[SO/URSA-CORE] Patient-Months with Active Plan Membership

  • Published on Apr 10, 2026
  • 2 minute(s) read
Prev Next

Object Description

One record per patient-month for patients with an active health plan membership at any time in that month, favoring the "primary" membership (as determined by the upstream synthetic object logic) for patients with multiple concurrent memberships. This object should also publish information about the risk attribution status of the patient, and which organizations, markets, regions, etc., they are associated with.

Metadata

  • Table Name: ursa.so_ursa_core_fin_006
  • Layer: SYNTHETIC_OBJECT
  • Object Type: Single Stack
  • Temporal Class: Interval (Timeline)
  • Case ID: Patient ID
  • Interval Start Date: Month Start Date
  • Interval End Date: Month End Date
  • Primary Key: Patient ID, Month Start Date, Month 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)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Risk Program Entity ID
    • Primary Plan Attributee Individual Provider ID
    • Primary Plan Attributee Provider Group Provider ID
    • Source ID -- The identifier for the original source data system from which the current record originated.

  • Operations Support Fields

    • Primary Plan Member Number
    • Primary Plan Attributee Provider Contract Operational ID

  • Date Fields

    • Month Start Date -- The start date (e.g., January 1, February 1, etc.) of the month in the patient's life described by the current record.
    • Month End Date
    • First Membership Date in Month
    • Last Membership Date in Month

  • Insurance Fields

    • Primary Plan CMS Contract Number
    • Primary Plan CMS PBP Number
    • Primary Plan CMS Segment Number
    • 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.
    • 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 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.
    • Primary Plan Attributee Provider NPI in Contract
    • Primary Plan Attributee Provider TIN in Contract

  • Metadata Fields

    • Count Membership Days in Month
    • Membership Days as Fraction of Month

  • Validation Only Fields

    • MMR Plan ID
    • CMS RAF Score According to Membership Record
    • CMS RAF Score According to MMR

Foreign Keys

  • pat_id → ursa.no_ursa_core_pat_001.pat_id
  • plan_id → ursa.no_ursa_core_struct_005.plan_id