| Atomic Warehouse Model Data Model |
| Description | A modification that is made to a claim after it is adjudicated. An adjustment may occur at the service or line item level or at the claim level. |
| Relationship | |
 Claim Adjustment Detail_Anchor_FK |
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| Primary Key | |
 Claim Adjustment Detail PK |
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| Dependencies | |
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| Reverse Dependencies | |
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| Attribute Details |
Adjusted Units of Service
| Description | The number of units by which the claimed units of service is being adjusted. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Adjustment Amt
| Description | The monetary amount by which the claim is being adjusted. For post payment adjustments this may be the amount by which the claim paid amount is adjusted. For overpayments this will be a negative amount while for underpayments this will be a positive amount. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Adjustment Dt
| Description | The date upon which the adjustment was made. |
| 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 |
Adjustment Reason Code Sk
| Description | Indicates why a claim was adjusted. For example: Additional documentation provided CMO override Contractual obligations Corrected miscoded diagnosis Corrected miscoded procedure Duplicate claim Incorrectly calculated Incorrectly coded diagnostic Incorrectly denied Predetermination, anticipated payment upon completion of services. Severity adjustment |
| 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 |
Claim Adjustment Sk
| Description | Anchor surrogate key for the Encounter 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 |
Claim Adjustment Status Code Sk
| Description | Indicates the status of the adjustment to the claim. For example: Completed Pending Reversed |
| 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 |
Claim Adjustment Type Code Sk
| Description | Indicates the nature of an modification made to a previously adjudicated or finalized claim. For example: Co-insurance Adjustment Non Covered Days/ Room Charge Adjustment |
| 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 |
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 |
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 |
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 Code Sk
| Description | Identifies the actual type of the entry based on the entity 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 |
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 |
Claim Adjustment Detail_Anchor_FK
| Is Identifying Relationship | true |
| Child Table | Claim Adjustment 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 | Claim Adjustment |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Primary Key Details |
Claim Adjustment Detail PK
| Key Attribute | Claim Adjustment Sk |
| Key Attribute | Valid From Ts |
| Atomic Warehouse Model Data Model |