Measure Description
Among professional claim service line items, the percentage for which another record exists with identical patient, service start date, line number, HCPCS code plus the first HCPCS modifier code, and service provider. A positive value suggests the claims data have not been properly reconciled to final action, or some other failure to resolve duplicates.
Metadata
- Measure Identifier: URSA-CORE-920
- Measure Type: Rate Measure
- Temporal Structure: Event
- Component Class: Normal-Form
- Denominator Case Field: Claim Service Line Item ID
- Target Direction: Down
Denominator Description
Professional claim service line items.
Numerator Description
Denominator observations with at least one other professional claim service line item with the same patient, service start date, service line number, HCPCS code plus the first HCPCS modifier, and service provider.
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)
- Claim Service Line Item ID -- The identifier for a service line item on an institutional or professional claim.
- Service Line Number -- The integer-valued ordinal representing the position of a service line item in a claim, bill, encounter, or other master record. May not necessarily match the analogous value in the source data for the same record.
- 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)
- Service Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the service provider. (See also [URSA-CORE] Service Provider)
- Payor ID -- The identifier for the health insurance organization associated with the current record.
- Source ID -- The identifier for the original source data system from which the current record originated.
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Date Fields
- Service Start Date -- The first calendar date a service was delivered.
- 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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Clinical Services Fields
- HCPCS Code -- The Healthcare Common Procedure Coding System (HCPCS) code associated with a service. Includes both HCPCS Level I codes (commonly called CPT codes) and Level II codes (which includes products, supplies, and services not included in CPT). Level II codes consist of a letter followed by four numeric digits. Current Dental Terminology codes are included in the Level II codes as HCDT. (See also [URSA-CORE] HCPCS Description)
- HCPCS Modifier 1 Code -- The 2-character code modifying a HCPCS code.
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Financial Fields
- Claim Service Line Item Allowed Amount -- The amount determined by the payor to be the maximum allowed amount for all the a claim service line item, representing, for example, negotiated contractual amounts.
- Claim Service Line Item Plan Paid Amount -- The amount paid by an insurance plan for a claim service line item.
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Numerator Fields
- Count of Suspected Duplicate Records
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Measure Fields
- Denominator