| Atomic Warehouse Model Data Model |
Description | An agreement that summarizes the particulars of an Insured's policy as known by the organization. |
Relationship | |
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Primary Key | |
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Dependencies | |
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Reverse Dependencies | |
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Attribute Details |
Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Used to further identify an insurance plan. For example: S - Standard U - Unified M - Maternity |
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 |
Description | Indicates 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 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 |
Description | The average room rate that the policy covers. |
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 |
Description | Indicates whether or not the baby is included in the coverage. Y - baby coverage N - no baby coverage |
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 |
Description | Use this field instead of UB1-2 - Blood Deductible, as the blood deductible can be associated with the specific insurance plan via this field. |
Data Type | Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Date [DATE] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Indicates whether certification is required. Y - certification required N - certification not required |
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 |
Description | Indicates if this eligibility is being retained under COBRA program. |
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 |
Description | The amount of insurance liability assumed by the Member. |
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 |
Description | Indicates whether or not to combine baby bill. Y - combine bill N - normal billing |
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 |
Description | Optional information to further define the data in Insurance Company Id. |
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 |
Description | Indicates whether or not this member's data is confidential. |
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 |
Description | Identifies 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 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 |
Description | If the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc. |
Data Type | Standards - Data Domains.ddm/Data Domains/Small Counter [SHORT] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Name of the county for the address. |
Data Type | Standards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The anchor surrogate key for the Provider Patient Insurance data. |
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 |
Description | Identifies 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 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 |
Description | Indicates the currency as selected by the customer to be used on any monetary information provided to the customer. |
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 |
Description | The amount of the deductible. |
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 |
Description | The number of days to apply the deductible. If "number of days" is not valued, the deductible is ongoing. |
Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The number of days after which the daily deductible begins. |
Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The delay before lifetime reserve days. |
Data Type | Standards - Data Domains.ddm/Data Domains/Count [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
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 |
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 |
Description | Amount of the Copay for ER Visit expenses. |
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 |
Description | The group number of the insured's insurance. |
Data Type | Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Indicates the state or status of the plan member's health plan group. |
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 |
Description | A unique identifier for the insurance plan associated with this coverage eligibility record. |
Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Amount of the Copay for Inpatient Visit expenses. |
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 |
Description | The number of days left for a certain service to be provided or covered under an insurance policy. |
Data Type | Standards - Data Domains.ddm/Data Domains/Count [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Indicates the nature of commercial enterprise of the modeled organization. |
Data Type | Standards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
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 |
Description | The maximum private room rate that the policy covers. |
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 |
Description | Amount of the Copay for Managed Care Program. |
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 |
Description | The Medicaid case number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's Medicaid policy. |
Data Type | Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The next date at which the enforce status of the coverage agreement must be re-evaluated or re-conducted. |
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 |
Description | The date upon which a review of the coverage agreement is planned. |
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 |
Description | The penalty that will be assessed if the pre-certification is not performed. Can be an absolute value or a percentage. |
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 |
Description | Indicates 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 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 |
Description | Amount of the Copay for Office Visit expenses. |
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 |
Description | Indicates the reason that the Medicare Part A coverage ended for the plan member. |
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 |
Description | Indicates the reason that the Medicare Part B coverage ended for plan member. |
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 |
Description | Amount of the Copay for Pharmacy expenses. |
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 |
Description | Indicates whether or not the plan member has joined a pharmacy program. |
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 |
Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Date [DATE] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Date [DATE] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The date upon which the end of the coverage agreement is planned. |
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 |
Description | Indicates the type of health plan associated with this coverage eligibility record. For example: Medicare Medicaid Blue Cross HMO |
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 |
Description | The amount specified by the insurance plan that is the responsibility of the guarantor (i.e. deductible, excess, etc.). |
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 |
Description | The maximum amount that the insurance policy will pay. In some cases, the limit may be for a single encounter. |
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 |
Description | The maximum number of days that the insurance policy will cover. |
Data Type | Standards - Data Domains.ddm/Data Domains/Small Counter [SHORT] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The individual policy number of the insured to uniquely identify this patient's plan. |
Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Identifies the extent of the coverage for a participating member. For example: Single Family |
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 |
Description | Indicates how or from what source the policy information was established. |
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 |
Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Indicates the type of the policy covered by the insurance. For example: Ancillary Major medical |
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 |
Description | Uniquely identifies the prior insurance plan when the plan ID changes. |
Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | Indicates 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 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 |
Description | Indicates 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 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 |
Description | Indicates the type of amount covered by the insurance. For example: Limit Percentage |
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 |
Description | The amount covered by the insurance for a room. |
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 |
Description | Indicates the room type covered by the insurance. For example: Private Semi-private |
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 |
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 |
Description | The title of the person who approves special coverage. |
Data Type | Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The state of a country in which the insurance policy is underwritten. |
Data Type | Standards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
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 |
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 |
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 |
Is Identifying Relationship | true |
Child Table | Coverage Eligibility 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 | Coverage Eligibility |
Parent Multiplicity | ONE |
Parent Referential Integrity: On Delete | NONE |
Parent Referential Integrity: On Insert | NONE |
Parent Referential Integrity: On Update | NONE |
Primary Key Details |
Key Attribute | Coverage Eligibility Sk |
Key Attribute | Valid From Ts |
| Atomic Warehouse Model Data Model |