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[SO/URSA-HCC] Patient Timelines of Final Action CMS-HCC Model Demographic Inputs

  • Published on Nov 4, 2026
  • 7 minute(s) read
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Object Description

One record per patient-period during which the patient had an active membership or was covered by an MMR record; the most reliable demographic component values for each period are obtained (or imputed) from membership and/or MMR records. For months with multiple MMR records, the most recent ("final action") record is used.

Metadata

  • Table Name: ursa.so_ursa_hcc_pat_001
  • Layer: SYNTHETIC_OBJECT
  • Object Type: Complex Timeline
  • Temporal Class: Interval (Timeline)
  • Case ID: Patient ID
  • Interval Start Date: Period Start Date
  • Interval End Date: Period End Date
  • Primary Key: Patient 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)

  • Patient Fields

    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Is Patient Sex Female -- Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.

  • Date Fields

    • Calendar Year Start Date
    • Period Start Date -- The date identifying the start of a period of time. Period Start Date values are inclusive; e.g., a period with Period Start Date = January 1 would begin be considered to begin at 00:00 on January 1.
    • Period End Date -- The date identifying the end of an period of time. Period End Date values are exclusive; e.g., a period with Period End Date = January 1 would begin be considered to end at precisely 00:00 on January 1 (meaning that the period did not include any time on January 1).

  • Insurance Fields

    • 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.
    • 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.
    • Is CMS Full Dual Status
    • Is CMS Partial Dual Status
    • 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 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.
    • CMS MMR Risk Adjustment Age Group Code -- That standard 4-digit CMS Risk Adjustment Age Group (RAAG) Code, describing the age category of the patient as used to calculate RAF scores. This field contains the same values as the CMS MMR "Risk Adjustment Age Group (RAAG)" field, which the CMS documentation defines as: "The Risk Adjustment Age Group for the beneficiary (BBEE). In general it is based upon the age as of February 1 of payment year. BB = Beginning Age; EE = Ending Age".

  • Metadata Fields

    • Is Membership Member-Month Coverage
    • Is MMR Member-Month Coverage

  • Validation Only Fields

    • Is Patient Sex Female from Membership
    • Is Patient Sex Female from MMR Original Field
    • Is Dual Medicare-Medicaid Enrolled from Membership Original Field
    • Is CMS MMR Full or Partial Medicaid Status from MMR Original Field
    • Is CMS Full Dual Status from Membership RAF Type Code
    • Is CMS Full Dual Status from MMR RAF Type Code
    • Is CMS Partial Dual Status from Membership RAF Type Code
    • Is CMS Partial Dual Status from MMR RAF Type Code
    • Is CMS ESRD Status from Membership RAF Type Code
    • Is CMS ESRD Status from Membership Original Field
    • Is CMS ESRD Status from MMR RAF Type Code
    • Is CMS ESRD Status from MMR Original Field
    • Is CMS LTI Status from Membership RAF Type Code
    • Is CMS LTI Status from Membership Original Field
    • Is CMS LTI Status from MMR RAF Type Code
    • Is CMS LTI Status from MMR Original Field
    • Is CMS New Enrollee Status from Membership RAF Type Code
    • Is CMS New Enrollee Status from Membership Original Field
    • Is CMS New Enrollee Status from MMR RAF Type Code
    • Tokenized Membership CMS RAF Type Code
    • Tokenized Membership CMS Original Reason for Entitlement Code
    • Tokenized Membership CMS Dual Status Code
    • Tokenized MMR CMS RAF Type Code
    • Tokenized MMR CMS Original Reason for Entitlement Code
    • Tokenized MMR CMS Dual Status Code
    • CMS RAF Type Code According to Membership
    • CMS Original Reason for Entitlement Code According to Membership
    • CMS Dual Status Code According to Membership
    • CMS RAF Type Code According to MMR
    • CMS Original Reason for Entitlement Code According to MMR
    • CMS Dual Status Code According to MMR
    • Is CMS Full Dual Status According to Membership Original Field
    • Is CMS Partial Dual Status According to Membership Original Field
    • Is CMS Full Dual Status According to MMR Original Field
    • Is CMS Partial Dual Status According to MMR Original Field
    • Patient Age According to Membership
    • Patient Date of Birth from Membership
    • Patient Age According to MMR

  • Module Fields

    • Is CMS-HCC ESRD Status
    • CMS-HCC Patient Age -- For a given reference date or month, the patient age, expressed as an integer, evaluated as of February 1 of the calendar year containing the reference date or month; this is the method used to establish a patient's age for calculation of HCC/RAF score results.
    • CMS-HCC Patient Sex Code -- Takes the value of "M" for male patients and "F" for female patients, which are the values expected by the CMS-HCC RAF score model. Because the model requires patient sex as an input, patients are assumed to be female if their sex is not known.
    • CMS-HCC Original Reason for Entitlement Code -- The CMS Original Reason for Entitlement Code (OREC) for the patient used by the CMS-HCC model. Takes the same values as the standard CMS Original Reason for Entitlement Code field. This value is obtained from the MMR if available there, then from the membership record. Because the model requires this code as an input, patients are assumed to be OREC = Aged if their true status is not known. (See also [URSA-CORE] CMS Original Reason for Entitlement Code)
    • Is CMS-HCC Medicaid Patient -- The binary value used by the CMS-HCC model to identify Medicaid patients. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). (See also [URSA-HCC] CMS RAF Type Code)
    • Is CMS-HCC Full Dual Medicaid Patient
    • Is CMS-HCC Partial Dual Medicaid Patient
    • Is CMS-HCC LTI Status
    • Is CMS-HCC New Enrollee Status
    • Is CMS-HCC ESRD Dialysis Patient
    • Is CMS-HCC ESRD Post-Transplant Patient
    • CMS-HCC Months Since Kidney Transplant
    • CMS-HCC Eligibility Code -- The coded value used by the CMS-HCC model to characterize the patient's community vs. long-term institutional residential status, full dual vs. partial dual vs. non-dual status, and aged vs. disabled Medicare eligibility status. Values are as follows: CFA = Community Full Benefit Dual Aged; CFD = Community Full Benefit Dual Disabled; CNA = Community Non-Dual Aged; CND = Community Non-Dual Disabled; CPA: Community Partial Benefit Dual Aged; CPD = Community Partial Benefit Dual Disabled; INS = Long Term Institutional; NE = New Enrollee; SNPNE = SNP NE. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). Because the model requires this code as an input, patients are assumed to be CNA if their true status is not known. (See also [URSA-HCC] CMS RAF Type Code)

Dedicated Precursors

  • [SO/URSA-HCC] Patient Timelines of Final Action CMS-HCC Model Demographic Inputs, Precursor 1 (Claims-Based ESRD Model Demographic Inputs): One record per patient timeline period for patients with a history of kidney transplant; includes CMS-HCC ESRD model inputs imputed from claims data.