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[NO/URSA-CORE] Claim Transactions

  • Published on Sep 2, 2026
  • 16 minute(s) read
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Object Description

One record per claim transaction; includes both claim header- and line-item-level transactions, for professional, institutional, and pharmacy claims.

Metadata

  • Table Name: ursa.no_ursa_core_fin_006
  • Layer: NATURAL_OBJECT
  • Object Type: Single Stack
  • Temporal Class: Event
  • Case ID: Transaction ID
  • Event Date: Transaction Effective Date
  • Primary Key: Transaction ID

Published Fields

  • Data Model Keys

    • Transaction ID -- The internal database identifier (used, e.g., for joins and primary keys) for the transaction. (See also [URSA-CORE] Claim or Billing Transaction)
    • Claim ID -- The internal database identifier (used, e.g., for joins and primary keys) for the claim. (See also [URSA-CORE] Claim)
    • Claim Service Line Item ID -- The identifier for a service line item on an institutional or professional claim.
    • 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.
    • 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 Header ID
    • 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.) (See also [URSA-CORE] Patient)
    • Billing Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the billing provider. (See also [URSA-CORE] Billing Provider)
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
    • Service Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the service provider. (See also [URSA-CORE] Service Provider)
    • Referring Provider ID
    • Prescribing Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the prescribing provider. (See also [URSA-CORE] Prescribing Provider)
    • Payor ID -- The identifier for the health insurance organization associated with the current record.
    • Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
    • Source ID -- The identifier for the original source data system from which the current record originated.

  • Source Local Keys

    • Source Local Transaction ID -- The internal database identifier for the transaction in the source data system this record originated from. (See also [URSA-CORE] Claim or Billing Transaction)
    • Source Local Claim ID -- The internal database identifier for the claim in the source data system this record originated from. (See also [URSA-CORE] 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 Service Line Number -- The integer-valued ordinal for a service line item in the original source data system.
    • Source Local Transaction Sequence Number -- The identifier for the transaction sequence number in the original source data system. (See also [URSA-CORE] Transaction Sequence Number)
    • Source Local Patient ID -- The internal database identifier for the patient in the source data system this record originated from. (See also [URSA-CORE] Patient)
    • Source Local Billing Provider ID -- The internal database identifier for the billing provider in the source data system this record originated from. (See also [URSA-CORE] Billing Provider)
    • Source Local Facility Provider ID -- The internal database identifier for the facility provider in the source data system this record originated from. (See also [URSA-CORE] Facility Provider)
    • Source Local Attending Provider ID -- The internal database identifier for the attending provider in the source data system this record originated from. (See also [URSA-CORE] Attending Provider)
    • Source Local Service Provider ID -- The internal database identifier for the service provider in the source data system this record originated from. (See also [URSA-CORE] Service Provider)
    • Source Local Referring Provider ID
    • Source Local Prescribing Provider ID -- The internal database identifier for the prescribing provider in the source data system this record originated from. (See also [URSA-CORE] Prescribing Provider)

  • Date Fields

    • 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 Effective Datetime -- 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 Paid Date -- The date the payment associated with the transaction was made, or would have been made (in the case of $0 transactions).
    • Claim Covered Start Date -- The start date of services covered by a claim.
    • Claim Covered End Date -- The end date of services covered by a claim.
    • Service Start Date -- The first calendar date a service was delivered.
    • Service End Date -- The last calendar date a service was delivered.
    • 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.
    • Discharge Date -- The date the patient was discharged from a care facility.
    • Payor Incurred Date -- The date the payor considers the services associated with the record to be incurred for accounting purposes.

