income, Not Originally Disabled; 6 = ESRD, Low Income, Not Originally Disabled; 7 = ESRD, Not Low Income, Originally Disabled; 8 = ESRD, Low Income, Originally Disabled Spaces = Not applicable"; with NULL = "Not applicable".

CMS Part D RAF Score

The patient-level Risk Adjustment Factor (RAF) value obtained by the RxHCC risk model methodology.

CMS Part D RAF Type Code

The standard 2-character CMS Part D Risk Adjustment Factor (RAF) Type code; e.g., D1 = Community Non-Low Income Continuing Enrollee, D2 = Community Low Income Continuing Enrollee, etc.

CMS Patient Discharge Status Code

The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.

CMS Patient Discharge Status Description

The natural language description of a standard CMS Patient Discharge Status code.

Linked Terms: CMS Patient Discharge Status Code

CMS Place of Service Code

The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.

CMS Place of Service Description

The natural language description of a standard CMS Place of Service code

Linked Terms: CMS Place of Service Code

CMS Premium Amount

The amount paid by CMS to a Medicare Advantage organization for covering specified health care services over a specified period of time. This value does not reflect the deduction, if applicable, of the CMS Sequestration Amount. Equivalent to the sum of the Medicare Part C and Medicare Part D premium amounts.

Linked Terms: CMS Sequestration Amount

CMS RAF Score

The patient-level total Risk Adjustment Factor (RAF) value obtained by the CMS-HCC risk model methodology and normalized so that the average value across all Medicare beneficiaries in a year is 1.0.

CMS Raw RAF Score

The patient-level total Risk Adjustment Factor (RAF) value obtained by the CMS-HCC risk model methodology but without the normalization to an average beneficiary value of 1.0.

CMS Revenue Center Code

The standard CMS 4-digit Revenue Center code; e.g., 0001 = Total charge, etc. CMS Revenue Center codes should include leading zeros.

CMS Revenue Center Description

The natural language description of a CMS Revenue Center code

Linked Terms: CMS Revenue Center Code

CMS Sequestration Amount

The amount removed from CMS Premium payments to Medicare Advantage organizations as part of the across-the-board reduction in certain federal spending enacted by the Budget Control Act of 2011. The amount is typically calculated as 2% of payments, but was reduced to 0% from May 2020 - March 2022 and 1% from April 2022 - June 2022 in response to the COVID-19 pandemic.

Linked Terms: CMS Premium Amount

CMS Type of Bill Code

The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.

CMS Type of Bill Code Description

The natural language description of a standard CMS Type of Bill (TOB) code.

Linked Terms: CMS Type of Bill Code

CMS Type of Service Code

The standard CMS 1-character Type of Service (TOS) code; 0 = Whole Blood, 1 = Medical Care, etc.

CMS Type of Service Description

The natural language description of a CMS Type of Service (TOS) code

Linked Terms: CMS Type of Service Code

COB Paid Amount

The total amount paid to the provider by one or more health plans other than the plan identified on the claim record as part of a "coordination of benefit" (COB) action; a COB scenario can arise when a patient has multiple concurrent plan memberships.

Communication Duration Minutes

The duration of the communication in minutes, calculated as the elapsed time between communication start and end; for asynchronous communication, this might include time between the communication start and end not spent in active communication.

Communication End Date

The date on which the current instance of patient communication ended.

Communication End Datetime

The date and time at which the current instance of patient communication ended.

Communication Start Date

The date the current instance of patient communication started.

Communication Start Datetime

The date and time the current instance of patient communication started.

Conclusion Description

The natural language description of the results of activity, such as a task or instance of communication, whether it was completed successfully or not.

Conclusion Operational ID

The "real-life" identifier for the results of activity, such as a task or instance of communication, whether it was completed successfully or not.

Content Description

The natural language description of the content of an instance of communication; could be the actual transcript of the communication, or a summary, as desired.

Content Type Description

The natural language description of the type of content discussed in the current instance of communication, e.g., "Appointment Reminder Email".

Content Type Operational ID

The "real-life" identifier of the type of content discussed in the current instance of communication.

Continuous Medical Claim Data Coverage Episode

A continuous period of Data Coverage for medical claims from at least one data source (typically, a payor organization). Any gap in coverage, even a single day, is sufficient to interrupt the episode.

Linked Terms: Data Coverage

Continuous Pharmacy Claim Data Coverage Episode

A continuous period of Data Coverage for pharmacy claims from at least one data source (typically, a payor organization). Any gap in coverage, even a single day, is sufficient to interrupt the episode.

Continuous Primary Payor Membership Episode

A continuous period of membership with the Primary Payor (regardless of the particular insurance product offered by that organization). Any gap in coverage, even a single day, is sufficient to interrupt the episode.

Linked Terms: Primary Payor

Contractual Adjustment Amount

The amount representing the difference between the initial amount charged by a provider for a service or product and the amount the health plan has agreed to pay; typically a negative value (representing a discount). The final Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount to the Charge Amount.

Linked Terms: Charge Amount, Allowed Amount

Count CCW Conditions

The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library.

Linked Terms: CCW Comorbidity Category, Count Potentially Disabling Events, CMS Chronic Condition Warehouse (CCW), Count Chronic Conditions

Count CCW Systems

The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary.

Linked Terms: CMS Chronic Condition Warehouse (CCW)

Count Chronic Conditions

A subset of the total count of CCW Conditions which includes both chronic conditions and potentially disabling events, this field solely represents the number of active CCW Conditions that further qualify as chronic; excluding those are categorized as potentially disabling events.

Linked Terms: Count CCW Conditions, Count Potentially Disabling Events

Count Distinct Data Sources

For a given patient (or other type of entity) and time period, the count of distinct data sources contributing some degree of data coverage for that entity during that time period.

Linked Terms: Data Coverage

Count of Unique Systems with CCW

The count of distinct systems of the body with one or more active CCW Condition. This serves as a parent to the individual CCW Conditions grouping them into the following categories; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary.

Count Potentially Disabling Events

A subset of the total count of CCW Conditions which includes both chronic conditions and potentially disabling events, this field solely represents the number of active CCW Conditions that further qualify as potentially disabling events including; Acute Myocardial Infarctions, Stroke or Transient Ischemic Attack, or Hip or Pelvis Fracture.

Linked Terms: Count CCW Conditions, CCW Type Category, Count Chronic Conditions

Linked Value Sets: CMS CCW AMI (URSA-CORE ICD10CM), CMS CCW STROKE OR TRANSIENT ISCHEMIC ATTACK EXCLUSIONS (URSA-CORE ICD10CM), CMS CCW HIP OR PELVIC FRACTURE (URSA-CORE ICD10CM)

Count Refills Allowed

The number of refills (in addition to the initial fill) allowed on this medication order. (E.g., a value of 2 would allow a total of 3 fills from the order.)

Covered Month Start Date

The start date (e.g., January 1, February 1, etc.) of the month in the patient's life described by the current record.

Covered Service Type

A classification system describing the type of service associated with the given financial record; e.g., dental care, vision care, transportation, etc.

Covered Service Type Description

The natural language description of a financial record's Covered Service Type.

Linked Terms: Covered Service Type

Credential

Any degree, license, certification, or other qualifications, related to the credential-holder's expertise. Canonical credential abbreviations for degrees include MD, DO, PharmD, ADN, BSN, MSN, MSNA, DNP, DNS, DNAP, PhD, MA, MS, BA, and BS; canonical credential abbreviations for licenses include CNA, LPN, RN, APRN, NP, CNS, CNM, CNA, etc.

Current Continuous Medical Claim Data Coverage Episode End Date

The end date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Continuous Medical Claim Data Coverage Episode, Period End Date

Current Continuous Medical Claim Data Coverage Episode Start Date

The start date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record.

Linked Terms: Continuous Medical Claim Data Coverage Episode

Current Continuous Pharmacy Claim Data Coverage Episode End Date

The end date of the Continuous Pharmacy Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Continuous Pharmacy Claim Data Coverage Episode

Current Continuous Pharmacy Claim Data Coverage Episode Start Date

The start date of the Continuous Pharmacy Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record.

Linked Terms: Continuous Pharmacy Claim Data Coverage Episode

Current Continuous Primary Payor Membership Episode End Date

The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Continuous Primary Payor Membership Episode, Period End Date

Current Continuous Primary Payor Membership Episode Start Date

The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record.

Linked Terms: Continuous Primary Payor Membership Episode

Current Non-Membership Episode End Date

The end date of the Non-Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Non-Membership Episode, Period End Date

Current Non-Membership Episode Start Date

The start date of the Non-Membership Episode in effect as of the (potentially historical) period covered by the record.

Linked Terms: [Non-Membership Episode](#nonmembership-episode

Data Coverage

Having "data coverage" for an entity (e.g., a patient) for a particular type of data (e.g., medical claims) from a particular data source over a particular time period means that the relevant objects in the data model associated with that type of data can be expected to contain records for that entity over that time period if that information is available in that source system. For example, if a particular patient has medical claims data coverage from payor X for calendar year Y, we would expect to find medical claims for that patient from payor X and with a covered start date falling in year Y in the appropriate data objects if (and only if) that patient actually had such claims in the source system. In other words, having data coverage does not tell us those objects contain certain records; rather, it tells us that those objects would contain certain records if they exist in the source system.

Days Supply

The number of calendar days, including the date the medication was dispensed, the dispensed medication will last at the patient's intended dosage as defined in their prescription.

Days Supply per Fill

The days supply of medication to be dispensed per fill of this medication order.

DEA Schedule Description

Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules by the US Drug Enforcement Agency (DEA) depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs have a high potential for abuse and the potential to create severe psychological and/or physical dependence. As the drug schedule changes-- Schedule II, Schedule III, etc., so does the abuse potential-- Schedule V drugs represents the least potential for abuse. A Listing of drugs and their schedule are located at Controlled Substance Act (CSA) Scheduling or CSA Scheduling by Alphabetical Order. See more at https://www.dea.gov/drug-information/drug-scheduling

Linked Terms: Is DEA Schedule 1, Is DEA Schedule 2, Is DEA Schedule 3, Is DEA Schedule 4, Is DEA Schedule 5

Diagnosis ICD-10-CM Code

The standard ICD-10-CM diagnosis code; e.g., A00 = Cholera. ICD-10-CM diagnosis codes longer than 3 digits must include a decimal point after the 3rd digit.

Diagnosis ICD-10-CM Description

The natural language description of a ICD-10-CM diagnosis code.

Linked Terms: Diagnosis ICD-10-CM Code

Diagnosis ICD-9-CM Code

The standard ICD-9-CM diagnosis code; e.g., 001.0 = Cholera due to vibrio cholerae. ICD-9-CM diagnosis codes longer than 3 digits must include a decimal point after the 3rd digit.

Diagnosis ICD-9-CM Description

The natural language description of a ICD-9-CM diagnosis code.

Linked Terms: Diagnosis ICD-9-CM Code

Diagnosis Line Number

The integer-valued ordinal representing the position of a diagnosis on a claim, bill, encounter, or other master record. May not necessarily match the analogous value in the source data for the same record. Typically, the diagnosis in the first position is considered the principal diagnosis, though this is not an absolute rule, and the Is Principal Diagnosis field should be used to identify the principal diagnosis.

Diagnosis Line Number of Principal Diagnosis

The diagnosis line number containing the principal diagnosis.

Linked Terms: Diagnosis Line Number

Dialysis Facility Encounter

A patient encounter at a dedicated outpatient dialysis facility. The encounter need not include the performance of dialysis. Identified either by the presence of a qualifying Type of Bill Code; by a HCPCS or Revenue Center Code for dialysis combined with a qualifying Place of Service code; or as a single-day EMR Encounter with a qualifying EMR Encounter Type or Place of Service Code value.

Linked Value Sets: URSA SETTING TIER 1 = DIALYSIS CENTER (URSA-CORE CMS_TYPE_OF_BILL_CODE), DIALYSIS (URSA-CORE HCPCS), DIALYSIS (URSA-CORE CMS_REVENUE_CENTER_CODE), URSA SETTING TIER 1 = DIALYSIS CENTER (URSA-CORE CMS_PLACE_OF_SERVICE_CODE)

Discharge Date

The date the patient was discharged from a care facility.

Document

A record from one of a set of designated Natural Objects representing the basic building blocks from which more complicated business logic is typically built. Each such document is assigned a Document ID that is unique within an instance of Ursa Studio.

Document Effective Date

The most appropriate single date that events associated with the document occurred. For documents spanning multiple calendar days, the earliest date is typically used; Document Effective Start Date and Document Effective End Date can be used for a more precise range of dates, if necessary.

Document Effective End Date

The last date on which events associated with the document occurred or continued until.

Document Effective Start Date

The date that the events associated with the document began.

Document ID

The internal database identifier (used, e.g., for joins and primary keys) for the document.

Linked Terms: Document

Dosage

The instructions for how a given medication is to be taken by the patient; typically includes dose frequency and quantity per dose, but can also include other guidance.

Dosage Description

The natural language description of the medication order dosage. Also called the Sig.

Linked Terms: Dosage

Dose Frequency

The frequency, often expressed as a number of doses per day, with which the patient should be taking the medication. A key component (with dose quantity) of dosage.

Linked Terms: Dosage

Dose Frequency Description

The natural language description of dose frequency.

Linked Terms: Dose Frequency

Dose Quantity

The quantity of medication (e.g., number of tablets, volume of liquid, etc.) to be taken at each dose. A key component (with dose frequency) of dosage.

Linked Terms: Dosage

Dose Quantity Description

The natural language description of the dose quantity.

Linked Terms: Dose Quantity

Dose Quantity Numeric

The numeric component of a dose quantity, expressed as a number, including non-integer values, if applicable.

Dose Quantity Unit Description

The natural language description of the unit component of dose quantity.

Linked Terms: Dose Quantity

Doses per Day

The dose frequency expressed as a number of doses per day.

Linked Terms: Dose Frequency

Emergency Department Level of Service

Categorizes the level of severity of the Emergency Department visit based on complexity, performed work (including cognitive effort), volume, and intensity of resources used by the facility to provide care which can be on the professional or institutional claim.

Emergency Department Visit Parent Encounter

An encounter during which the patient received care in an emergency room setting; operationally defined by the presence of one or more of the following: (1) a qualifying revenue center code value on an institutional claim or bill; (2) a qualifying HCPCS code on an institutional claim or bill; or (3) an EMR encounter record flagged as an ED visit (i.e., Is Encounter Type ED Visit = 1).

Linked Value Sets: EMERGENCY ROOM SETTING (URSA-CORE CMS_REVENUE_CENTER_CODE), EMERGENCY ROOM VISIT (URSA-CORE HCPCS)

EMR Encounter

An encounter as represented in an EMR or equivalent clinical or administrative system acting as a data source. (We make a distinction between an "encounter" and an "EMR encounter" because the definition of an encounter in an EMR might not match that used in the data model.)

Linked Terms: Encounter

EMR Encounter Diagnosis ID

The identifier for the instance of documented diagnosis associated with an EMR Encounter.

EMR Encounter ID

The internal database identifier (used, e.g., for joins and primary keys) for the EMR encounter.

Linked Terms: EMR Encounter

EMR Encounter Service Line Item ID

The identifier for the instance of a performed service during an EMR Encounter.

Encounter

An interaction between a patient and one or more providers, occurring over a single unbroken period of time at a single location, during which some type of health care service is provided. Encounters can be both in-person or virtual; can last several days or longer; can take place in the patient’s residence; and can involve only diagnostic services.

Encounters can be nested; that is, one “parent” encounter can contain one or more “child” encounters. For example, a patient’s SNF stay might include multiple visits from individual providers, each of which could qualify as its own child encounter. There is no theoretical limit to the number of nesting levels, though in practice parent encounters typically have at most a single generation of children.

Encounter ID

The internal database identifier (used, e.g., for joins and primary keys) for the encounter.

Linked Terms: Encounter

Encounter Primary Payor ID

Data model key for the primary payor documented in the billing for an encounter.

Encounter Primary Plan ID

Data model key for the primary plan documented in the billing for an encounter.

Entity Participation End Date

The date the program entity stopped participating in the program. (Uses the interval convention for end dates.)

Linked Terms: Program Entity

Entity Participation Start Date

The date the program entity started participating in the program.

