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    URSA-PHF-013: Plan Paid Per Clinician Office Visit
    • 28 Jun 2025
    • 4 Minutes to read
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    URSA-PHF-013: Plan Paid Per Clinician Office Visit

    • Updated on 28 Jun 2025
    • 4 Minutes to read
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    Article summary

    Measure Description

    Among clinician office visits with a positive plan paid amount for the encounter, the average plan paid per encounter across claim financials.

    Metadata

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

    Denominator Description

    One record per clinician office visit with a positive plan paid or allowed amount.

    Numerator Description

    The total plan paid amount across pharmacy, medical claim, or medical claim service line items associated with the clinician office visit; includes documents with a positive plan paid amount.

    Published Fields

    • Data Model Keys

      • Encounter ID
      • Patient ID
      • Visit Facility Provider ID
      • Visit Service Provider ID
      • Visit Attending Provider ID
      • Visit Provider Group Provider ID
      • Primary Plan Attributee Provider ID
      • Empirical Attributee Primary Care Individual Provider ID
      • Empirical Attributee Primary Care Provider Group Provider ID
      • Patient Primary Payor ID
      • Patient Primary Plan ID

    • Patient Fields

      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Primary Care Engagement Category
      • Specialty Care Engagement Category
      • Primary or Specialty Care Engagement Category
      • Count Clinician Office Visits in Last 3 Years

    • Date Fields

      • Visit Encounter 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)

    • Encounter Fields

      • Is Visit with Primary Plan Attributee Provider
      • Is Visit with Empirical Attributee Primary Care Individual
      • Is Visit with Empirical Attributee Primary Care Provider Group
      • Visit Ursa Clinician Office Visit Type Tier 1 Category
      • Visit Ursa Clinician Office Visit Type Tier 2 Category
      • Is Visit Primary Care Clinician Office Visit
      • Is Visit Specialist Clinician Office Visit
      • Is Visit Encounter with Qualifying Preventive Primary Care Service
      • Is Visit Preventive Care Visit from Non-Primary Care Specialist
      • Is Visit Annual Wellness Visit Encounter
      • Is Visit Urgent Care Visit

    • Provider Fields

      • Primary Plan Attributee Provider Description
      • Empirical Attributee Primary Care Individual Provider Description
      • Empirical Attributee Primary Care Provider Group Provider Description
      • Is Visit Any Provider Qualifying Primary Care Provider
      • Visit Service Provider NPI
      • Visit Service Provider Description
      • Visit Service Provider Primary NUCC Provider Taxonomy Description
      • Visit Provider Group Provider NPI
      • Visit Provider Group Description
      • Visit Provider Group Primary NUCC Provider Taxonomy Description
      • Visit Attending Provider Provider NPI
      • Visit Attending Provider Description
      • Visit Facility Provider Provider NPI
      • Visit Facility Provider Description
      • Visit Ursa Physician Specialty Type Description

    • Location Fields

      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • Patient County Description
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

      • Patient Primary Payor Description
      • Patient Primary Plan Description
      • Patient Primary Plan Financial Class Description

    • Clinical Services Fields

      • Visit Qualifying Document HCPCS Code
      • Visit Qualifying Document HCPCS Short Description
      • Visit Qualifying Preventive Primary Care HCPCS Code
      • Visit Qualifying Preventive Primary Care HCPCS Code Description

    • Diagnosis Fields

      • Visit Principal Discharge Diagnosis ICD-10-CM Code
      • Visit Principal Discharge Diagnosis ICD-10-CM Description
      • Visit Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
      • Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
      • CCW Count Category
      • Count CCW Conditions
      • Is CCW Acquired Hypothyroidism
      • Is CCW Acute Myocardial Infarction
      • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
      • Is CCW Alzheimers Disease
      • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
      • Is CCW Anemia
      • Is CCW Anxiety Disorders
      • Is CCW Asthma
      • Is CCW Atrial Fibrillation
      • Is CCW Autism Spectrum Disorder
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Bipolar Disorder
      • Is CCW Blindness and Visual Impairment
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW Cerebral Palsy
      • Is CCW CKD
      • Is CCW Colorectal Cancer
      • Is CCW COPD and Bronchiectasis
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depression
      • Is CCW Depressive Disorders
      • Is CCW Diabetes
      • Is CCW Endometrial Cancer
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Glaucoma
      • Is CCW Heart Failure
      • Is CCW Hip or Pelvic Fracture
      • Is CCW Hyperlipidemia
      • Is CCW Hypertension
      • Is CCW Intellectual Disability
      • Is CCW Ischemic Heart Disease
      • Is CCW Learning Disability
      • Is CCW Leukemia
      • Is CCW Lung Cancer
      • Is CCW Migraine and Chronic Headache
      • Is CCW Mobility Impairment
      • Is CCW Multiple Sclerosis
      • Is CCW Muscular Dystrophy
      • Is CCW Obesity
      • Is CCW Osteoporosis
      • Is CCW Other Developmental Delay
      • Is CCW Personality Disorder
      • Is CCW Pressure or Chronic Ulcer
      • Is CCW Prostate Cancer
      • Is CCW PTSD
      • Is CCW PVD
      • Is CCW Rheumatoid Arthritis or Osteoarthritis
      • Is CCW Schizophrenia
      • Is CCW Schizophrenia or Other Psychotic Disorders
      • Is CCW Stroke or Transient Ischemic Attack
      • CCW Systems Category
      • Count CCW Systems
      • Is CCW System Behavioral Health
      • Is CCW System Cardiovascular
      • Is CCW System Congenital
      • Is CCW System Endocrine/Metabolic
      • Is CCW System Genitourinary
      • Is CCW System Hematologic
      • Is CCW System Musculoskeletal
      • Is CCW System Neurological
      • Is CCW System Oncologic
      • Is CCW System Ophthalmologic
      • Is CCW System Pulmonary
      • Is CCW System Other

    • Financial Fields

      • Visit Patient Paid Amount
      • Visit Primary Plan Allowed Amount
      • Visit Primary Plan Paid Amount
      • Visit Total Plan Paid Amount from All Plans
      • Visit Encounter Total Plan Paid Amount from All Plans Category

    • Numerator Fields

      • Document ID
      • Document Effective Date
      • Claim ID
      • Billing Provider ID
      • Billing Provider Description
      • Claim Class Category
      • Document Type Category
      • Ursa Setting Tier 1 Description
      • Ursa Service Type Tier 1 Description
      • Is Documented Related to Multiple URSA-CORE Encounter Types
      • Principal Diagnosis ICD-10-CM Code
      • Principal Diagnosis ICD-10-CM Description
      • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
      • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description
      • HCPCS Code
      • HCPCS Description
      • HCPCS RBCS Category Description
      • HCPCS RBCS Subcategory Description
      • HCPCS RBCS Family Description
      • NDC Code
      • Label Description
      • Document Allowed Amount
      • Document Plan Paid Amount
      • Document Patient Responsibility Amount
      • Document Patient Paid Amount

    • Measure Fields

      • Denominator
      • Numerator

    • [No Field Group]

      • Ursa Serial ID
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