[SO/URSA-HCC] Standard Initial, Midyear, and Final Run CMS-HCC Model Demographic Inputs

Object Description

One record per MMR Member-Month Transaction record used to generate a CMS standard Initial, Midyear, or Final Run CMS-HCC RAF score. For Initial Run results, only January - June records with payment month = covered month are used; for Midyear Run results, the most recent MMR records with payment date up through July of that year are used for January - June, and only MMR records with payment month = covered month are used from July - December; for Final Run results, the most recent MMR records with payment date up through November of the subsequent year are used for all calendar months.

Metadata

• Table Name: ursa.so_ursa_hcc_pat_021
• Layer: SYNTHETIC_OBJECT
• Object Type: Single Stack
• Case ID: Transaction ID
• Primary Key: Transaction ID

Published Fields

• Data Model Keys

  • Transaction ID -- The internal database identifier (used, e.g., for joins and primary keys) for the transaction. (See also [URSA-CORE] Claim or Billing Transaction)
  • 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)
  • Source ID -- The identifier for the original source data system from which the current record originated.

• Date Fields

  • Covered Month Start Date -- The start date (e.g., January 1, February 1, etc.) of the month in the patient's life described by the current record.
  • Covered Month End Date
  • CMS MMR Payment Date -- The monthly period, expressed as text in YYYYMM format, in which any new or updated financial calculations in the current MMR record actually contributed to the amount paid by CMS to the Medicare Advantage organization. This field contains the same values as the CMS MMR "Payment Date" field, which the CMS documentation defines as: "Payment month for the report (YYYYMM)" (Note that we use the word "date" in the field name here -- even though the field does not, strictly speaking, contain a date -- for consistency with the official MMR field name.) (See also [URSA-CORE] Covered Month Start Date)
  • Calendar Year Start Date

• Module Fields

  • CMS-HCC Patient Age
  • CMS-HCC Patient Sex Code
  • Is CMS-HCC Medicaid Patient
  • CMS-HCC Original Reason for Entitlement Code
  • CMS-HCC Eligibility Code

• Patient Fields

  • Patient Age Integer
  • Is Patient Sex Female

• Insurance Fields

  • Is CMS ESRD Status
  • Is CMS LTI Status
  • Is CMS New Enrollee Status
  • Is CMS Full Dual Status
  • Is CMS Partial Dual Status
  • CMS RAF Type Code -- The standard 1- or 2-character CMS Part C Risk Adjustment Factor Type Code; e.g., E = New Enrollee, I = Institutional, D = Dialysis (ESRD), CF = Community Full Dual, CP = Community Partial Dual, CN = Community Non-Dual, etc.
  • CMS Original Reason for Entitlement Code -- The standard CMS 1-digit code, commonly abbreviated OREC, identifying the original reason the patient was entitled to Medicare; 0 = Old Age and Survivor's Insurance, 1 = Disability Insurance Benefit, 2 = ESRD, 3 = Both Disability and ESRD, 9 = None of the Above.
  • CMS Dual Status Code -- The standard 2-character CMS Dual Status Code, which identifies the patient's most recent entitlement status for Medicaid and other qualifying non-Medicare programs; e.g., 01 = QMB only, 02 = QMB + full Medicaid, etc.

• Metadata Fields

  • Is Initial Run MMR Member-Month Transaction
  • Is Midyear Run MMR Member-Month Transaction

• Validation Only Fields

  • Is CMS ESRD Status from MMR RAF Type Code
  • Is CMS LTI Status from MMR RAF Type Code
  • Is CMS New Enrollee Status from MMR RAF Type Code
  • Is CMS Full Dual Status from MMR RAF Type Code
  • Is CMS Partial Dual Status from MMR RAF Type Code
  • Is CMS Full Dual Status According to MMR Original Field
  • Is CMS Partial Dual Status According to MMR Original Field
  • Patient Age