Linked Terms: Program Entity

Facility Provider

The organizational provider associated with the physical facility in which care was delivered.

Facility Provider Description

The natural language description of the facility provider.

Linked Terms: Facility Provider

Facility Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the facility provider.

Linked Terms: Facility Provider

Facility Provider NPI

The 10-digit National Provider Identifier for the facility provider.

Linked Terms: Facility Provider

FDA Dosage Form Code

The standard Food and Drug Administration (FDA) dosage form code describing the medication form; e.g., C42887 = aerosol.

Linked Terms: Medication Form

Filled Date

The date a prescription or medication order was filled, with medications dispensed.

Filling Provider

The provider, typically a pharmacy or other facility provider, that filled a prescription or other medication order by dispensing a medication.

Filling Provider DEA Number

The 9-character alphanumeric Drug Enforcement Agency (DEA) identifier for the filling provider.

Linked Terms: Filling Provider

Filling Provider Description

The natural language description of the filling provider.

Linked Terms: Filling Provider

Filling Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the filling provider.

Filling Provider NPI

The 10-digit National Provider Identifier for the filling provider.

Linked Terms: Filling Provider

Filling Provider Practice Address State Abbreviation

The two-character state abbreviation for the filling provider's practice address.

Linked Terms: Filling Provider

Filling Provider Practice Address ZIP Code 5-Digit

The five-digit ZIP code for the filling provider's practice address.

Linked Terms: Filling Provider

Filling Provider Primary NUCC Provider Taxonomy Code

The primary NUCC Provider Taxonomy code for the filling provider.

Linked Terms: Filling Provider, Primary NUCC Provider Taxonomy Code

Filling Provider Primary NUCC Provider Taxonomy Description

The primary NUCC Provider Taxonomy description for the filling provider.

Linked Terms: Filling Provider, Primary NUCC Provider Taxonomy Description

Filling Provider TIN

The 9-digit federal Tax Identification Number for the filling provider.

Linked Terms: Filling Provider

Filling Setting

The setting in which a medication order is to be filled; e.g., inpatient, outpatient, or community.

Filling Setting Description

The natural language description of the filling setting.

Linked Terms: Filling Setting

Fill Number

The ordinal number, chronologically ordered, of the fill among other fills made on the same prescription; with the first fill assigned a value of 1.

Financial Class

The broad category of health insurance plan that a member is enrolled in, or that a claim is associated with. There are five categories of financial class in the Ursa Core Data Model: commercial, Medicare FFS (fee-for-service), Medicare Advantage, Medicaid, and other.

Financial Class Description

The natural language description of the financial class of a claim or plan. (A claim's financial class is inherited from its associated plan.)

Linked Terms: Financial Class

Form Description

The natural language description of the medication's form.

Linked Terms: Medication Form

Formulary Tier Description

The natural language description of the formulary tier to which the medication is assigned, as defined by the relevant authority (e.g., plan).

Formulary Tier Operational ID

The "real-life" identifier for the formulary tier to which the medication is assigned, as defined by the relevant authority (e.g., plan).

Funding Year Start Date

The start date of the calendar year (i.e., January 1) that the financial amounts on the record are associated with.

Grandparent Document ID

The document ID for the document two levels above the current document in the object hierarchy,

Linked Terms: Document ID

HCPCS Code

The Healthcare Common Procedure Coding System (HCPCS) code associated with a service. Includes both HCPCS Level I codes (commonly called CPT codes) and Level II codes (which includes products, supplies, and services not included in CPT). Level II codes consist of a letter followed by four numeric digits. Current Dental Terminology codes are included in the Level II codes as HCDT.

Linked Terms: HCPCS Description

HCPCS Description

The natural language description of a HCPCS code.

Linked Terms: HCPCS Code

HCPCS Modifier Code

The 2-character code modifying a HCPCS code.

HCPCS Modifier Description

The natural language description of a HCPCS code modifier.

Linked Terms: HCPCS Modifier Code

Health System

A large organization that provides health care services to patients; serves practically as a parent organization within which smaller affiliated entities -- individual providers, smaller organizational providers, or program entities -- can be grouped.

Health System ID

The internal database identifier (used, e.g., for joins and primary keys) for the health system.

Linked Terms: Health System

HIPPS Code

The standard CMS 5-digit Health Insurance Prospective Payment System (HIPPS) code; e.g., AAA00 = Default Code.

HIPPS Description

The natural language description of a HIPPS code.

Linked Terms: HIPPS Code

Home Health Care Visit

A patient encounter in which the patient receives care of some sort in their home or other long-term residential setting. Includes but is not limited to Home Health Agency (HHA) care. Identified either by the presence of a qualifying Type of Bill Code or Place of Service Code; by a HCPCS or Revenue Center Code for home health care combined with a non-contradictory Place of Service code; or as an EMR Encounter with a qualifying EMR Encounter Type or service line item HCPCS value.

Linked Value Sets: URSA SETTING TIER 1 = HOME (URSA-CORE CMS_TYPE_OF_BILL_CODE), HOME HEALTH CARE (URSA-CORE HCPCS), HOME HEALTH CARE (URSA-CORE CMS_REVENUE_CENTER_CODE), URSA SETTING TIER 1 = HOME (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = LONG-TERM RESIDENTIAL (URSA-CORE CMS_PLACE_OF_SERVICE_CODE)

Increase to Allowed Amount

The increase to the Allowed Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Allowed Amount

Increase to Anesthesia Base Unit Count

The increase to the Anesthesia Base Unit Count from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Anesthesia Base Unit Count

Increase to Anesthesia Physical Status Unit Count

The increase to the Anesthesia Physical Status Unit Count from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Anesthesia Physical Status Unit Count

Increase to Anesthesia Time Unit Count

The increase to the Anesthesia Time Unit Count from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Anesthesia Time Unit Count

Increase to Bad Debt Write-Off Amount

The change to the current bad debt write-off amount. Positive values indicate an increase to the final bad debt write-off amount.

Increase to Charge Amount

The increase to the Charge Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Charge Amount

Increase to CMS MMR LIS Premium Subsidy Amount

The increase to the CMS MMR LIS Premium Subsidy Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR LIS Premium Subsidy Amount

Increase to CMS MMR Low-Income Subsidy Cost-Sharing Amount

The increase to the CMS MMR Low-Income Subsidy Cost-Sharing Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Low-Income Subsidy Cost-Sharing Amount

Increase to CMS MMR Medication Therapy Management Add-On Amount

The increase to the CMS MMR Medication Therapy Management Add-On Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Medication Therapy Management Add-On Amount

Increase to CMS MMR Monthly Risk-Adjusted Part A Amount

The increase to the CMS MMR Monthly Risk-Adjusted Part A Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Monthly Risk-Adjusted Part A Amount

Increase to CMS MMR Monthly Risk-Adjusted Part B Amount

The increase to the CMS MMR Monthly Risk-Adjusted Part B Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Monthly Risk-Adjusted Part B Amount

Increase to CMS MMR PACE Cost Sharing Add-on Amount

The increase to the CMS MMR PACE Cost Sharing Add-on Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR PACE Cost Sharing Add-on Amount

Increase to CMS MMR PACE Premium Add-On Amount

The increase to the CMS MMR PACE Premium Add-On Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR PACE Premium Add-On Amount

Increase to CMS MMR Part A Monthly Rate for Payment or Adjustment

The increase to the CMS MMR Part A Monthly Rate for Payment or Adjustment from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part A Monthly Rate for Payment or Adjustment

Increase to CMS MMR Part A MSP Reduction Amount

The increase to the CMS MMR Part A MSP Reduction Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part A MSP Reduction Amount

Increase to CMS MMR Part B Monthly Rate for Payment or Adjustment

The increase to the CMS MMR Part B Monthly Rate for Payment or Adjustment from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part B Monthly Rate for Payment or Adjustment

Increase to CMS MMR Part B MSP Reduction Amount

The increase to the CMS MMR Part B MSP Reduction Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part B MSP Reduction Amount

Increase to CMS MMR Part C Basic Premium Part A Amount

The increase to the CMS MMR Part C Basic Premium Part A Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part C Basic Premium Part A Amount

Increase to CMS MMR Part C Basic Premium Part B Amount

The increase to the CMS MMR Part C Basic Premium Part B Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part C Basic Premium Part B Amount

Increase to CMS MMR Part D Basic Premium Amount

The increase to the CMS MMR Part D Basic Premium Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part D Basic Premium Amount

Increase to CMS MMR Part D Coverage Gap Discount Amount

The increase to the CMS MMR Part D Coverage Gap Discount Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part D Coverage Gap Discount Amount

Increase to CMS MMR Part D Direct Subsidy Amount

The increase to the CMS MMR Part D Direct Subsidy Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part D Direct Subsidy Amount

Increase to CMS MMR Part D Monthly Rate for Payment or Adjustment

The increase to the CMS MMR Part D Monthly Rate for Payment or Adjustment from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Part D Monthly Rate for Payment or Adjustment

Increase to CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount

The increase to the CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount

Increase to CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount

The increase to the CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount

Increase to CMS MMR Rebate for Part A Cost Sharing Reduction Amount

The increase to the CMS MMR Rebate for Part A Cost Sharing Reduction Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part A Cost Sharing Reduction Amount

Increase to CMS MMR Rebate for Part B Cost Sharing Reduction Amount

The increase to the CMS MMR Rebate for Part B Cost Sharing Reduction Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part B Cost Sharing Reduction Amount

Increase to CMS MMR Rebate for Part B Premium Reduction Part A Amount

The increase to the CMS MMR Rebate for Part B Premium Reduction Part A Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part B Premium Reduction Part A Amount

Increase to CMS MMR Rebate for Part B Premium Reduction Part B Amount

The increase to the CMS MMR Rebate for Part B Premium Reduction Part B Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part B Premium Reduction Part B Amount

Increase to CMS MMR Rebate for Part D Basic Premium Reduction Amount

The increase to the CMS MMR Rebate for Part D Basic Premium Reduction Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part D Basic Premium Reduction Amount

Increase to CMS MMR Rebate for Part D Supplemental Benefits Part A Amount

The increase to the CMS MMR Rebate for Part D Supplemental Benefits Part A Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part D Supplemental Benefits Part A Amount

Increase to CMS MMR Rebate for Part D Supplemental Benefits Part B Amount

The increase to the CMS MMR Rebate for Part D Supplemental Benefits Part B Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Rebate for Part D Supplemental Benefits Part B Amount

Increase to CMS MMR Reinsurance Subsidy Amount

The increase to the CMS MMR Reinsurance Subsidy Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Reinsurance Subsidy Amount

Increase to CMS MMR Total MA Payment Part A Amount

The increase to the CMS MMR Total MA Payment Part A Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Total MA Payment Part A Amount

Increase to CMS MMR Total MA Payment Part B Amount

The increase to the CMS MMR Total MA Payment Part B Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Total MA Payment Part B Amount

Increase to CMS MMR Total MA Payment Part C Amount

The increase to the CMS MMR Total MA Payment Part C Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Total MA Payment Part C Amount

Increase to CMS MMR Total Payment Part D Amount

The increase to the CMS MMR Total Payment Part D Amount from an MMR transaction record; negative values indicate a decrease.

Linked Terms: CMS MMR Total Payment Part D Amount

Increase to COB Paid Amount

The increase to the COB Paid Amount from a claim transaction; negative values indicate a decrease.

Linked Terms: COB Paid Amount

Increase to Contractual Adjustment Amount

The increase to the Contractual Adjustment Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Contractual Adjustment Amount

Increase to Days Supply

The increase to the Days Supply from a transaction; negative values indicate a decrease.

Linked Terms: Days Supply

Increase to Net Paid Amount

The increase to Net Paid Amount from a transaction; negative values indicate a decrease.

Linked Terms: Net Paid Amount

Increase to Non-Contractual Adjustment Amount

The increase to the Non-Contractual Adjustment Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Non-Contractual Adjustment Amount

Increase to Patient Paid Amount

The increase to the Patient Paid Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Patient Paid Amount

Increase to Patient Responsibility Amount

The increase to the Patient Responsibility Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Patient Responsibility Amount

Increase to Plan Paid Amount

The increase to the Plan Paid Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Plan Paid Amount

Increase to Quantity Dispensed

The increase to the Quantity Dispensed from a transaction; negative values indicate a decrease.

Linked Terms: Quantity Dispensed

Increase to Service Unit Count

The increase to the service unit count from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Service Unit Count

Increase to Total Due Amount

The increase to the Total Due Amount from a billing or claim transaction; negative values indicate a decrease.

Linked Terms: Total Due Amount

Inpatient LOS Category Tier 1

Classifies the encounter based on the length of stay in elapsed midnights between the encounter inpatient status start date (or encounter start date when inpatient status start date is unavailable) and the encounter end date (patient discharge from inpatient status).

Institutional Claims Expense Amount

The Claims Expense Amount associated with institutional claims.

Linked Terms: Claims Expense Amount

Is Accounting Activity Type Capitation Expense

Indicates the transaction has an Accounting Activity Type of "Capitation Expense" (indicating the transaction amount represents Capitation Expense).

Linked Terms: Accounting Activity Type, Capitation Expense

Is Accounting Activity Type Capitation Revenue

Indicates the transaction has an Accounting Activity Type of "Capitation Revenue" (indicating the transaction amount represents Capitation Revenue).

Linked Terms: Accounting Activity Type, Capitation Revenue

Is Accounting Activity Type Cash Flow Payment

Indicates the transaction has an Accounting Activity Type of "Cash Flow Payment" (indicating the transaction amount represents a Cash Flow Payment).

Linked Terms: Cash Flow Payment

Is Accounting Activity Type Manual Adjustment

Indicates the transaction has an Accounting Activity Type of "Manual Adjustment" (indicating the transaction amount represents a Manual Adjustment).

Linked Terms: Accounting Activity Type, Manual Adjustment

Is Active Condition

Indicates the condition is currently unresolved as of the source data effective date.

Is Active Location

Indicates the location is in active use as of the current source data effective date.

Linked Terms: Location

Is Active Medication

Indicates the medication is in active use by the patient as of the current source data effective date.

Is Active Provider

Indicates the provider is currently designated in the relevant administrative system as actively treating patients. Typically only used for individual providers, not organizational providers.

Is Admitting Diagnosis

Indicates that a diagnosis was the admitting diagnosis for an encounter.

Is Anesthesia Billing Format

Indicates that the claim or bill should include values in fields associated with anesthesia billing, e.g., anesthesia base unit count, physical status unit count, and time unit count.

Is Any Hospital Encounter Type

True if the URSA-CORE meets any of the criteria for one or more of the following encounter types: (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, or (5) Other Hospital Outpatient Department Encounters.

Is APR-DRG Medical Surgical Type Medical

Indicates the APR-DRG has been classified as a medical (non-surgical) code.

Is APR-DRG Medical Surgical Type Surgical

Indicates the APR-DRG has been classified as a surgical code.

Is Billing Provider in Network

Indicates whether the billing provider is considered to be in a plan's or payor's provider network.

Linked Terms: Billing Provider

Is Brand According to Plan

Indicates the medication is considered by the plan to be a brand name drug.

Is Brand According to Provider

Indicates that the medication is considered to be a brand medication by the ordering provider or their organization.

Is Brand According to Reference

Indicates that the medication is considered to be a brand medication in the relevant reference dataset.

Is CCW Acquired Hypothyroidism

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW ACQUIRED HYPOTHYROIDISM (URSA-CORE ICD10CM)

Is CCW Acute Myocardial Infarction

At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.

Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome

At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW ADHD, CONDUCT DISORDERS, AND HYPERKINETIC SYNDROME (URSA-CORE ICD10CM)

Is CCW Alzheimers Disease

At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.

Linked Value Sets: CMS CCW ALZHEIMERS DISEASE (URSA-CORE ICD10CM)

Is CCW Alzheimers Disease and Related Disorders or Senile Dementia

At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.

Linked Value Sets: CMS CCW ALZHEIMERS DISEASE AND RELATED DISORDERS OR SENILE DEMENTIA (URSA-CORE ICD10CM)

Is CCW Anemia

At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Is CCW Anxiety Disorders

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW ANXIETY DISORDERS (URSA-CORE ICD10CM)

Is CCW Asthma

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW ASTHMA (URSA-CORE ICD10CM)

Is CCW Atrial Fibrillation

At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.

