URSA-CORE-919: Pharmacy Claims with Suspected Duplicate

Measure Description

Among pharmacy claims, the percentage with multiple records with identical patient, filled date, days supply, and NDC; the idea is that these duplicates will appear if the claims data have not been properly reconciled to final action.

Metadata

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

Denominator Description

Pharmacy claim service line items.

Numerator Description

Denominator observations with at least one other pharmacy claim for the same patient, with the same filled date, NDC, and days supply.

Published Fields

• Data Model Keys

  • Claim ID
  • Patient ID
  • Filling Provider ID
  • Payor ID
  • Plan ID
  • Source ID

• Operations Support Fields

  • Prescription Number

• Date Fields

  • Filled Date
  • 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)

• Medication Fields

  • NDC Code 11-Digit
  • Label Description
  • Quantity Dispensed
  • Days Supply

• Financial Fields

  • Claim Plan Paid Amount

• Numerator Fields

  • Count of Suspected Duplicate Records

• Measure Fields

  • Denominator