[SO/URSA-CORE] Claim Aggregator

  • Published on Apr 10, 2026
  • 10 minute(s) read
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Object Description

One record per institutional, professional, or pharmacy claim (header) record. Includes open, paid, and denied claims.

Metadata

  • Table Name: ursa.so_ursa_core_fin_001
  • Layer: SYNTHETIC_OBJECT
  • Object Type: Integrator
  • Temporal Class: Event
  • Case ID: Claim ID
  • Event Date: Claim Covered Start Date
  • Primary Key: Claim ID

Published Fields

  • Data Model Keys

    • Claim ID -- The internal database identifier (used, e.g., for joins and primary keys) for the claim. (See also [URSA-CORE] 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)
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Service or Prescribing Provider ID
    • 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
    • Document ID -- The internal database identifier (used, e.g., for joins and primary keys) for the document. (See also [URSA-CORE] Document)
    • Source ID -- The identifier for the original source data system from which the current record originated.

  • Date Fields

    • Claim Covered Start Date -- The start date of services covered by a claim.
    • Claim Covered End Date -- The end date of services covered by a claim.
    • Payor Incurred Date -- The date the payor considers the services associated with the record to be incurred for accounting purposes.
    • Claim Received Date -- The date the claim was originally received for processing by the payor.
    • Claim Paid Date -- The date the claim was paid by the payor.
    • Claim Calendar Year Start Date -- The start date of the calendar year (i.e., January 1) containing the Claim Covered Start Date. (See also [URSA-CORE] Claim Covered Start Date)
    • Claim Calendar Quarter Start Date -- The start date of the calendar quarter (e.g., January 1, April 1, etc.) containing the Claim Covered Start Date. (See also [URSA-CORE] Claim Covered Start Date)
    • Claim Calendar Month Start Date -- The start date of the calendar month (e.g., January 1, February 1, etc.) containing the Claim Covered Start Date. (See also [URSA-CORE] Claim Covered Start Date)
    • Payor Incurred Month Start Date

  • Provider Fields

    • Billing Provider Description -- The natural language description of the billing provider. (See also [URSA-CORE] Billing Provider)
    • Facility Provider Description -- The natural language description of the facility provider. (See also [URSA-CORE] Facility Provider)
    • Service or Prescribing Provider Description

  • Insurance Fields

    • Is Risk Contract Eligible -- Indicates the record -- typically a claim, but also potentially another type of financial transaction -- is eligible to be included in calculations determining provider risk associated with a value-based contract. Note that such records may ultimately be excluded from risk-related calculations if the patient was determined to not be attributed with risk at the time the service or transaction was incurred.
    • Is Medicare Part A -- Indicates that this record is associated with the Medicare Part A benefit.
    • Is Medicare Part B -- Indicates that this record is associated with the Medicare Part B benefit. Note that some institutional claims and pharmacy claims may be designated Part B.
    • Is Medicare MSB -- Indicates that this record is associated with a Medicare Advantage Mandatory Supplemental Benefit (MSB).
    • Is Medicare Part C -- Indicates that this record is associated with the Medicare Part C benefit. Medicare Part C covers Medicare Part A, Medicare Part B, and Medicare MSB (Mandatory Supplemental Benefit), and so records flagged as Medicare Part A, Medicare Part B, or Medicare MSB should also be flagged as Medicare Part C; but the converse need not be true, e.g., a record known to be covered by Medicare Part C but without knowing whether the specific coverage is through Part A, Part B, or MSB might still be flagged as Medicare Part C while the other flags are not used.
    • Is Medicare Part D -- Indicates that this record is associated with the Medicare Part D benefit.
    • 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)

  • Clinical Services Fields

    • CMS Type of Bill Code -- The standard CMS 3-digit Type of Bill (TOB) Code; 111 = Hospital Inpatient Admit Through Discharge, etc.
    • CMS Type of Bill Code Description -- The natural language description of a standard CMS Type of Bill (TOB) code. (See also [URSA-CORE] CMS Type of Bill Code)
    • 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)

  • 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.
    • 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)

  • 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

  • Billing and Claims Fields

    • Is Claim Processed Status Open -- Indicates that the claim has been received but not yet paid or denied.
    • Is Claim Processed Status Denied -- Indicates the claim has been denied.
    • Is Claim Processed Status Paid -- Indicates that the claim has completed processing without denial, with any outstanding balance paid.

  • Financial Fields

    • Claim Charge Amount -- The amount charged for this claim on the original bill, before any contractual adjustments or other discounts were applied.
    • Claim Allowed Amount -- The amount determined by the payor to be the maximum allowed amount for all the billed services on a claim, often representing a negotiated contractual amount. (See also [URSA-CORE] Claim)
    • Claim Plan Paid Amount -- The amount paid by an insurance plan for all services on a claim.
    • Claim COB Paid Amount -- The amount paid for all services on a claim by other insurance plans as part of a "coordination of benefit" (COB) arrangement.
    • Claim Patient Responsibility Amount -- The amount determined by a plan to be owed by the patient for all services on a claim.
    • Claim Patient Paid Amount -- The amount paid by the patient for all services on a claim.