Linked Value Sets: CMS CCW ATRIAL FIBRILLATION (URSA-CORE ICD10CM)

Is CCW Autism Spectrum Disorder

At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW AUTISM SPECTRUM DISORDERS (URSA-CORE ICD10CM)

Is CCW Benign Prostatic Hyperplasia

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. Exclusion: If any of the qualifying claims also have an ICD-10 DX of D29.1, then it is excluded.

Linked Value Sets: CMS CCW BPH (URSA-CORE ICD10CM), CMS CCW BPH EXCLUSIONS (URSA-CORE ICD10CM)

Is CCW Bipolar Disorder

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW BIPOLAR DISORDER (URSA-CORE ICD10CM)

Is CCW Blindness and Visual Impairment

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW SENSORY - BLINDNESS AND VISUAL IMPAIRMENT (URSA-CORE ICD10CM)

Is CCW Breast Cancer

At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in prior 1 year.

Linked Value Sets: CMS CCW BREAST CANCER (URSA-CORE ICD10CM)

Is CCW Cataract

At least 1 HOP or Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.

Linked Value Sets: CMS CCW CATARACT (URSA-CORE ICD10CM)

Is CCW Cerebral Palsy

At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes over the last 2 years

Linked Terms: CMS Chronic Condition Warehouse (CCW)

Linked Value Sets: CMS CCW CEREBRAL PALSY (URSA-CORE ICD10CM)

Is CCW CKD

Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years.

Linked Value Sets: CMS CCW CKD (URSA-CORE ICD10CM), CCW CKD (CMS ICD9CM)

Is CCW Colorectal Cancer

At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW COLORECTAL CANCER (URSA-CORE ICD10CM)

Is CCW COPD and Bronchiectasis

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW COPD AND BRONCHIECTASIS (URSA-CORE ICD10CM)

Is CCW Cystic Fibrosis and Other Metabolic Disorder

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW CYSTIC FIBROSIS (URSA-CORE ICD10CM)

Is CCW Deafness and Hearing Impairment

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW SENSORY - DEAFNESS AND HEARING IMPAIRMENT (URSA-CORE ICD10CM)

Is CCW Depression

At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW DEPRESSION (URSA-CORE ICD10CM)

Is CCW Depressive Disorders

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW DEPRESSIVE DISORDER (URSA-CORE ICD10CM)

Is CCW Diabetes

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW DIABETES (URSA-CORE ICD10CM)

Is CCW Endometrial Cancer

At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW ENDOMETRIAL CANCER (URSA-CORE ICD10CM)

Is CCW Epilepsy

At least 1 inpatient claim OR 2 other non-drug claims of any service type during the two-year period

Linked Terms: CMS Chronic Condition Warehouse (CCW)

Linked Value Sets: CMS CCW EPILEPSY (URSA-CORE ICD10CM)

Is CCW Fibromyalgia and Chronic Pain and Fatigue

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW FIBROMYALGIA (URSA-CORE ICD10CM)

Is CCW Glaucoma

At least 1 Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.

Linked Value Sets: CMS CCW GLAUCOMA (URSA-CORE ICD10CM)

Is CCW Heart Failure

At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW HEART FAILURE (URSA-CORE ICD10CM)

Is CCW Hip or Pelvic Fracture

At least 1 inpatient or SNF claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW HIP OR PELVIC FRACTURE (URSA-CORE ICD10CM)

Is CCW Hyperlipidemia

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW HYPERLIPIDEMIA (URSA-CORE ICD10CM)

Is CCW Hypertension

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW HYPERTENSION (URSA-CORE ICD10CM)

Is CCW Intellectual Disability

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW INTELLECTUAL DISABILITIES AND RELATED CONDITIONS (URSA-CORE ICD10CM)

Is CCW Ischemic Heart Disease

At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW ISCHEMIC HEART DISEASE (URSA-CORE ICD10CM)

Is CCW Learning Disability

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW LEARNING DISABILITIES (URSA-CORE ICD10CM)

Is CCW Leukemia

At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW LEUKEMIA (URSA-CORE ICD10CM)

Is CCW Lung Cancer

At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW LUNG CANCER (URSA-CORE ICD10CM)

Is CCW Migraine and Chronic Headache

At least 1 inpatient claim OR 2 non-inpatient claims with DX codes within a 2 year period.

Linked Terms: CMS Chronic Condition Warehouse (CCW)

Linked Value Sets: CMS CCW MIGRAINE (URSA-CORE ICD10CM)

Is CCW Mobility Impairment

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW MOBILITY IMPAIRMENTS (URSA-CORE ICD10CM)

Is CCW Multiple Sclerosis

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW MULTIPLE SCLEROSIS (URSA-CORE ICD10CM)

Is CCW Muscular Dystrophy

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW MUSCULAR DYSTROPHY (URSA-CORE ICD10CM)

Is CCW Obesity

At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW OBESITY (URSA-CORE ICD10CM)

Is CCW Osteoporosis

At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW OSTEOPOROSIS (URSA-CORE ICD10CM)

Is CCW Other Developmental Delay

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW OTHER DEVELOPMENTAL DELAYS (URSA-CORE ICD10CM)

Is CCW Personality Disorder

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW PERSONALITY DISORDERS (URSA-CORE ICD10CM)

Is CCW Pressure or Chronic Ulcer

At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW PRESSURE AND CHRONIC ULCERS (URSA-CORE ICD10CM)

Is CCW Prostate Cancer

At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.

Linked Value Sets: CMS CCW PROSTATE CANCER (URSA-CORE ICD10CM)

Is CCW PTSD

At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW POST-TRAUMATIC STRESS DISORDER (PTSD) (URSA-CORE ICD10CM)

Is CCW PVD

At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW PVD (URSA-CORE ICD10CM)

Is CCW Rheumatoid Arthritis or Osteoarthritis

At least 2 inpatient, SNF, HHA, HOP, or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW RA OR OA (URSA-CORE ICD10CM)

Is CCW Schizophrenia

At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes at least one day apart in the prior within the 2 year reference period. Qualifying codes can also be found as a subset of those in the CCW "Schizophrenia or Other Psychotic Disorders".

Linked Terms: Is CCW Schizophrenia or Other Psychotic Disorders

Linked Value Sets: CMS CCW SCHIZOPHRENIA (URSA-CORE ICD10CM)

Is CCW Schizophrenia or Other Psychotic Disorders

At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.

Linked Value Sets: CMS CCW SCHIZOPHRENIA OR PSYCHOTIC DISORDERS (URSA-CORE ICD10CM)

Is CCW Stroke or Transient Ischemic Attack

At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.

Linked Value Sets: CMS CCW STROKE OR TRANSIENT ISCHEMIC ATTACK (URSA-CORE ICD10CM)

Is CCW System Behavioral Health

Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.

Is CCW System Cardiovascular

Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).

Is CCW System Congenital

Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.

Is CCW System Endocrine/Metabolic

Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.

Is CCW System Genitourinary

Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).

Is CCW System Hematologic

Indicates the patient has one or more of the following CCW conditions; Anemia.

Is CCW System Musculoskeletal

Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.

Is CCW System Neurological

Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.

Is CCW System Oncologic

Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.

Is CCW System Ophthalmologic

Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.

Is CCW System Other

Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.

Is CCW System Pulmonary

Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.

Is Claim Class Institutional

Indicates the record is associated with an institutional claim or bill.

Is Claim Class Pharmacy

Indicates the record is associated with a pharmacy claim.

Is Claim Class Professional

Indicates the record is associated with a professional claim or bill.

Is Claim Financial Class Other

Indicates the financial class of the claim or plan is something other than commercial, Medicare FFS (fee-for-service), Medicare Advantage, or Medicaid.

Linked Terms: Financial Class

Is Claim Processed Status Denied

Indicates the claim has been denied.

Is Claim Processed Status Open

Indicates that the claim has been received but not yet paid or denied.

Is Claim Processed Status Paid

Indicates that the claim has completed processing without denial, with any outstanding balance paid.

Is Claim Processed Status Reversed

Indicates the claim has been reversed. In contrast to a denied claim, the presumption is that the services associated with a reversed claim did not occur, or resulted in a different claim.)

Is Claim Service Line Item Processed Status Denied

Indicates the claim service line item has been denied.

Is Claim Service Line Item Processed Status Open

Indicates that the claim service line item has been received but not yet paid or denied.

Is Claim Service Line Item Processed Status Paid

Indicates that the claim service line item has completed processing without denial, with any outstanding balance paid.

Is CMS Aged Status

Indicates the patient meets the Medicare aged eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code.

Linked Terms: CMS Medicare Beneficiary Status Code

Is CMS Disabled Status

Indicates the patient meets the Medicare Disabled eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code.

Linked Terms: CMS Medicare Beneficiary Status Code

Is CMS DRG Medical Surgical Type Medical

Indicates that the MS-DRG code is classified as a medical DRG by CMS.

Is CMS DRG Medical Surgical Type Surgical

Indicates that the MS-DRG code is classified as a surgical DRG by CMS.

Is CMS ESRD Status

Indicates the patient meets the Medicare ESRD eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code.

Linked Terms: CMS Medicare Beneficiary Status Code

Is CMS Hospice Status

Indicates the patient is considered to be Hospice status.

Is CMS LTI Status

Indicates the patient meets the CMS criteria to be considered a Long-Term Institutional (LTI) patient. Among other potential uses, this status is used in the calculation of RAF scores.

Is CMS MMR Aged or Disabled MSP

Indicates the patient meets the CMS definition of Medicare Secondary Payer (MSP). This field reflects the values of the CMS MMR "Aged/Disabled MSP" field, which the CMS documentation defines as: "Indicator that Medicare is Secondary Payer".

Is CMS MMR Frailty Factor

Indicates whether an additional adjustment factor related to the patient's frailty status has been used to calculate payments. This field reflects the values of the CMS MMR "Frailty Indicator (PACE/FIDE SNP only)" field, which the CMS documentation defines as: "Indicator that a Plan-level Frailty Factor was included in the calculation of the payment or adjustment. Y = Frailty Factor Included; N = No Frailty Factor".

Is CMS MMR Full or Partial Medicaid Status

Indicates whether CMS considers the Medicare beneficiary to be a Medicaid patient (either full or partial). This field reflects the values of the CMS MMR "Medicaid Full/Partial/Nondual" field, which the CMS documentation defines as: "The Medicaid status that is in effect for the month used to determine the appropriate: Non-ESRD community (enrollees in MAOs or PACE organizations) or ESRD risk factor for a beneficiary (MAOs only; not applicable for beneficiaries enrolled in a PACE organization with ESRD status). (Medicaid status = Current Payment Month (CPM) minus 3 months). For all other risk factors, this field is informational. 1 = Beneficiary is determined to be full or partial Medicaid (F or P); 0 = Beneficiary is not Medicaid (N)"; with NULL = "This is a retroactive adjustment for a month prior to January 2017".

Is CMS MMR Medicaid Add-On Factor

Indicates whether an additional adjustment factor has been used to calculate payments for Medicare beneficiaries that are also eligible for Medicaid. This field reflects the values of the CMS MMR "Medicaid Add-on Factor Indicator" field, which the CMS documentation defines as: "Indicator that the Medicaid Add-on factor was used for this payment or adjustment for a beneficiary: Before 2023, this field indicates when the Medicaid Add-on factor was used for: PACE; ESRD; or LTI risk scores. After 2023, this field indicates when the Medicaid Add-on factor was used for: PACE ESRD; or any beneficiary who is in LTI status, enrolled in any plan"; with 1 = "A RASS supplied Medicaid add-on factor is used in the payment"; and 0 = "No Medicaid Add-on was used".

Is CMS MMR New Medicare Beneficiary Medicaid Status Flag

Indicates whether the new Medicare beneficiary is also eligible for Medicaid. This field reflects the values of the CMS MMR "New Medicare Beneficiary Medicaid Status Flag" field, which the CMS documentation defines as: "Beneficiary Medicaid Status used for the month being paid or adjusted"; 1 = "Medicaid and a default risk factor was used"; 0 = "Not Medicaid and a default risk factor was used"; NULL = "No default risk factor or beneficiary is Part D only".

Is CMS MMR Out of Area Indicator

Indicates the patient meets the CMS Out of Area definition for the given month. This field reflects the values of the CMS MMR "Out of Area Indicator" field, which the CMS documentation defines as: "Indicator that the beneficiary is Out of Area for the Plan".

Is CMS MMR Part D Low-Income Status

Indicates whether CMS considers the Medicare beneficiary to be low income status for the purpose of applying the Part D Low-Income Multiplier to the payment or adjustment amount. This field reflects the values of the CMS MMR "Part D Low-Income Indicator" field, which the CMS documentation defines as: "Indicator of beneficiary’s Low Income status for the Part D payment or adjustment. Calculations for a Low Income beneficiary include a Part D Low-Income multiplier. Y = beneficiary is Low Income; N = beneficiary is not Low Income"; with NULL = "Not applicable".

Is CMS New Enrollee Status

Indicates the patient meets the CMS criteria to be considered a New Enrollee. Among other potential uses, this status is used in the calculation of RAF scores.

Is CMS Part A Entitlement

Indicates the patient is entitled to Medicare Part A as determined by CMS. This field reflects the values of the CMS MMR "Part A Entitlement" field, which the CMS documentation defines as: "Indicator that the beneficiary is entitled to Part A".

Is CMS Part B Entitlement

Indicates the patient is entitled to Medicare Part B as determined by CMS. This field reflects the values of the CMS MMR "Part B Entitlement" field, which the CMS documentation defines as: "Indicator that the beneficiary is entitled to Part B".

Is Compound Drug

Indicates the medication is a mixture of two or more drugs, typically created individually for a particular patient.

Is Contractual Adjustment Transaction

Indicates that the billing or claim transaction is related to a contractual adjustment; includes transactions with a contractual adjustment amount of $0. Contractual adjustments are used to calculate the Allowed Amount on a bill or claim record.

Linked Terms: Allowed Amount

Is C-SNP

Indicates the plan is a Chronic Condition Special Needs Plan, or C-SNP.

Is DEA Schedule 1

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.

Linked Terms: DEA Schedule Description

Is DEA Schedule 2

Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin

Linked Terms: DEA Schedule Description

Is DEA Schedule 3

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone

Linked Terms: DEA Schedule Description

Is DEA Schedule 4

Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol

Linked Terms: DEA Schedule Description

Is DEA Schedule 5

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin

Linked Terms: DEA Schedule Description

Is Denial Transaction

Indicates the transaction represents the denial of some or all of a bill or claim by the payor.

Is Designated Primary Care Provider

Indicates that a provider, either an individual or an organization, has been administratively designated -- e.g., in a plan registry -- as a primary care provider.

Is Designated Specialty Care Provider

Indicates that a provider, either an individual or an organization, has been administratively designated -- e.g., in a plan registry -- as a specialty care provider.

Is Diagnosis POA

Indicates that a diagnosis was documented as present on admission (POA).

Is Disenrollment Transaction

Indicates the transaction effects the disenrollment of the patient from the plan identified on the record.

Is Dispense as Written

Indicates that the medication order should be filled as written, without any substitutions allowed.

Is Dose Frequency PRN

Indicates a dose frequency of PRN (guidance to take the medication as needed).

Is D-SNP

Indicates the plan is a Dual Eligible Special Needs Plan, or D-SNP.

Is Dual Medicare-Medicaid Enrolled

Indicates that the patient is concurrently enrolled in both Medicare and Medicaid programs. (Identifies the population often described as "dually eligible" or "duals".)

Is Electronic Prescription for Controlled Substance (EPCS)

Electronic prescribing for controlled substances (EPCS) refers to the prescriber's ability to electronically transmit an accurate, error-free, and understandable prescription for controlled substances directly to a pharmacy from the point-of-care. There are DEA requirements for electronic prescribing for controlled substances.

Is Emergency Department Frequent Flyer

A patient with 3 or more Emergency Department encounters within the prior 12 months.

Linked Terms: Is Hospital Inpatient Frequent Flyer

Is Field Block Custom Clinical Features

Indicates the current record contains values related to the Custom Clinical Features block of time-varying patient features; used during integration to avoid mistaking fields that are simply not present in a particular source table for a positive assertion that the field value is missing or not known. This field is not needed once data have been integrated, and so is not published in the Natural Object Layer.

