URSA-CORE-906: Professional Claims with Single Paid Line Item

Measure Description

Among professional 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.

Metadata

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

Denominator Description

Professional 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
  • Payor ID
  • Source 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