Ursa Health HCC/RAF Module Terms

CMS-HCC Age Category

A categorical value describing the patient's age with respect to the age ranges used to group patients for the CMS-HCC RAF score calculation.

CMS-HCC Model Outputs

Coded values generated by the CMS-HCC model representing distinct disease-component-related features of the patient that were used to calculate the RAF score. These may be individual HCCs (e.g., "HCC19", indicating the HCC for Diabetes without Complication in the v24 model) or other concepts (e.g., "HCC85_HCC96", representing the additional risk associated with the interaction of Congestive Heart Failure and Specified Heart Arrhythmias in the v24 model).

CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score generated using diagnoses and other input data as of the time period on the current record but using the model blend of 2024 (i.e., 67% from v24 and 33% from v28).

CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score generated using diagnoses and other input data as of the time period on the current record but using the model blend of 2025 (i.e., 33% from v24 and 67% from v28).

Count Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs

A count of all distinct outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the count of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Count Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs

A count of all distinct outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the count of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Scenario

An approach to calculating a counterfactual CMS-HCC RAF score as of a given reference date in which every qualifying diagnosis from the prior 2 years are used, in addition to any diagnoses in the reference calendar year itself, to calculate the RAF score.

Historical-Diagnoses CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is a list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, using the CMS-HCC model v24.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is a list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, using the CMS-HCC model v28.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses vs. Standard Final Action CMS-HCC RAF Score Gap

The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Standard Final Action scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario, Standard Final Action CMS-HCC Scenario

Historical-Diagnoses vs. Within-Year-Updated CMS-HCC RAF Score Gap

The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Within-Year-Updated scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year. A negative value indicates a higher RAF score obtained using only diagnoses documented so far in the current year compared to the prior two calendar years of diagnoses.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Is CMS Dual Coverage Level Full

Indicates, for dually eligible patients, whether their coverage meets the CMS criteria for "Full Coverage". Among other potential uses, this value is used in the calculation of RAF scores.

Is CMS Dual Coverage Level Partial

Indicates, for dually eligible patients, whether their coverage meets the CMS criteria for "Partial Coverage". Among other potential uses, this value is used in the calculation of RAF scores.

Is Medicaid Patient

Indicates the patient is a Medicaid plan member; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicaid = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicaid

Is Medicare Advantage Patient

Indicates the patient is a Medicare Advantage plan member; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicare Advantage = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicare Advantage

Is Medicare FFS Patient

Indicates the patient is a Medicare Fee-for-Service (FFS) beneficiary; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicare FFS = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicare FFS

Standard Final Action CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Standard Final Action scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Standard Final Action scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score as of a given reference date that uses the patient's most recent ("final action") demographics for that reference date with all qualifying diagnoses (from both final action claims and final action MAO-004 encounters) in the prior calendar year, following the standard catchment period window.

Standard Final Action CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, using the CMS-HCC model v24.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v24 to v28 Increase in RAF Score

The increase in RAF score from the Standard Final Action CMS-HCC v24 RAF score to the CMS-HCC v28 RAF score; a positive number indicates the v28 score is higher than the v24 score.

Linked Terms: Standard Final Action CMS-HCC v24 RAF Score, Standard Final Action CMS-HCC v28 RAF Score

Standard Final Action CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, using the CMS-HCC model v28.

Linked Terms: Standard Final Action CMS-HCC Scenario

Within-Year-Updated CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score as of a given reference date in which only qualifying diagnoses documented since the start of the calendar year containing the reference date are used in the RAF score calculation (i.e., diagnoses documented later in the year, after the reference date, are ignored).

Within-Year-Updated CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, using the CMS-HCC model v24.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, using the CMS-HCC model v28.

Linked Terms: Within-Year-Updated CMS-HCC Scenario