Adjusted Units of ServiceAdjustment AmtAdjustment DateAdjustment ReasonClaim Adjustment StatusClaim Adjustment Type
| Business Data Model Data Model |
| Description | A modification that is made to a claim after it is adjudicated. An adjustment may occur at the service or line item level or at the claim level. |
| Attributes | |
| Adjusted Units of Service |
|
| Adjustment Amt |
|
| Adjustment Date |
|
| Adjustment Reason |
|
| Claim Adjustment Status |
|
| Claim Adjustment Type |
|
| Relationship | |
 Claim Adjustment_Claim Line_FK |
|
| Claim Adjustment_Party Role_FK |
|
| Claim Adjustment_Claim_FK |
|
| Generalization | |
 Claim Adjustment_Financial Transaction_Gen |
|
| Dependencies | |
 NONE |
|
| Reverse Dependencies | |
| |
|
| Attribute Details |
Adjusted Units of Service
| Description | The number of units by which the claimed units of service is being adjusted. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Adjustment Amt
| Description | The monetary amount by which the claim is being adjusted. For post payment adjustments this may be the amount by which the claim paid amount is adjusted. For overpayments this will be a negative amount while for underpayments this will be a positive amount. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Adjustment Date
| Description | The date upon which the adjustment was made. |
| 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 |
Adjustment Reason
| Description | Indicates why a claim was adjusted. For example: Additional documentation provided CMO override Contractual obligations Corrected miscoded diagnosis Corrected miscoded procedure Duplicate claim Incorrectly calculated Incorrectly coded diagnostic Incorrectly denied Predetermination, anticipated payment upon completion of services. Severity adjustment |
| 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 |
Claim Adjustment Status
| Description | Indicates the status of the adjustment to the claim. For example: Completed Pending Reversed |
| 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 |
Claim Adjustment Type
| Description | Indicates the nature of an modification made to a previously adjudicated or finalized claim. For example: Co-insurance Adjustment Non Covered Days/ Room Charge Adjustment |
| 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 |
Claim Adjustment_Claim Line_FK
| Is Identifying Relationship | false |
| Child Table | Claim Adjustment |
| Child Role Name | adjusts |
| 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 | Claim Line |
| Parent Role Name | is adjusted by |
| Parent Multiplicity | ZERO_TO_ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Claim Adjustment_Party Role_FK
| Is Identifying Relationship | false |
| Child Table | Claim Adjustment |
| Child Role Name | is created 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 | creates |
| Parent Multiplicity | ZERO_TO_ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Claim Adjustment_Claim_FK
| Is Identifying Relationship | false |
| Child Table | Claim Adjustment |
| Child Role Name | adjusts |
| 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 | Claim |
| Parent Role Name | is adjusted by |
| Parent Multiplicity | ZERO_TO_ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Generalization Details |
Claim Adjustment_Financial Transaction_Gen
| Supertype | Financial Transaction |
| Subtype | Claim Adjustment |
| Transform As | TABLE |
| Business Data Model Data Model |