URSA-CORE-905: Institutional Claims with Single Paid Line Item

Measure Description

Among institutional claims with at least one line item with a positive plan paid amount and 4 or more lines, the percentage with exactly one line item with a positive plan paid amount.

When a data source has frequent institutional claims with multiple line items but only a single paid line item, it suggests that the putatively line-level amounts might actually be header-level amounts. Financial amounts that are truly header-level should be stored in the appropriate header-level fields, not assigned to a single line item; so higher results on this measure for a particular data source should prompt a review of the integration logic for that source, with special attention paid to the possibility that paid amounts labelled as line-level might actually be header-level.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Claim ID
• Target Direction: Down

Denominator Description

Institutional claims with at least one line item with a positive plan paid amount and 4 or more lines

Numerator Description

Denominator observations with exactly one line item with a positive plan paid amount

Published Fields

• Data Model Keys

  • Claim ID
  • Patient ID
  • Source ID
  • Payor ID

• Date Fields

  • 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)

• Denominator Fields

  • Count of Claim Service Line Items

• Numerator Fields

  • Count Claim Service Line Items with Positive Plan Paid Amount

• Measure Fields

  • Denominator
  • Numerator