[SO/URSA-HCC] Periods of Most Recent CMS-HCC Qualifying Diagnosis Submissions

Object Description

One record per "acceptable" allowed CMS MAO-004 encounter-diagnosis pair (for non-deleted diagnoses; i.e., grain = CMS MAO-004 Diagnosis Transaction Natural Object), qualifying and acceptable claim diagnosis, or qualifying and acceptable billing diagnosis; with the time period of its influence on HCC/RAF calculations. For MAO-004-based records, this period starts on the submitted date and ends on the submission date of the subsequent submission for that encounter, if it exists (else "distant future"); for claims and bills submission, this period starts on the claim paid date and claim covered end date, respectively, and ends in "distant future".

In other words, restricting to periods containing a given snapshot date will identify all the qualifying-and-still-surviving diagnoses relevant for HCC/RAF score calculations as of that snapshot date.

Metadata

• Table Name: ursa.so_ursa_hcc_cond_002
• Layer: SYNTHETIC_OBJECT
• Object Type: Integrator
• Temporal Class: Interval
• Case ID: Document ID
• Interval Start Date: Period Start Date
• Interval End Date: Period End 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)
  • 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)

• Operations Support Fields

  • CMS MAO-004 Encounter ICN

• Date Fields

  • Period Start Date
  • Period End Date
  • Diagnosis Effective Date

• Insurance Fields

  • CMS MAO-004 Service Type Code
  • CMS MAO-004 Service Type Description

• Diagnosis Fields

  • Diagnosis ICD-10-CM Code -- The standard ICD-10-CM diagnosis code; e.g., A00 = Cholera. ICD-10-CM diagnosis codes longer than 3 digits must include a decimal point after the 3rd digit.
  • Diagnosis ICD-10-CM Description -- The natural language description of a ICD-10-CM diagnosis code. (See also [URSA-CORE] Diagnosis ICD-10-CM Code)

• Metadata Fields

  • Is CMS MAO-004 Diagnosis -- Indicates that at least one qualifying MAO-004 diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.
  • Is Acceptable Diagnosis Document Type

• Module Fields

  • CMS-HCC ICD-10-CM Code