[NO/URSA-CORE] Institutional Claim Service Line Items

Object Description

One record per non-reversed institutional claim service line item; includes denied line items.

Metadata

• Table Name: ursa.no_ursa_core_fin_002
• Layer: NATURAL_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Claim Service Line Item ID
• Event Date: Service Start Date
• Primary Key: Claim Service Line Item ID

Published Fields

• Data Model Keys

  • 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.
  • 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)
  • 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)
  • Document ID
  • Source ID -- The identifier for the original source data system from which the current record originated.

• Source Local Keys

  • 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 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

  • Claim Service Line Item Operational ID -- The identifier for an institutional or professional claim service line item used to identify a record in an operational or administrative system; i.e., the "real life" identifier for the record that might be used by staff or other operators.

• Date Fields

  • 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
  • Service End Date

• Provider Fields

  • Service Provider NPI -- The 10-digit National Provider Identifier for the service provider. (See also [URSA-CORE] Service Provider)
  • Service Provider Description

• Clinical Services Fields

  • 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 Description
  • HCPCS Modifier 1 Code -- The 2-character code modifying a HCPCS code.
  • HCPCS Modifier 2 Code
  • HCPCS Modifier 3 Code
  • HCPCS Modifier 4 Code
  • HCPCS Modifier 5 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 Revenue Center Description
  • HIPPS Code -- The standard CMS 5-digit Health Insurance Prospective Payment System (HIPPS) code; e.g., AAA00 = Default Code.
  • HCPCS Modifier 1 Description -- The natural language description of a HCPCS code modifier. (See also [URSA-CORE] HCPCS Modifier Code)
  • HCPCS Modifier 2 Description
  • HCPCS Modifier 3 Description
  • HCPCS Modifier 4 Description
  • HCPCS Modifier 5 Description
  • HIPPS Description -- The natural language description of a HIPPS code. (See also [URSA-CORE] HIPPS Code)

• Billing and Claims Fields

  • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
  • CMS Place of Service Description -- The natural language description of a standard CMS Place of Service code (See also [URSA-CORE] CMS Place of Service Code)
  • Service Unit Count -- The number of units of a service delivered to the patient; includes non-integer values, if appropriate.
  • 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 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.

• Financial Fields

  • Claim Service Line Item Charge Amount -- The amount charged for this claim service line item on the original bill, before any contractual adjustments or other discounts were applied.
  • Claim Service Line Item Allowed Amount -- The amount determined by the payor to be the maximum allowed amount for all the a claim service line item, representing, for example, negotiated contractual amounts.
  • Claim Service Line Item Plan Paid Amount -- The amount paid by an insurance plan for a claim service line item.
  • Claim Service Line Item COB Paid Amount -- The amount paid for a claim service line item by other insurance plans as part of a "coordination of benefit" (COB) arrangement.
  • Claim Service Line Item Patient Responsibility Amount -- The amount determined by a plan to be owed by the patient for a claim service line item.
  • Claim Service Line Item Patient Paid Amount -- The amount paid by the patient for a claim service line item.

• 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.
  • 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

• claim_id → ursa.no_ursa_core_fin_001.claim_id
• pat_id → ursa.no_ursa_core_pat_001.pat_id
• service_prov_id → ursa.no_ursa_core_prov_001.prov_id

Dedicated Precursors

• [NO/URSA-CORE] Institutional Claim Service Line Items, Precursor 1 (All Source Records): One record per non-reversed institutional claim service line item; includes denied line items