[NO/URSA-CORE] Institutional Bill Headers

Object Description

One record per institutional bill header.

Metadata

• Table Name: ursa.no_ursa_core_fin_011
• Layer: NATURAL_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Bill ID
• Event Date: Bill Covered Start Date
• Primary Key: Bill ID

Published Fields

• Data Model Keys

  • Bill ID -- The identifier for a professional or institutional bill header record; Bill ID values are consistent over the lifetime of a bill, including when a bill is adjusted. On a claim record, this field refers to the bill sent to the plan that originated the claim record.
  • 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
  • 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)
  • Operating Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the operating provider. (See also [URSA-CORE] Operating Provider)
  • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
  • Secondary Payor ID -- The identifier for the health insurance organization that is the second party responsible for payment.
  • Tertiary Payor ID -- The identifier for the health insurance organization that is the third party responsible for payment.
  • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
  • Secondary Plan ID -- The identifier for the health insurance plan product that is the second party responsible for payment.
  • Tertiary Plan ID -- The identifier for the health insurance plan product that is the third party responsible for payment.
  • EMR Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the EMR encounter. (See also [URSA-CORE] EMR Encounter)
  • Document ID
  • Source ID -- The identifier for the original source data system from which the current record originated.

• Source Local Keys

  • Source Local Bill ID -- The identifier for the bill in the original source data system. On a claim record, this field refers to the bill sent to the plan that originated the claim record.
  • 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

  • Bill Operational ID

• Date Fields

  • Bill Covered Start Date
  • Bill Covered End Date
  • 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.
  • Bill Sent Date

• Provider Fields

  • Billing Provider Description -- The natural language description of 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)
  • Billing Provider NPI -- The 10-digit National Provider Identifier for the billing provider. (See also [URSA-CORE] Billing Provider)
  • Is Billing Provider in Primary Plan Network
  • Is Billing Provider in Secondary Plan Network
  • Is Billing Provider in Tertiary Plan Network
  • Facility Provider Description
  • Facility Provider NPI
  • Attending Provider Description -- The natural language description of the attending provider; typically, the name of the provider. (See also [URSA-CORE] Attending Provider)
  • Attending Provider NPI -- The 10-digit National Provider Identifier for the attending provider. (See also [URSA-CORE] Attending Provider)
  • Operating Provider Description -- The natural language description of the operating provider; typically, the name of the provider. (See also [URSA-CORE] Operating Provider)
  • Operating Provider NPI -- The 10-digit National Provider Identifier for the operating provider. (See also [URSA-CORE] Operating Provider)

• Diagnosis Fields

  • Admitting Diagnosis ICD-9-CM Code -- The ICD-9-CM diagnosis code documented as the admitting diagnosis for an encounter. (See also [URSA-CORE] Diagnosis ICD-9-CM Code)
  • Admitting Diagnosis ICD-9-CM Description
  • Admitting Diagnosis ICD-10-CM Code
  • Admitting Diagnosis ICD-10-CM Description
  • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
  • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
  • 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 Description -- The natural language description of a standard 3-digit All Patient Refined Diagnosis Related Group code. (See also [URSA-CORE] APR-DRG Code)
  • 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.

• Billing and Claims Fields

  • Is Primary Plan Non-FFS Encounter Record
  • Is Secondary Plan Non-FFS Encounter Record
  • Is Tertiary Plan Non-FFS Encounter Record
  • CMS Type of Bill Code -- The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.
  • CMS Type of Bill Description -- The natural language description of a standard CMS Type of Bill (TOB) code. (See also [URSA-CORE] CMS Type of Bill Code)
  • CMS Admission Type Code -- The standard CMS 1-digit Admission Type code; 1 = Emergency, 2 = Urgent, etc.
  • CMS Admission Type Description -- The natural language description of a CMS Admission Type code (See also [URSA-CORE] CMS Admission Type Code)
  • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • CMS Admit Source Description -- The natural language description of a standard CMS Admit Source code. (See also [URSA-CORE] CMS Admit Source Code)
  • 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.
  • CMS Patient Discharge Status Description -- The natural language description of a standard CMS Patient Discharge Status code. (See also [URSA-CORE] CMS Patient Discharge Status Code)
  • Is Bill Processed Status Open
  • Is Bill Processed Status Closed
  • Is Bill Primary Plan Processed Status Denied
  • Is Bill Secondary Plan Processed Status Denied
  • Is Bill Tertiary Plan Processed Status Denied

• Financial Fields

  • Bill Charge Amount -- The total header-level Charge Amount for the bill; for bills with a Charge Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Charge Amount)
  • Bill Contractual Adjustment Amount -- The total header-level Contractual Adjustment Amount for the bill; for bills with a Contractual Adjustment Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Contractual Adjustment Amount)
  • Bill Primary Plan Allowed Amount -- The total header-level Primary Plan Allowed Amount for the bill; for bills with a Primary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Allowed Amount)
  • Bill Secondary Plan Allowed Amount -- The total header-level Secondary Plan Allowed Amount for the bill; for bills with a Secondary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Allowed Amount)
  • Bill Tertiary Plan Allowed Amount -- The total header-level Tertiary Plan Allowed Amount for the bill; for bills with a Tertiary Plan Allowed Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Allowed Amount)
  • Bill Non-Contractual Adjustment Amount -- The total header-level Non-Contractual Adjustment Amount for the bill; for bills with a Non-Contractual Adjustment Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Non-Contractual Adjustment Amount)
  • Bill Total Due Amount -- The header-level Total Due Amount for the bill; for bills with a Total Due Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Total Due Amount)
  • Bill Primary Plan Paid Amount -- The total header-level Primary Plan Paid Amount for the bill; for bills with a Primary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Secondary Plan Paid Amount -- The total header-level Secondary Plan Paid Amount for the bill; for bills with a Secondary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Tertiary Plan Paid Amount -- The total header-level Tertiary Plan Paid Amount for the bill; for bills with a Tertiary Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Any Plan Paid Amount -- The total header-level Any Plan Paid Amount for the bill; for bills with an Any Plan Paid Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Patient Responsibility Amount -- The total header-level Patient Responsibility Amount for the bill; for bills with a Patient Responsibility Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Patient Responsibility Amount)
  • Bill Patient Paid Amount -- The total header-level Patient Paid Amount for the bill; for bills with a Patient Paid Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Patient Paid Amount)
  • Bill Bad Debt Write-Off Amount -- The total header-level Bad Debt Write-Off Amount for the bill; for bills with a Bad Debt Write-Off Amount listed for each service line item, this will typically be the sum of those line-level values. (See also [URSA-CORE] Bad Debt Write-Off Amount)

• Metadata 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.
  • Other EMR Comments -- Any other annotations or comments associated with the current record entered into the EMR.
  • 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

• pat_id → ursa.no_ursa_core_pat_001.pat_id
• billing_prov_id → ursa.no_ursa_core_prov_001.prov_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• attending_prov_id → ursa.no_ursa_core_prov_001.prov_id
• operating_prov_id → ursa.no_ursa_core_prov_001.prov_id
• primary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• secondary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• tertiary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• primary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• secondary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• tertiary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• emr_enc_id → ursa.no_ursa_core_enc_001.emr_enc_id

Dedicated Precursors

• [NO/URSA-CORE] Institutional Bill Headers, Precursor 1 (All Source Records): One record per institutional bill header