Atomic Warehouse Model Data Model

Entity

Entity Benefit Eligibility Enquiry Detail

Description

An inquiry into whether a member is eligible to receive a specific healthcare benefits.
Such an inquiry will normally occur between a healthcare provider and a health plan organization.

Attributes
Benefit Eligibility Enquiry Sk
Benefit Eligibility Enquiry Type Code Sk
Effective From Dt
Effective To Dt
Enquiring Provider Role Code Sk
Enquiry Response
Load Info Sk
Medicaid Spend Down Amt
Patient Is Subscriber Ind
Proposed Admission Dt
Proposed Eligibility End Dt
Proposed Eligibility Start Dt
Proposed Healthcare Facility Type Code Sk
Proposed Healthcare Task Dt
Proposed Healthcare Task Type Code Sk
Proposed Provider Role Code Sk
Proposed Provider Specialty Code Sk
Source Code Sk
Tenant Sk
Type Of Enquiry Code Sk
Valid From Ts
Valid To Ts

Relationship
Benefit Eligibility Enquiry Detail_Benefit Eligibility Enquiry_FK

Primary Key
Benefit Eligibility Enquiry Detail PK

Dependencies

Reverse Dependencies

Attribute Details

Benefit Eligibility Enquiry Sk

Description	Surrogate key for the anchor entity.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Benefit Eligibility Enquiry Type Code Sk

Description	Code identifying the actual type of the entity as per the type hierarchy defined in the business data model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Effective From Dt

Description	Establishes a period where a set of attributes are true according to the business.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Effective To Dt

Description	Ends a period of effectivity.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Enquiring Provider Role Code Sk

Description	Indicates the healthcare function of the party making the inquiry, where the inquirer is a healthcare provider. For example: Admitting Attending Billing Consulting Covering Home Health Care Hospital Laboratory Other Physician Performing Pharmacist Pharmacy Primary Care Physician Referring Rural Health Clinic Skilled Nursing Facility Submitting Supervising
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Enquiry Response

Description	A textual or codified response to the enquiry. For example: Active coverage Cannot process Inactive pending investigation Not deemed a medical necessity
Data Type	Standards - Data Domains.ddm/Data Domains/Text Medium [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Load Info Sk

Description	The surrogate key of the load information entry describing the details regarding the loading of the row.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Medicaid Spend Down Amt

Description	In the content of the United States Medicaid Program, the amount of healthcare costs that must be met personally before an individual qualifies for Medicaid coverage. This may be the amount that was effective at the time the enquiry was made or the amount by which the individual's spend down amount should be decreased as a result of this medical service occurring.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Patient Is Subscriber Ind

Description	Indicates whether or not the subject of the enquiry is the subscriber or the dependent.
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Admission Dt

Description	The date proposed for the admission where an admission is being enquired about.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Eligibility End Dt

Description	The end of the period for which the enquiring party wish to confirm whether an individual has Health plan membership entitlements.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Eligibility Start Dt

Description	The start of the period for which the enquiring party wish to confirm whether an individual has Health plan membership entitlements.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Healthcare Facility Type Code Sk

Description	Place of Service (POS) codes are two-digit codes, typically placed on healthcare professional claims to indicate the setting in which a healthcare task was executed. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes. This relates to a specific medical service being proposed or enquired about. For example: 11 OFFICE 53 COMMUNITY MENTAL HEALTH CENTER
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Healthcare Task Dt

Description	The date proposed for a healthcare task, where a particular healthcare task is being enquired about.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Healthcare Task Type Code Sk

Description	Indicates the type of healthcare task being enquired about. For example: Anesthesia Blood Charges Consultation Diagnostic Lab Diagnostic X-Ray Medical Care Other Medical Radiation Therapy Surgical Surgical Assistance Used Durable Medical Equipment
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Provider Role Code Sk

Description	Indicates the role of the proposed provider in relation to the medical service being enquired about. For example: Admitting Attending Billing Consulting Covering Home Health Care Hospital Laboratory Other Physician Performing Pharmacist Pharmacy Primary Care Physician Referring Rural Health Clinic Skilled Nursing Facility Submitting Supervising
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Proposed Provider Specialty Code Sk

Description	Indicates the medical specialty required by a healthcare provider to carry out the medical service being enquired about.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Source Code Sk

Description	The origin of the data identifying the actual load source, vendor, manual key entry, or context of the data in a specific row in the database.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Tenant Sk

Description	The surrogate key of the entry identifying the legal owner of the data.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Type Of Enquiry Code Sk

Description	Indicates the nature of the benefit eligibility enquiry.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Valid From Ts

Description	Establishes a period where a set of attributes are true in the source system. This would be populated with the transaction timestamp and would be used for the snapshot date.
Data Type	Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Valid To Ts

Description	Ends a period of validity.
Data Type	Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Relationship Details

Benefit Eligibility Enquiry Detail_Benefit Eligibility Enquiry_FK

Is Identifying Relationship	true
Child Table	Benefit Eligibility Enquiry Detail
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Benefit Eligibility Enquiry
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

Benefit Eligibility Enquiry Detail PK

Key Attribute	Benefit Eligibility Enquiry Sk
Key Attribute	Valid From Ts

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Atomic Warehouse Model Data Model