  • Provider Fields

    • Billing Provider CCN
    • Billing Provider NPI -- The 10-digit National Provider Identifier for the billing provider. (See also [URSA-CORE] Billing Provider)
    • Billing Provider TIN -- The 9-digit federal Tax Identification Number for the billing provider. (See also [URSA-CORE] Billing Provider)
    • Facility Provider CCN
    • Facility Provider NPI -- The 10-digit National Provider Identifier for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Attending Provider NPI -- The 10-digit National Provider Identifier for the attending provider. (See also [URSA-CORE] Attending Provider)
    • Referring Provider NPI
    • Prescribing Provider NPI -- The 10-digit National Provider Identifier for the prescribing provider. (See also [URSA-CORE] Prescribing Provider)

  • Insurance Fields

    • Is Risk Contract Eligible -- Indicates the record -- typically a claim, but also potentially another type of financial transaction -- is eligible to be included in calculations determining provider risk associated with a value-based contract. Note that such records may ultimately be excluded from risk-related calculations if the patient was determined to not be attributed with risk at the time the service or transaction was incurred.
    • Is Medicare Part A -- Indicates that this record is associated with the Medicare Part A benefit.
    • Is Medicare Part B -- Indicates that this record is associated with the Medicare Part B benefit. Note that some institutional claims and pharmacy claims may be designated Part B.
    • Is Medicare MSB -- Indicates that this record is associated with a Medicare Advantage Mandatory Supplemental Benefit (MSB).
    • Is Medicare Part C -- Indicates that this record is associated with the Medicare Part C benefit. Medicare Part C covers Medicare Part A, Medicare Part B, and Medicare MSB (Mandatory Supplemental Benefit), and so records flagged as Medicare Part A, Medicare Part B, or Medicare MSB should also be flagged as Medicare Part C; but the converse need not be true, e.g., a record known to be covered by Medicare Part C but without knowing whether the specific coverage is through Part A, Part B, or MSB might still be flagged as Medicare Part C while the other flags are not used.
    • Is Medicare Part D -- Indicates that this record is associated with the Medicare Part D benefit.

  • Billing and Claims Fields

    • Is Claim Class Institutional -- Indicates the record is associated with an institutional claim or bill.
    • Is Claim Class Professional -- Indicates the record is associated with a professional claim or bill.
    • Is Claim Class Pharmacy -- Indicates the record is associated with a pharmacy claim.
    • 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.
    • CMS Type of Bill Code -- The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.
    • CMS Admission Type Code -- The standard CMS 1-digit Admission Type code; 1 = Emergency, 2 = Urgent, etc.
    • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, 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.
    • 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. (See also [URSA-CORE] HCPCS Description)
    • HCPCS Modifier 1 Code -- The 2-character code modifying a HCPCS code.
    • HCPCS Modifier 2 Code -- The 2-character code modifying a HCPCS code.
    • HCPCS Modifier 3 Code -- The 2-character code modifying a HCPCS code.
    • HCPCS Modifier 4 Code -- The 2-character code modifying a HCPCS code.
    • HCPCS Modifier 5 Code -- The 2-character code modifying a HCPCS code.
    • 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 Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
    • CMS Type of Service Code -- The standard CMS 1-character Type of Service (TOS) code; 0 = Whole Blood, 1 = Medical Care, etc.
    • NDC Code 11-Digit -- The standard 11-digit National Drug Code; e.g., 00045012400 = Tylenol 500 mg.
    • Label Description -- Supplies the name given to the product by the manufacturer.
    • 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.
    • Is Generic According to Plan -- Indicates the medication is considered by the plan to be a generic drug.
    • Is Brand According to Plan -- Indicates the medication is considered by the plan to be a brand name drug.
    • Increase to Service Unit Count -- The increase to the service unit count from a billing or claim transaction; negative values indicate a decrease. (See also [URSA-CORE] Service Unit Count)
    • 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. (See also [URSA-CORE] 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. (See also [URSA-CORE] 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. (See also [URSA-CORE] Anesthesia Time Unit Count)
    • Increase to Quantity Dispensed -- The increase to the Quantity Dispensed from a transaction; negative values indicate a decrease. (See also [URSA-CORE] Quantity Dispensed)
    • Increase to Days Supply -- The increase to the Days Supply from a transaction; negative values indicate a decrease. (See also [URSA-CORE] Days Supply)
    • 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. (See also [URSA-CORE] Service Unit Count)
    • 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. (See also [URSA-CORE] 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. (See also [URSA-CORE] 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. (See also [URSA-CORE] Anesthesia Time Unit Count)
    • 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. (See also [URSA-CORE] Quantity Dispensed)
    • 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. (See also [URSA-CORE] Days Supply)
    • 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.
    • Is Final Action Record
    • Is Claim Processed Status Open -- Indicates that the claim has been received but not yet paid or denied.
    • 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 Processed Status Paid -- Indicates that the claim has completed processing without denial, with any outstanding balance paid.
    • Is Claim Processed Status Denied -- Indicates the claim 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 Reversed
    • 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 Claim Service Line Item Processed Status Denied -- Indicates the claim service line item has been denied.
    • 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. (See also [URSA-CORE] Claim or Billing Transaction Detail)

