[NO/URSA-CORE] Patient-Plan Timelines of Plan Membership

Object Description

One record per patient-plan timeline period in which the patient had an active membership in the plan; overlapping periods are reconciled to eliminate overlapping periods, with precedence given to the period with the more recent start date.

Metadata

• Table Name: ursa.no_ursa_core_fin_005
• Layer: NATURAL_OBJECT
• Object Type: Simple Timeline
• Temporal Class: Interval (Timeline)
• Case ID: Patient ID, Plan ID
• Interval Start Date: Period Start Date
• Interval End Date: Period End Date
• Primary Key: Patient ID, Plan ID, Period Start Date, Period End 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.
  • Subscriber Patient ID
  • Plan Attributee Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider. (See also [URSA-CORE] Plan Attributee Provider)
  • Plan Attributee Individual Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Individual Provider. (See also [URSA-CORE] Plan Attributee Individual Provider)
  • Plan Attributee Provider Group Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider Group. (See also [URSA-CORE] Plan Attributee Provider Group)
  • Plan Attributee Provider Contract ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Plan Attributee Provider Contract. (See also [URSA-CORE] Plan Attributee Provider Contract)
  • Risk Program Entity ID
  • 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)
  • Source Local Plan ID -- The identifier for the health plan in the original source data system.

• Date Fields

  • Period Start Date
  • Period End Date

• Operations Support Fields

  • Member Number -- The unique identifier assigned by the payor to each individual patient with insurance coverage. This value is often found on the patient's insurance card.
  • Member Policy Number -- The identifier assigned by the payor to the insurance product or contract providing coverage to the member. Depending on the payor and insurance product, this value could be unique to each subscriber or shared by a number of subscribers, e.g., those in the same group. Unlike the Member Number, this identifier will likely change when the patient changes plans within the same a payor. (See also [URSA-CORE] Member Number)
  • Plan Attributee Provider Contract Operational ID

• Insurance Fields

  • Group Operational ID
  • Subgroup Operational ID
  • Employer Operational ID
  • Plan Description
  • Payor Description
  • Group Description
  • Subgroup Description
  • Employer Description
  • Coverage Position Number
  • Is Coverage Position Primary
  • Is Coverage Position Secondary
  • Is Coverage Position Tertiary
  • Is Patient Attributed -- Indicates the patient is, during the period specified by the current record, considered attributed to the Ursa client organization.
  • Is Patient Attributed with Risk -- Indicates the patient is, during the period specified by the current record, considered attributed to the Ursa client organization, and, additionally, considered qualified for inclusion in risk-based payment model calculations.
  • Plan Attributee Organization Operational ID
  • Plan Attributee Organization Description
  • Risk Program Operational ID
  • Risk Program Entity Operational ID
  • Plan Attributee Provider NPI in Contract -- The NPI of the Plan Attributee Provider as defined in the Provider Contract during the patient membership period defined by the record; this field memorializes the provider's NPI as it appears in the patient's membership record, where it is guaranteed to be preserved regardless of provider mastering or other updates that might alter the NPI in the Provider Natural Object. (See also [URSA-CORE] Plan Attributee Provider, [URSA-CORE] Provider Contract)
  • Plan Attributee Provider TIN in Contract -- The TIN of the Plan Attributee Provider as defined in the Provider Contract during the patient membership period defined by the record; this field memorializes the provider's TIN as it appears in the patient's membership record, where it is guaranteed to be preserved regardless of provider mastering or other updates that might alter the NPI in the Provider Natural Object. (See also [URSA-CORE] Plan Attributee Provider, [URSA-CORE] Provider Contract)
  • CMS Contract Number
  • CMS PBP Number
  • CMS Segment Number
  • Member HICN
  • Member MBI
  • CMS Medicare Beneficiary Status Code -- The standard 2-digit CMS code Beneficiary Status Code, which identifies the reason for a beneficiary's entitlement to Medicare benefits as of a particular date; e.g.,10 = Aged without ESRD, 11 = Aged with ESRD, 20 = Disabled without ESRD, 21 = Disabled with ESRD, 31 = ESRD only.
  • Is CMS Aged Status -- Indicates the patient meets the Medicare aged eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
  • Is CMS Disabled Status -- Indicates the patient meets the Medicare Disabled eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
  • Is CMS ESRD Status -- Indicates the patient meets the Medicare ESRD eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
  • Is CMS Hospice Status -- Indicates the patient is considered to be Hospice status.
  • 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 Raw RAF Score -- The patient-level total Risk Adjustment Factor (RAF) value obtained by the CMS-HCC risk model methodology but without the normalization to an average beneficiary value of 1.0.
  • CMS RAF Demographic Component Score
  • CMS RAF Disease Component Score
  • CMS RAF Type Code -- The standard 1- or 2-character CMS Part C Risk Adjustment Factor Type Code; e.g., E = New Enrollee, I = Institutional, D = Dialysis (ESRD), CF = Community Full Dual, CP = Community Partial Dual, CN = Community Non-Dual, etc.
  • CMS Original Reason for Entitlement Code -- The standard CMS 1-digit code, commonly abbreviated OREC, identifying the original reason the patient was entitled to Medicare; 0 = Old Age and Survivor's Insurance, 1 = Disability Insurance Benefit, 2 = ESRD, 3 = Both Disability and ESRD, 9 = None of the Above.
  • Is CMS LTI Status -- Indicates the patient meets the CMS criteria to be considered a Long-Term Institutional (LTI) patient. Among other potential uses, this status is used in the calculation of RAF scores.
  • Is CMS New Enrollee Status -- Indicates the patient meets the CMS criteria to be considered a New Enrollee. Among other potential uses, this status is used in the calculation of RAF scores.
  • Is Dual Medicare-Medicaid Enrolled -- Indicates that the patient is concurrently enrolled in both Medicare and Medicaid programs. (Identifies the population often described as "dually eligible" or "duals".)
  • CMS Dual Status Code -- The standard 2-character CMS Dual Status Code, which identifies the patient's most recent entitlement status for Medicaid and other qualifying non-Medicare programs; e.g., 01 = QMB only, 02 = QMB + full Medicaid, etc.
  • Member Medicaid Number
  • Subscriber Relationship Type Description
  • Is Subscriber Relationship Type Self
  • Is Subscriber Relationship Type Spouse
  • Is Subscriber Relationship Type Child
  • Is Subscriber Relationship Type Other

• 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

• plan_id → ursa.no_ursa_core_struct_005.plan_id
• payor_id → ursa.no_ursa_core_struct_004.payor_id
• subscriber_pat_id → ursa.no_ursa_core_pat_001.pat_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] Patient-Plan Timelines of Plan Membership, Precursor 1 (All Source Records): One record per patient-plan timeline period during which the patient had an active membership in the health plan; periods for the same patient-plan pair might be overlapping