Entity Coverage Eligibility Detail

DescriptionAn agreement that summarizes the particulars of an Insured's policy as known by the organization.

Attributes
Agreement Status ReasonAgreement Status Reason
Agreement Type Code SkAgreement Type Code Sk
Assignment Of Benefits Code SkAssignment Of Benefits Code Sk
Average Semi-Private Room Rate AmtAverage Semi-Private Room Rate Amt
Baby Coverage IndBaby Coverage Ind
Blood DeductibleBlood Deductible
Bound DtBound Dt
Certification Required IndCertification Required Ind
COBRA IndCOBRA Ind
Coinsurance AmtCoinsurance Amt
Combine Baby Bill IndCombine Baby Bill Ind
Company Plan Code SkCompany Plan Code Sk
Confidentiality IndConfidentiality Ind
Coordination Of Benefits Code SkCoordination Of Benefits Code Sk
Coordination Of Benefits Priority CntCoordination Of Benefits Priority Cnt
County NmCounty Nm
Coverage Eligibility SkCoverage Eligibility Sk
Coverage Type Code SkCoverage Type Code Sk
Currency Code SkCurrency Code Sk
Daily Deductible AmtDaily Deductible Amt
Daily Deductible Applicable Days CntDaily Deductible Applicable Days Cnt
Daily Deductible Delay Days CntDaily Deductible Delay Days Cnt
Delay Before LR Day CntDelay Before LR Day Cnt
Effective From DtEffective From Dt
Effective To DtEffective To Dt
ER Copay AmtER Copay Amt
Group NumGroup Num
Group Status Code SkGroup Status Code Sk
Insurance Plan NumInsurance Plan Num
IP Copay AmtIP Copay Amt
Lifetime Reserved Days CntLifetime Reserved Days Cnt
Line Of BusinessLine Of Business
Load Info SkLoad Info Sk
Max Private Room Rate AmtMax Private Room Rate Amt
MCP Copay AmtMCP Copay Amt
Medicaid Case NumMedicaid Case Num
Next Renewal DtNext Renewal Dt
Next Review DtNext Review Dt
Non-Certification Penalty AmtNon-Certification Penalty Amt
Notice Of Admission IndNotice Of Admission Ind
Office Visit Copay AmtOffice Visit Copay Amt
Part A Termination Reason Code SkPart A Termination Reason Code Sk
Part B Termination Reason Code SkPart B Termination Reason Code Sk
Pharmacy Copay AmtPharmacy Copay Amt
Pharmacy Join IndPharmacy Join Ind
Plan Effective DtPlan Effective Dt
Plan Expiration DtPlan Expiration Dt
Planned End DtPlanned End Dt
Plan Type Code SkPlan Type Code Sk
Policy Deductible AmtPolicy Deductible Amt
Policy Max Limit AmtPolicy Max Limit Amt
Policy Max Limit Days CntPolicy Max Limit Days Cnt
Policy NumPolicy Num
Policy Scope Code SkPolicy Scope Code Sk
Policy Source Code SkPolicy Source Code Sk
Policy StatusPolicy Status
Policy Type Code SkPolicy Type Code Sk
Prior Plan Code NumPrior Plan Code Num
Release Of Information Code SkRelease Of Information Code Sk
Report Of Eligibility IndReport Of Eligibility Ind
Room Coverage Amount Type Code SkRoom Coverage Amount Type Code Sk
Room Coverage AmtRoom Coverage Amt
Room Coverage Type Code SkRoom Coverage Type Code Sk
Source Code SkSource Code Sk
Special Coverage Approval Title TxtSpecial Coverage Approval Title Txt
State NmState Nm
Tenant SkTenant Sk
Valid From TsValid From Ts
Valid To TsValid To Ts

Relationship
Provider Patient Insurance Detail_Provider Patient Insurance_FKProvider Patient Insurance Detail_Provider Patient Insurance_FK

Primary Key
Coverage Eligibility Detail PKCoverage Eligibility Detail PK

Dependencies
 
 

Reverse Dependencies
 

Attribute Details

 Agreement Status Reason
DescriptionIndicates the motivation or cause for changing the status of the coverage agreement.

