URSA-PHF-R11: Registry of Clinician Office Visits

Measure Description

One record Clinician Office Visit with published characteristics about the patient (plan membership, chronic conditions, etc.) as of the encounter date as well as flag for whether the visit was with a plan or empirically attributed provider.

Metadata

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

Published Fields

• Data Model Keys

  • Encounter ID
  • Patient ID
  • Encounter Primary Payor ID
  • Encounter Primary Plan ID
  • Facility Provider ID
  • Service Provider ID
  • Attending Provider ID
  • Provider Group Provider ID
  • Patient Primary Payor ID
  • Patient Primary Plan ID

• Patient Fields

  • Patient Date of Birth
  • Patient Age Integer
  • Patient Age Category Tier 1
  • Patient Age Category Tier 2
  • Patient Sex Category
  • PCP Attribution Category
  • Primary Care Engagement Category
  • Specialty Care Engagement Category
  • Count Specialty Care Office Visits in Last 36 Months
  • Primary or Specialty Care Engagement Category

• Date Fields

  • Encounter Date
  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership Episode End 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)

• Encounter Fields

  • Ursa Clinician Office Visit Type Tier 1 Category
  • Ursa Clinician Office Visit Type Tier 2 Category
  • Is Primary Care Clinician Office Visit
  • Is Specialist Clinician Office Visit
  • Is Encounter with Qualifying Preventive Primary Care Service
  • Is Preventive Care Visit from Non-Primary Care Specialist
  • Is Annual Wellness Visit Encounter
  • Is Urgent Care Visit

• Provider Fields

  • Is Any Provider Qualifying Primary Care Provider
  • Service Provider NPI
  • Service Provider Description
  • Service Provider Primary NUCC Provider Taxonomy Description
  • Provider Group Provider NPI
  • Provider Group Description
  • Provider Group Primary NUCC Provider Taxonomy Description
  • Attending Provider Provider NPI
  • Attending Provider Description
  • Facility Provider Provider NPI
  • Facility Provider Description
  • Ursa Physician Specialty Type Description
  • Primary Plan Attributee Provider Description
  • Empirical Attributee Primary Care Individual Provider Description
  • Empirical Attributee Primary Care Provider Group Provider Description

• Insurance Fields

  • Is Any Current Plan Membership
  • Patient Primary Payor Description
  • Patient Primary Plan Description
  • Primary Plan Financial Class Description

• Clinical Services Fields

  • Qualifying Document HCPCS Code
  • Qualifying Document HCPCS Short Description
  • Qualifying Document HCPCS AHRQ CCS Single-Level Procedure Category Code
  • Qualifying Document HCPCS AHRQ CCS Single-Level Procedure Category Description
  • Qualifying Preventive Primary Care HCPCS Code
  • Qualifying Preventive Primary Care HCPCS Code Description

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
  • Principal Discharge Diagnosis WHO ICD-10 Chapter Description
  • Principal Discharge Diagnosis WHO ICD-10 Block Description
  • CCW Count Category
  • Count CCW Conditions
  • CCW Systems Category
  • Count CCW Systems
  • Is CCW System Behavioral Health
  • Is CCW System Cardiovascular
  • Is CCW System Congenital
  • Is CCW System Endocrine/Metabolic
  • Is CCW System Genitourinary
  • Is CCW System Hematologic
  • Is CCW System Musculoskeletal
  • Is CCW System Neurological
  • Is CCW System Oncologic
  • Is CCW System Ophthalmologic
  • Is CCW System Pulmonary
  • Is CCW System Other

• Billing and Claims Fields

  • Qualifying Document CMS Revenue Center Code
  • Qualifying Document CMS Revenue Center Description
  • CMS Place of Service Code
  • CMS Place of Service Description

• Financial Fields

  • Encounter Total Plan Paid Amount from All Plans Category
  • Primary Plan Allowed Amount
  • Primary Plan Paid Amount
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount

• Metadata Fields

  • Qualifying Document EMR Encounter Type Description

• Measure Fields

  • Is Visit with Primary Plan Attributee Provider
  • Is Visit with Empirical Attributee Primary Care Individual
  • Is Visit with Empirical Attributee Primary Care Provider Group