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[DM/URSA-CORE] Data Mart for Claim Financials

  • Published on Jun 11, 2026
  • 18 minute(s) read
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Object Description

One record per pharmacy claim, medical claim, or medical claim service line item with a non-zero allowed or paid amount; this object contains line-level data for patient-source pairs in which claims data from that source include line-level paid amounts, and header-level data otherwise; only records (of any grain) with a non-zero allowed amount, plan paid amount, or patient paid amount field will be included.

Metadata

  • Table Name: ursa.dm_ursa_core_020
  • Layer: DATA_MART
  • Object Type: Single Stack
  • Temporal Class: Event
  • Case ID: Document ID
  • Event Date: Document Effective Date
  • Primary Key: Document ID

Published Fields

  • Data Model Keys

    • Document ID -- The internal database identifier (used, e.g., for joins and primary keys) for the document. (See also [URSA-CORE] Document)
    • Claim ID -- The internal database identifier (used, e.g., for joins and primary keys) for the claim. (See also [URSA-CORE] Claim)
    • Claim Service Line Item ID -- The identifier for a service line item on an institutional or professional claim.
    • 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)
    • Billing Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the billing provider. (See also [URSA-CORE] Billing Provider)
    • Payor ID -- The identifier for the health insurance organization associated with the current record.
    • Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
    • Primary Encounter ID
    • Source ID -- The identifier for the original source data system from which the current record originated.

  • Date Fields

    • Document Effective Date -- The most appropriate single date that events associated with the document occurred. For documents spanning multiple calendar days, the earliest date is typically used; Document Effective Start Date and Document Effective End Date can be used for a more precise range of dates, if necessary.
    • Document Effective Date Text YYYYMM

  • Provider Fields

    • Billing Provider Description -- The natural language description of the billing provider. (See also [URSA-CORE] Billing Provider)
    • CMS Type of Bill Code -- The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.
    • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
    • CMS Place of Service Description -- The natural language description of a standard CMS Place of Service code (See also [URSA-CORE] CMS Place of Service Code)

  • Clinical Services Fields

    • HCPCS Code -- The Healthcare Common Procedure Coding System (HCPCS) code associated with a service. Includes both HCPCS Level I codes (commonly called CPT codes) and Level II codes (which includes products, supplies, and services not included in CPT). Level II codes consist of a letter followed by four numeric digits. Current Dental Terminology codes are included in the Level II codes as HCDT. (See also [URSA-CORE] HCPCS Description)
    • HCPCS Description -- The natural language description of a HCPCS code. (See also [URSA-CORE] HCPCS Code)
    • CMS Revenue Center Code -- The standard CMS 4-digit Revenue Center code; e.g., 0001 = Total charge, etc. CMS Revenue Center codes should include leading zeros.
    • CMS Revenue Center Description -- The natural language description of a CMS Revenue Center code (See also [URSA-CORE] CMS Revenue Center Code)

  • Medication Fields

    • NDC Code -- The standard 11-digit National Drug Code; e.g., 00045012400 = Tylenol 500 mg.
    • Label Description -- Supplies the name given to the product by the manufacturer.

  • Diagnosis Fields

    • Principal Diagnosis ICD-10-CM Code -- The ICD-10-CM diagnosis code documented as the principal diagnosis for a claim, bill, encounter, etc.
    • Principal Diagnosis ICD-10-CM Description -- The natural language description of the Principal Diagnosis ICD-10-CM Code. (See also [URSA-CORE] Principal Diagnosis ICD-10-CM Code)
    • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
    • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description

  • Financial Fields

    • Document Allowed Amount
    • Document Plan Paid Amount
    • Document Patient Responsibility Amount
    • Document Patient Paid Amount

