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

  • Published on Apr 10, 2026
  • 2 minute(s) read
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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 Identifier: URSA-CORE-931
  • 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 -- 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)
    • Billing Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the billing provider. (See also [URSA-CORE] Billing Provider)
    • 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.
    • Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
    • Service Line Item Document ID
    • Source ID -- The identifier for the original source data system from which the current record originated.

  • 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 -- The natural language description of the service provider; typically, the name of the provider. (See also [URSA-CORE] Service Provider)
    • Service Primary NUCC Provider Taxonomy Description

  • Insurance Fields

    • Plan Description
    • Plan Financial Class Description -- The natural language description of the financial class of a claim or plan. (A claim's financial class is inherited from its associated plan.) (See also [URSA-CORE] Financial Class)

  • 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)

  • Billing and Claims Fields

    • Is Anesthesia Billing Format -- Indicates that the claim or bill should include values in fields associated with anesthesia billing, e.g., anesthesia base unit count, physical status unit count, and time unit count.
    • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
    • Is Service Line Number 1

  • Financial Fields

    • Service Line Item Charge Amount

  • Numerator Fields

    • Is Positive Allowed or Paid Amounts

  • Measure Fields

    • Denominator