For example:
Not eligible (if agreement rejected)
Not taken up (if agreement rejected)
Data TypeStandards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Agreement Type Code Sk
DescriptionUsed to further identify an insurance plan.
For example:
S - Standard
U - Unified
M - Maternity
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Assignment Of Benefits Code Sk
DescriptionIndicates the insured's elected assignment of benefits. If the insured agreed to assign the insurance benefits to the healthcare provider, the insurance will pay the provider directly.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Semi-Private Room Rate Amt
DescriptionThe average room rate that the policy covers.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Baby Coverage Ind
DescriptionIndicates whether or not the baby is included in the coverage.
Y - baby coverage
N - no baby coverage
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Blood Deductible
DescriptionUse this field instead of UB1-2 - Blood Deductible, as the blood deductible can be associated with the specific insurance plan via this field.
Data TypeStandards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Bound Dt
DescriptionThe date upon which the coverage agreement is considered legally binding, or in force. Depending on the legislation the bound date can be the date when the coverage agreement is signed by both parties and/or when the first premium has been paid.
Derived from the status related information.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Certification Required Ind
DescriptionIndicates whether certification is required.
Y - certification required
N - certification not required
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 COBRA Ind
DescriptionIndicates if this eligibility is being retained under COBRA program.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Coinsurance Amt
DescriptionThe amount of insurance liability assumed by the Member.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Combine Baby Bill Ind
DescriptionIndicates whether or not to combine baby bill.
Y - combine bill
N - normal billing
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Company Plan Code Sk
DescriptionOptional information to further define the data in Insurance Company Id.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Confidentiality Ind
DescriptionIndicates whether or not this member's data is confidential.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Coordination Of Benefits Code Sk
DescriptionIdentifies whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. 
For example:
CO - Coordination
IN - Independent
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Coordination Of Benefits Priority Cnt
DescriptionIf the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 County Nm
DescriptionName of the county for the address.
Data TypeStandards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Coverage Eligibility Sk
DescriptionThe anchor surrogate key for the Provider Patient Insurance data.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Coverage Type Code Sk
DescriptionIdentifies the type of insurance coverage, or what types of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans that cover physician/professional charges.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Currency Code Sk
DescriptionIndicates the currency as selected by the customer to be used on any monetary information provided to the customer.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Daily Deductible Amt
DescriptionThe amount of the deductible.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Daily Deductible Applicable Days Cnt
DescriptionThe number of days to apply the deductible.
If "number of days" is not valued, the deductible is ongoing.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Daily Deductible Delay Days Cnt
DescriptionThe number of days after which the daily deductible begins.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Delay Before LR Day Cnt
DescriptionThe delay before lifetime reserve days.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Effective From Dt
DescriptionEstablishes a period where a set of attributes are true according to the business.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Effective To Dt
DescriptionEnds a period of effectivity.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 ER Copay Amt
DescriptionAmount of the Copay for ER Visit expenses.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Group Num
DescriptionThe group number of the insured's insurance.
Data TypeStandards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Group Status Code Sk
DescriptionIndicates the state or status of the plan member's health plan group.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Insurance Plan Num
DescriptionA unique identifier for the insurance plan associated with this coverage eligibility record.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 IP Copay Amt
DescriptionAmount of the Copay for Inpatient Visit expenses.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Lifetime Reserved Days Cnt
DescriptionThe number of days left for a certain service to be provided or covered under an insurance policy.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Line Of Business
DescriptionIndicates the nature of commercial enterprise of the modeled organization.
Data TypeStandards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Load Info Sk
DescriptionThe surrogate key of the load information entry describing the details regarding the loading of the row.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Max Private Room Rate Amt
DescriptionThe maximum private room rate that the policy covers.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 MCP Copay Amt
DescriptionAmount of the Copay for Managed Care Program.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medicaid Case Num
DescriptionThe Medicaid case number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's Medicaid policy.
Data TypeStandards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Next Renewal Dt
DescriptionThe next date at which the enforce status of the coverage agreement must be re-evaluated or re-conducted.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Next Review Dt
DescriptionThe date upon which a review of the coverage agreement is planned.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Non-Certification Penalty Amt
DescriptionThe penalty that will be assessed if the pre-certification is not performed. Can be an absolute value or a percentage.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Notice Of Admission Ind
DescriptionIndicates whether or not the insurance company requires a written notice of admission from the healthcare provider.
Y - written notice of admission required
N - no notice required
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Office Visit Copay Amt
DescriptionAmount of the Copay for Office Visit expenses.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Part A Termination Reason Code Sk
DescriptionIndicates the reason that the Medicare Part A coverage ended for the plan member.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Part B Termination Reason Code Sk
DescriptionIndicates the reason that the Medicare Part B coverage ended for plan member.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Pharmacy Copay Amt
DescriptionAmount of the Copay for Pharmacy expenses.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Pharmacy Join Ind
DescriptionIndicates whether or not the plan member has joined a pharmacy program.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Plan Effective Dt
DescriptionThe date upon which the coverage agreement first starts. For renewable coverage agreements, this date represents the date of the original coverage agreement before any renewal.
Derived from the status related information.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Plan Expiration Dt
DescriptionThe date upon which the coverage agreement actually terminates. This may pre- or post-date the Planned End Date. For example, early termination of a contract due to poor performance. The termination date of the coverage agreement is also represented in the status date for the terminated status.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Planned End Dt
DescriptionThe date upon which the end of the coverage agreement is planned.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Plan Type Code Sk
DescriptionIndicates the type of health plan associated with this coverage eligibility record.
For example:
Medicare
Medicaid
Blue Cross
HMO
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Deductible Amt
DescriptionThe amount specified by the insurance plan that is the responsibility of the guarantor (i.e. deductible, excess, etc.).
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Max Limit Amt
DescriptionThe maximum amount that the insurance policy will pay. In some cases, the limit may be for a single encounter.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Max Limit Days Cnt
DescriptionThe maximum number of days that the insurance policy will cover.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Num
DescriptionThe individual policy number of the insured to uniquely identify this patient's plan.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Scope Code Sk
DescriptionIdentifies the extent of the coverage for a participating member.
For example:
Single
Family
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Source Code Sk
DescriptionIndicates how or from what source the policy information was established.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Status
DescriptionIndicates the coverage agreement's current status.