  • Metadata Fields

    • Is Service Line Item Financial Data Coverage -- Indicates whether financial information associated with a bill or claim is available and generally accurate at the service line item level; a value of 0 indicates that line-level financials are not available or not reliably accurate, and that header-level financial information should be used despite its coarser grain.
    • Document Type Code
    • Document Type Category
    • Document Type Description
    • Claim Class Category -- Identifies a record as associated with a professional, institutional, or pharmacy claim.
    • Claim Class Description
    • 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.
    • 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)
    • Is Claim Financial Class Commercial -- Indicates the financial class of the claim or plan is commercial. (See also [URSA-CORE] Financial Class)
    • Is Claim Financial Class Medicare FFS -- Indicates the financial class of the claim or plan is Medicare fee-for-service (FFS). (See also [URSA-CORE] Financial Class)
    • Is Claim Financial Class Medicare Advantage -- Indicates the financial class of the claim or plan is Medicare Advantage. (See also [URSA-CORE] Financial Class)
    • Is Claim Financial Class Medicaid -- Indicates the financial class of the claim or plan is Medicaid (See also [URSA-CORE] Financial Class)
    • Is Claim Financial Class Other -- Indicates the financial class of the claim or plan is something other than commercial, Medicare FFS (fee-for-service), Medicare Advantage, or Medicaid. (See also [URSA-CORE] Financial Class)
    • Ursa Claim Type Code
    • Ursa Claim Type Category
    • Ursa Claim Type Description
    • 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
    • Is Ursa Claim Type Pharmacy
    • Is Ursa Claim Type Unclassifiable
    • Ursa Consolidated Utilization Type Code
    • Ursa Consolidated Utilization Type Category
    • Ursa Consolidated Utilization Type Description
    • Ursa Encounter Type Tier 1 Code
    • Ursa Encounter Type Tier 1 Category
    • Ursa Encounter Type Tier 1 Description
    • Ursa Encounter Type Tier 2 Code
    • Ursa Encounter Type Tier 2 Category
    • Ursa Encounter Type Tier 2 Description
    • Ursa Surgery Encounter Type Code
    • Ursa Surgery Encounter Type Category
    • Ursa Surgery Encounter Type Description
    • Ursa Setting Tier 1 Code
    • Ursa Setting Tier 1 Category
    • Ursa Setting Tier 1 Description -- The natural language description of the top-tier category within the Ursa Setting classification system that the record has been assigned to. (See also [URSA-CORE] Ursa Setting)
    • Ursa Service Type Tier 1 Code
    • Ursa Service Type Tier 1 Category
    • Ursa Service Type Tier 1 Description
    • Record Last Updated Datetime -- The date and time the current record was last updated in the original data source.
    • Source Data Effective Datetime -- The "as of" date and time of the original source data system at the moment the current record was extracted. For example, if a snapshot of the data in a production system is taken at 12:05 AM on the first of each month and used to generate a package of flat files that are eventually loaded into the Ursa Studio client database later that month, the Source Data Effective Datetime of all records in that month's package will be 12:05 AM on the first. Not to be confused with Record Last Updated Datetime. (See also [URSA-CORE] Record Last Updated Datetime)
    • Is Behavioral Health Services on All Lines

  • Validation Only Fields

    • Is Ursa CUT IRF Encounter Raw
    • Is Ursa CUT LTCH Encounter Raw
    • Is Ursa CUT IPF Encounter Raw
    • Is Ursa CUT Freestanding SNF Encounter Raw
    • Is Ursa CUT Swing-Bed SNF Encounter Raw
    • Is Ursa CUT Other Inpatient Facility Care Raw
    • Is Ursa CUT Observation Stay Raw
    • Is Ursa CUT Emergency Department Visit Raw
    • Is Ursa CUT Ambulatory Surgical Center Encounter Raw
    • Is Ursa CUT Hospital Outpatient Surgery Encounter Raw
    • Is Ursa CUT DME Raw
    • Is Ursa CUT Urgent Care Visit Raw
    • Is Ursa CUT FQHC Encounter Raw
    • Is Ursa CUT RHC Encounter Raw
    • Is Ursa CUT Other Primary Care Clinician Office Visit Raw
    • Is Ursa CUT Other Clinician Office Visit Raw
    • Is Ursa CUT Dialysis Facility Encounter Raw
    • Is Ursa CUT Non-Inpatient Behavioral Health Raw
    • Is Ursa CUT Hospice Raw
    • Is Ursa CUT HHA Visit Raw
    • Is Ursa CUT Other Home Health Care Raw
    • Is Ursa CUT Long-Term Residential Raw
    • Is Ursa CUT Outpatient Labs and Other Tests Raw
    • Is Ursa CUT Outpatient Medication Raw
    • Is Ursa CUT Pharmacy Raw
    • Is Ursa CUT Outpatient Imaging Raw
    • Is Ursa CUT Outpatient PT / OT / ST / Chiropractic Raw
    • Is Ursa CUT Transport Raw
    • Is Ursa CUT Other Outpatient Procedures Raw

Foreign Keys

  • pat_id → ursa.no_ursa_core_pat_001.pat_id
  • billing_prov_id → ursa.no_ursa_core_prov_001.prov_id
  • payor_id → ursa.no_ursa_core_struct_004.payor_id
  • plan_id → ursa.no_ursa_core_struct_005.plan_id
  • document_id → ursa.so_ursa_core_pat_001.document_id