Measure Description
Among non-denied institutional, professional, or pharmacy claims, the percentage for patients without any contemporaneous plan membership as of the claim covered start date. Claims whose denial status is not known are considered denied for the purpose of this measure if the allowed and plan paid amounts are both zero.
Metadata
- Measure Identifier: URSA-CORE-901
- Measure Type: Rate Measure
- Temporal Structure: Event
- Component Class: Normal-Form
- Denominator Case Field: Claim ID
- Target Direction: Down
Denominator Description
One per non-denied institutional, professional, or pharmacy claims. Claims whose denial status is not known are considered denied for the purpose of this measure if the allowed and plan paid amounts are both zero.
Numerator Description
One per qualifying denominator observation without any contemporaneous plan membership, for any plan, as of the claim covered start date.
Published Fields
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Data Model Keys
- Claim ID -- The internal database identifier (used, e.g., for joins and primary keys) for the claim. (See also [URSA-CORE] Claim)
- 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)
- Payor ID -- The identifier for the health insurance organization associated with the current record.
- Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
- Document ID -- The internal database identifier (used, e.g., for joins and primary keys) for the document. (See also [URSA-CORE] Document)
- Source ID -- The identifier for the original source data system from which the current record originated.
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Date Fields
- Claim Covered Start Date -- The start date of services covered by a claim.
- Claim Covered End Date -- The end date of services covered by a claim.
- Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
- Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
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Insurance Fields
- Claim Payor Description
- Claim Plan Description
- Claim Plan Financial Class Description
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Billing and Claims Fields
- Claim Class Category -- Identifies a record as associated with a professional, institutional, or pharmacy claim.
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Denominator Fields
- Is Zero Plan Paid Amount Claim
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Numerator Fields
- Patient Contemporaneous Primary Plan ID
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Measure Fields
- Denominator