URSA-CORE-905: Institutional Claims with Single Paid Line Item
  • 28 Aug 2023
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URSA-CORE-905: Institutional Claims with Single Paid Line Item

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Article summary

Measure Description

Among institutional claims with at least one line item with a positive plan paid amount and 4 or more lines, the percentage with exactly one line item with a positive plan paid amount.

When a data source has frequent institutional claims with multiple line items but only a single paid line item, it suggests that the putatively line-level amounts might actually be header-level amounts. Financial amounts that are truly header-level should be stored in the appropriate header-level fields, not assigned to a single line item; so higher results on this measure for a particular data source should prompt a review of the integration logic for that source, with special attention paid to the possibility that paid amounts labelled as line-level might actually be header-level.

Metadata

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

Denominator Description

Institutional claims with at least one line item with a positive plan paid amount and 4 or more lines

Numerator Description

Denominator observations with exactly one line item with a positive plan paid amount


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