Measure Description
Among institutional claims with at least one line item with a positive plan paid amount and 4 or more lines, the percentage with exactly one line item with a positive plan paid amount.
When a data source has frequent institutional claims with multiple line items but only a single paid line item, it suggests that the putatively line-level amounts might actually be header-level amounts. Financial amounts that are truly header-level should be stored in the appropriate header-level fields, not assigned to a single line item; so higher results on this measure for a particular data source should prompt a review of the integration logic for that source, with special attention paid to the possibility that paid amounts labelled as line-level might actually be header-level.
Metadata
- Measure Identifier: URSA-CORE-905
- Measure Type: Rate Measure
- Temporal Structure: Event
- Component Class: Normal-Form
- Denominator Case Field: Claim ID
- Target Direction: Down
Denominator Description
Institutional claims with at least one line item with a positive plan paid amount and 4 or more lines
Numerator Description
Denominator observations with exactly one line item with a positive plan paid amount
Published Fields
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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)
- Source ID -- The identifier for the original source data system from which the current record originated.
- Payor ID -- The identifier for the health insurance organization associated with the current record.
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Date Fields
- Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
- Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
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Denominator Fields
- Count of Claim Service Line Items
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Numerator Fields
- Count Claim Service Line Items with Positive Plan Paid Amount
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Measure Fields
- Denominator