  • Metadata Fields

    • Document Type Code
    • Document Type Category
    • Document Type Description
    • Is Document Type Institutional Claim Header
    • Is Document Type Institutional Claim Service Line Item
    • Is Document Type Professional Claim Header
    • Is Document Type Professional Claim Service Line Item
    • Is Document Type Pharmacy Claim
    • Claim Financial Class Description -- The natural language description of the financial class of a claim or plan. (A claim's financial class is inherited from its associated plan.) (See also [URSA-CORE] Financial Class)
    • Medicare Benefit Type Category -- A categorical value identifying whether the claim is a Medicare FFS or Medicare Advantage claim and, if known, what Medicare program component -- i.e., Part A, Part B, or Part D -- it is associated with. (See also [URSA-CORE] Is Medicare Part A, [URSA-CORE] Is Medicare Part B, [URSA-CORE] Is Medicare Part D)
    • Claim Class Category -- Identifies a record as associated with a professional, institutional, or pharmacy claim.
    • Is Claim Class Institutional -- Indicates the record is associated with an institutional claim or bill.
    • Is Claim Class Professional -- Indicates the record is associated with a professional claim or bill.
    • Is Claim Class Pharmacy -- Indicates the record is associated with a pharmacy claim.
    • Ursa Claim Type Code -- A short code (e.g., "HINP", "HOUT", "SNF", "HHA", "OINST", "PROF", "PHARM") identifying the type of claim based on billing form and facility classification. Sourced from the claim header object (so_ursa_core_fin_001) and reflects how the provider billed — not where the patient was seen or what encounter was constructed. Institutional claims are sub-typed; professional and pharmacy are their own categories. The corresponding sort-friendly label is Ursa Claim Type Category; the plain-English name is Ursa Claim Type Description.
    • Ursa Claim Type Category -- The numbered, sort-friendly label for the claim type represented by Ursa Claim Type Code (e.g., "[01] Hospital Inpatient", "[06] Professional"). Same origin — inherited from the claim header — with a numeric prefix for consistent ordering. (See also [URSA-CORE] Ursa Claim Type Code)
    • Ursa Claim Type Description -- The plain-English claim type name (e.g., "Hospital Inpatient", "Professional") — identical content to Ursa Claim Type Category but without the numeric sort prefix. (See also [URSA-CORE] Ursa Claim Type Code, [URSA-CORE] Ursa Claim Type Category)
    • Is Ursa Claim Type Hospital Inpatient -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a hospital inpatient claim. Derived from Ursa Claim Type Code where the value is "HINP." Based on how the provider billed the claim (billing form and facility classification on the claim header), not on encounter grouping or where the patient was physically seen. Use this flag as a quick filter to isolate hospital inpatient claims without needing to reference Ursa Claim Type Code directly. Mutually exclusive with Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type HHA, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Professional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type Hospital Outpatient -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a hospital outpatient claim. Derived from Ursa Claim Type Code where the value is "HOUT." Based on how the provider billed the claim (billing form and facility classification on the claim header), not on encounter grouping. Includes all hospital outpatient department services billed on an institutional claim (e.g., ED visits, outpatient surgery, radiology, lab) regardless of the specific encounter type constructed. Use this flag to isolate hospital outpatient facility charges. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type HHA, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Professional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type SNF -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a Skilled Nursing Facility (SNF) claim. Derived from Ursa Claim Type Code where the value is "SNF." Based on how the provider billed the claim (billing form and facility classification on the claim header). Covers both freestanding SNF claims and hospital swing-bed SNF claims. Use this flag to isolate post-acute SNF spending. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type HHA, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Professional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type HHA -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a Home Health Agency (HHA) claim. Derived from Ursa Claim Type Code where the value is "HHA." Based on how the provider billed the claim (billing form and facility classification on the claim header). Covers institutional claims submitted by certified home health agencies. Use this flag to isolate home health spending. