URSA-PHF-R11: Registry of Clinician Office Visits

  • Published on Apr 23, 2026
  • 9 minute(s) read
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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 Identifier: URSA-PHF-R11
  • 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 -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
    • 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)
    • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
    • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Service Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the service provider. (See also [URSA-CORE] Service Provider)
    • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
    • Provider Group Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the provider group. (See also [URSA-CORE] Provider Group)
    • Patient Primary Payor ID
    • Patient Primary Plan ID

  • Patient Fields

    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • 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 -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period 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 -- A Clinician Office Visit encounter with a primary care provider or in which primary care services were delivered; operationally defined by the presence of one or more of the following: (1) a service provider or attending provider identified as a primary care provider or with a qualifying primary NUCC taxonomy code; or (2) a qualifying HCPCS code for preventive and/or primary care services. (See also [URSA-CORE] 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 -- Indicates the encounter had one or more claim document with a HCPCS, Revenue Center Code, or Place of Service Code specific to Urgent Care Facility claim filing.
    • Is FQHC Encounter
    • Is RHC Encounter

  • Provider Fields

    • Is Any Provider Qualifying Primary Care Provider
    • Service Provider NPI -- The 10-digit National Provider Identifier for the service provider. (See also [URSA-CORE] Service Provider)
    • Service Provider Description -- The natural language description of the service provider; typically, the name of the provider. (See also [URSA-CORE] Service Provider)
    • 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 -- The natural language description of the attending provider; typically, the name of the provider. (See also [URSA-CORE] Attending Provider)
    • Facility Provider Provider NPI
    • Facility Provider Description -- The natural language description of the facility provider. (See also [URSA-CORE] Facility Provider)
    • 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 -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions)
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.
    • Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).
    • Is CCW System Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
    • Is CCW System Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.
    • Is CCW System Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
    • Is CCW System Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.

  • Billing and Claims Fields

    • Qualifying Document CMS Revenue Center Code
    • Qualifying Document CMS Revenue Center Description
    • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
    • CMS Place of Service Description -- The natural language description of a standard CMS Place of Service code (See also [URSA-CORE] CMS Place of Service Code)

  • Financial Fields

    • Encounter Total Plan Paid Amount from All Plans Category
    • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
    • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
    • Total Plan Paid Amount from All Plans
    • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

  • 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