[NO/URSA-CORE] Plans

Object Description

One record per health plan.

Metadata

• Table Name: ursa.no_ursa_core_struct_005
• Layer: NATURAL_OBJECT
• Object Type: Single Stack
• Temporal Class: Entity
• Case ID: Plan ID
• Primary Key: Plan ID

Published Fields

• Data Model Keys

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

• Source Local Keys

  • Source Local Plan ID -- The identifier for the health plan in the original source data system.

• Operations Support Fields

  • Plan Operational ID

• Insurance Fields

  • Plan Description
  • Plan CMS Contract Number -- This variable is the unique identification for a managed care organization (MCO) enabling the entity to provide coverage to eligible Medicare beneficiaries. The first character of the contract ID is a letter that indicates the type of plan. For local managed care contracts, it begins with 'H' or '9'; for regional managed care contracts, it begins with 'R'; for prescription drug plans (PDPs), it begins with 'S'; for fallback contracts, it begins with 'F', for Employer-Direct PDP and Employer-Direct PFFS it begins with 'E'. The remaining 4 digits are numeric. It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP (Plan Benefit Package) Number, when those two values are available, to generate the Plan ID. (See also [URSA-CORE] Plan ID)
  • Plan CMS PBP Number -- The standard 3-digit Plan Benefit Package (PBP) Number, maintained by CMS, identifying a particular insurance product offered by a given Medicare Advantage organization (identified by the CMS Contract Number). It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP Number, when those two values are available, to generate the Plan ID. (See also [URSA-CORE] Plan ID, [URSA-CORE] Plan CMS Contract Number)
  • Plan CMS Segment Number -- The standard 3-digit numeric value, maintained by CMS, that identifies distinct groups of Medicare Advantage beneficiaries (with, potentially, distinct benefits from other segments) within a CMS Contract Number and CMS PBP Number. (For Medicare Advantage plans, it is a standard Ursa Health convention to define a plan as a distinct CMS Contract Number - CMS PBP Number - CMS Segment Number triples when those values are available.) (See also [URSA-CORE] Plan CMS Contract Number, [URSA-CORE] Plan CMS PBP Number)
  • Plan NAHDO Source of Payment Code
  • Plan X12 Claim Filing Indicator Code
  • Is Plan Coverage Type Medical
  • Is Plan Coverage Type Pharmacy
  • Plan Financial Class Description -- The natural language description of the financial class of a claim or plan. (A claim's financial class is inherited from its associated plan.) (See also [URSA-CORE] Financial Class)
  • Is Plan Financial Class Commercial -- Indicates the financial class of the claim or plan is commercial. (See also [URSA-CORE] Financial Class)
  • Is Plan Financial Class Medicare FFS -- Indicates the financial class of the claim or plan is Medicare fee-for-service (FFS). (See also [URSA-CORE] Financial Class)
  • Is Plan Financial Class Medicare Advantage -- Indicates the financial class of the claim or plan is Medicare Advantage. (See also [URSA-CORE] Financial Class)
  • Is Plan Financial Class Medicaid -- Indicates the financial class of the claim or plan is Medicaid (See also [URSA-CORE] Financial Class)
  • Is Plan Financial Class Other -- Indicates the financial class of the claim or plan is something other than commercial, Medicare FFS (fee-for-service), Medicare Advantage, or Medicaid. (See also [URSA-CORE] Financial Class)
  • Is MMP -- Indicates the plan is a Medicare-Medicaid Plan, or MMP.
  • Is SNP -- Indicates the plan is a Special Needs Plan, or SNP.
  • Is C-SNP -- Indicates the plan is a Chronic Condition Special Needs Plan, or C-SNP.
  • Is D-SNP -- Indicates the plan is a Dual Eligible Special Needs Plan, or D-SNP.
  • Is I-SNP -- Indicates the plan is a Institutional Special Needs Plan, or I-SNP.
  • Plan Product Type Tier 1 Description
  • Plan Product Type Tier 1 Operational ID
  • Plan Product Type Tier 2 Description
  • Plan Product Type Tier 2 Operational ID
  • Plan Product Type Tier 3 Description
  • Plan Product Type Tier 3 Operational ID

• 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

• payor_id → ursa.no_ursa_core_struct_004.payor_id

Dedicated Precursors

• [NO/URSA-CORE] Plans, Precursor 1 (All Source Records): One record per health plan.