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Professional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type Other Institutional -- A binary flag (1 = yes, 0 = no) indicating the record is associated with an institutional claim that does not fall into the Hospital Inpatient, Hospital Outpatient, SNF, or HHA categories. Derived from Ursa Claim Type Code where the value is "OINST." Based on how the provider billed the claim (billing form and facility classification on the claim header). May include hospice, psychiatric facility, rehabilitation facility, or other institutional provider types billed on a UB-04 form. Use this flag to capture residual institutional spending not covered by the more specific institutional flags. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type HHA, Is Ursa Claim Type Professional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type Professional -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a professional claim. Derived from Ursa Claim Type Code where the value is "PROF." Based on how the provider billed the claim (billing form classification on the claim header), typically a CMS-1500 or equivalent. Covers physician services, outpatient therapy, DME billed professionally, lab, imaging, and other services submitted on professional claim forms regardless of the physical setting where the service was rendered. Use this flag to isolate professional fee spending. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type HHA, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Pharmacy, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type Pharmacy -- A binary flag (1 = yes, 0 = no) indicating the record is associated with a pharmacy claim. Derived from Ursa Claim Type Code where the value is "PHARM." Based on the claim class being pharmacy (typically an NCPDP transaction). Covers retail, mail-order, and specialty pharmacy dispensing claims. Use this flag to isolate pharmacy drug spending. Mutually exclusive with Is Ursa Claim Type Hospital Inpatient, Is Ursa Claim Type Hospital Outpatient, Is Ursa Claim Type SNF, Is Ursa Claim Type HHA, Is Ursa Claim Type Other Institutional, Is Ursa Claim Type Professional, and Is Ursa Claim Type Unclassifiable.
    • Is Ursa Claim Type Unclassifiable -- A binary flag (1 = yes, 0 = no) indicating the record could not be classified into any of the standard Ursa Claim Type categories (Hospital Inpatient, Hospital Outpatient, SNF, HHA, Other Institutional, Professional, or Pharmacy). Derived from Ursa Claim Type Code when classification logic cannot determine the claim type due to missing or ambiguous billing form or facility data. A non-trivial volume of unclassifiable records may indicate data quality issues in the source claims. Mutually exclusive with all other Is Ursa Claim Type flags.
    • Ursa Consolidated Utilization Type Code -- A short alphanumeric code (e.g., "ACHIA", "ED", "PHARM") assigning each financial record to one of approximately 30 mutually exclusive utilization buckets. Determined by a priority-ordered waterfall that evaluates Ursa Encounter Type Tier 1 Code first, then Ursa Setting Tier 1 Code, then Ursa Service Type Tier 1 Code, then Claim Class Category, ensuring every dollar maps to exactly one category with no overlap. This is the recommended field for total-cost decomposition and PMPM breakdowns because it is exhaustive and non-overlapping. Use the Code variant when you need to join, filter, or write logic against specific values. See Ursa Consolidated Utilization Type Category for a sort-friendly labeled version and Ursa Consolidated Utilization Type Description for a plain-English label.
    • Ursa Consolidated Utilization Type Category -- A numbered, sort-friendly label (e.g., "[01] Acute Care Hospital Inpatient Admission") representing the same mutually exclusive utilization bucket as Ursa Consolidated Utilization Type Code. The bracketed numeric prefix controls display order from highest-acuity inpatient categories down to residual outpatient. Derived from a lookup table keyed on Ursa Consolidated Utilization Type Code. Use this variant when building visualizations or reports where consistent sort order matters. (See also [URSA-CORE] Ursa Consolidated Utilization Type Code)
    • Ursa Consolidated Utilization Type Description -- The plain-English name of the consolidated utilization bucket (e.g., "Acute Care Hospital Inpatient Admission"). Contains the same content as Ursa Consolidated Utilization Type Category but without the numeric sort prefix. Use this variant for user-facing labels in dashboards or exports where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Consolidated Utilization Type Code, [URSA-CORE] Ursa Consolidated Utilization Type Category)
