[SO/URSA-HCC] Patient Timelines Master for URSA-HCC Concepts

Object Description

One record per patient-period in which the patient had a calculated RAF score. (RAF scores are generated during calendar years in which the patient had an active membership at any time.)

Metadata

• Table Name: ursa.so_ursa_hcc_pat_002
• 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)
  • 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)
  • Primary Plan ID
  • Primary Plan Attributee Provider ID
  • Empirical Attributee Primary Care Individual Provider ID
  • Empirical Attributee Primary Care Provider Group Provider ID

• Date Fields

  • Period Start Date
  • Period End Date
  • Current Continuous Primary Payor Membership Episode Start Date -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
  • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End Date)
  • Current Continuous Medical Claim Data Coverage Episode Start Date -- The start date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Medical Claim Data Coverage Episode)
  • Current Continuous Medical Claim Data Coverage Episode End Date -- The end date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Medical Claim Data Coverage Episode, [URSA-CORE] Period End Date)

• Module Fields

  • 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 Age Category
  • 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.
  • 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)
  • 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)
  • 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)
  • Standard Final Action CMS-HCC RAF Score
  • Standard Final Action CMS-HCC Raw RAF Score
  • Standard Final Action CMS-HCC Demographic Component RAF Score
  • Standard Final Action CMS-HCC Disease Component RAF Score
  • Standard Final Action CMS-HCC v24 RAF Score
  • Standard Final Action CMS-HCC v28 RAF Score
  • Standard Final Action CMS-HCC v24 to v28 Increase in RAF Score
  • Standard Final Action CMS-HCC RAF Score Using 2024 Blend
  • Standard Final Action CMS-HCC RAF Score Using 2025 Blend
  • Standard Final Action CMS-HCC v24 All Outputs Summary
  • Standard Final Action CMS-HCC v28 All Outputs Summary
  • Within-Year-Updated CMS-HCC RAF Score
  • Within-Year-Updated CMS-HCC Raw RAF Score
  • Within-Year-Updated CMS-HCC Demographic Component RAF Score
  • Within-Year-Updated CMS-HCC Disease Component RAF Score
  • Within-Year-Updated CMS-HCC v24 RAF Score
  • Within-Year-Updated CMS-HCC v28 RAF Score
  • Within-Year-Updated CMS-HCC RAF Score Using 2024 Blend
  • Within-Year-Updated CMS-HCC RAF Score Using 2025 Blend
  • Within-Year-Updated CMS-HCC v24 All Outputs Summary
  • Within-Year-Updated CMS-HCC v28 All Outputs Summary
  • Within-Year-Updated Count CMS-HCC v24 HCCs
  • Within-Year-Updated Count CMS-HCC v28 HCCs
  • Historical-Diagnoses CMS-HCC RAF Score
  • Historical-Diagnoses CMS-HCC Raw RAF Score
  • Historical-Diagnoses CMS-HCC Demographic Component RAF Score
  • Historical-Diagnoses CMS-HCC Disease Component RAF Score
  • Historical-Diagnoses CMS-HCC v24 RAF Score
  • Historical-Diagnoses CMS-HCC v28 RAF Score
  • Historical-Diagnoses CMS-HCC RAF Score Using 2024 Blend
  • Historical-Diagnoses CMS-HCC RAF Score Using 2025 Blend
  • Historical-Diagnoses CMS-HCC v24 All Outputs Summary
  • Historical-Diagnoses CMS-HCC v28 All Outputs Summary
  • Historical-Diagnoses Count CMS-HCC v24 HCCs
  • Historical-Diagnoses Count CMS-HCC v28 HCCs
  • Historical-Diagnoses vs. Standard Final Action CMS-HCC RAF Score Gap
  • Historical-Diagnoses vs. Within-Year-Updated CMS-HCC RAF Score Gap
  • Count Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs
  • Count Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs
  • Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs Summary
  • Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs Summary
  • Standard Initial Run CMS-HCC RAF Score
  • Standard Initial Run CMS-HCC Raw RAF Score
  • Standard Initial Run CMS-HCC Demographic Component RAF Score
  • Standard Initial Run CMS-HCC Disease Component RAF Score
  • Standard Initial Run CMS-HCC RAF Score Using 2024 Blend
  • Standard Initial Run CMS-HCC RAF Score Using 2025 Blend
  • Standard Initial Run CMS-HCC v24 RAF Score
  • Standard Initial Run CMS-HCC v28 RAF Score
  • Standard Initial Run CMS-HCC v24 All Outputs Summary
  • Standard Initial Run CMS-HCC v28 All Outputs Summary
  • Standard Midyear Run CMS-HCC RAF Score
  • Standard Midyear Run CMS-HCC Raw RAF Score
  • Standard Midyear Run CMS-HCC Demographic Component RAF Score
  • Standard Midyear Run CMS-HCC Disease Component RAF Score
  • Standard Midyear Run CMS-HCC RAF Score Using 2024 Blend
  • Standard Midyear Run CMS-HCC RAF Score Using 2025 Blend
  • Standard Midyear Run CMS-HCC v24 RAF Score
  • Standard Midyear Run CMS-HCC v28 RAF Score
  • Standard Midyear Run CMS-HCC v24 All Outputs Summary
  • Standard Midyear Run CMS-HCC v28 All Outputs Summary
  • Is Patient With CMS-HCC Calculations Using MAO-004 Diagnoses
  • Is Patient With CMS-HCC Calculations Using Claim Diagnoses
  • Is Patient With CMS-HCC Calculations Using Bill Diagnoses

• Patient Fields

  • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
  • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
  • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 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.