URSA-CORE-931: Zero-Cost Professional Service Line Items

Measure Description

Among professional billing or claims service line items from sources with line-level financial data coverage, the percentage with zero-dollar or missing allowed and paid amounts

Metadata

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

Denominator Description

Professional billing or claims service line items

Numerator Description

Denominator observations with missing or zero-valued line allowed amount, line plan paid amount, line COB paid amount, and line patient paid amount.

Published Fields

• Data Model Keys

  • Patient ID
  • Billing Provider ID
  • Service Provider ID
  • Payor ID
  • Plan ID
  • Service Line Item Document ID
  • Source ID

• Date Fields

  • Covered Start 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)

• Provider Fields

  • Billing Primary NUCC Provider Taxonomy Description
  • Service Provider Description
  • Service Primary NUCC Provider Taxonomy Description

• Insurance Fields

  • Plan Description
  • Plan Financial Class Description

• Clinical Services Fields

  • HCPCS Code

• Billing and Claims Fields

  • Is Anesthesia Billing Format
  • CMS Place of Service Code
  • Is Service Line Number 1

• Financial Fields

  • Service Line Item Charge Amount

• Numerator Fields

  • Is Positive Allowed or Paid Amounts

• Measure Fields

  • Denominator
  • Numerator