URSA-CORE-901: Claims without Contemporaneous Membership

Measure Description

Among non-denied institutional, professional, or pharmacy claims, the percentage for patients without any contemporaneous plan membership as of the claim covered start date. Claims whose denial status is not known are considered denied for the purpose of this measure if the allowed and plan paid amounts are both zero.

Metadata

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

Denominator Description

One per non-denied institutional, professional, or pharmacy claims. Claims whose denial status is not known are considered denied for the purpose of this measure if the allowed and plan paid amounts are both zero.

Numerator Description

One per qualifying denominator observation without any contemporaneous plan membership, for any plan, as of the claim covered start date.