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    [NO/URSA-CORE] Capitation Member Summary Report Member-Months
    • 28 Jun 2025
    • 13 Minutes to read
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    [NO/URSA-CORE] Capitation Member Summary Report Member-Months

    • Updated on 28 Jun 2025
    • 13 Minutes to read
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    Article summary

    Object Description

    One record per member-month in a capitation member summary report from any data source. Values represent the final action status of the member-month net of all report updates received over time.

    Metadata

    • Table Name: ursa.no_ursa_core_fin_023
    • Layer: NATURAL_OBJECT
    • Object Type: Single Stack
    • Case ID: Patient ID, Plan ID, Provider Contract ID, Covered Month Start Date
    • Primary Key: Patient ID, Plan ID, Provider Contract ID, Covered Month Start Date

    Published Fields

    • Data Model Keys

      • 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)
      • Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
      • Payor ID -- The identifier for the health insurance organization associated with the current record.
      • 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)
      • Source ID -- The identifier for the original source data system from which the current record originated.

    • Source Local Keys

      • 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)

    • Date Fields

      • 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.
      • Last Report Month Start Date
      • 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).

    • Insurance Fields

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

    • Financial Fields

      • Total 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. (See also [URSA-CORE] CMS Sequestration Amount)
      • Medicare Part A CMS Premium Amount -- The CMS Premium Amount associated with the 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] CMS Premium Amount)
      • Medicare Part B CMS Premium Amount -- The CMS Premium Amount associated with the 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] CMS Premium Amount)
      • Mandatory Supplemental Benefit CMS Premium Amount -- The CMS Premium Amount associated with the Mandatory Supplemental Benefit. (See also [URSA-CORE] CMS Premium 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, Medicare Part B CMS Premium Amount, and Mandatory Supplemental Benefit CMS Premium Amount values. (See also [URSA-CORE] CMS Premium Amount, [URSA-CORE] Medicare Part A CMS Premium Amount, [URSA-CORE] Medicare Part B CMS Premium Amount, [URSA-CORE] Mandatory Supplemental Benefit CMS Premium Amount)
      • Medicare Part D CMS Premium Amount -- The CMS Premium Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] CMS Premium Amount)
      • 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. (See also [URSA-CORE] CMS Premium Amount)
      • Total Post-Sequestration CMS Premium Amount -- The CMS Premium Amount less the CMS Sequestration Amount. (See also [URSA-CORE] CMS Premium Amount, [URSA-CORE] CMS Sequestration Amount)
      • 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. (Note that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Medicare Part A CMS Premium Amount, [URSA-CORE] CMS Sequestration 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. (Note that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Medicare Part B CMS Premium Amount, [URSA-CORE] CMS Sequestration Amount)
      • Mandatory Supplemental Benefit Post-Sequestration CMS Premium Amount -- The Mandatory Supplemental Benefit Amount less the MSB component of the CMS Sequestration Amount. (See also [URSA-CORE] Mandatory Supplemental Benefit CMS Premium Amount, [URSA-CORE] CMS Sequestration 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. (See also [URSA-CORE] Medicare Part C CMS Premium Amount, [URSA-CORE] CMS Sequestration Amount, [URSA-CORE] Medicare Part A Post-Sequestration CMS Premium Amount, [URSA-CORE] Medicare Part B Post-Sequestration CMS Premium Amount, [URSA-CORE] Mandatory Supplemental Benefit Post-Sequestration CMS Premium 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. (See also [URSA-CORE] Medicare Part D CMS Premium Amount, [URSA-CORE] CMS Sequestration Amount)
      • Total Member Premium Amount -- The amount billed to the patient for insurance coverage. For members with Part D premiums, this amount reflects the (reduced) premium due from the patient after the LIS Premium Subsidy has been applied. This amount does not necessarily reflect the amount actually paid by the member. (See also [URSA-CORE] CMS MMR LIS Premium Subsidy Amount)
      • Medicare Part C Member Premium Amount -- The Member Premium Amount associated with the Medicare Part C benefit. (See also [URSA-CORE] Member Premium Amount)
      • Medicare Part D Member Premium Amount -- The Member Premium Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] Member Premium Amount)
      • 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.) (See also [URSA-CORE] CMS Premium Amount, [URSA-CORE] Member Premium Amount, [URSA-CORE] Capitation Revenue, [URSA-CORE] Percent of Premium Calculation Fraction)
      • 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. (See also [URSA-CORE] CMS Premium Amount, [URSA-CORE] Member Premium Amount, [URSA-CORE] Capitation Revenue)
      • 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). (See also [URSA-CORE] CMS Premium Amount, [URSA-CORE] Member Premium Amount, [URSA-CORE] Capitation Revenue, [URSA-CORE] Percent of Premium Calculation Fraction)
      • Total Capitation Revenue Amount -- 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.
