Business Data Model Data Model

Entity

Entity Authorization Result

Description

The decision that the health plan organization reaches in respect of the request for approval to provide healthcare treatment to a member.

Attributes
Authorization Num
Authorization Result Reason
Authorization Result Type
Level Of Service Rating
Number Of Service Units Approved
Proposed Date
Second Opinion Ind
Urgency Rating

Relationship
Authorization Request results in Authorization Result
Authorization Result_Medical Treatment Authorization_FK

Dependencies
NONE

Reverse Dependencies

Description	Prior authorization or medical certification, assigned by healthcare insurer or pharmacy benefit management company.
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

Description	Classifies the reason of the authorization result.
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

Description	Classifies an authorization result according to its type.
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

Description	Indicates the intensity of service required or provided for a particular procedure.
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

Description	The number of units of medical service that were 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

Description	The proposed date upon which the service is to be performed.
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

Description	Indicates whether or not a second medical opinion is required for this authorization result. For example: 0 = No Second Opinion Required 1 = Second Opinion Required
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

Description	Indicates the urgency of performing a particular procedure.
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

Is Identifying Relationship	false
Child Table	Authorization Result
Child Role Name	is result of
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 Request
Parent Role Name	results in
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Is Identifying Relationship	false
Child Table	Authorization Result
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	Medical Treatment Authorization
Parent Multiplicity	ZERO_TO_MANY
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Entity

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