Appeal Reason TxtDescrNameStart DateUrgent Ind
| Business Data Model Data Model |
| Description | A request that a member or practitioner makes to a health plan organization to reconsider a service approval request that was denied. |
| Attributes | |
| Appeal Reason Txt |
|
| Descr |
|
| Name |
|
| Start Date |
|
| Urgent Ind |
|
| Relationship | |
 Party submits Authorization Appeal |
|
| Authorization Result is appealed in Authorization Appeal |
|
| Dependencies | |
 NONE |
|
| Reverse Dependencies | |
| |
|
| Attribute Details |
Appeal Reason Txt
| Description | Textual description of the reason of the authorization appeal. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Text Very Large [VARCHAR(2048)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Descr
| Description | The textual representation of information about an occurrence of authorization appeal. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Text Large [VARCHAR(1024)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Name
| Description | The word or phrase identifying an occurrence of authorization appeal. |
| 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 |
Start Date
| Description | The date upon which the authorization appeal is considered as having started. |
| 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 |
Urgent Ind
| Description | Indicates that the authorization appeal needs to be processed urgently, often owing to the immediate or emergency nature of the service originally authorized by appealed authorization result. For example: 0 = Standard Appeal 1 = Urgent Appeal |
| 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 |
| Relationship Details |
Party submits Authorization Appeal
| Is Identifying Relationship | false |
| Child Table | Authorization Appeal |
| Child Role Name | is submitted by |
| 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 | Party Role |
| Parent Role Name | submits |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Authorization Result is appealed in Authorization Appeal
| Is Identifying Relationship | false |
| Child Table | Authorization Appeal |
| Child Role Name | appeals |
| 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 | Authorization Result |
| Parent Role Name | is appealed in |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Business Data Model Data Model |