      • Medicare Part A Capitation Revenue Amount -- The Capitation Revenue amount associated with the 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] Capitation Revenue)
      • Medicare Part B Capitation Revenue Amount -- The Capitation Revenue amount associated with the Medicare Part B benefit. (See also [URSA-CORE] Capitation Revenue)
      • Mandatory Supplemental Benefit Capitation Revenue Amount -- The Capitation Revenue amount associated with a Medicare Advantage Mandatory Supplemental Benefit. (See also [URSA-CORE] Capitation Revenue)
      • 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. (See also [URSA-CORE] Capitation Revenue, [URSA-CORE] Medicare Part A Capitation Revenue Amount, [URSA-CORE] Medicare Part B Capitation Revenue Amount, [URSA-CORE] Mandatory Supplemental Benefit Capitation Revenue Amount)
      • Medicare Part D Capitation Revenue Amount -- The Capitation Revenue Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] Capitation Revenue)
      • Total Capitation Expense Amount -- 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.
      • Medicare Part A Capitation Expense Amount -- The Capitation Expense amount associated with the 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] Capitation Expense)
      • Medicare Part B Capitation Expense Amount -- The Capitation Revenue amount associated with the 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] Capitation Revenue)
      • Mandatory Supplemental Benefit Capitation Expense Amount -- The Capitation Expense amount associated with a Medicare Advantage Mandatory Supplemental Benefit. (See also [URSA-CORE] Capitation Expense)
      • 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. (See also [URSA-CORE] Capitation Expense, [URSA-CORE] Medicare Part A Capitation Expense Amount, [URSA-CORE] Medicare Part B Capitation Expense Amount, [URSA-CORE] Mandatory Supplemental Benefit Capitation Expense Amount)
      • Medicare Part D Capitation Expense Amount -- The Capitation Expense Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] Capitation Expense)
      • Total Manual Adjustment Amount
      • Medicare Part A Manual Adjustment Amount -- The Manual Adjustment Amount associated with the 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] Manual Adjustment)
      • Medicare Part B Manual Adjustment Amount -- The Manual Adjustment Amount associated with the 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] Manual Adjustment)
      • Mandatory Supplemental Benefit Manual Adjustment Amount -- The Manual Adjustment Amount associated with the Mandatory Supplemental Benefit. (See also [URSA-CORE] Manual Adjustment)
      • 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. (See also [URSA-CORE] Manual Adjustment, [URSA-CORE] Medicare Part A Manual Adjustment Amount, [URSA-CORE] Medicare Part B Manual Adjustment Amount, [URSA-CORE] Mandatory Supplemental Benefit Manual Adjustment Amount)
      • Medicare Part D Manual Adjustment Amount -- The Manual Adjustment Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] Manual Adjustment)
      • Total Cash Flow Payment Amount -- A cash payment; not considered to be Capitation Revenue. (See also [URSA-CORE] Capitation Expense)
      • Total 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.
      • Medicare Part A Claims Expense Amount -- The Claims Expense Amount associated with the 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] Claims Expense Amount)
      • 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; note also that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Claims Expense Amount)
      • Mandatory Supplemental Benefit Claims Expense Amount -- The Claims Expense Amount associated with the Mandatory Supplemental Benefit. (See also [URSA-CORE] Claims Expense 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. (See also [URSA-CORE] Medicare Part A Claims Expense Amount, [URSA-CORE] Medicare Part B Claims Expense Amount, [URSA-CORE] Mandatory Supplemental Benefit Claims Expense Amount)
      • Medicare Part D Claims Expense Amount -- The Claims Expense Amount associated with the Medicare Part D benefit. (See also [URSA-CORE] Claims Expense Amount)
      • 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. (See also [URSA-CORE] Claims Expense Amount, [URSA-CORE] Institutional Claims Expense Amount, [URSA-CORE] Professional Claims Expense Amount)
      • Institutional Claims Expense Amount -- The Claims Expense Amount associated with institutional claims. (See also [URSA-CORE] Claims Expense Amount)
      • Professional Claims Expense Amount -- The Claims Expense Amount associated with professional claims. (See also [URSA-CORE] Claims Expense Amount)
      • Pharmacy Claims Expense Amount -- The Claims Expense Amount associated with pharmacy claims. (See also [URSA-CORE] Claims Expense Amount)
      • Medicare Part B Pharmacy Claims Expense Amount -- The Claims Expense Amount associated with pharmacy claims for medications covered by Medicare Part B. (Note that Mandatory Supplemental Benefits are not considered to be Medicare Part A or B for these purposes.) (See also [URSA-CORE] Claims Expense Amount)
      • Medicare Part D Pharmacy Claims Expense Amount -- The Claims Expense Amount associated with pharmacy claims for medications covered by Medicare Part D. (See also [URSA-CORE] Claims Expense 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
    • prov_contract_id → ursa.no_ursa_core_fin_008.prov_contract_id

    Dedicated Precursors

    • [NO/URSA-CORE] Capitation Member Summary Report Member-Months, Precursor 1 (All Source Records): One record per member-month in a capitation member summary report from any data source. Values represent the final action status of the member-month net of all report updates received over time.
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