[SO/URSA-HCC] Final Action Qualifying Diagnoses for CMS-HCC Calculations

Object Description

One record per distinct patient-final action diagnosis code-calendar date triple for records that are qualifying for use in calculating HCC/RAF score, either because they meet the claims or billing data standard or because they are associated with an allowed MAO-004 record. Includes patient-code-date triples with disallowed MAO-004 records if there is a diagnosis from a qualifying claim or bill present on that same date; this provides flexibility to downstream logic as to whether to use only allowed MAO-004 records or to cast a wider net (i.e., to include claims and/or billing data).

Metadata

• Table Name: ursa.so_ursa_hcc_cond_001
• Layer: SYNTHETIC_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
• Event Date: Diagnosis Effective Date
• Primary Key: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code

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 Diagnosis Document ID

• Date Fields

  • Diagnosis Effective Date
  • Earliest Claim Paid Date

• Diagnosis Fields

  • Diagnosis ICD-10-CM Code
  • Diagnosis ICD-10-CM Description

• Module Fields

  • CMS-HCC ICD-10-CM Code

• Metadata Fields

  • Is CMS MAO-004 Diagnosis
  • Is Claim Diagnosis
  • Is Bill Diagnosis
  • Is Acceptable CMS MAO-004 Diagnosis
  • Is Acceptable Claim Diagnosis
  • Is Acceptable Bill Diagnosis
  • Is Acceptable Diagnosis Document Type

• Validation Only Fields

  • Qualifying Master Document ID