[NO/URSA-CORE] Capitation Financial Transactions

Object Description

One record per capitation financial transaction record; includes records representing increases or decreases to account balances related to revenue, expenses, or other financial considerations associated with a capitation contract between a payor and a risk-bearing provider entity.

Metadata

• Table Name: ursa.no_ursa_core_fin_022
• 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)
  • Transaction Family ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Transaction Family. (See also [URSA-CORE] Transaction Family)
  • 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.
  • 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.
  • Provider Contract ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Provider Contract. (See also [URSA-CORE] Provider Contract)
  • 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)
  • 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 Patient ID -- The internal database identifier for the patient in the source data system this record originated from. (See also [URSA-CORE] Patient)

• Operations Support Fields

  • 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. (See also [URSA-CORE] Provider Contract)
  • Is Reversal Transaction -- Indicates the transaction represents the reversal of some or all of a bill or claim.

• 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
  • Transaction Paid Date -- The date the payment associated with the transaction was made, or would have been made (in the case of $0 transactions).
  • 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.
  • 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.
  • 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).
  • Original Covered Period End Date -- The end 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).

• Financial Fields

  • Accounting Activity Type Description -- The natural language description of a financial record's Accounting Activity Type. (See also [URSA-CORE] Accounting Activity Type)
  • Is Accounting Activity Type Capitation Revenue -- Indicates the transaction has an Accounting Activity Type of "Capitation Revenue" (indicating the transaction amount represents Capitation Revenue). (See also [URSA-CORE] Accounting Activity Type, [URSA-CORE] Capitation Revenue)
  • Is Accounting Activity Type Capitation Expense -- Indicates the transaction has an Accounting Activity Type of "Capitation Expense" (indicating the transaction amount represents Capitation Expense). (See also [URSA-CORE] Accounting Activity Type, [URSA-CORE] Capitation Expense)
  • 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). (See also [URSA-CORE] Accounting Activity Type, [URSA-CORE] Manual Adjustment)
  • 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). (See also [URSA-CORE] Cash Flow Payment)
  • 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.
  • Benefit Type Description -- The natural language description of the Benefit Type category. (See also [URSA-CORE] Benefit Type)
  • Is Medicare Part A Benefit -- Indicates the financial transaction has a Benefit Type that is considered a Medicare Part A benefit. (Note that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Benefit Type)
  • Is Medicare Part B Benefit -- Indicates the financial transaction has a Benefit Type that is considered a Medicare Part B benefit. (Note that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Benefit Type)
  • Is Mandatory Supplemental Benefit -- Indicates the financial transaction has a Benefit Type that is considered a Medicare Advantage Mandatory Supplemental Benefit (MSB). (See also [URSA-CORE] Benefit Type)
  • Is Vision Mandatory Supplemental Benefit
  • Is Dental Mandatory Supplemental Benefit
  • Is Hearing Mandatory Supplemental Benefit
  • Is Transportation Mandatory Supplemental Benefit
  • Is OTC Drug Mandatory Supplemental Benefit
  • Is Wellness Mandatory Supplemental Benefit
  • Is Care Management Mandatory Supplemental Benefit
  • 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.) (See also [URSA-CORE] Benefit Type)
  • Is Medicare Part D Benefit -- Indicates the financial transaction has a Benefit Type that is considered a Medicare Part D benefit. (See also [URSA-CORE] Benefit Type)
  • Covered Service Type Description -- The natural language description of a financial record's Covered Service Type. (See also [URSA-CORE] Covered Service Type)
  • Increase to Net Paid Amount -- The increase to Net Paid Amount from a transaction; negative values indicate a decrease. (See also [URSA-CORE] Net Paid Amount)
  • 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. (See also [URSA-CORE] Net Paid Amount)

• Metadata Fields

  • 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)

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
• payor_id → ursa.no_ursa_core_struct_004.payor_id
• plan_id → ursa.no_ursa_core_struct_005.plan_id
• plan_attributee_prov_id → ursa.no_ursa_core_prov_001.prov_id
• plan_attributee_individual_prov_id → ursa.no_ursa_core_prov_001.prov_id
• plan_attributee_prov_group_prov_id → ursa.no_ursa_core_prov_001.prov_id

Dedicated Precursors

• [NO/URSA-CORE] Capitation Financial Transactions, Precursor 1 (All Source Records): One record per capitation financial transaction record.