URSA-CORE-933: Claims or Bills with Negative Financial Amount

Measure Description

Among institutional claim or bill headers, professional claim or bill service line items, or pharmacy claims with at least one non-NULL allowed amount, plan paid amount, patient responsibility amount, or patient paid amount, the percentage with a negative amount in at least one of those fields.

Metadata

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

Denominator Description

One per institutional claim or bill headers, professional claim or bill service line items, or pharmacy claims with at least one non-NULL allowed amount, plan paid amount, patient responsibility amount, or patient paid amount.

Numerator Description

One per qualifying denominator observation with a negative allowed amount, plan paid amount, patient responsibility amount, or patient paid amount.

Published Fields

• Data Model Keys

  • Document ID
  • Institutional Claim ID
  • Professional Claim Service Line Item ID
  • Institutional Bill ID
  • Professional Bill Service Line Item ID
  • Service Line Number
  • Plan ID
  • Payor ID
  • Source ID

• Date Fields

  • Document Effective 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)

• Clinical Services Fields

  • HCPCS Code

• Billing and Claims Fields

  • CMS Type of Bill Code

• Financial Fields

  • Document Allowed Amount
  • Document Plan Paid Amount
  • Document Patient Responsibility Amount
  • Document Patient Paid Amount

• Numerator Fields

  • Is Allowed Amount Negative
  • Is Plan Paid Amount Negative
  • Is Patient Responsibility Amount Negative
  • Is Patient Paid Amount Negative

• Metadata Fields

  • Document Type Description

• Measure Fields

  • Denominator