Atomic Warehouse Model Data Model

Entity

Entity Plan Member Detail

Description

A person that is covered by a health plan.

Attributes
Birth Dt
Birthplace Nm
Citizenship Country Code Sk
Contact Person Reason Code Sk
Continuous Cover Maintained Ind
Current Entitlement Reason Code Sk
Dependent Of Military Recipient Code Sk
Disability Code Sk
Disability Status Code Sk
Effective From Dt
Effective To Dt
Employee Num
Employer Contact Reason Code Sk
Employment End Ts
Employment Start Ts
Employment Status Code Sk
Encounter Participation Pct
ESRD Ind
Fraud and Abuse Ind
Gender Code Sk
Guarantor Relationship Code Sk
Healthcare Insurer Contact Reason Code Sk
Healthcare Insurer Patient Member Num
Health Program Participation Status
Job Class Code Sk
Job Status Code Sk
Job Title Nm
Language Code Sk
Level1 Txt
Level2 Txt
Level3 Txt
Level4 Txt
Living Arrangement Code Sk
Living Dependency Code Sk
Load Info Sk
Marital Status Code Sk
Medicare Health Insurance Card Num
Medicare Status Code Sk
Member Card Group Num
Member Card ID Num
Military Handicapped Program Code Sk
Military ID Num
Military Non-Avail Cert On File Ind
Military Organization Nm
Military Rank Code Sk
Military Retire Dt
Military Service Code Sk
Military Station Nm
Military Status Code Sk
Multiple Coverage Status
Multiple Coverage Status Reason
Nationality Country Code Sk
Original Entitlement Reason Code Sk
Personal Data Access Status
Personal Health Record Usage Type
Plan Member Sk
Protection Ind
Publicity Code Sk
Religion Code Sk
Social Security Num
Source Code Sk
Student Ind
Supplied Date Of Birth
Tenant Sk
Valid From Ts
Valid To Ts
VIP Code Sk

Relationship
Plan Member Detail_Plan Member_FK

Primary Key
Plan Member Detail PK

Dependencies

Reverse Dependencies

Attribute Details

Birth Dt

Description	Date of birth of the insured.
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

Birthplace Nm

Description	A textual description of the place an individual was born.
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

Citizenship Country Code Sk

Description	Indicates the insured's country of citizenship.
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

Contact Person Reason Code Sk

Description	A textual description of the reason(s) a person should be contacted regarding the insured.
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

Continuous Cover Maintained Ind

Description	Indicates whether the plan member maintained continuous coverage without an interruption of a specified number of days, prior to enrollment with the health plan organization. 1 Yes 0 No
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

Current Entitlement Reason Code Sk

Description	indicates why an individual is still in an entitlement program.
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

Dependent Of Military Recipient Code Sk

Description	Specifies if the individual is a military recipient dependent.
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

Disability Code Sk

Description	Indicates the nature of an individual's disability. For example: Wheelchair bound Visually impaired Deaf
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

Disability Status Code Sk

Description	Indicates any permanent or transient handicapped conditions. Also known as ambulatory status.
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

Employee Num

Description	The insured's employee number.
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

Employer Contact Reason Code Sk

Description	A textual description of the reason(s) that an employer of an individual.
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

Employment End Ts

Description	The date and time that the employment ended.
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

Employment Start Ts

Description	The date and time that the employment began.
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

Employment Status Code Sk

Description	Indicates the current employment status of an individual. For example: Full time employed Part time employed Self-employed, Contract, per diem Leave of absence (for example, Family leave, sabbatical, etc.) Temporarily unemployed Unemployed Retired On active military duty Other Unknown
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

Encounter Participation Pct

Description	The plan member's attendance at scheduled treatment, therapy, encounters or other program sessions expressed as a percentage of the number of scheduled encounters.
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

ESRD Ind

Description	Indication of whether the individual is in End State Renal Disease.
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

Fraud and Abuse Ind

Description	Indicates whether a plan member has been found to have submitted fraudulent claims or to have abused their cover or acted suspiciously in some other way. May also indicate that the plan member is currently under investigation for such behavior.
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

Gender Code Sk

Description	Identifies the gender of an individual.
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

Guarantor Relationship Code Sk

Description	Indicates the relationship of the guarantor to the insured.
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

Healthcare Insurer Contact Reason Code Sk

Description	Indicates how and why the healthcare insurer should be contacted. For example: Medicare claim status Medicaid claim status Name/address change
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

Healthcare Insurer Patient Member Num

Description	An identifying number assigned by the payor for each individual covered by the insurance policy issued to the insured. For example, each individual family member may have a different member number from the insurance policy number issued to the head of household.
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

Health Program Participation Status

Description	Indicates the current participation state of a member in a health program., such as a disease management program, prevention and wellness program, smoking cessation program.
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

Job Class Code Sk

Description	Indicates the classification of an individual's job.
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

Job Status Code Sk

Description	Indicates the current status of an individual's job.
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

