Measure Description
Among institutional claim or bill headers, professional claim or bill service line items, or pharmacy claims with at least one non-NULL allowed amount, plan paid amount, patient responsibility amount, or patient paid amount, the percentage with a negative amount in at least one of those fields.
Metadata
- Measure Type: Rate Measure
- Temporal Structure: Event
- Component Class: Normal-Form
- Denominator Case Field: Document ID
- Target Direction: Down
Denominator Description
One per institutional claim or bill headers, professional claim or bill service line items, or pharmacy claims with at least one non-NULL allowed amount, plan paid amount, patient responsibility amount, or patient paid amount.
Numerator Description
One per qualifying denominator observation with a negative allowed amount, plan paid amount, patient responsibility amount, or patient paid amount.
Published Fields
-
Data Model Keys
- Document ID
- Institutional Claim ID
- Professional Claim Service Line Item ID
- Institutional Bill ID
- Professional Bill Service Line Item ID
- Service Line Number
- Plan ID
- Payor ID
- Source ID
-
Date Fields
- Document Effective Date
- 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)
-
Clinical Services Fields
- HCPCS Code
-
Billing and Claims Fields
- CMS Type of Bill Code
-
Financial Fields
- Document Allowed Amount
- Document Plan Paid Amount
- Document Patient Responsibility Amount
- Document Patient Paid Amount
-
Numerator Fields
- Is Allowed Amount Negative
- Is Plan Paid Amount Negative
- Is Patient Responsibility Amount Negative
- Is Patient Paid Amount Negative
-
Metadata Fields
- Document Type Description
-
Measure Fields
- Denominator