Is Field Block Custom Operational Features

Indicates the current record contains values related to the Custom Operational Features block of time-varying patient features; used during integration to avoid mistaking fields that are simply not present in a particular source table for a positive assertion that the field value is missing or not known. This field is not needed once data have been integrated, and so is not published in the Natural Object Layer.

Is Filling Provider in Network

Indicates the filling provider is considered in network for the referenced plan.

Linked Terms: Filling Provider

Is Filling Provider Mail Order Pharmacy

Indicates the filling provider is a mail-order pharmacy.

Linked Terms: Filling Provider

Is Filling Setting Community

Indicates that the order is to be filled in a community setting, including pharmacies or other filling settings where the intent is for the patient to consume or be administered the medications in their residence.

Linked Terms: Filling Setting

Is Filling Setting Inpatient

Indicates that the order is to be filled in an inpatient setting.

Linked Terms: Filling Setting

Is Filling Setting Outpatient

Indicates that the order is to be filled in an outpatient setting, including emergency department and hospital observation settings; does not include community pharmacies or other filling settings where the intent is for the patient to consume or be administered the medications in their residence.

Linked Terms: Filling Setting

Is Financial Class Commercial

Indicates the financial class of the claim or plan is commercial.

Linked Terms: Financial Class

Is Financial Class Medicaid

Indicates the financial class of the claim or plan is Medicaid

Linked Terms: Financial Class

Is Financial Class Medicare Advantage

Indicates the financial class of the claim or plan is Medicare Advantage.

Linked Terms: Financial Class

Is Financial Class Medicare FFS

Indicates the financial class of the claim or plan is Medicare fee-for-service (FFS).

Linked Terms: Financial Class

Is Generic According to Plan

Indicates the medication is considered by the plan to be a generic drug.

Is Generic According to Provider

Indicates that the medication is considered to be a generic by the ordering provider or their organization.

Is Generic According to Reference

Indicates that the medication is considered to be a generic in the relevant reference dataset.

Is Hospital Inpatient Frequent Flyer

A patient with 3 or more hospital inpatient stays within the prior 12 months. Typically represents 3 to 8% of the total patient population in a hospital but 12 to 28% of all admissions (NIH, 2020).

Linked Terms: Is Emergency Department Frequent Flyer

Is Imaging Order

Indicates that the service order is for an imaging-related service.

Linked Terms: Service Order

Is Individual Provider

Indicates that the provider is an individual, rather than an organization.

Linked Terms: Provider

Is Individual Provider Taxonomy Code

Indicates that the taxonomy code is appropriate for classification of individual providers (i.e., not organizational providers).

Is in Formulary

Indicates the medication is in the formulary of the relevant authority (e.g., plan). For formularies with multiple tiers, this field should be used to represent assignment to any formulary tier.

Is Institutional Claim Data Coverage

Indicates data coverage for institutional claims from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Institutional Claim Paid Amount Data Coverage

Indicates data coverage for institutional claims, with plan paid amounts populated at least at the claim header level, from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Institutional Claim Service Line Item Paid Amount Data Coverage

Indicates data coverage for institutional claims, with plan paid amounts populated at the claim service line item level, from at least one data source for the patient and time period specified on the record. (Having line-level paid amounts allows finer-grained analyses than those possible when paid amounts are only available at the header-level.)

Linked Terms: Data Coverage

Is I-SNP

Indicates the plan is a Institutional Special Needs Plan, or I-SNP.

Is Lab Order

Indicates that the service order is for a lab-related service.

Linked Terms: Service Order

Is Mandatory Supplemental Benefit

Indicates the financial transaction has a Benefit Type that is considered a Medicare Advantage Mandatory Supplemental Benefit (MSB).

Linked Terms: Benefit Type

Is Medical Claim Data Coverage

Indicates data coverage for medical claims (i.e., institutional and professional claims) from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Medicare Part A

Indicates that the coverage for this claim or bill is provided by Medicare Part A.

Is Medicare Part A Benefit

Indicates the financial transaction has a Benefit Type that is considered a Medicare Part A benefit.

Linked Terms: Benefit Type

Is Medicare Part B

Indicates that the coverage for this claim or bill is provided by Medicare Part B. Note that some institutional claims and pharmacy claims may be designated Part B.

Linked Value Sets: MEDICARE PART B (URSA-CORE CMS_TYPE_OF_BILL_CODE)

Is Medicare Part B Benefit

Indicates the financial transaction has a Benefit Type that is considered a Medicare Part B benefit.

Linked Terms: Benefit Type

Is Medicare Part C Benefit

Indicates the financial transaction has a Benefit Type that is considered a Medicare Part C benefit. (Transactions flagged as Medicare Part A, Medicare Part B, or Mandatory Supplemental Benefit should also be flagged as Medicare Part C; but the converse need not be true, i.e., a transaction may be flagged as Medicare Part C without knowing whether it is Medicare Part A vs. Part B vs. MSB.)

Linked Terms: Benefit Type

Is Medicare Part D

Indicates that the coverage for this claim or bill is provided by Medicare Part D.

Is Medicare Part D Benefit

Indicates the financial transaction has a Benefit Type that is considered a Medicare Part D benefit.

Linked Terms: Benefit Type

Is Medium Email

Indicates the medium of the current instance of communication is email. (A conversation over email can be represented by a single Patient Communication instance, or by a series of Patient Communication instances contained within a Parent Patient Communication instance.)

Is Medium Letter

Indicates the medium of the current instance of communication is a mailed letter.

Is Medium Other

Indicates the medium of the current instance of communication is something other than letter, email, telephone call, text message, or web chat. (Should not be used to indicate that the medium is unknown.)

Is Medium Telephone Call

Indicates the medium of the current instance of communication is a telephone call.

Is Medium Text Message

Indicates the medium of the current instance of communication is a text message. (A conversation over text can be represented by a single Patient Communication instance, or by a series of Patient Communication instances contained within a Parent Patient Communication instance.)

Is Medium Web Chat

Indicates the medium of the current instance of communication is a web chat. (A conversation over web chat can be represented by a single Patient Communication instance, or by a series of Patient Communication instances contained within a Parent Patient Communication instance.)

Is MMP

Indicates the plan is a Medicare-Medicaid Plan, or MMP.

Is MSK Related Encounter

Indicates the surgery encounter had a principal/primary procedure (HCPCS or ICD-10-PCS) or diagnosis (DRG or ICD-10-CM) code pertaining to the musculoskeletal system. Qualifying values include; (1) MS-DRG with a MDC code of "08" for MSK System, (2) Principal ICD-10-PCS with an AHRQ CCS Multi-Level Tier 1 code of "14" for procedures of the MSK system, (3) Primary Procedure HCPCS Code >= 20100 and <= 2999 for procedures of the MSK system, (4) or a Principal Discharge Diagnosis ICD-10-CM within the AHRQ CCS Multi-Level Tier 1 Category Code of "13" for MSK system.

Is Non-FFS Encounter Record

Indicates that the claim or bill is an administrative record of particular services not requiring payment. Used, for example, to document care delivered under capitated or other non-fee-for-service (FFS) contracts.

Is Order Ever Order Status Active

Indicates that the order reached an order status of active at any point, whether or not it was subsequently accepted, completed, cancelled, or suspended.

Linked Terms: Is Order Status Active

Is Order for Pharmacy Fill

Indicates that the medication order represents a traditional prescription to be filled by the patient in a pharmacy, rather than an order for a provider to administer the medication to the patient directly.

Linked Terms: Medication Order

Is Order for Provider Administration

Indicates that the medication order represents a request to administer the medication to the patient, not merely to dispense the medication.

Linked Terms: Medication Order

Is Order Status Active

Indicates that the order has been issued and accepted by the receiving provider, but not completed, cancelled, or suspended.

Linked Terms: Order Status

Is Order Status Cancelled

Indicates that activities to complete the order have been permanently stopped, either by request of the ordering provider or some other authority. In most cases, an order that has been replaced should be considered cancelled.

Linked Terms: Order Status

Is Order Status Completed

Indicates that the order has been completed by the receiving provider.

Linked Terms: Order Status

Is Order Status Draft

Indicates that the order is in draft form, and not yet issued.

Linked Terms: Order Status

Is Order Status Issued Only

Indicates that the order has been finalized and sent to the receiving provider but not yet accepted; nor suspended or cancelled.

Linked Terms: Order Status

Is Order Status Suspended

Indicates that activities to complete the order have been temporarily stopped, either by request of the ordering provider or some other authority.

Linked Terms: Order Status

Is Original Transaction

Indicates the transaction was the first transaction within this Transaction Family.

Linked Terms: Transaction Family

Is OTC

Indicates that the medication is an over-the-counter (OTC) drug that does not require a prescription.

Is Patient Sex Female

Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.

Is Patient Sex Male

Indicates the patient's sex is male. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.

Is Payment Transaction

Indicates that the transaction includes information on a payment; includes payment transactions with a paid amount of $0.

Is Pharmacy Claim Data Coverage

Indicates data coverage for pharmacy claims from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Pharmacy Claim Paid Amount Data Coverage

Indicates data coverage for pharmacy claims, with plan paid amounts populated, from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Plan CMS Employer Group Health Plan

Indicates that the beneficiary's plan meets the CMS definition of an Employer Group Health Plan (EGHP). This field reflects the values of the CMS MMR "EGHP Flag" field, which the CMS documentation defines as: "Indicator that the Plan is an Employer Group Health Plan"; with 1 = "Employer Group Health Plan"; 0 = "Not an Employer Group Health Plan".

Is Plan Non-Primary

Indicates that the plan documented on the current record was designated as a secondary, tertiary, or other non-primary source of payment

Is Plan Primary

Indicates that the plan documented on the current record was designated the primary source of payment

Is Principal Diagnosis

Indicates that a diagnosis was documented as the principal diagnosis for the claim, bill, encounter, etc.

Is Principal Procedure

Indicates that a procedure was documented as the principal diagnosis for the claim, bill, encounter, etc.

Is Professional Claim Data Coverage

Indicates data coverage for professional claims from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Professional Claim Paid Amount Data Coverage

Indicates data coverage for professional claims, with plan paid amounts populated at least at the claim header level, from at least one data source for the patient and time period specified on the record.

Linked Terms: Data Coverage

Is Professional Claim Service Line Item Paid Amount Data Coverage

Indicates data coverage for professional claims, with plan paid amounts populated at the claim service line item level, from at least one data source for the patient and time period specified on the record. (Having line-level paid amounts allows finer-grained analyses than those possible when paid amounts are only available at the header-level.)

Linked Terms: Data Coverage

Is Record Deleted

Indicator for whether the current record should be considered deleted; useful for certain incremental data loading scenarios.

Is Red Book Branded Generic

A branded generic is a generic drug that has gone through the ANDA process, and is assigned a name other than the chemical name. These branded generic drugs may be developed by a generic drug company, or by the original manufacturer after patent expiration. The branded generic name is owned by the company.

Is Red Book Exceptional Drug

Indicates that the medication meets the Red Book "Exceptional Drug" criteria, which "identifies products that may be excluded from coverage by certain third party programs."

Is Referral Order

Indicates that the service order is a referral.

Linked Terms: Service Order

Is Refill

Indicates the fill is not the first fill on a prescription.

Is Renewal Medication Order

Indicates that the current medication order renews a prior order.

Linked Terms: Renewed Medication Order

Is Replacement Medication Order

Indicates that the current medication order is meant to replace a prior order.

Linked Terms: Replaced Medication Order

Is Reversal Transaction

Indicates the transaction represents the reversal of some or all of a bill or claim.

Is Sender Patient

Indicates that the current instance of communication originated with the patient. (A value of 0 indicates the communication originated with the provider.)

Is Service Line Item Financial Data Coverage

Indicates whether financial information associated with a bill or claim is available and generally accurate at the service line item level; a value of 0 indicates that line-level financials are not available or not reliably accurate, and that header-level financial information should be used despite its coarser grain.

Is Single Denominator Observation

Indicates that the record represents a single denominator observation (rather than an aggregate result representing the combined contributions of multiple denominator observations).

Is Single Source According to Reference

Indicates that the medication is considered to be a single source medication in the relevant reference dataset.

Is Slot Availability Status Booked

Indicates a Slot Availability Status of Booked, meaning the time has been booked for an appointment (and is therefore no longer available).

Linked Terms: Slot Availability Status

Is Slot Availability Status Closed

Indicates a Slot Availability Status of Closed, meaning the time is unavailable for reasons other than being already booked for an appointment.

Linked Terms: Slot Availability Status

Is Slot Availability Status Open

Indicates a Slot Availability Status of Open, meaning the time is available to be booked for an appointment.

Linked Terms: Slot Availability Status

Is SNP

Indicates the plan is a Special Needs Plan, or SNP.

Is Specialty Drug According to Plan

Indicates the medication is considered by the plan to be a specialty drug.

Is Specialty Drug According to Provider

Indicates that the medication is considered to be a specialty drug by the ordering provider or their organization.

Is Surgery Encounter

Indicates an encounter in which the patient underwent surgery; identified by the presence, among the documents associated with an encounter, of a surgical HCPCS code or a revenue center code for operating room setting care.

Linked Value Sets: URSA SERVICE TYPE TIER 1 = SURGICAL PROCEDURES (URSA-CORE HCPCS), OPERATING ROOM SETTING (URSA-CORE CMS_REVENUE_CENTER_CODE)

Is Transaction Scope Header-Level

Indicates whether the transaction should apply to header-level fields (rather than service-line-item-level fields)

Is Transaction Source Patient

Indicates that the transaction involves the patient's account, not a plan associated with the bill, if any.

Is Transaction Source Plan

Indicates that the transaction involves a plan's account, not the patient's.

Is Urgent Care Visit

Indicates the encounter had one or more claim document with a HCPCS, Revenue Center Code, or Place of Service Code specific to Urgent Care Facility claim filing.

Linked Value Sets: URGENT CARE CLINIC (URSA-CORE CMS_REVENUE_CENTER_CODE), URGENT CARE FACILITY CMS PLACE OF SERVICE CODES (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URGENT CARE FACILITY HCPCS CODES (URSA-CORE HCPCS)

Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Behavioral Health

Indicates an admission met the criteria for a Behavioral Health admission, a category of the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system. Behavioral Health admissions relate to behavioral health conditions and related treatments.

Linked Terms: Ursa Hospital Admission Condition-Treatment Type

Linked Value Sets: URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = BEHAVIORAL HEALTH (URSA-CORE ICD10CM), URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = BEHAVIORAL HEALTH (URSA-CORE MSDRG)

Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Maternity

Indicates an admission met the criteria for a Maternity admission, a category of the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system. Maternity admissions relate to pregnancy and childbirth.

Linked Terms: Ursa Hospital Admission Condition-Treatment Type

Linked Value Sets: URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = MATERNITY (URSA-CORE ICD10CM), URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = MATERNITY (URSA-CORE MSDRG)

Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Medical

Indicates an admission met the criteria for a Surgical admission, a category of the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system. Medical admissions are admissions with a qualifying MS-DRG for medical condition and/or treatment or with a known principal discharge diagnosis that fails to meet the criteria for Maternity, Behavioral Health, or Surgical categories.

Linked Terms: Ursa Hospital Admission Condition-Treatment Type

Linked Value Sets: URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = MEDICAL (URSA-CORE MSDRG)

Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Surgical

Indicates an admission met the criteria for a Surgical admission, a category of the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system. Surgical admissions involve the performance of one or more surgical procedures.

Linked Terms: Ursa Hospital Admission Condition-Treatment Type

Linked Value Sets: URSA HOSPITAL ADMISSION CONDITION-TREATMENT TYPE TIER 1 = SURGICAL (URSA-CORE MSDRG), URSA SERVICE TYPE TIER 1 = SURGICAL PROCEDURES (URSA-CORE HCPCS), URSA SERVICE TYPE TIER 1 = SURGICAL PROCEDURES (URSA-CORE CMS_REVENUE_CENTER_CODE)

Is Verification Status Confirmed

Indicates a clinical conclusion that the patient has or had the condition or allergy / intolerance.

Linked Terms: Verification Status

Is Verification Status Pre-Confirmation

Indicates a level of evidence insufficient to conclude whether or not the patient has or had the condition or allergy / intolerance.

Linked Terms: Verification Status

Is Verification Status Refuted

Indicates a clinical conclusion that the patient does not have or did not have the condition or allergy / intolerance.

