Level Of Service RatingNumber Of Service Units RequestedUrgency Rating
| Business Data Model Data Model |
| Description | An inquiry that a practitioner submits to a health plan organization seeking approval to provide medical services to a member before the services are rendered. Approval by a health insurer indicates that it will cover the cost of the specified medical service, product or treatment. |
| Attributes | |
| Level Of Service Rating |
|
| Number Of Service Units Requested |
|
| Urgency Rating |
|
| Dependencies | |
 NONE |
|
| Reverse Dependencies | |
| |
|
| Attribute Details |
Level Of Service Rating
| Description | Indicates the intensity of service required or provided for a particular procedure request. |
| 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 |
Number Of Service Units Requested
| Description | Indicates the number of units of medical service that were requested to be approved. |
| 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 |
Urgency Rating
| Description | Indicates the urgency of the required medical service. |
| 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 |
Authorization Request_Procedure Code_FK
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| 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 | Procedure Code |
| Parent Multiplicity | ZERO_TO_MANY |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Member is involved in Authorization Request
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| Child Role Name | involves |
| 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 Role Name | is involved in |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Party Role submits Authorization Request
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| 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 |
Provider is involved in Authorization Request
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| Child Role Name | involves |
| 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 | Provider |
| Parent Role Name | is involved in |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Authorization Request_Recommended Treatment Program_FK
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| 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 | Recommended Treatment Program |
| Parent Multiplicity | ZERO_TO_MANY |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Healthcare Insurer processes Authorization Request
| Is Identifying Relationship | false |
| Child Table | Authorization Request |
| Child Role Name | is processed 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 | Healthcare Insurer |
| Parent Role Name | processes |
| 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 |