URSA-CORE-915: Conflicting Claim Header and Line Financials

Measure Description

Among medical claims with line-level financials, the percentage with conflicting header-level and aggregate line-level amounts for any of the following: Allowed Amount, Plan Paid Amount, COB Paid Amount, Patient Responsibility Amount, and Patient Paid Amount.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Claim ID
• Target Direction: Down

Denominator Description

One per medical claim with line-level financials.

Numerator Description

One per qualifying denominator observation with conflicting header-level and aggregate line-level amounts for any of the following: Allowed Amount, Plan Paid Amount, COB Paid Amount, Patient Responsibility Amount, and Patient Paid Amount.