[NO/URSA-CORE] Claim Transactions

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.
  • 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.
  • Parent Transaction ID -- The internal database identifier (used, e.g., for joins and primary keys) for the parent transaction. (See also [URSA-CORE] Parent Transaction)
  • 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)
  • 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 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)

• 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).
  • 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.

• 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 Transaction Scope Header-Level -- Indicates whether the transaction should apply to header-level fields (rather than service-line-item-level fields)
  • 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 Original Transaction -- Indicates the transaction was the first transaction within this Transaction Family. (See also [URSA-CORE] Transaction Family)
  • Is Reversal Transaction -- Indicates the transaction represents the reversal of some or all of a bill or claim.
  • Is Denial Transaction -- Indicates the transaction represents the denial of some or all of a bill or claim by the payor.
  • 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)
  • 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)

• 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

  • 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

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.