URSA-PHF-R10: Registry of Claim Service Financials

Measure Description

One record per pharmacy claim, medical claim, or medical claim service line item with a non-zero allowed or paid amount; this object contains line-level data for patient-source pairs in which claims data from that source include line-level paid amounts, and header-level data otherwise; only records (of any grain) with a non-zero allowed amount, plan paid amount, or patient paid amount field will be included.

Metadata

• Measure Type: Registry
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Document ID
• Target Direction: None

Published Fields

• Data Model Keys

  • Document ID
  • Claim ID
  • Claim Service Line Item ID
  • Patient ID
  • Billing Provider ID
  • Payor ID
  • Plan ID
  • Source ID

• Date Fields

  • Document Effective Date
  • Document Effective Date Text YYYYMM
  • 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)

• Encounter Fields

  • Ursa Encounter Type Tier 1 Category
  • Ursa Encounter Type Tier 2 Category
  • Ursa Surgery Encounter Type Category

• Provider Fields

  • Ursa Setting Tier 1 Description
  • Billing Provider Description
  • CMS Type of Bill Code
  • CMS Place of Service Code
  • CMS Place of Service Description

• Insurance Fields

  • Claim Financial Class Description
  • Medicare Benefit Type Category

• Clinical Services Fields

  • Ursa Service Type Tier 1 Description
  • HCPCS Code
  • HCPCS Description
  • CMS Revenue Center Code
  • CMS Revenue Center Description

• Medication Fields

  • NDC Code
  • Label Description
  • AHFS Therapeutic Class Tier 1 Description
  • AHFS Therapeutic Class Tier 2 Description

• Diagnosis Fields

  • Principal Diagnosis ICD-10-CM Code
  • Principal Diagnosis ICD-10-CM Description
  • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
  • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description

• Billing and Claims Fields

  • Document Type Category
  • Claim Class Category
  • Is Claim Class Institutional
  • Is Claim Class Professional
  • Is Claim Class Pharmacy

• Financial Fields

  • Document Allowed Amount
  • Document Plan Paid Amount
  • Document Patient Responsibility Amount
  • Document Patient Paid Amount

• Measure Fields

  • Denominator

• Module Fields