Linked Terms: Verification Status

Label Description

Supplies the name given to the product by the manufacturer.

Last CMS MMR Payment Date

The most recent CMS MMR Payment Date from among the MMR Member-Month Transaction records contributing to the current (final action) MMR Member-Month record.

Linked Terms: CMS MMR Payment Date

Last CMS MMR Run Date

The most recent CMS MMR Run Date from among the MMR Member-Month Transaction records contributing to the current (final action) MMR Member-Month record.

Linked Terms: CMS MMR Run Date

Last Continuous Primary Payor Membership Episode End Date

The end date of the most recent prior completed Continuous Primary Payor Membership Episode as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Continuous Primary Payor Membership Episode, Period End Date

Last Continuous Primary Payor Membership Episode Start Date

The start date of the most recent prior completed Continuous Primary Payor Membership Episode as of the (potentially historical) period covered by the record.

Linked Terms: Continuous Primary Payor Membership Episode

Location

A physical space in which patients receive health care services. The scope of a location is flexible – it can be as broadly or narrowly defined as needed. Locations can also be nested, with larger “parent” locations (such as a hospital) containing smaller locations (such as a room).

Location ID

The internal database identifier (used, e.g., for joins and primary keys) for the location.

Linked Terms: Location

Mandatory Supplemental Benefit Capitation Expense Amount

The Capitation Expense amount associated with a Medicare Advantage Mandatory Supplemental Benefit.

Linked Terms: Capitation Expense

Mandatory Supplemental Benefit Capitation Revenue Amount

The Capitation Revenue amount associated with a Medicare Advantage Mandatory Supplemental Benefit.

Linked Terms: Capitation Revenue

Mandatory Supplemental Benefit Claims Expense Amount

The Claims Expense Amount associated with the Mandatory Supplemental Benefit.

Linked Terms: Claims Expense Amount

Mandatory Supplemental Benefit CMS Premium Amount

The CMS Premium Amount associated with the Mandatory Supplemental Benefit.

Linked Terms: CMS Premium Amount

Mandatory Supplemental Benefit Manual Adjustment Amount

The Manual Adjustment Amount associated with the Mandatory Supplemental Benefit.

Linked Terms: Manual Adjustment

Mandatory Supplemental Benefit Post-Sequestration CMS Premium Amount

The Mandatory Supplemental Benefit Amount less the MSB component of the CMS Sequestration Amount.

Linked Terms: Mandatory Supplemental Benefit CMS Premium Amount, CMS Sequestration Amount

Manual Adjustment

A positive or negative adjustment to the funding balance for a patient not already reflected in Capitation Revenue, Capitation Expense, or Claims Expense Amounts. Effectively, an "other" category of accounting activity.

Linked Terms: Capitation Revenue, Capitation Expense, Claims Expense Amount

Manufacturer Description

Identifies the name of the company that markets the product. The name appearing in this field corresponds to the FDA-registered labeler name identified by the five-digit labeler code on the NDC number. Therefore, names appearing in this field will include distributors and repackagers in addition to original manufacturers.

MDC Code

The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc.

Linked Terms: MDC Description

MDC Description

The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc.

Linked Terms: MDC Code

Medical Claims Expense Amount

The Claims Expense Amount associated with all medical (i.e., institutional and professional) claims. Equivalent to the sum of the Institutional Claims Expense Amount and Professional Claims Expense Amount values.

Linked Terms: Claims Expense Amount, Institutional Claims Expense Amount, Professional Claims Expense Amount

Medicare Benefit Type Category

A categorical value identifying whether the claim is a Medicare FFS or Medicare Advantage claim and, if known, what Medicare program component -- i.e., Part A, Part B, or Part D -- it is associated with.

Linked Terms: Is Medicare Part A, Is Medicare Part B, Is Medicare Part D

Medicare Part A Capitation Expense Amount

The Capitation Expense amount associated with the Medicare Part A benefit.

Linked Terms: Capitation Expense

Medicare Part A Capitation Revenue Amount

The Capitation Revenue amount associated with the Medicare Part A benefit.

Linked Terms: Capitation Revenue

Medicare Part A Claims Expense Amount

The Claims Expense Amount associated with the Medicare Part A benefit.

Linked Terms: Claims Expense Amount

Medicare Part A CMS Premium Amount

The CMS Premium Amount associated with the Medicare Part A benefit.

Linked Terms: CMS Premium Amount

Medicare Part A Manual Adjustment Amount

The Manual Adjustment Amount associated with the Medicare Part A benefit.

Linked Terms: Manual Adjustment

Medicare Part A Post-Sequestration CMS Premium Amount

The Medicare Part A CMS Premium Amount less the Part A component of the CMS Sequestration Amount.

Linked Terms: Medicare Part A CMS Premium Amount, CMS Sequestration Amount

Medicare Part B Capitation Expense Amount

The Capitation Revenue amount associated with the Medicare Part B benefit.

Linked Terms: Capitation Revenue

Medicare Part B Capitation Revenue Amount

The Capitation Revenue amount associated with the Medicare Part B benefit.

Linked Terms: Capitation Revenue

Medicare Part B Claims Expense Amount

The Claims Expense Amount associated with the Medicare Part B benefit. (Note that while the majority of Medicare Part B services are billed through professional claims, both institutional and pharmacy claims may also include services covered by Medicare Part B.)

Linked Terms: Claims Expense Amount

Medicare Part B CMS Premium Amount

The CMS Premium Amount associated with the Medicare Part B benefit.

Linked Terms: CMS Premium Amount

Medicare Part B Manual Adjustment Amount

The Manual Adjustment Amount associated with the Medicare Part B benefit.

Linked Terms: Manual Adjustment

Medicare Part B Pharmacy Claims Expense Amount

The Claims Expense Amount associated with pharmacy claims for medications covered by Medicare Part B.

Linked Terms: Claims Expense Amount

Medicare Part B Post-Sequestration CMS Premium Amount

The Medicare Part B CMS Premium Amount less the Part B component of the CMS Sequestration Amount.

Linked Terms: Medicare Part B CMS Premium Amount, CMS Sequestration Amount

Medicare Part C Capitation Expense Amount

The Capitation Expense Amount associated with the Medicare Part C benefit. Equivalent to the sum of the Medicare Part A Capitation Expense Amount, Medicare Part B Capitation Expense Amount, and Mandatory Supplemental Benefit Capitation Expense Amount values.

Linked Terms: Capitation Expense, Medicare Part A Capitation Expense Amount, Medicare Part B Capitation Expense Amount, Mandatory Supplemental Benefit Capitation Expense Amount

Medicare Part C Capitation Revenue Amount

The Capitation Revenue Amount associated with the Medicare Part C benefit. Equivalent to the sum of the Medicare Part A Capitation Revenue Amount, Medicare Part B Capitation Revenue Amount, and Mandatory Supplemental Benefit Capitation Revenue Amount values.

Linked Terms: Capitation Revenue, Medicare Part A Capitation Revenue Amount, Medicare Part B Capitation Revenue Amount, Mandatory Supplemental Benefit Capitation Revenue Amount

Medicare Part C Claims Expense Amount

The Claims Expense Amount associated with the Medicare Part C benefit. Equivalent to the sum of the Medicare Part A Claims Expense Amount, Medicare Part B Claims Expense Amount, and Mandatory Supplemental Benefit Claims Expense Amount.

Linked Terms: Medicare Part A Claims Expense Amount, Medicare Part B Claims Expense Amount, Mandatory Supplemental Benefit Claims Expense Amount

Medicare Part C CMS Premium Amount

The CMS Premium Amount associated with the Medicare Part C benefit. Equivalent to the sum of the Medicare Part A CMS Premium Amount and Medicare Part B CMS Premium Amount values.

Linked Terms: CMS Premium Amount, Medicare Part A CMS Premium Amount, Medicare Part B CMS Premium Amount

# Medicare Part C Manual Adjustment Amount
The Manual Adjustment Amount associated with the Medicare Part C benefit. Equivalent to the sum of the Medicare Part A Manual Adjustment Amount, Medicare Part B Manual Adjustment Amount, and Mandatory Supplemental Benefit Manual Adjustment Amount values.

Linked Terms: Manual Adjustment, Medicare Part A Manual Adjustment Amount, Medicare Part B Manual Adjustment Amount, Mandatory Supplemental Benefit Manual Adjustment Amount

Medicare Part C Member Premium Amount

The Member Premium Amount associated with the Medicare Part C benefit.

Linked Terms: Member Premium Amount

Medicare Part C Post-Sequestration CMS Premium Amount

The Medicare Part C CMS Premium Amount less the Part C component of the CMS Sequestration Amount. Equivalent to the sum of the Medicare Part A Post-Sequestration CMS Premium Amount, Medicare Part B Post-Sequestration CMS Premium Amount, and Mandatory Supplemental Benefit Post-Sequestration CMS Premium Amount values.

Linked Terms: Medicare Part C CMS Premium Amount, CMS Sequestration Amount, Medicare Part A Post-Sequestration CMS Premium Amount, Medicare Part B Post-Sequestration CMS Premium Amount, Mandatory Supplemental Benefit Post-Sequestration CMS Premium Amount

Medicare Part D Capitation Expense Amount

The Capitation Expense Amount associated with the Medicare Part D benefit.

Linked Terms: Capitation Expense

Medicare Part D Capitation Revenue Amount

The Capitation Revenue Amount associated with the Medicare Part D benefit.

Linked Terms: Capitation Revenue

Medicare Part D Claims Expense Amount

The Claims Expense Amount associated with the Medicare Part D benefit.

Linked Terms: Claims Expense Amount

Medicare Part D CMS Premium Amount

The CMS Premium Amount associated with the Medicare Part D benefit.

Linked Terms: CMS Premium Amount

Medicare Part D Manual Adjustment Amount

The Manual Adjustment Amount associated with the Medicare Part D benefit.

Linked Terms: Manual Adjustment

Medicare Part D Member Premium Amount

The Member Premium Amount associated with the Medicare Part D benefit.

Linked Terms: Member Premium Amount

Medicare Part D Pharmacy Claims Expense Amount

The Claims Expense Amount associated with pharmacy claims for medications covered by Medicare Part D.

Linked Terms: Claims Expense Amount

Medicare Part D Post-Sequestration CMS Premium Amount

The Medicare Part D CMS Premium Amount less the Part D component of the CMS Sequestration Amount.

Linked Terms: Medicare Part D CMS Premium Amount, CMS Sequestration Amount

Medication

A drug or other consumable substance used to diagnose, treat, mitigate, or prevent illness. Includes non-prescription (“over-the-counter”) drugs, chemical compounds, vaccines, vitamins, nutritional supplements, and any product that has been assigned a National Drug Code (NDC). Can, when packaged together, additionally include the non-consumable delivery system (such as a patch or nebulizer) for a qualifying substance.

Medication Description

The natural language description of the medication.

Linked Terms: Medication

Medication Form

The physical form of the medication; e.g., tablet, liquid, inhalant, etc.

Linked Terms: Medication

Medication ID

The internal database identifier (used, e.g., for joins and primary keys) for the medication.

Linked Terms: Medication

Medication List Entry

A record documenting that a patient received a specified medication at a specified time, or was using a specified medication over a specified time period. Can include short-term use of medications in inpatient or other non-community settings, vaccinations, self-reported medication use described by the patient without further documentation, and historical periods of use of a medication the patient is no longer taking. Other evidence of medication fills and/or administrations – e.g., from pharmacy or professional claims – should not be used alone as medication list entries; this concept is meant to reflect only the information documented in a consolidated medication list in the patient’s medical record.

Linked Terms: Medication

Medication List Entry ID

The internal database identifier (used, e.g., for joins and primary keys) for the medication list entry.

Linked Terms: Medication List Entry

Medication Order

An order to dispense or administer a medication to a patient.

Linked Terms: Medication

Medication Order ID

The internal database identifier (used, e.g., for joins and primary keys) for the medication order.

Linked Terms: Medication Order

Medication Strength

The potency of a medication, typically expressed as one or more amounts or concentrations of a medication's active ingredient(s).

Medi-Span GPI Code 14-Digit

The 14-digit Medi-Span Generic Product Identifier (GPI) for the medication. The GPI is a 7-level hierarchical classification, with each level represented by two digits in the GPI. The full 14-digit GPI describes a medication's class, ingredients, dosage form, and strength. GPI values should include leading and trailing zeros and should not include hyphens or other special characters.

Medium Description

The natural language description of the medium through which the communication takes place, e.g., telephone call, email, etc.

Medium Operational ID

The "real-life" identifier for the medium through which the communication takes place.

Member Number

The unique identifier assigned by the payor to each individual patient with insurance coverage. This value is often found on the patient's insurance card.

Member Policy Number

The identifier assigned by the payor to the insurance product or contract providing coverage to the member. Depending on the payor and insurance product, this value could be unique to each subscriber or shared by a number of subscribers, e.g., those in the same group. Unlike the Member Number, this identifier will likely change when the patient changes plans within the same a payor.

Linked Terms: Member Number

Member Premium Amount

The amount paid by the patient to the health plan for insurance coverage.

MS-DRG Code

The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.

MS-DRG Description

The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.

NCPDP Dispense as Written Code

The standard 1-digit Dispense as Written (DAW) code developed and maintained by the National Council for Prescription Drug Programs (NCPDP), identifying the types of substitutions, if any, the pharmacy can make when filling the prescription; e.g., 1 = Substitution not allowed by prescriber.

NDC Code 11-Digit

The standard 11-digit National Drug Code; e.g., 00045012400 = Tylenol 500 mg.

Net Paid Amount

The gross amount from payments (or other account-increasing transaction types) minus the gross amount from expenses (or other account-decreasing transaction types) paid from one party on a transaction to the other; the final action amount obtained after reconciling a family of transactions.

Next Continuous Primary Payor Membership Episode End Date

The end date of the next Continuous Primary Payor Membership Episode starting after the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates.

Linked Terms: Continuous Primary Payor Membership Episode, Period End Date

Next Continuous Primary Payor Membership Episode Start Date

The start date of the next Continuous Primary Payor Membership Episode starting after the (potentially historical) period covered by the record.

Linked Terms: Continuous Primary Payor Membership Episode

Non-Contractual Adjustment Amount

The amount representing adjustments to a billing or claim record for reasons other than contractual discounts; typically a negative number (representing a discount to the paying party). The Total Due Amount can be calculated by adding both the Contractual Adjustment Amount and Non-Contractual Adjustment Amount to the Charge Amount; equivalently, the Total Due Amount can be calculated by adding the Non-Contractual Adjustment Amount to the Allowed Amount (which is itself the sum of the Charge Amount and the Contractual Adjustment Amount).

Linked Terms: Charge Amount, Contractual Adjustment Amount, Allowed Amount, Total Due Amount

Non-Membership Episode

A continuous period of membership during which the patient had no known health plan membership with any payor organization.

NUCC Provider Taxonomy Tier 1 Description

The natural language description of a given NUCC Taxonomy Code's category using the first, coarsest-grain classification in the NUCC system. (The code's "Grouping" in the original NUCC nomenclature.)

NUCC Provider Taxonomy Tier 2 Description

The natural language description of a given NUCC Taxonomy Code's category using the second classification in the NUCC system. (The code's "Classification" in the original NUCC nomenclature.)

NUCC Provider Taxonomy Tier 3 Description

The natural language description of a given NUCC Taxonomy Code's category using the third, finest-grain classification in the NUCC system. (The code's "Specialization" in the original NUCC nomenclature.)

Observation Report

A summary of one or more Patient Observations, including documentation of any clinical conclusions, when applicable. Observation Reports can be used, for example, to synthesize a panel of lab results, imaging data, pathology findings, and other atomic diagnostic results into a coherent narrative

Linked Terms: Patient Observation

Observation Report ID

The internal database identifier (used, e.g., for joins and primary keys) for the Observation Report

Linked Terms: Observation Report

Operating Provider

The individual provider identified as the operating provider on an institutional bill or claim; typically the primary surgeon for the most intensive surgery performed during the covered period.

Linked Terms: Provider

Operating Provider Description

The natural language description of the operating provider; typically, the name of the provider.

Linked Terms: Operating Provider

Operating Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the operating provider.

Linked Terms: Operating Provider

Operating Provider NPI

The 10-digit National Provider Identifier for the operating provider.

