| Business Data Model Data Model |
| Description | The association between an encounter and coverage eligibility. Used to identify the eligibility for benefits reported by a patient for an encounter. |
| Dependencies | |
 NONE |
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| Reverse Dependencies | |
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| Attribute Details |
Authorization Num
| Description | An insurer-issued authorization number or code that is usually obtained before all non-emergency admissions and within 48 hours of an emergency admission. |
| 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 |
Billing Status
| Description | Indicates the status of the insurance billing. |
| 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 |
Charge Suspend Ind
| Description | Indicates whether or not charges should be suspended for a patient |
| 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 |
Copay Limit Reached Ind
| Description | Indicates whether or not the patient has reached the co-pay limit. |
| 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 |
Eligibility Authorization Date
| Description | The date upon which the insurer issued authorization for patient eligibility. |
| 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 |
Insurance Verification Status
| Description | The status of this patient's relationship with this insurance carrier. |
| 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 |
Insured Relation To Patient
| Description | Indicates the insured's relationship to the patient. |
| 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 |
Insured Relation To Patient End Dt
| Description | The date after which the insured's relationship to the patient is no longer effective. |
| 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 |
Insured Relation To Patient Start Dt
| Description | The date upon which the insured's relationship to the patient began. For example: Parent (insurer) and child (patient) |
| 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 |
Notice Of Admission Date Ts
| Description | The date and time that a notice of admission was sent. |
| 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 |
Patient Relation To Insured
| Description | The relationship of the patient to the insured. For example: Patient is insured Spouse Natural child/insured financial responsibility Natural child/Insured does not have financial responsibility Step child Foster child Ward of the court Employee Unknown Handicapped dependent Organ donor Cadaver donor Grandchild Niece/nephew Injured plaintiff Sponsored dependent Minor dependent of a minor dependent Parent Grandparent |
| 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 |
Report Of Eligibility Date Ts
| Description | The date and time that a Report of Eligibility (ROE) was received |
| 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 |
Signature Date Ts
| Description | The date and time that the patient/subscriber authorization signature was obtained. |
| 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 |
Signature Type
| Description | Indicates how the patient/subscriber authorization signature was obtained and how it is being retained by the provider. For example: Signed CMS-1500 claim form on file Signed authorization for release of any medical or other information necessary to process this claim on file. Signed authorization for assignment of benefits on file. Signature generated by provider because the patient was not physically present for services. |
| 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 |
Stoploss Limit Reached Ind
| Description | Indicates whether or not the patient has reached the stop loss limit established in the Contract Master. |
| 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 |
Verification Date Time
| Description | The date and time that the healthcare provider verified that the patient has the indicated benefits. |
| 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 |
| Relationship Details |
Encounter / Provider Patient Insurance Rlshp_Encounter_FK
| Is Identifying Relationship | true |
| Child Table | Encounter / Coverage Eligibility |
| Child Role Name | refers to |
| 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 | Encounter |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Encounter / Provider Patient Insurance Rlshp_Provider Patient Insurance_FK
| Is Identifying Relationship | true |
| Child Table | Encounter / Coverage Eligibility |
| Child Role Name | based on |
| 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 | Coverage Eligibility |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Encounter / Provider Patient Insurance Rlshp_Party Name_FK
| Is Identifying Relationship | false |
| Child Table | Encounter / Coverage Eligibility |
| Child Role Name | verified 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 Name |
| Parent Multiplicity | ZERO_TO_ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Business Data Model Data Model |