URSA-QUALITY-WCV: Child and Adolescent Well-Care Visits (WCV)

Measure Description

The percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Entity
• Component Class: Long-Form
• Denominator Case Field: Patient ID, Output NCQA Payer Type Code
• Target Direction: Up

Denominator Description

Patients aged 3-21

Numerator Description

Qualifying denominator patients with at least one (1) comprehensive well-care visit with a PCP or an OB/GYN practitioner in the prior 12 months.

Published Fields

• Data Model Keys

  • Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

  • Patient Operational ID
  • Patient Date of Birth
  • Patient Age Integer
  • Is Patient Sex Female
  • Is Patient Sex Male
  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit
  • Patient Date of Death

• Date Fields

  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership Episode 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.

• Provider Fields

  • Primary Plan Attributee Provider ID
  • Primary Plan Attributee Provider Description
  • Primary Plan Attributee Primary NUCC Provider Taxonomy Description

• Insurance Fields

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

• Denominator Fields

  • Is Eligible Population
  • Is Continuous Membership Criterion Met
  • Is Any Required Exclusion
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Patient Death
  • Denominator Excluded Reasons Description
  • Measure ID
  • Measure Name

• Numerator Fields

  • Numerator HCPCS Code
  • Numerator HCPCS Description
  • Numerator Document ID
  • Numerator Document Effective Date
  • Numerator Source ID
  • Is Numerator Qualifying Using Standard End-of-Year Timing
  • Numerator Component Contribution Using Standard End-of-Year Timing
  • Numerator Document Type Description

• Metadata Fields

  • Is Parameter Set to Override Continuous Enrollment Criteria
  • Is Parameter Set to Override Payor Criteria

• Measure Fields

  • Denominator
  • Numerator

• NCQA Cert Fields

  • Is NCQA Numerator Criteria Met
  • Is Record with Payer that Meets NCQA Epop Criteria
  • Output NCQA Payer Type Code
  • Is Excluded Record for Dual Enrolled Patient
  • NCQA Race Code
  • NCQA Ethnicity Code
  • NCQA Gender Code
  • Patient Age Integer Unbounded by Death

• [No Field Group]

  • Ursa Serial ID