Linked Terms: Operating Provider

Ordered Date

The calendar date the order was entered into the EMR or otherwise created.

Ordered Datetime

The date and time the order was entered into the EMR or otherwise created.

Order Expiration Date

The calendar date on which the order is considered to have expired.

Ordering Provider

The provider authorizing the service or medication order; this should be the provider making the clinical decision that a service or medication is indicated, even if they were not the individual that created the order.

Ordering Provider Description

The natural language description of the ordering provider.

Linked Terms: Ordering Provider

Ordering Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the ordering provider.

Linked Terms: Ordering Provider

Ordering Provider NPI

The 10-digit National Provider Identifier for the ordering provider.

Linked Terms: Ordering Provider

Order Number

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the service order.

Linked Terms: Service Order

Order Status

The status of an order with respect to whether it has been issued, accepted and considered active by the receiving provider, suspended, cancelled, or completed.

Order Status Description

The natural language description of the order status.

Linked Terms: Order Status

Order Status Operational ID

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the order status.

Linked Terms: Order Status

Original CMS MMR Number of Payment or Adjustment Months Part A

The count of Part A months in the patient's life covered by the contents of the original MMR record (prior to being reshaped into member-month grain). This field contains the same values as the CMS MMR "Number of Payment/Adjustment Months Part A" field, which the CMS documentation defines as: "Number of months included in this payment or adjustment for Part A".

Original CMS MMR Number of Payment or Adjustment Months Part B

The count of Part B months in the patient's life covered by the contents of the original MMR record (prior to being reshaped into member-month grain). This field contains the same values as the CMS MMR "Number of Payment/Adjustment Months Part B" field, which the CMS documentation defines as: "Number of months included in this payment or adjustment for Part B".

Original CMS MMR Number of Payment or Adjustment Months Part D

The count of Part D months in the patient's life covered by the contents of the original MMR record (prior to being reshaped into member-month grain). This field contains the same values as the CMS MMR "Number of Payment/Adjustment Months Part D" field, which the CMS documentation defines as: "Number of months included in this payment or adjustment for Part D".

Original CMS MMR Payment or Adjustment End Date

The end date of the period in the patient's life covered by the contents of the original MMR record prior to being reshaped into records with member-month grain. This field is based on the CMS MMR "Payment/Adjustment End Date" field, which the CMS documentation defines as: "Latest date covered by this payment or adjustment". (This field uses the standard Ursa Health exclusive convention for period end dates; i.e., this field will take the value one day after the original CMS value.)

Original CMS MMR Payment or Adjustment Start Date

The start date of the period in the patient's life covered by the contents of the original MMR record prior to being reshaped into records with member-month grain. This field contains the same values as the CMS MMR "Payment/Adjustment Start Date" field, which the CMS documentation defines as: "Earliest date covered by this payment or adjustment".

Original Covered Period Start Date

The start date of the period in the patient's life described by the current record as originally stated in the source data record (prior to any potential reshaping to a different grain size, e.g., monthly).

Originating EMR Encounter

The EMR encounter during which, or as a direct result of which, a given order, task, problem list entry, or other clinical or operational documentation was created.

Originating EMR Encounter ID

The internal database identifier (used, e.g., for joins and primary keys) for the EMR encounter that is the originating encounter of the given document.

Linked Terms: EMR Encounter, Originating EMR Encounter

Other EMR Comments

Any other annotations or comments associated with the current record entered into the EMR.

Parent Document Effective End Date

The last date on which events associated with the current document's parent document occurred or continued until.

Parent Document Effective Start Date

The date that the events associated with the current document's parent document began.

Parent Document ID

The document ID for the document one level above the current document in the object hierarchy,

Linked Terms: Document ID

Parent EMR Encounter ID

The database identifier for the EMR Encounter during or within which the event associated with the current record occurred.

Parent Patient Communication ID

The Patient Communication ID for the instance of communication of which the current record is a subordinate component.

Linked Terms: Patient Communication ID

Parent Transaction

The coarser-grained transaction record summarizing or covering one or more finer-grained subordinate ("child") transactions. For example, adjustments to an institutional claim with multiple subordinate service line item records might take the form of a single header transaction record (describing the changes to properties of the institutional claim header) and multiple subordinate child transaction records (describing changes to the properties of the claim service line items).

Parent Transaction ID

The internal database identifier (used, e.g., for joins and primary keys) for the parent transaction.

Linked Terms: Parent Transaction

Patient

A past, current, or potential future individual consumer of health care services.

Patient Age Category Tier 1

Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2.

Linked Terms: Patient Age Category Tier 2

Patient Age Category Tier 2

Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/

Linked Terms: Patient Age Category Tier 1

Patient Age Integer

Patient age, expressed as an integer, as of a reference date or interval.

Patient Communication ID

The database identifier for an instance of communication between a provider organization staff member and a patient.

Patient Date of Birth

The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.

Patient ID

The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.)

Linked Terms: Patient

Patient MBI

The patient's Medicare Beneficiary Identifier (MBI). On the Patients Natural Object, this reflects the most recent MBI known for the patient; on the Patient-Plan Timelines of Plan Membership Natural Object, this reflects the contemporaneous MBI during the respective timeline period.

Patient Observation

An instance of a documented observation about a patient, such as a lab result, imaging study, assessment tool response, flowchart entry, etc.; a Patient Observation object includes fields capturing the service that was performed to generate the observation, the type of result, and the result value; Patient Observations may also have subordinate Patient Observations representing finer-grained, component results that contribute to a higher-level result.

Patient Observation ID

The internal database identifier (used, e.g., for joins and primary keys) for the Patient Observation

Linked Terms: Patient Observation

Patient Operational ID

The user-facing value used by staff used to uniquely identify the Patient in their administrative systems and/or day-to-day operations.

Linked Terms: Patient

Patient Paid Amount

The amount paid by the patient to the provider for health care services or products.

Patient Responsibility Amount

The amount determined to be owed by the patient to the provider; includes copayments, deductibles, and coinsurance obligations for insured patients. Subtracting the Plan Paid Amount from the Total Due Amount typically yields the Patient Responsibility Amount.

Linked Terms: Total Due Amount, Plan Paid Amount

Payor ID

The identifier for the health insurance organization associated with the current record.

Payor Incurred Date

The date the payor considers the services associated with the record to be incurred for accounting purposes.

Percent of Premium Calculation Fraction

The fraction, sometimes referred to as the "POP" (percent of premium) rate, applied to qualifying CMS Premium and Member Premium Amounts received by a Medicare Advantage organization (with other adjustments potentially applied) to determine the Capitation Revenue paid to risk-bearing providers.

Linked Terms: CMS Premium Amount, Member Premium Amount, Capitation Revenue

Period End Date

The date identifying the end of an period of time. Period End Date values are exclusive; e.g., a period with Period End Date = January 1 would begin be considered to end at precisely 00:00 on January 1 (meaning that the period did not include any time on January 1).

Period Start Date

The date identifying the start of a period of time. Period Start Date values are inclusive; e.g., a period with Period Start Date = January 1 would begin be considered to begin at 00:00 on January 1.

Pharmacy Claims Expense Amount

The Claims Expense Amount associated with pharmacy claims.

Linked Terms: Claims Expense Amount

Plan Attributee Individual Provider

The individual Plan Attributee Provider. (This concept can be used to identify the individual provider in cases where the plan attributes the member to both an individual provider and a provider group.)

Linked Terms: Plan Attributee Provider

Plan Attributee Individual Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Individual Provider.

Linked Terms: Plan Attributee Individual Provider

Plan Attributee Provider

The Provider, often a PCP, to which a health plan member has been attributed by the plan; includes cases where the patient selects the provider themselves, as long as that selection is accepted by the plan.

Linked Terms: Provider

Plan Attributee Provider Contract

The Provider Contract for the Plan Attributee Provider.

Linked Terms: Provider Contract, Plan Attributee Provider

Plan Attributee Provider Contract ID

The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider Contract.

Linked Terms: Plan Attributee Provider Contract

Plan Attributee Provider Group

The Provider Group identified as Plan Attributee Provider. (This concept can be used to identify the provider group in cases where the plan attributes the member to both an individual provider and a provider group.)

Linked Terms: Plan Attributee Provider, Provider Group

Plan Attributee Provider Group Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider Group.

Linked Terms: Plan Attributee Provider Group

Plan Attributee Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider.

Linked Terms: Plan Attributee Provider

Plan CMS Contract Number

This variable is the unique identification for a managed care organization (MCO) enabling the entity to provide coverage to eligible Medicare beneficiaries. The first character of the contract ID is a letter that indicates the type of plan. For local managed care contracts, it begins with 'H' or '9'; for regional managed care contracts, it begins with 'R'; for prescription drug plans (PDPs), it begins with 'S'; for fallback contracts, it begins with 'F', for Employer-Direct PDP and Employer-Direct PFFS it begins with 'E'. The remaining 4 digits are numeric. It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP (Plan Benefit Package) Number, when those two values are available, to generate the Plan ID.

Linked Terms: Plan ID

Plan CMS PBP Number

The standard 3-digit Plan Benefit Package (PBP) Number, maintained by CMS, identifying a particular insurance product offered by a given Medicare Advantage organization (identified by the CMS Contract Number). It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP Number, when those two values are available, to generate the Plan ID.

Linked Terms: Plan ID, Plan CMS Contract Number

Plan CMS Segment Number

The standard 3-digit numeric value, maintained by CMS, that identifies distinct groups of Medicare Advantage beneficiaries (with, potentially, distinct benefits from other segments) within a CMS Contract Number and CMS PBP Number. (For Medicare Advantage plans, it is a standard Ursa Health convention to define a plan as a distinct CMS Contract Number - CMS PBP Number - CMS Segment Number triples when those values are available.)

Linked Terms: Plan CMS Contract Number, Plan CMS PBP Number

Plan ID

The identifier for a particular health insurance plan product offered by a payor.

Plan Paid Amount

The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.

Practice Location

For a given individual provider, the primary location where that provider delivers care to patients.

Practice Location ID

The internal database identifier (used, e.g., for joins and primary keys) for the practice location.

Linked Terms: Practice Location

Prescribed Date

The date the prescription or medication order was signed.

Prescribing Provider

The individual provider that wrote the prescription, or otherwise ordered the medication.

Prescribing Provider DEA Number

The 9-character alphanumeric Drug Enforcement Agency (DEA) identifier for the prescribing provider.

Linked Terms: Prescribing Provider

Prescribing Provider Description

The natural language description of the prescribing provider.

Linked Terms: Prescribing Provider

Prescribing Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the prescribing provider.

Linked Terms: Prescribing Provider

Prescribing Provider NPI

The 10-digit National Provider Identifier for the prescribing provider.

Linked Terms: Prescribing Provider

Prescription Number

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the medication order.

Linked Terms: Medication Order

Primary Agent Description

The primary active ingredient in the medication. In medications with multiple active ingredients, this identifies by name only the primary agent.

Primary Billing TIN

The Tax Identification Number (TIN) typically used by a provider for billing and related administrative purposes; in particular, the Primary Billing TIN need not be that provider's own TIN. (In contrast, an individual or organizational provider's own TIN would be considered their Provider TIN.)

Primary Care Clinician Office Visit

A Clinician Office Visit encounter with a primary care provider or in which primary care services were delivered; operationally defined by the presence of one or more of the following: (1) a service provider or attending provider identified as a primary care provider or with a qualifying primary NUCC taxonomy code; or (2) a qualifying HCPCS code for preventive and/or primary care services.

Linked Terms: Clinician Office Visit

Linked Value Sets: PRIMARY CARE SPECIALTIES (URSA-CORE NUCC_PROV_TAXONOMY_CODE), PREVENTIVE PRIMARY CARE SERVICES (URSA-CORE HCPCS)

Primary Indication

The most important clinical reason for an order. If an order has multiple indications of equal importance, this is the indication listed first.

Primary Indication Description

The natural language description of the order's primary indication.

Linked Terms: Primary Indication

Primary Indication ICD-10-CM Code

The standard ICD-10-CM code for the order's primary indication.

Linked Terms: Primary Indication

Primary Indication SNOMED CT Code

The standard SNOMED CT code for the order's primary indication.

Linked Terms: Primary Indication

Primary NUCC Provider Taxonomy Code

The 10-character National Uniform Claim Committee (NUCC) provider taxonomy code designated as the primary scope of practice in the referenced provider's entry in the National Provider Identifier (NPI) registry. Typically identifies an individual provider's primary specialty, or an organizational provider's facility type.

Primary NUCC Provider Taxonomy Description

The natural language description of the provider's Primary NUCC Provider Taxonomy Code.

Linked Terms: Primary NUCC Provider Taxonomy Code

Primary Payor

The health insurance organization that is the first party responsible for payment for covered health care products and services.

Primary Payor ID

The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor.

Linked Terms: Primary Payor

Primary Plan ID

The identifier for the health insurance plan product that is the first party responsible for payment.

Principal Diagnosis ICD-10-CM Code

The ICD-10-CM diagnosis code documented as the principal diagnosis for a claim, bill, encounter, etc.

Principal Diagnosis ICD-10-CM Description

The natural language description of the Principal Diagnosis ICD-10-CM Code.

Linked Terms: Principal Diagnosis ICD-10-CM Code

Principal Diagnosis ICD-9-CM Code

The ICD-9-CM diagnosis code documented as the principal diagnosis for a claim, bill, encounter, etc.

Linked Terms: Diagnosis ICD-9-CM Code

Principal Diagnosis ICD-9-CM Description

The natural language description of the Principal Diagnosis ICD-9-CM Code.

Linked Terms: Principal Diagnosis ICD-9-CM Code

Problem List Entry

Documentation of a clinical condition that is currently active, or was historically active, for a patient; typically includes a start date identifying the onset of the condition and, when applicable, an end date identifying when the condition was resolved.

Procedure ICD-10-PCS Code

The standard 7-character ICD-10-PCS code; e.g., 00760ZZ = Dilation of Cerebral Ventricle, Open Approach.

Procedure ICD-10-PCS Description

The natural language description of a ICD-10-PCS code.

Procedure ICD-9-CM Code

The standard 4-digit ICD-9-CM procedure code; e.g., 00.01 = Therapeutic ultrasound of vessels of head and neck. ICD-9-CM procedure codes must include a decimal point after the 2nd digit.

Procedure ICD-9-CM Description

The natural language description of a ICD-9-CM procedure code.

Procedure Line Number

The integer-valued ordinal representing the position of a procedure on a claim, bill, encounter, or other master record. May not necessarily match the analogous value in the source data for the same record.

Procedure Performed Date

The date the procedure documented on the current record was performed. For procedures lasting more than one calendar date, this is presumed to be the procedure start date.

Professional Claims Expense Amount

The Claims Expense Amount associated with professional claims.

Linked Terms: Claims Expense Amount

Program Entity

A collection of individuals or organizations, particularly providers, participating as a single entity in a program of some sort (e.g., an accountable care organization).

Program Entity Provider ID

The provider ID for the program entity, if the program entity is itself a provider.

Linked Terms: Program Entity, Provider ID

Provider

An individual or organization involved in the provision of care to patients; includes provider organization staff that are only indirectly involved in the provision of care, such as receptionists, back office staff, and technology professionals.

Provider Contract

An agreement between a provider (either an individual or organization) and a counterparty (typically a payor organization or subsidiary), often allowing the provider to bill for certain qualifying services and/or defining a risk-sharing or other financial relationship between the provider and the counterparty. Key information describing a Provider Contract includes one or more provider identifiers, such as a TIN or NPI, a payor identifier, and a time period during which the contract is active.

Provider Contract ID

The internal database identifier (used, e.g., for joins and primary keys) for the Provider Contract.

Linked Terms: Provider Contract

Provider Contract Operational ID

The user-facing value used by staff used to uniquely identify the Provider Contract in their administrative systems and/or day-to-day operations.

Linked Terms: Provider Contract

Provider Description in Contract

The name or description of the provider as given in the contract.

Provider Group

A type of organizational provider that employs individual providers; in some cases, patients may be administratively assigned to a provider groups rather than individual providers.

Provider Group Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the provider group.

Linked Terms: Provider Group

Provider ID

The database identifier for a individual or organization provider.

