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 Identifier: URSA-CORE-933
- 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
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Data Model Keys
- Document ID -- The internal database identifier (used, e.g., for joins and primary keys) for the document. (See also [URSA-CORE] Document)
- Institutional Claim ID -- The internal database identifier (used, e.g., for joins and primary keys) for the claim. (See also [URSA-CORE] Claim)
- Professional Claim Service Line Item ID -- The identifier for a service line item on an institutional or professional claim.
- Institutional Bill ID -- The identifier for a professional or institutional bill header record; Bill ID values are consistent over the lifetime of a bill, including when a bill is adjusted. On a claim record, this field refers to the bill sent to the plan that originated the claim record.
- Professional Bill Service Line Item ID -- The identifier for a service line item on an institutional or professional bill.
- 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.
- Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
- 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
- Document Effective Date -- The most appropriate single date that events associated with the document occurred. For documents spanning multiple calendar days, the earliest date is typically used; Document Effective Start Date and Document Effective End Date can be used for a more precise range of dates, if necessary.
- 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)
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Billing and Claims Fields
- CMS Type of Bill Code -- The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.
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Financial Fields
- Document Allowed Amount
- Document Plan Paid Amount
- Document Patient Responsibility Amount
- Document Patient Paid Amount
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Numerator Fields
- Is Allowed Amount Negative
- Is Plan Paid Amount Negative
- Is Patient Responsibility Amount Negative
- Is Patient Paid Amount Negative
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Metadata Fields
- Document Type Description
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Measure Fields
- Denominator