    • Ursa Encounter Type Tier 1 Code -- A short code (e.g., "HIA", "ED", "OBS", "OFFICE", "SNF", "ASC", "HOSURG", "HOME", "DIAL", "OTH", "NONE") identifying the broad clinical encounter type associated with the financial record. Sourced from Ursa encounter-grouping logic, which links claims and service lines to constructed encounters. A value of "NONE" means no encounter was built for the record (e.g., pharmacy claims, which are never encounter-grouped). Unlike Ursa Setting Tier 1 Code, which reflects where a service was rendered based on billing codes, this field reflects the clinical episode context in which the claim participates. Use the Code variant when filtering or joining on specific encounter types. For more granular sub-types, see Ursa Encounter Type Tier 2 Code. (See also [URSA-CORE] Ursa Encounter Type Tier 1 Category, [URSA-CORE] Ursa Encounter Type Tier 1 Description, [URSA-CORE] Ursa Encounter Type Tier 2 Code)
    • Ursa Encounter Type Tier 1 Category -- The numbered, sort-friendly label for the broad encounter type represented by Ursa Encounter Type Tier 1 Code (e.g., "[01] Hospital Inpatient Admission Encounter", "[03] Emergency Department Visit Only"). Resolved via a lookup table keyed on Ursa Encounter Type Tier 1 Code. Use this variant when building visualizations or reports where consistent sort order matters. (See also [URSA-CORE] Ursa Encounter Type Tier 1 Code)
    • Ursa Encounter Type Tier 1 Description -- The plain-English broad encounter type name (e.g., "Hospital Inpatient Admission Encounter", "Emergency Department Visit Only"). Contains the same content as Ursa Encounter Type Tier 1 Category but without the numeric sort prefix. Use this variant for user-facing labels where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Encounter Type Tier 1 Code, [URSA-CORE] Ursa Encounter Type Tier 1 Category)
    • Ursa Encounter Type Tier 2 Code -- A more granular encounter code that subdivides Ursa Encounter Type Tier 1 Code into specific sub-types (e.g., "HIA/EDOBS" for admission via ED or observation, "HIA/DAC" for direct acute care admission, "HIA/IRF" for inpatient rehabilitation facility, "OFFICE/FQHC" for FQHC visit, "OFFICE/URG" for urgent care, "HOME/HHA" for home health agency visit). Also sourced from the encounter-grouping logic. Provides the most specific encounter classification available in the data model. Use this field when you need to distinguish sub-types within a broad encounter category (e.g., separating urgent care visits from other office visits, or identifying the admission pathway for inpatient stays).
    • Ursa Encounter Type Tier 2 Category -- The numbered, sort-friendly label for the detailed encounter type represented by Ursa Encounter Type Tier 2 Code (e.g., "[01] Direct Acute Care Hospital Inpatient Admission", "[09] Urgent Care Visit"). Resolved via a lookup table keyed on Ursa Encounter Type Tier 2 Code. Use this variant when building visualizations or reports where consistent sort order matters within the more granular encounter classification. (See also [URSA-CORE] Ursa Encounter Type Tier 2 Code)
    • Ursa Encounter Type Tier 2 Description -- The plain-English detailed encounter type name (e.g., "Direct Acute Care Hospital Inpatient Admission", "Urgent Care Visit"). Contains the same content as Ursa Encounter Type Tier 2 Category but without the numeric sort prefix. Use this variant for user-facing labels where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Encounter Type Tier 2 Code, [URSA-CORE] Ursa Encounter Type Tier 2 Category)
    • Ursa Surgery Encounter Type Code -- A short code (e.g., "HIASURG", "HOSURG", "ASCSURG", "ASCNO", "OTHNO", "NONE") classifying the financial record by whether and where a surgical encounter occurred. Derived from the encounter-grouping logic by evaluating whether the associated encounter qualifies as a surgery encounter and, if so, in what setting. Values include: HIASURG (hospital inpatient admission with surgery), HOSURG (hospital outpatient surgery), ASCSURG (ambulatory surgical center encounter with surgery), ASCNO (ASC encounter without surgery), OTHNO (other encounter without surgery), and NONE (no associated Ursa encounter). Use this field to isolate surgical spending by setting or to identify non-surgical claims within surgical encounter types.
    • Ursa Surgery Encounter Type Category -- The numbered, sort-friendly label for the surgery encounter classification represented by Ursa Surgery Encounter Type Code (e.g., "[01] Hospital Inpatient Admission with Surgery", "[03] Ambulatory Surgical Center Encounter with Surgery"). Use this variant when building visualizations or reports where consistent sort order matters for surgical encounter analysis. (See also [URSA-CORE] Ursa Surgery Encounter Type Code)