Linked Terms: Provider

Provider TIN

A provider's own Tax Identification Number (TIN). Typically only applicable for organizational providers; for individual providers, Provider TIN should only be used if the TIN is also their SSN. (For individual providers billing under a dedicated organizational TIN, the Primary Billing TIN concept should be used to capture that value.)

Provider TIN in Contract

The TIN identified for the contract provider as given in the contract; note that this may not be a dedicated TIN for the provider, nor must it be the provider's current primary billing TIN.

Quantity Dispensed

The quantity of medication dispensed in the fill. For medications with discrete forms (e.g., tablets, capsules, etc.) this is the number of those discrete units dispensed. For non-discrete forms (e.g., solution, cream, etc.) this is some other measure of quantity, including (but not necessarily) the number of doses dispensed.

Quantity per Fill

The quantity of medication (e.g., number of tablets) to be dispensed per fill of this medication order.

RBCS Category Code

Identified as the first character of the RBCS code, categories are the highest level of the taxonomy and represent broad concepts such as “procedures,” “tests,” and “imaging.” These groupings give shape to the overall structure of the taxonomy and help guide subsequent code assignments.

Linked Terms: RBCS Code

RBCS Code

The Restructured BETOS Category System (RBCS) identifier which is comprised of 6 characters. The first character identifies the category; the second character identifies the subcategory; the third, fourth, and fifth characters identify the family, and the sixth character identifies whether the service is a major procedure.

RBCS Family Code

Families represent the lowest level of the hierarchy and subdivide the subcategories into groups of HCPCS codes based on the similarity of the procedural approach. For example, the “digestive/gastrointestinal” subcategory of the “procedures” category contains families such as “cholecystectomy – laparoscopic” and “upper GI endoscopy.” The “anatomic pathology” subcategory of the “tests” category contains families such as “immunohistochemistry” and “surgical pathology examination.” Clinical and coding experts, as well as AMA CPT section and subsection headings, are the primary means by which similar HCPCS codes are grouped. The 2022 RBCS taxonomy includes 172 named families. It is important to note that while all HCPCS codes in the RBCS taxonomy are given a category and subcategory, not all HCPCS codes are assigned to a family. The RBCS code family development process begins by identifying the highest spending among non-anesthesia HCPCS codes that, when combined, account for 90% of total allowed spending in the claims data being reviewed for the current year. These high-spend HCPCS codes (referred to below as “start codes”) are used as starting points to build RBCS code families.

Linked Terms: RBCS Code

RBCS Subcategory Code

Identified by the combined first and second characters of the RBCS code, subcategories are the mid-level of the taxonomy, further dividing categories into specific service groups or organ 7 systems. For example, the “procedures” category contains subcategories specific to organ systems, such as “breast,” “cardiovascular,” or “skin.” The tests category contains subcategories that are specific to test type, such as “anatomic pathology” and “pulmonary function.”

Linked Terms: RBCS Code

Reason for Encounter Description

The natural language description of the reason for or purpose of the encounter; could be a description of the admitting diagnosis, if applicable for the current encounter type, but need not be.

Receiving Provider

The provider to which the service or medication order is directed; the expectation is that the receiving provider will render the requested service or fill the medication order.

Receiving Provider Description

The natural language description of the receiving provider.

Linked Terms: Receiving Provider

Receiving Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the receiving provider.

Linked Terms: Receiving Provider

Receiving Provider NPI

The 10-digit National Provider Identifier for the receiving provider.

Linked Terms: Receiving Provider

Record Created Datetime

The date and time that the current record was created in the original data source.

Record Last Updated Datetime

The date and time the current record was last updated in the original data source.

Red Book Generic Cross Reference Code

A unique 6-digit code assigned to all products that contain the same set of active ingredients. By extracting all records containing this code, users can identify comparable products regardless of trade or generic name.

Linked Terms: Red Book Generic Formulation Code

Red Book Generic Formulation Code

A unique 6-digit code identifying drugs with common active ingredients, master dosage form, strength, and route of administration. The GFC is not manufacturer or package size specific, and can therefore be used in preparation of drug utilization reports and analysis of generic alternatives for substitution and formulary development. The GFC may also be used within pharmacy and claims administration systems as an efficient means of linking NDC numbers to clinical screening functions.

Linked Terms: Red Book Generic Cross Reference Code

Referenced EMR Encounter ID

The database identifier for the EMR Encounter referred to or discussed in the event associated with the current record.

Remittance Advice Remark Code

The standard 2-, 3-, or 4-character Remittance Advice Remark Code (RARC); e.g., M23 = Missing invoice, N203 = Missing/incomplete/invalid dispensed date, etc.

Remittance Advice Remark Description

The natural language description of the Remittance Advice Remark Code (RARC).

Renewed Medication Order

A medication order that has been used as the basis for a subsequent order for the same medication, without itself being cancelled. Typically, the renewed order has been completed -- e.g., its allotted refills exhausted -- and the subsequent renewal order provides the means for the continued dispensing of the medication to the patient.

Renewed Medication Order ID

The internal database identifier (used, e.g., for joins and primary keys) for the original medication order that the current order has renewed.

Linked Terms: Renewed Medication Order

Replaced Medication Order

A medication order that has been replaced by a subsequent order before it has been completed; the replaced medication order is typically considered cancelled. In the case of a reissue of a prior completed order, the original order should not be considered replaced.

Replaced Medication Order ID

The internal database identifier (used, e.g., for joins and primary keys) for the original medication order that the current order replaced.

Linked Terms: Replaced Medication Order

Reporting Segment

A period of time during which measure observations are aggregated when viewing results over time; determined by the periodicity and start and end dates of the report, and shared by all measures in the same report instance.

Resulting Allowed Amount

The resulting Allowed Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Allowed Amount

Resulting Anesthesia Base Unit Count

The resulting Anesthesia Base Unit Count obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Anesthesia Base Unit Count

Resulting Anesthesia Physical Status Unit Count

The resulting Anesthesia Physical Status Unit Count obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Anesthesia Physical Status Unit Count

Resulting Anesthesia Time Unit Count

The resulting Anesthesia Time Unit Count obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Anesthesia Time Unit Count

Resulting Bad Debt Write-Off Amount

The resulting Bad Debt Write-Off Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Bad Debt Write-Off Amount

Resulting Charge Amount

The resulting Charge Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Charge Amount

Resulting CMS MMR LIS Premium Subsidy Amount

The resulting CMS MMR LIS Premium Subsidy Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR LIS Premium Subsidy Amount

Resulting CMS MMR Low-Income Subsidy Cost-Sharing Amount

The resulting CMS MMR Low-Income Subsidy Cost-Sharing Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Low-Income Subsidy Cost-Sharing Amount

Resulting CMS MMR Medication Therapy Management Add-On Amount

The resulting CMS MMR Medication Therapy Management Add-On Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Medication Therapy Management Add-On Amount

Resulting CMS MMR Monthly Risk-Adjusted Part A Amount

The resulting CMS MMR Monthly Risk-Adjusted Part A Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Monthly Risk-Adjusted Part A Amount

Resulting CMS MMR Monthly Risk-Adjusted Part B Amount

The resulting CMS MMR Monthly Risk-Adjusted Part B Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Monthly Risk-Adjusted Part B Amount

Resulting CMS MMR PACE Cost Sharing Add-on Amount

The resulting CMS MMR PACE Cost Sharing Add-on Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR PACE Cost Sharing Add-on Amount

Resulting CMS MMR PACE Premium Add-On Amount

The resulting CMS MMR PACE Premium Add-On Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR PACE Premium Add-On Amount

Resulting CMS MMR Part A Monthly Rate for Payment or Adjustment

The resulting CMS MMR Part A Monthly Rate for Payment or Adjustment obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part A Monthly Rate for Payment or Adjustment

Resulting CMS MMR Part A MSP Reduction Amount

The resulting CMS MMR Part A MSP Reduction Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part A MSP Reduction Amount

Resulting CMS MMR Part B Monthly Rate for Payment or Adjustment

The resulting CMS MMR Part B Monthly Rate for Payment or Adjustment obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part B Monthly Rate for Payment or Adjustment

Resulting CMS MMR Part B MSP Reduction Amount

The resulting CMS MMR Part B MSP Reduction Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part B MSP Reduction Amount

Resulting CMS MMR Part C Basic Premium Part A Amount

The resulting CMS MMR Part C Basic Premium Part A Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part C Basic Premium Part A Amount

Resulting CMS MMR Part C Basic Premium Part B Amount

The resulting CMS MMR Part C Basic Premium Part B Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part C Basic Premium Part B Amount

Resulting CMS MMR Part D Basic Premium Amount

The resulting CMS MMR Part D Basic Premium Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part D Basic Premium Amount

Resulting CMS MMR Part D Coverage Gap Discount Amount

The resulting CMS MMR Part D Coverage Gap Discount Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part D Coverage Gap Discount Amount

Resulting CMS MMR Part D Direct Subsidy Amount

The resulting CMS MMR Part D Direct Subsidy Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part D Direct Subsidy Amount

Resulting CMS MMR Part D Monthly Rate for Payment or Adjustment

The resulting CMS MMR Part D Monthly Rate for Payment or Adjustment obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Part D Monthly Rate for Payment or Adjustment

Resulting CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount

The resulting CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Other Part A Mandatory Supplemental Benefits Amount

Resulting CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount

The resulting CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Other Part B Mandatory Supplemental Benefits Amount

Resulting CMS MMR Rebate for Part A Cost Sharing Reduction Amount

The resulting CMS MMR Rebate for Part A Cost Sharing Reduction Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part A Cost Sharing Reduction Amount

Resulting CMS MMR Rebate for Part B Cost Sharing Reduction Amount

The resulting CMS MMR Rebate for Part B Cost Sharing Reduction Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part B Cost Sharing Reduction Amount

Resulting CMS MMR Rebate for Part B Premium Reduction Part A Amount

The resulting CMS MMR Rebate for Part B Premium Reduction Part A Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part B Premium Reduction Part A Amount

Resulting CMS MMR Rebate for Part B Premium Reduction Part B Amount

The resulting CMS MMR Rebate for Part B Premium Reduction Part B Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part B Premium Reduction Part B Amount

Resulting CMS MMR Rebate for Part D Basic Premium Reduction Amount

The resulting CMS MMR Rebate for Part D Basic Premium Reduction Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part D Basic Premium Reduction Amount

Resulting CMS MMR Rebate for Part D Supplemental Benefits Part A Amount

The resulting CMS MMR Rebate for Part D Supplemental Benefits Part A Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part D Supplemental Benefits Part A Amount

Resulting CMS MMR Rebate for Part D Supplemental Benefits Part B Amount

The resulting CMS MMR Rebate for Part D Supplemental Benefits Part B Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Rebate for Part D Supplemental Benefits Part B Amount

Resulting CMS MMR Reinsurance Subsidy Amount

The resulting CMS MMR Reinsurance Subsidy Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Reinsurance Subsidy Amount

Resulting CMS MMR Total MA Payment Part A Amount

The resulting CMS MMR Total MA Payment Part A Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Total MA Payment Part A Amount

Resulting CMS MMR Total MA Payment Part B Amount

The resulting CMS MMR Total MA Payment Part B Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Total MA Payment Part B Amount

Resulting CMS MMR Total MA Payment Part C Amount

The resulting CMS MMR Total MA Payment Part C Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Total MA Payment Part C Amount

Resulting CMS MMR Total Payment Part D Amount

The resulting CMS MMR Total Payment Part D Amount obtained after processing the MMR transaction; note that this may not represent the final action status of the MMR member-month.

Linked Terms: CMS MMR Total Payment Part D Amount

Resulting COB Paid Amount

The resulting COB Paid Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: COB Paid Amount

Resulting Contractual Adjustment Amount

The resulting Contractual Adjustment Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Contractual Adjustment Amount

Resulting Days Supply

The resulting Days Supply obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Days Supply

Resulting EMR Encounter ID

The internal database identifier (used, e.g., for joins and primary keys) for the EMR encounter that ultimately occurred associated with the referenced appointment, referral, or other scheduling event.

Linked Terms: EMR Encounter

Resulting Net Paid Amount

The resulting Net Paid Amount obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Net Paid Amount

Resulting Non-Contractual Adjustment Amount

The resulting Non-Contractual Adjustment Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Non-Contractual Adjustment Amount

Resulting Patient Paid Amount

The resulting Patient Paid Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Patient Paid Amount

Resulting Patient Responsibility Amount

The resulting Patient Responsibility Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Patient Responsibility Amount

Resulting Plan Paid Amount

The resulting Plan Paid Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Plan Paid Amount

Resulting Quantity Dispensed

The resulting Quantity Dispensed obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Quantity Dispensed

Resulting Service Unit Count

The resulting Service Unit Count obtained after processing the current transaction; note that this might not represent the final action value, as subsequent transactions might further modify it.

Linked Terms: Service Unit Count

Resulting Total Due Amount

The resulting Total Due Amount obtained after processing the billing or claim transaction; note that this may not represent the final action status of the billing or claim record.

Linked Terms: Total Due Amount

Route of Administration Description

The natural language description of the medication's route of administration.

RxNorm Code

The standard RxNorm code for medications; e.g., 315253 = acetaminophen 160 MG.

Secondary Payor ID

The identifier for the health insurance organization that is the second party responsible for payment.

Secondary Plan ID

The identifier for the health insurance plan product that is the second party responsible for payment.

Segment End Date

The end date of the reporting segment.

Linked Terms: Reporting Segment

Segment Start Date

The start date of the reporting segment.

Linked Terms: Reporting Segment

Service

An activity that effects or supports the delivery of health care to a patient. Can include activities performed by non-clinical personnel, activities provided virtually, or activities not directly involving the patient. Includes the provision of DME or other healthcare-related equipment to patients. Does not typically include the dispensing of medications without an administration component.

Service Description

The natural language description of the service.

Linked Terms: Service

Service End Date

The last calendar date a service was delivered.

Service ID

The internal database identifier (used, e.g., for joins and primary keys) for the service.

Linked Terms: Service

Service Line Number

The integer-valued ordinal representing the position of a service line item in a claim, bill, encounter, or other master record. May not necessarily match the analogous value in the source data for the same record.

Service Order

An order by a provider to deliver a service to a patient. This concept covers any order from a provider that is not a medication order, including referrals to other providers and orders for the provision of DME or other clinically relevant products. Can also be used to capture orders for the administration of certain medications with a service component – for example, injections or infusions – as appropriate to best reflect local EMR documentation conventions.

Linked Terms: Service

Service Order ID

The internal database identifier (used, e.g., for joins and primary keys) for the service order.

Linked Terms: Service Order

Service Provider

The individual provider delivering a service to a patient; also sometimes called the rendering provider.

Linked Terms: Provider

Service Provider Description

The natural language description of the service provider; typically, the name of the provider.

Linked Terms: Service Provider

Service Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the service provider.

Linked Terms: Service Provider

Service Provider NPI

The 10-digit National Provider Identifier for the service provider.

Linked Terms: Service Provider

Service Start Date

The first calendar date a service was delivered.

Service Unit Count

The number of units of a service delivered to the patient; includes non-integer values, if appropriate.

Slot Availability Status

The classification system used to describe the status of an appointment slot with respect to whether it is still available to be booked for an appointment.

Slot Availability Status Description

The natural language description of the slot availability status.

Linked Terms: Slot Availability Status

Slot Availability Status Operational ID

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the slot availability status.

Linked Terms: Slot Availability Status

Slot End Datetime

The date and time that the referenced appointment slot end. (Appointment slots are considered intervals, and so the end datetime is considered exclusive.)

Linked Terms: Appointment Slot

Slot Provider Group

The provider group assigned to an appointment slot. Note that this need not be the same provider group as the appointment provider group or the provider group eventually involved in the actual encounter.

Linked Terms: Provider Group

Slot Provider Group Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the slot provider group.

Linked Terms: Slot Provider Group

Slot Provider Type

The classification system describing the type of provider eligible to be assigned to a referenced appointment slot. This system, which can be different from one source system to another, could be defined by specialty, license type, location, etc.

Linked Terms: Appointment Slot

Slot Provider Type Description

The natural language description of the slot provider type.

Linked Terms: Slot Provider Type

Slot Provider Type Operational ID

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the slot provider type.

Linked Terms: Slot Provider Type

Slot Service Provider

The service provider assigned to an appointment slot. Note that this need not be the same provider as the appointment provider or the provider eventually involved in the actual encounter.

