[SO/URSA-CORE] Primary Care Clinician Office Visits

Object Description

One record per office visit with a primary care clinician, or in which primary care services were delivered; clinician office visits meeting any of the following criteria are considered primary care: (1) a service provider or attending provider with a qualifying primary care primary specialty; (2) a HCPCS code associated with preventive primary care services; (3) a service provider, attending provider, or provider group provider designated as a primary care provider in the Providers object.

Metadata

• Table Name: ursa.so_ursa_core_enc_301
• Layer: SYNTHETIC_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Encounter ID
• Event Date: Encounter Date
• Primary Key: Encounter ID

Published Fields

• Data Model Keys

  • Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
  • 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)
  • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
  • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
  • 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 Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the service provider. (See also [URSA-CORE] Service Provider)
  • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
  • Provider Group Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the provider group. (See also [URSA-CORE] Provider Group)

• Date Fields

  • Encounter Date

• Encounter Fields

  • Is Annual Wellness Visit
  • Is Urgent Care Visit -- Indicates the encounter had one or more claim document with a HCPCS, Revenue Center Code, or Place of Service Code specific to Urgent Care Facility claim filing.
  • Is First AWV with Provider
  • Is Subsequent AWV with Provider
  • Is Initial Preventive Physician Examination (IPPE)
  • Is FQHC Visit for IPPE or AWV

• Provider Fields

  • Is Qualifying Primary Care Service Provider
  • Is Qualifying Primary Care Attending
  • Is Qualifying Primary Care Provider Group

• Clinical Services Fields

  • Is Qualifying Preventive Primary Care Service
  • Qualifying Document HCPCS Code
  • Qualifying Preventive Primary Care HCPCS Code
  • Qualifying Preventive Primary Care HCPCS Code Description
  • Qualifying Annual Wellness Visit HCPCS Code
  • Qualifying Annual Wellness Visit HCPCS Code Description

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description

• Billing and Claims Fields

  • Qualifying Document CMS Revenue Center Code
  • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
  • CMS Admit Type Code -- The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.
  • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.

• Financial Fields

  • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
  • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

• Metadata Fields

  • Qualifying Document EMR Encounter Type Description

Terms

• Primary Care Clinician Office Visit: A Clinician Office Visit encounter with a primary care provider or in which primary care services were delivered; operationally defined by the presence of one or more of the following: (1) a service provider or attending provider identified as a primary care provider or with a qualifying primary NUCC taxonomy code; or (2) a qualifying HCPCS code for preventive and/or primary care services.

Foreign Keys

• pat_id → ursa.no_ursa_core_pat_001.pat_id
• service_prov_id → ursa.no_ursa_core_prov_001.prov_id
• attending_prov_id → ursa.no_ursa_core_prov_001.prov_id
• prov_group_prov_id → ursa.no_ursa_core_prov_001.prov_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• enc_primary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• enc_primary_plan_id → ursa.no_ursa_core_struct_005.plan_id