For Example:
Active
Cancelled
Expired
Final
In Force
In Process
Initial
Lapsed
Not taken up
Offered
Rejected
Suspended
Terminated
Under Negotiation
Data TypeStandards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Policy Type Code Sk
DescriptionIndicates the type of the policy covered by the insurance.
For example:
Ancillary
Major medical
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Prior Plan Code Num
DescriptionUniquely identifies the prior insurance plan when the plan ID changes.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Release Of Information Code Sk
DescriptionIndicates whether the provider has a signed statement on file permitting the release of medical data to other organizations.
For example:
- Appropriate Release of Information on File at Health Care Service Provider or at Utilization Review Organization
- Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes
- The Provider has Limited or Restricted Ability to Release Data Related to a Claim
- No, Provider is Not Allowed to Release Data
- On file at Payor or at Plan Sponsor
- Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Report Of Eligibility Ind
DescriptionIndicates whether or not this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits.
Y - eligibility report is sent
N - no eligibility report is sent
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Room Coverage Amount Type Code Sk
DescriptionIndicates the type of amount covered by the insurance.
For example:
Limit
Percentage
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Room Coverage Amt
DescriptionThe amount covered by the insurance for a room.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Room Coverage Type Code Sk
DescriptionIndicates the room type covered by the insurance.
For example:
Private
Semi-private
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Source Code Sk
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Special Coverage Approval Title Txt
DescriptionThe title of the person who approves special coverage.
Data TypeStandards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 State Nm
DescriptionThe state of a country in which the insurance policy is underwritten.
Data TypeStandards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Tenant Sk
DescriptionThe surrogate key of the entry identifying the legal owner of the data.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Valid From Ts
DescriptionEstablishes 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 TypeStandards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Valid To Ts
DescriptionEnds a period of validity.
Data TypeStandards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse

Relationship Details

 Provider Patient Insurance Detail_Provider Patient Insurance_FK
Is Identifying Relationshiptrue
Child TableCoverage Eligibility Detail
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableCoverage Eligibility
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE

Primary Key Details

 Coverage Eligibility Detail PK
Key AttributeCoverage Eligibility Sk
Key AttributeValid From Ts