URSA-PHF-R12: Registry of Primary Care Office Visits

Measure Description

One record per Primary Care 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
  • Prior Primary Care Office Visit Encounter 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
  • Primary or Specialty Care Engagement Category

• Date Fields

  • Encounter Date
  • Prior Primary Care Office Visit Encounter Date
  • Days Since Prior Primary Care Office Visit
  • 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

  • Is Preventive Care Visit from Non-Primary Care Specialist
  • Is Annual Wellness Visit
  • Is First AWV with Provider
  • Is Subsequent AWV with Provider
  • Is Initial Preventive Physician Examination (IPPE)
  • Is FQHC Visit for IPPE or AWV
  • Is Urgent Care Visit

• Provider Fields

  • Is Any Provider Qualifying Primary Care Provider
  • Service Provider Provider NPI
  • Service Provider Provider Description
  • Service Provider Primary NUCC Provider Taxonomy Code
  • Service Provider Primary NUCC Provider Taxonomy Description
  • Service Provider Affiliated Provider Group Description
  • Provider Group Description
  • Provider Group Primary NUCC Provider Taxonomy Description
  • Ursa Service Provider Specialty Type Category
  • Primary Plan Attributee Provider Description
  • Empirical Attributee Primary Care Individual Provider Description
  • Empirical Attributee Primary Care Provider Group Provider Description

• Location Fields

  • Service Provider Practice Address State Abbreviation
  • Service Provider Practice Address ZIP Code 5-Digit
  • Provider Group Practice Address State Abbreviation
  • Provider Group Practice Address ZIP Code 5-Digit

• Insurance Fields

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

• Clinical Services Fields

  • Is Qualifying Preventive Primary Care Service
  • Qualifying Document HCPCS Code
  • Qualifying Preventive Primary Care HCPCS Code
  • Qualifying Preventive Primary Care HCPCS Code Description
  • Qualifying Annual Wellness Visit HCPCS Code
  • Qualifying Annual Wellness Visit HCPCS Code Description

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Principal Discharge Diagnosis WHO ICD-10 Chapter Description
  • Principal Discharge Diagnosis WHO ICD-10 Block 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
  • 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

  • CMS Admit Type Description
  • CMS Admit Source Description
  • CMS Patient Discharge Status Description
  • Qualifying Document CMS Revenue Center Code
  • CMS Place of Service Code
  • CMS Admit Type Code
  • CMS Admit Source Code
  • CMS Patient Discharge Status 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

  • Is Qualifying Primary Care Service Provider
  • Is Qualifying Primary Care Attending
  • Is Qualifying Primary Care Provider Group
  • 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