Access Fee AmtAdministration Fee AmtAffiliated Plan CodeFinancial Intermediary FeeHome PlanHost PlanSurcharge AmtTransaction Fee Amt
| Business Data Model Data Model |
| Description | A claim that is submitted by or on behalf of a member for an out-of-area medical service. That is a medical service rendered outside the service area of the health plan organization that enrolled the member. |
| Attributes | |
| Access Fee Amt |
|
| Administration Fee Amt |
|
| Affiliated Plan Code |
|
| Financial Intermediary Fee |
|
| Home Plan |
|
| Host Plan |
|
| Surcharge Amt |
|
| Transaction Fee Amt |
|
| Generalization | |
 Affiliated Healthcare Claim_Claim_Gen |
|
| Dependencies | |
 NONE |
|
| Reverse Dependencies | |
| |
|
| Attribute Details |
Access Fee Amt
| Description | The fee charged by a host plan on a claim for making its negotiated provider fees available for out of area services that are rendered to a member of another health plan. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Administration Fee Amt
| Description | The administrative expense allowance for out-of-area claims that is based on the type of provider and group size. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Affiliated Plan Code
| Description | A code that indicates the affiliation characteristics of the claim. |
| 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 |
Financial Intermediary Fee
| Description | The amount that is charged by an intermediary for processing an out-of-area claim where the intermediary reconciles financial data between the home and host health plan products for the out-of-area claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Home Plan
| Description | Identifies the health plan that enrolled the member who has received out-of-area medical 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 |
Host Plan
| Description | Identifies the health plan that serves the area where the out-of-area medical service was rendered. The host plan maintains provider contracts and issues payment for an affiliated healthcare claim. |
| 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 |
Surcharge Amt
| Description | A surcharge imposed on the claim transaction. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Transaction Fee Amt
| Description | The fee charged for routing the claim transaction. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
| Generalization Details |
Affiliated Healthcare Claim_Claim_Gen
| Supertype | Claim |
| Subtype | Affiliated Healthcare Claim |
| Transform As | TABLE |
| Business Data Model Data Model |