Linked Terms: Service Provider

Slot Service Provider ID

The internal database identifier (used, e.g., for joins and primary keys) for the slot service provider.

Linked Terms: Slot Service Provider

Slot Service Type

The classification system describing the type of service to be performed during the encounter resulting from a referenced appointment slot. This system can be different from one source system to another, i.e., there is no canonical URSA-CORE classification system.

Linked Terms: Appointment Slot

Slot Service Type Description

The natural language description of the slot service type.

Linked Terms: Slot Service Type

Slot Service Type Operational ID

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the slot service type.

Linked Terms: Slot Service Type

Slot Start Datetime

The date and time that the referenced appointment slot starts.

Linked Terms: Appointment Slot

Snapshot Date

The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

SNOMED CT Code

The standard Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) code for the referenced concept; e.g., 284196006 = burn of skin. SNOMED CT codes can be used to identify conditions, medications, services, labs, and other clinical concepts.

Source Data Covered End Date

The end date of the period from which records in the current source data system extract were pulled, based on some designated anchor date; for example, an extract containing all claims records with a service date in January would have a source data covered end date of February 1.

Source Data Covered Start Date

The start date of the period from which records in the current source data system extract were pulled, based on some designated anchor date; for example, an extract containing all claims records with a service date in January would have a source data covered start date of January 1.

Source Data Effective Datetime

The "as of" date and time of the original source data system at the moment the current record was extracted. For example, if a snapshot of the data in a production system is taken at 12:05 AM on the first of each month and used to generate a package of flat files that are eventually loaded into the Ursa Studio client database later that month, the Source Data Effective Datetime of all records in that month's package will be 12:05 AM on the first. Not to be confused with Record Last Updated Datetime.

Linked Terms: Record Last Updated Datetime

Source ID

The identifier for the original source data system from which the current record originated.

Source Local Attending Provider ID

The internal database identifier for the attending provider in the source data system this record originated from.

Linked Terms: Attending Provider

Source Local Bill ID

The identifier for the bill in the original source data system. On a claim record, this field refers to the bill sent to the plan that originated the claim record.

Source Local Billing Provider ID

The internal database identifier for the billing provider in the source data system this record originated from.

Linked Terms: Billing Provider

Source Local Bill Service Line Item ID

The identifier for the bill service line item in the original source data system. On a claim record, this field refers to the bill sent to the plan that originated the claim record.

Source Local Child Patient Communication Sequence Number

The original value in the source system for the current record's Child Patient Communication Sequence Number.

Linked Terms: Child Patient Communication Sequence Number

Source Local Claim ID

The internal database identifier for the claim in the source data system this record originated from.

Linked Terms: Claim

Source Local Claim Service Line Item ID

The identifier for the institutional or professional service line item in the original source data system.

Source Local Diagnosis Line Number

The integer-valued ordinal for a diagnosis in the original source data system.

Source Local Facility Provider ID

The internal database identifier for the facility provider in the source data system this record originated from.

Linked Terms: Facility Provider

Source Local Filling Provider ID

The internal database identifier for the filling provider in the source data system this record originated from.

Linked Terms: Filling Provider

Source Local Medication ID

The internal database identifier for the medication in the source data system this record originated from.

Linked Terms: Medication

Source Local Medication List Entry ID

The internal database identifier for the medication list entry in the source data system this record originated from.

Linked Terms: Medication List Entry

Source Local Medication Order ID

The internal database identifier for the medication order in the source data system this record originated from.

Linked Terms: Medication Order

Source Local Observation Report ID

The internal database identifier for the Observation Report in the source data system this record originated from.

Linked Terms: Observation Report

Source Local Operating Provider ID

The internal database identifier for the operating provider in the source data system this record originated from.

Linked Terms: Operating Provider

Source Local Ordering Provider ID

The internal database identifier for the ordering provider in the source data system this record originated from.

Linked Terms: Ordering Provider

Source Local Originating EMR Encounter ID

The internal database identifier for the originating EMR encounter in the source data system this record originated from.

Linked Terms: Originating EMR Encounter

Source Local Parent EMR Encounter ID

The original value in the source system for the current record's Parent EMR Encounter ID.

Linked Terms: Parent EMR Encounter ID

Source Local Parent Patient Communication ID

The original database identifier in the source system for the parent of the instance of patient communication associated with the current record.

Source Local Patient Communication ID

The database identifier in the source system for the instance of patient communication associated with the current record.

Source Local Patient ID

The internal database identifier for the patient in the source data system this record originated from.

Linked Terms: Patient

Source Local Patient Master Identity ID

An identifier used to uniquely identify the patient in the original source data system; typically derived through a data mastering process that identifies duplicate Source Local Patient ID values for the same (real-life) patient.

Source Local Payor ID

The identifier for the payor organization in the original source data system.

Source Local Plan ID

The identifier for the health plan in the original source data system.

Source Local Prescribing Provider ID

The internal database identifier for the prescribing provider in the source data system this record originated from.

Linked Terms: Prescribing Provider

Source Local Procedure Line Number

The integer-valued ordinal for a procedure in the original source data system.

Source Local Provider ID

The original value in the source system for the current record's Provider ID.

Linked Terms: Provider ID

Source Local Receiving Provider ID

The internal database identifier for the receiving provider in the source data system this record originated from.

Linked Terms: Receiving Provider

Source Local Record ID

The internal database identifier for the record in the source data system this record originated from.

Source Local Referenced EMR Encounter ID

The original value in the source system for the current record's Referenced EMR Encounter ID.

Linked Terms: Referenced EMR Encounter ID

Source Local Renewed Medication Order ID

The internal database identifier for the renewed medication order in the source data system this record originated from.

Linked Terms: Renewed Medication Order

Source Local Replaced Medication Order ID

The internal database identifier for the replaced medication order in the source data system this record originated from.

Linked Terms: Replaced Medication Order

Source Local Service ID

The internal database identifier for the service in the source data system this record originated from.

Linked Terms: Service

Source Local Service Line Number

The integer-valued ordinal for a service line item in the original source data system.

Source Local Service Order ID

The internal database identifier for the service order in the source data system this record originated from.

Linked Terms: Service Order

Source Local Service Provider ID

The internal database identifier for the service provider in the source data system this record originated from.

Linked Terms: Service Provider

Source Local Task ID

The internal database identifier for the Task in the source data system this record originated from.

Linked Terms: Task

Source Local Transaction Detail ID

The internal database identifier for the transaction detail in the source data system this record originated from.

Linked Terms: Claim or Billing Transaction Detail

Source Local Transaction Detail Line Number

The integer representing the ordinal position of a transaction detail item within a parent transaction record in the original source data system from which the current record originated.

Linked Terms: Claim or Billing Transaction Detail, Claim or Billing Transaction

Source Local Transaction Header ID

The internal database identifier for the transaction header in the source data system this record originated from. (This field, along with Source Local Transaction Service Line Item ID, can be used when integrating data from source systems containing both header- and service-line-item-level transactions, to avoid conflating the two.)

Linked Terms: Claim or Billing Transaction

Source Local Transaction ID

The internal database identifier for the transaction in the source data system this record originated from.

Linked Terms: Claim or Billing Transaction

Source Local Transaction Sequence Number

The identifier for the transaction sequence number in the original source data system.

Linked Terms: Transaction Sequence Number

Source Local Transaction Service Line Item ID

The internal database identifier for the transaction service line item in the source data system this record originated from. (This field, along with Source Local Transaction Header ID, can be used when integrating data from source systems containing both header- and service-line-item-level transactions, to avoid conflating the two.)

Linked Terms: Claim or Billing Transaction

Strength Description

A natural language description of the medication strength. For medications with multiple active ingredients, the standard convention is to list strength values in the alphabetical order of the active ingredients.

Linked Terms: Medication Strength

Strength Numeric

The numeric component of medication strength, expressed as a number, including non-integer values, if applicable. For medications with multiple strengths, this field should take the value of the first ingredient's numeric strength.

Linked Terms: Medication Strength

Strength Unit Description

The natural language description of the unit component of medication strength; e.g., mg, mg / 5 ml.

Linked Terms: Medication Strength

Task

A request for an activity to be performed, and information about the progress of its performance, including when the activity is never started or not successfully completed. Includes requests for activities that do not involve interactions with a patient; does not include the kind of clinical requests handled by Medication Orders or Service Orders.

Linked Terms: Medication Order, Service Order

Task ID

The internal database identifier (used, e.g., for joins and primary keys) for the Task.

Linked Terms: Task

Task Operational ID

The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the Task.

Linked Terms: Task

Tertiary Payor ID

The identifier for the health insurance organization that is the third party responsible for payment.

Tertiary Plan ID

The identifier for the health insurance plan product that is the third party responsible for payment.

Total Due Amount

The amount due to the provider after accounting for all contractual and non-contractual adjustments, not including bad debt write-offs. The Total Due Amount is calculated by adding both the Contractual Adjustment Amount and Non-Contractual Adjustment Amount (typically negative values) to the Charge Amount. Subtracting the Plan Paid Amount from the Total Due Amount yields the Patient Responsibility Amount.

Linked Terms: Contractual Adjustment Amount, Non-Contractual Adjustment Amount, Plan Paid Amount, Patient Responsibility Amount, Charge Amount

Total Payor Administrative Fee Amount

The amount of qualifying premium revenue (e.g., the sum of the CMS Premium and Member Premium Amounts) retained by the Medicare Advantage payor organization after passing the appropriate Capitation Revenue amount to the risk-bearing provider. Typically calculated using the Percent of Premium Calculation Fraction ("POP rate") as: Total Percent of Premium Calculation Eligible Amount x (1 - POP rate).

Linked Terms: CMS Premium Amount, Member Premium Amount, Capitation Revenue, Percent of Premium Calculation Fraction

Total Percent of Premium Calculation Eligible Amount

The total qualifying premium amount, e.g., the sum of CMS Premium and Member Premium amounts, eligible to be used to calculate the risk-bearing provider's Capitation Revenue using the Percent of Premium Calculation Fraction. (Different contracts might call for pre- vs. post-sequestration amounts, or have other adjustments to the eligible amount; this figure is intended to capture the net impact of all those idiosyncratic requirements, reflecting the final number used in the POP calculation.)

Linked Terms: CMS Premium Amount, Member Premium Amount, Capitation Revenue, Percent of Premium Calculation Fraction

Total Post-Sequestration CMS Premium Amount

The CMS Premium Amount less the CMS Sequestration Amount.

Linked Terms: CMS Premium Amount, CMS Sequestration Amount

Transaction Annotation Codes Text

A delimited list of annotation codes -- group, reasonm remark codes -- associated with a transaction. In billing systems that contain only a single annotation per transaction, this field will hold that annotation.

Transaction Detail ID

The internal database identifier (used, e.g., for joins and primary keys) for the Transaction Detail record.

Linked Terms: Claim or Billing Transaction Detail

Transaction Detail Line Number

The integer representing the ordinal position of a transaction detail item within a parent transaction record.

Linked Terms: Claim or Billing Transaction Detail, Claim or Billing Transaction

Transaction Detail Summary Description

A free-text, descriptive summary of any transaction details associated with the record; convenient when reviewing cases as a digest of child record information that would otherwise require a join to surface.

Linked Terms: Claim or Billing Transaction Detail

Transaction Effective Date

The date or datetime the transaction was considered to take effect in the original source system. Often useful in determining the order in which a series of transactions within the same transaction family should be evaluated.

Transaction Family

The collection of transactions associated with the same claim, bill, event, etc. For example, the collection of transactions for a single claim header record, from the original transaction through the last adjustment or reversal, would be considered a Transaction Family. Identifying the Transaction Family of each transaction is necessary to appropriately reconcile the final action status of the concept undergoing transactional changes.

Transaction Family ID

The internal database identifier (used, e.g., for joins and primary keys) for the Transaction Family.

Linked Terms: Transaction Family

Transaction ID

The internal database identifier (used, e.g., for joins and primary keys) for the transaction.

Linked Terms: Claim or Billing Transaction

Transaction Paid Date

The date the payment associated with the transaction was made, or would have been made (in the case of $0 transactions).

Transaction Payor ID

The Payor ID associated with a claim or billing transaction.

Linked Terms: Payor ID

Transaction Plan ID

The Plan ID associated with a claim or billing transaction.

Linked Terms: Plan ID

Transaction Sequence Number

The integer identifying the transaction's chronological order among other transactions for the same parent claim or bill. The first transaction in the sequence should take a value of 1.

Transaction Type Description

Natural language description of the type of transaction, including source-specific descriptions, potentially providing finer granularity than the structured transaction type fields.

Transaction Type Operational ID

The unique, user-facing ("real-world") identifier used by operational systems or staff to identify the Transaction Type.

Updating CMS MAO-004 Encounter

The subsequent CMS MAO-004 Encounter that updates the current MAO-004 diagnosis record.

Ursa Hospital Admission Condition-Treatment Type

A classification system for hospital inpatient admissions, developed and maintained by Ursa Health, that groups admissions based on the patient's condition and/or the type of treatment they receive during the admission. This classification is meant to generate broadly understandable groupings useful for reviewing of the composition of a general population's hospital inpatient utilization. The first tier of the classification includes four categories: Maternity, Behavioral Health, Medical, and Surgical.

Ursa Hospital Admission Condition-Treatment Type Tier 1 Category

A brief description, suitable for use in a chart or data table, identifying the type of admission using the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system.

Linked Terms: Ursa Hospital Admission Condition-Treatment Type

Ursa Setting

A classification system, developed and maintained by Ursa Health, that groups records based on the clinical setting in which case was delivered; based primarily on CMS Type of Bill Code and CMS Place of Service Code.

Linked Terms: CMS Place of Service Code, CMS Type of Bill Code

Linked Value Sets: URSA SETTING TIER 1 = ASC (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = ASC (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = CLINIC (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = CLINIC (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = DIALYSIS CENTER (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = DIALYSIS CENTER (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = HOME (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = HOME (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = HOSPICE (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = HOSPICE (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = HOSPITAL INPATIENT (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = HOSPITAL INPATIENT (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = HOSPITAL OUTPATIENT (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = HOSPITAL OUTPATIENT (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = LONG-TERM RESIDENTIAL (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = LONG-TERM RESIDENTIAL (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = OTHER (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = OTHER (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = PHARMACY (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = SNF (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = SNF (URSA-CORE CMS_TYPE_OF_BILL_CODE), URSA SETTING TIER 1 = TELEHEALTH (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = UNCLASSIFIABLE (URSA-CORE CMS_PLACE_OF_SERVICE_CODE), URSA SETTING TIER 1 = UNCLASSIFIABLE (URSA-CORE CMS_TYPE_OF_BILL_CODE)

Ursa Setting Tier 1 Description

The natural language description of the top-tier category within the Ursa Setting classification system that the record has been assigned to.

Linked Terms: Ursa Setting

UW HIP ADI Quintile Category

The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.

Linked Terms: UW HIP Area Deprivation Index National Percentile

UW HIP Area Deprivation Index National Percentile

A value between 1 and 100 representing the composite measure of socioeconomic deprivation from University of Wisconsin’s School of Medicine and Public Health. Scores are for Census Block Group geographic level, which generally contains between 600 and 3,000 people. Higher scores indicate more deprivation, so a score of 1 indicates the least deprivation while a score of 100 indicates the most deprivation. Percentiles are constructed by ranking the ADI from low to high for the nation and grouping the block groups into bins corresponding to each 1% range of the ADI. The 2019 ADI was constructed using the 2015-2019 5-year estimates from the US Census' American Community Survey and includes 17 component measures that span the domains of income, education, employment, and housing quality. It may be linked with the 9-digit ZIP code crosswalk, which was built to correspond directly to Census block groups. The 2019 ADI was released on 07/14/2021 and is the most recent version as of 02/02/22.

Verification Status

The extent to which the presence of a condition or allergy / intolerance has been substantiated for that patient; including whether it has been determined that the patient does not have the condition or allergy / intolerance.

Verification Status Description

The natural language description of the Verification Status, typically in the original language found in the source system.

Linked Terms: Verification Status

ZIP Code with Highest Percentage of Residences Contributed

Given a census tract, identifies the ZIP Code with the highest percentage of its residences contributed by that census tract. NB: even a census tract completely contained by a ZIP Code could have a low value if other census tracts' contributions are much larger.