[NO/URSA-CORE] Professional Bill Service Line Items

Object Description

One record per non-reversed professional bill service line item; includes denied line items; includes header-level fields.

Metadata

• Table Name: ursa.no_ursa_core_fin_013
• Layer: NATURAL_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Bill Service Line Item ID
• Event Date: Bill Covered Start Date
• Primary Key: Bill Service Line Item ID

Published Fields

• Data Model Keys

  • Bill Service Line Item ID -- The identifier for a service line item on an institutional or professional bill.
  • 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.
  • 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)
  • 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)
  • 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)
  • 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)
  • EMR Encounter Service Line Item ID -- The identifier for the instance of a performed service during an EMR Encounter.
  • Header Document ID
  • Service Line Item Document ID
  • Source ID -- The identifier for the original source data system from which the current record originated.

• Source Local Keys

  • Source Local Bill Service Line Item ID -- The identifier for the bill service line item 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 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 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)

• Date Fields

  • Bill Covered Start Date
  • Bill Covered End Date
  • Service Start Date
  • Service End Date
  • Bill Sent Date
  • Service Line Item Posted Date

• Provider Fields

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

• Clinical Services Fields

  • HCPCS Description
  • Anesthesia Surgical HCPCS Description
  • 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 Modifier 1 Code -- The 2-character code modifying a HCPCS code.
  • HCPCS Modifier 1 Description -- The natural language description of a HCPCS code modifier. (See also [URSA-CORE] HCPCS Modifier Code)
  • HCPCS Modifier 2 Code
  • HCPCS Modifier 2 Description
  • HCPCS Modifier 3 Code
  • HCPCS Modifier 3 Description
  • HCPCS Modifier 4 Code
  • HCPCS Modifier 4 Description
  • HCPCS Modifier 5 Code
  • HCPCS Modifier 5 Description
  • Anesthesia Surgical HCPCS Code -- The HCPCS code associated with the surgical procedure performed on a patient receiving anesthesia; sometimes included as a second HCPCS code on an anesthesia claim or bill. (See also [URSA-CORE] HCPCS Code)

• Billing and Claims Fields

  • Bill Operational ID
  • Bill Service Line Item Operational ID
  • 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)
  • CMS Type of Service Code -- The standard CMS 1-character Type of Service (TOS) code; 0 = Whole Blood, 1 = Medical Care, etc.
  • CMS Type of Service Description -- The natural language description of a CMS Type of Service (TOS) code (See also [URSA-CORE] CMS Type of Service Code)
  • Service Unit Count -- The number of units of a service delivered to the patient; includes non-integer values, if appropriate.
  • Total RVUs
  • Is Anesthesia Billing Format -- Indicates that the claim or bill should include values in fields associated with anesthesia billing, e.g., anesthesia base unit count, physical status unit count, and time unit count.
  • Is Primary Plan Non-FFS Encounter Record
  • Is Secondary Plan Non-FFS Encounter Record
  • Is Tertiary Plan Non-FFS Encounter Record
  • Anesthesia Base Unit Count -- The base units (or base factor) associated with the service documented on an anesthesia claim or bill.
  • Anesthesia Physical Status Unit Count -- The numeric physical status units associated with the service documented on an anesthesia claim or bill, representing the patient's physical condition. (NB: not the same as, but often derived from, the physical status modifier, e.g., P1, P2, etc.)
  • Anesthesia Time Unit Count -- The time units associated with the service documented on an anesthesia claim or bill.
  • 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
  • Is Bill Service Line Item Processed Status Open
  • Is Bill Service Line Item Processed Status Closed
  • Is Bill Service Line Item Primary Plan Processed Status Denied
  • Is Bill Service Line Item Secondary Plan Processed Status Denied
  • Is Bill Service Line Item 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)
  • Bill Service Line Item Charge Amount -- The Charge Amount for the bill service line item. (See also [URSA-CORE] Charge Amount)
  • Bill Service Line Item Contractual Adjustment Amount -- The Contractual Adjustment Amount for the bill service line item. (See also [URSA-CORE] Contractual Adjustment Amount)
  • Bill Service Line Item Primary Plan Allowed Amount -- The Primary Plan Allowed Amount for the bill service line item. (See also [URSA-CORE] Allowed Amount)
  • Bill Service Line Item Secondary Plan Allowed Amount -- The Secondary Plan Allowed Amount for the bill service line item. (See also [URSA-CORE] Allowed Amount)
  • Bill Service Line Item Tertiary Plan Allowed Amount -- The Tertiary Plan Allowed Amount for the bill service line item. (See also [URSA-CORE] Allowed Amount)
  • Bill Service Line Item Non-Contractual Adjustment Amount -- The Non-Contractual Adjustment Amount for the bill service line item. (See also [URSA-CORE] Non-Contractual Adjustment Amount)
  • Bill Service Line Item Total Due Amount -- The Total Due Amount for the bill service line item. (See also [URSA-CORE] Total Due Amount)
  • Bill Service Line Item Primary Plan Paid Amount -- The Primary Plan Paid Amount for the bill service line item. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Service Line Item Secondary Plan Paid Amount -- The Secondary Plan Paid Amount for the bill service line item. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Service Line Item Tertiary Plan Paid Amount -- The Tertiary Plan Paid Amount for the bill service line item. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Service Line Item Any Plan Paid Amount -- The Any Plan Paid Amount for the bill service line item. (See also [URSA-CORE] Plan Paid Amount)
  • Bill Service Line Item Patient Responsibility Amount -- The Patient Responsibility Amount for the bill service line item. (See also [URSA-CORE] Patient Responsibility Amount)
  • Bill Service Line Item Patient Paid Amount -- The Patient Paid Amount for the bill service line item. (See also [URSA-CORE] Patient Paid Amount)
  • Bill Service Line Item Bad Debt Write-Off Amount -- The Bad Debt Write-Off Amount for the bill service line item. (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.
  • Is Record Deleted -- Indicator for whether the current record should be considered deleted; useful for certain incremental data loading scenarios.
  • 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
• service_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
• emr_enc_service_line_item_id → ursa.no_ursa_core_enc_002.emr_enc_service_line_item_id

Dedicated Precursors

• [NO/URSA-CORE] Professional Bill Service Line Items, Precursor 1 (All Source Records): One record per professional bill service line item, with fields from both the header and service line items