URSA-CORE-938: Professional SLIs with Critical Missing Data

Measure Description

Among professional claim or bill service line item records, the percentage with at least one unpopulated critical field; critical fields are: Patient ID, Billing Provider ID, Header Covered Start Date, Service Start Date, and HCPCS Code.

Metadata

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

Denominator Description

One per professional claim or bill service line item record.

Numerator Description

One per qualifying denominator observation with at least one unpopulated critical field; critical fields are: Patient ID, Billing Provider ID, Header Covered Start Date, Service Start Date, and HCPCS Code.

Published Fields

• Data Model Keys

  • Document ID
  • Patient ID
  • Professional Claim Service Line Item ID
  • Professional Bill Service Line Item ID
  • Billing Provider ID
  • 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
  • HCPCS Description

• Numerator Fields

  • Is Patient ID NULL
  • Is Header Covered Start Date NULL
  • Is Service Start Date NULL
  • Is Billing Provider ID NULL
  • Is HCPCS Code NULL

• Metadata Fields

  • Document Type Description

• Measure Fields

  • Denominator