Job Title Nm

Description	Descriptive name of the individual's occupation. For example: Systems Analyst Accountant
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

Language Code Sk

Description	Identifies a language an individual can speak, read and / or write. May also identify the language or dialect in which a comment or text is recorded.
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

Level1 Txt

Description	An employer group defined element defining a level of employee, such as division, region, pay grade, etc.”
Data Type	Standards - Data Domains.ddm/Data Domains/Text Very Small [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Level2 Txt

Description	An employer group defined element defining a level of employee, such as division, region, pay grade, etc.”
Data Type	Standards - Data Domains.ddm/Data Domains/Text Very Small [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Level3 Txt

Description	An employer group defined element defining a level of employee, such as division, region, pay grade, etc.”
Data Type	Standards - Data Domains.ddm/Data Domains/Text Very Small [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Level4 Txt

Description	An employer group defined element defining a level of employee, such as division, region, pay grade, etc.”
Data Type	Standards - Data Domains.ddm/Data Domains/Text Very Small [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Living Arrangement Code Sk

Description	Indicates the situation that an individual lives in at his/her residential address. For example: A - Alone F - Family I - Institution R - Relative U - Unknown S - Spouse Only
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

Living Dependency Code Sk

Description	Indicates any dependency that relates to an individual in their day to day lives. For example: S Spouse Dependent M Medical Supervision Required C Small Children Dependent O Other U Unknown
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

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

Marital Status Code Sk

Description	Indicates the current marital status of an individual. For example: Married Single Divorced Widow
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

Medicare Health Insurance Card Num

Description	Medicare Health Insurance Number (HIN), defined by CMS or other regulatory agencies.
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

Medicare Status Code Sk

Description	Indicates the status of an individual in a Medicare program.
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

Member Card Group Num

Description	The health plan's group number that appears on the membership card.
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

Member Card ID Num

Description	A plan member's unique identifier appearing on the membership card.
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

Military Handicapped Program Code Sk

Description	Indicates a military program for the handicapped in which the individual is enrolled.
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

Military ID Num

Description	Military ID number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's military 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

Military Non-Avail Cert On File Ind

Description	Indicates whether or not a military non-available certificate is on file.
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

Military Organization Nm

Description	Description of the military organization to which the individual is associated.
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

Military Rank Code Sk

Description	Identifies the military rank/grade of an individual.
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

Military Retire Dt

Description	The date upon which the individual retired from the military service.
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

Military Service Code Sk

Description	The military service branch of the individual as defined by CMS or other regulatory agencies. For example: USA US Army USN US Navy USAF US Air Force USMC US Marine Corps USCG US Coast Guard USPHS US Public Health Service NOAA National Oceanic and Atmospheric Administration NATO North Atlantic Treaty Organization AUSA Australian Army AUSN Australian Navy AUSAF Australian Air Force
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

Military Station Nm

Description	Description of a specific military station.
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

Military Status Code Sk

Description	The military status of an individual as defined by CMS or other regulatory agencies. For example: ACT Active duty RET Retired DEC Deceased
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

Multiple Coverage Status

Description	Indicates whether or not plan members are currently covered for the same benefits under two or more policies.
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

Multiple Coverage Status Reason

Description	Indicates why the plan member is covered for the same benefits under two or more policies.
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

Nationality Country Code Sk

Description	Indicates the nation or national grouping to which a person belongs. This information may be different from a person's citizenship in countries in which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.).
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

Original Entitlement Reason Code Sk

Description	Indicates why the individual was in an entitlement program to begin with.
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

Personal Data Access Status

Description	Indicates whether a plan member has access to the personal data relating to them, stored internally by the healthcare insurer or benefits provider, for example their employer. For example: Yes No
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

Personal Health Record Usage Type

Description	Indicates the level of interaction a member has with their personal health record.
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

Plan Member Sk

Description	Surrogate key for 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

Protection Ind

Description	Identifies the individual's protection, which determines whether or not access to information about this person should be restricted from users who do not have adequate authority. 1 restrict access 0 do not restrict access
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

Publicity Code Sk

Description	Indicates what level of publicity is allowed for an individual. For example: No Publicity Family Only
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

Religion Code Sk

Description	Indicates the religion practiced by an individual.
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

Social Security Num

Description	The individual's social security number.
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

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

Student Ind

Description	Indicates whether the individual is currently a student, and whether the individual is a full-time or part-time student. 1 Student 0 Not a student
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

Supplied Date Of Birth

Description	The date of birth submitted for the plan member, that was the contractual basis for the membership. This may subsequently be discovered to be incorrect and therefore differing to the actual date of birth at the person level.
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

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

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

VIP Code Sk

Description	Indicates that the individual is considered a very important person (VIP) such as ahead of state or religious leader.
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

Relationship Details

Plan Member Detail_Plan Member_FK

Is Identifying Relationship	true
Child Table	Plan Member 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	Plan Member
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

Plan Member Detail PK

Key Attribute	Plan Member Sk
Key Attribute	Valid From Ts

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Atomic Warehouse Model Data Model