  • Diagnosis Fields

    • Admitting Diagnosis ICD-10-CM Code
    • Patient Reason for Visit 1 ICD-10-CM Code
    • Patient Reason for Visit 2 ICD-10-CM Code
    • Patient Reason for Visit 3 ICD-10-CM Code
    • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
    • 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 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.
    • 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.

  • Financial Fields

    • Increase to Charge Amount -- The increase to the Charge Amount from a billing or claim transaction; negative values indicate a decrease. (See also [URSA-CORE] Charge Amount)
    • Increase to Allowed Amount -- The increase to the Allowed Amount from a billing or claim transaction; negative values indicate a decrease. (See also [URSA-CORE] Allowed Amount)
    • Increase to Plan Paid Amount -- The increase to the Plan Paid Amount from a billing or claim transaction; negative values indicate a decrease. (See also [URSA-CORE] Plan Paid Amount)
    • Increase to COB Paid Amount -- The increase to the COB Paid Amount from a claim transaction; negative values indicate a decrease. (See also [URSA-CORE] COB 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. (See also [URSA-CORE] Patient Responsibility Amount)
    • Increase to Patient Paid Amount -- The increase to the Patient Paid Amount from a billing or claim transaction; negative values indicate a decrease. (See also [URSA-CORE] Patient Paid 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. (See also [URSA-CORE] Charge Amount)
    • 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. (See also [URSA-CORE] Allowed 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. (See also [URSA-CORE] Plan Paid 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. (See also [URSA-CORE] COB 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. (See also [URSA-CORE] Patient Responsibility 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. (See also [URSA-CORE] Patient Paid Amount)

  • Metadata Fields

    • Is Transaction Scope Header-Level -- Indicates whether the transaction should apply to header-level fields (rather than service-line-item-level fields)
    • 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.
    • Record Last Updated Datetime -- The date and time the current record was last updated in the original data source.
    • 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. (See also [URSA-CORE] Record Last Updated Datetime)
    • Source Data Loaded Datetime -- The date and time that the record was loaded into the current database environment. For systems that track the start and end datetimes of these loads, this value is meant to represent the end datetime (i.e., when the record or records have finished loading).
    • Source Data Filename -- The filename of the file that originally contained the current record; by convention, Source Data Filename values should not include the file path, but should include an extension, if it exists.

Foreign Keys

  • billing_prov_id → ursa.no_ursa_core_prov_001.prov_id
  • trx_payor_id → ursa.no_ursa_core_struct_004.payor_id
  • trx_plan_id → ursa.no_ursa_core_struct_005.plan_id
  • bill_id → ursa.no_ursa_core_fin_011.bill_id
  • bill_service_line_item_id → ursa.no_ursa_core_fin_012.bill_service_line_item_id
  • pat_id → ursa.no_ursa_core_pat_001.pat_id

Dedicated Precursors

  • [NO/URSA-CORE] Claim Transactions, Precursor 1 (All Source Records): One record per claim transaction; includes both claim header- and line-item-level transactions, for professional, institutional, and pharmacy claims.