URSA-PHF-901: Patients with Active Membership (Reduced Fields)

  • Published on Apr 23, 2026
  • 5 minute(s) read
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Measure Description

This measure is designed specifically for validation exercises in comparing patient counts to reports provided by the entity generating the source data (e.g., the payor) and has only critical and validation fields published. For analytics please use URSA-PHF-R01. The measure is the count of patients which, as of the snapshot date, are alive and have active plan membership in any plan. Patients are considered to be alive unless a date of death available from a validated data source.

Metadata

  • Measure Identifier: URSA-PHF-901
  • Measure Type: Registry
  • Temporal Structure: Entity
  • Component Class: Normal-Form
  • Denominator Case Field: Patient ID
  • Target Direction: None

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)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID
    • Primary Plan Attributee Individual Provider ID
    • Primary Plan Attributee Provider Group Provider ID

  • Patient Fields

    • Patient Last Name
    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Sex Category
    • Is Hospice in Last 12 Months -- Evidence of CMS hospice status or evidence of hospice services in the last 12 months. Typically used as a denominator exclusion.

  • Date Fields

    • Current Continuous Primary Payor Membership Episode Start Date -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End 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)
    • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

  • Location Fields

    • Patient State Abbreviation
    • Patient ZIP Code 5-Digit
    • Patient County Description
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)

  • Insurance Fields

    • Is Patient with Multiple Active Plan Memberships
    • Count Active Plan Memberships
    • Primary Payor Description
    • Primary Plan Description
    • Primary Plan Financial Class Description
    • Plan CMS Contract Number -- This variable is the unique identification for a managed care organization (MCO) enabling the entity to provide coverage to eligible Medicare beneficiaries. The first character of the contract ID is a letter that indicates the type of plan. For local managed care contracts, it begins with 'H' or '9'; for regional managed care contracts, it begins with 'R'; for prescription drug plans (PDPs), it begins with 'S'; for fallback contracts, it begins with 'F', for Employer-Direct PDP and Employer-Direct PFFS it begins with 'E'. The remaining 4 digits are numeric. It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP (Plan Benefit Package) Number, when those two values are available, to generate the Plan ID. (See also [URSA-CORE] Plan ID)
    • Plan CMS PBP Number -- The standard 3-digit Plan Benefit Package (PBP) Number, maintained by CMS, identifying a particular insurance product offered by a given Medicare Advantage organization (identified by the CMS Contract Number). It is a standard Ursa data modeling convention to use a combination of the CMS Contract Number and the CMS PBP Number, when those two values are available, to generate the Plan ID. (See also [URSA-CORE] Plan ID, [URSA-CORE] Plan CMS Contract Number)
    • Is Dual Medicare-Medicaid Enrolled -- Indicates that the patient is concurrently enrolled in both Medicare and Medicaid programs. (Identifies the population often described as "dually eligible" or "duals".)
    • Is MMP -- Indicates the plan is a Medicare-Medicaid Plan, or MMP.
    • Is SNP -- Indicates the plan is a Special Needs Plan, or SNP.
    • Is C-SNP -- Indicates the plan is a Chronic Condition Special Needs Plan, or C-SNP.
    • Is D-SNP -- Indicates the plan is a Dual Eligible Special Needs Plan, or D-SNP.
    • Is I-SNP -- Indicates the plan is a Institutional Special Needs Plan, or I-SNP.

  • Diagnosis Fields

    • CCW Count Category

  • Metadata Fields

    • Count Distinct Data Sources -- For a given patient (or other type of entity) and time period, the count of distinct data sources contributing some degree of data coverage for that entity during that time period. (See also [URSA-CORE] Data Coverage)
    • Is Medical Claim Data Coverage -- Indicates data coverage for medical claims (i.e., institutional and professional claims) from at least one data source for the patient and time period specified on the record. (See also [URSA-CORE] Data Coverage)
    • Is Professional Claim Data Coverage -- Indicates data coverage for professional claims from at least one data source for the patient and time period specified on the record. (See also [URSA-CORE] Data Coverage)
    • Is Pharmacy Claim Data Coverage -- Indicates data coverage for pharmacy claims from at least one data source for the patient and time period specified on the record. (See also [URSA-CORE] Data Coverage)

  • Measure Fields