Business Data Model Data Model

Entity

Entity Plan Member

Description

A person that is covered by a health plan.

Attributes
Birth Date
Birthplace Name
Contact Person Reason
Continuous Cover Maintained Ind
Current Entitlement Reason
Dependent Of Military Recipient
Disability Status
Disability Type
Employee Num
Employer Contact Reason
Employment End Date Ts
Employment Start Date Ts
Employment Status
Encounter Participation Pct
ERSD Ind
Fraud and Abuse Ind
Gender
Guarantor Relationship
Healthcare Insurer Contact Reason
Healthcare Insurer Patient Member Num
Health Program Participation Status
Job Class
Job Status
Job Title
Language
Living Arrangement
Living Dependency
Marital Status
Medicare Health Insurance Card Num
Medicare Status
Member Card Group Num
Member Card ID Num
Member Citizenship Country
Military Handicapped Program
Military Id
Military Non-Avail Cert On File Ind
Military Organization
Military Rank
Military Retire Date
Military Service
Military Station
Military Status
Multiple Coverage Status
Multiple Coverage Status Reason
Nationality Country
Original Entitlement Reason
Personal Data Access Status
Personal Health Record Usage Type
Protection Ind
Publicity Level
Religion Type
Social Security Num
Student Status
Supplied Date Of Birth
VIP

Relationship
is PCP for
Plan Member_Point Of Care Device_FK

Generalization
Generalization1

Dependencies
NONE

Reverse Dependencies

Attribute Details

Birth Date

Description	Date of birth of the plan member.
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 Name

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

Contact Person Reason

Description	Indicates why a person should be contacted regarding the plan member.
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

Continuous Cover Maintained Ind

Description	An indicator that shows whether the plan member maintained continuous coverage without interruption of a specified number of days, before enrollment with the health plan organization. For example: 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

Description	Indicates why an individual is still in an entitlement 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

Dependent Of Military Recipient

Description	Specifies if the individual is a military recipient dependent.
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

Disability Status

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

Disability Type

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

Employee Num

Description	The plan member'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

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

Employment End Date 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 Date 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

Description	The 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/Enumeration [VARCHAR(20)]
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

ERSD 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

Description	Identifies the gender of an individual.
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

Guarantor Relationship

Description	Indicates the relationship of the guarantor to the plan member.
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

Healthcare Insurer Contact Reason

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/Enumeration [VARCHAR(20)]
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

Description	Indicates the classification of an individual's job.
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 Status

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

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

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Living Arrangement

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Living Dependency

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Marital Status

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

Medicare Health Insurance Card Num

Description	The Medicare Health Insurance Number (HIN), assigned 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

Description	Indicates the status of an individual in a Medicare 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

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

Member Citizenship Country

Description	Indicates the member's country of citizenship.
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

Military Handicapped Program

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

Military Id

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/Identifier [VARCHAR(80)]
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

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

Description	Identifies the military rank/grade of an individual.
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

Military Retire Date

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

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Military Station

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

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/Enumeration [VARCHAR(20)]
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

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Original Entitlement Reason

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

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Publicity Level

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Religion Type

Description	Indicates the religion practiced by an individual.
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

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

Student Status

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

VIP

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/Enumeration [VARCHAR(20)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Relationship Details

is PCP for

Is Identifying Relationship	false
Child Table	Plan Member
Child Role Name	selects primary
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	Practitioner
Parent Role Name	is PCP for
Parent Multiplicity	ZERO_TO_ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Plan Member_Point Of Care Device_FK

Is Identifying Relationship	false
Child Table	Plan Member
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	Point Of Care Device
Parent Multiplicity	ZERO_TO_MANY
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Generalization Details

Generalization1

Supertype	Party Role
Subtype	Plan Member
Transform As	TABLE

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