    • Ursa Surgery Encounter Type Description -- The plain-English surgery encounter type name (e.g., "Hospital Inpatient Admission with Surgery", "Ambulatory Surgical Center Encounter with Surgery"). Contains the same content as Ursa Surgery Encounter Type Category but without the numeric sort prefix. Use this variant for user-facing labels where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Surgery Encounter Type Code, [URSA-CORE] Ursa Surgery Encounter Type Category)
    • Ursa Setting Tier 1 Code -- A short code (e.g., "HINP", "HOUT", "CLIN", "HOME", "ASC", "DIAL", "PHARM", "RES") identifying the physical or logical care site where the service was rendered. Derived from CMS Place of Service and/or Type of Bill codes on the claim header. This field is independent of encounter grouping and reflects billing-reported location regardless of how claims are bundled into encounters. Use Ursa Setting Tier 1 Code when you want to analyze cost by care site (e.g., hospital inpatient vs. clinic vs. home). Contrast with Ursa Encounter Type Tier 1 Code, which reflects the clinical episode context rather than the physical location. (See also [URSA-CORE] Ursa Setting Tier 1 Category)
    • Ursa Setting Tier 1 Category -- The numbered, sort-friendly label for the care setting represented by Ursa Setting Tier 1 Code (e.g., "[01] Hospital Inpatient", "[03] Clinic"). Derived from the same CMS Place of Service and Type of Bill codes as Ursa Setting Tier 1 Code, with a numeric prefix for consistent ordering. Use this variant when building visualizations or reports where consistent sort order matters. (See also [URSA-CORE] Ursa Setting Tier 1 Code, [URSA-CORE] Ursa Setting Tier 1 Description )
    • Ursa Setting Tier 1 Description -- The plain-English care setting name (e.g., "Hospital Inpatient", "Clinic"). Contains the same content as Ursa Setting Tier 1 Category but without the numeric sort prefix. Use this variant for user-facing labels where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Setting Tier 1 Code, [URSA-CORE] Ursa Setting Tier 1 Category)
    • Ursa Service Type Tier 1 Code -- A short code (e.g., "EM", "SPROC", "NSPROC", "ANES", "POSC", "MEDS", "DME", "IMAG", "LABS", "TRAN", "FACHOME", "OTH", "UNC") classifying the type of clinical service on the claim line based on HCPCS/CPT code ranges and revenue center codes. Categories include Evaluation and Management, Surgical Procedures, Non-Surgical Procedures, Anesthesia, PT/OT/ST/Chiropractic, Medication and Related Services, DME, Imaging, Labs and Other Tests, Transport, General Facility-Based or Home Care, Other Services, and Unclassifiable. This field is independent of both encounter grouping and care setting. Use it when you need to decompose spending by the nature of the service performed (e.g., how much is spent on imaging vs. procedures vs. E&M).
    • Ursa Service Type Tier 1 Category -- The numbered, sort-friendly label for the service type represented by Ursa Service Type Tier 1 Code (e.g., "[01] Evaluation and Management", "[03] Surgical Procedures", "[09] Imaging"). Use this variant when building visualizations or reports where consistent sort order matters for service-type analysis. (See also [URSA-CORE] Ursa Service Type Tier 1 Code)
    • Ursa Service Type Tier 1 Description -- The plain-English service type name (e.g., "Evaluation and Management", "Surgical Procedures", "Imaging"). Contains the same content as Ursa Service Type Tier 1 Category but without the numeric sort prefix. Use this variant for user-facing labels where the bracketed prefix is not desired. (See also [URSA-CORE] Ursa Service Type Tier 1 Code, [URSA-CORE] Ursa Service Type Tier 1 Category)
    • AHFS Therapeutic Class Tier 1 Description -- The natural language description of the first-tier category within the AHFS Therapeutic Classification System that the medication is assigned to. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • AHFS Therapeutic Class Tier 2 Description -- The natural language description of the second-tier category within the AHFS Therapeutic Classification System that the medication is assigned to. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • Random Integer 1 to 1000

Dedicated Precursors

  • [DM/URSA-CORE] Data Mart for Claim Financials, Precursor 1 (All Appropriate Claim Records): One record per pharmacy claim, medical claim, or medical claim service line item with a non-zero allowed or paid amount; this object contains line-level data for patient-source pairs in which claims data from that source include line-level paid amounts, and header-level data otherwise; only records (of any grain) with a non-zero allowed amount, plan paid amount, or patient paid amount field will be included.