Measure Description
Among pharmacy claims, the percentage with multiple records with identical patient, filled date, days supply, and NDC; the idea is that these duplicates will appear if the claims data have not been properly reconciled to final action.
Metadata
- Measure Identifier: URSA-CORE-919
- Measure Type: Rate Measure
- Temporal Structure: Event
- Component Class: Normal-Form
- Denominator Case Field: Claim ID
- Target Direction: Down
Denominator Description
Pharmacy claim service line items.
Numerator Description
Denominator observations with at least one other pharmacy claim for the same patient, with the same filled date, NDC, and days supply.
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)
- Filling Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the filling provider.
- Payor ID -- The identifier for the health insurance organization associated with the current record.
- Plan ID -- The identifier for a particular health insurance plan product offered by a payor.
- Source ID -- The identifier for the original source data system from which the current record originated.
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Operations Support Fields
- Prescription Number -- The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the medication order. (See also [URSA-CORE] Medication Order)
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Date Fields
- Filled Date -- The date a prescription or medication order was filled, with medications dispensed.
- 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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Medication Fields
- NDC Code 11-Digit -- The standard 11-digit National Drug Code; e.g., 00045012400 = Tylenol 500 mg.
- Label Description -- Supplies the name given to the product by the manufacturer.
- Quantity Dispensed -- The quantity of medication dispensed in the fill. For medications with discrete forms (e.g., tablets, capsules, etc.) this is the number of those discrete units dispensed. For non-discrete forms (e.g., solution, cream, etc.) this is some other measure of quantity, including (but not necessarily) the number of doses dispensed.
- Days Supply -- The number of calendar days, including the date the medication was dispensed, the dispensed medication will last at the patient's intended dosage as defined in their prescription.
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Financial Fields
- Claim Plan Paid Amount -- The amount paid by an insurance plan for all services on a claim.
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Numerator Fields
- Count of Suspected Duplicate Records
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Measure Fields
- Denominator