| Business Data Model Data Model |
| Description | An activity that a health plan organization undertakes to charge a proportion of claimed benefits onwards to a third party, reinsurer or coinsurer. |
| Relationship | |
 Claim Recovery_Claim Line_FK |
|
| Claim Recovery_Claim_FK |
|
| Claim Recovery_Party_FK |
|
| Dependencies | |
 NONE |
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| Reverse Dependencies | |
| |
|
| Attribute Details |
Actual End Date
| Description | Actual date upon which the activity was completed. |
| 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 |
Actual Labor Hours
| Description | Actual number hours that it took to perform the activity. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Small Counter [SHORT] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Actual Start Date
| Description | The actual date upon which the activity was started. |
| 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 |
Actual Time Spent
| Description | The actual time spent performing the activity. This differs from the labor hours by describing the elapsed time over which the labor hours were spread. For example, an activity may involve 4 hours actual work over 3 days. |
| 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 |
Business Activity Type
| Description | Indicates the nature of a claim recovery. |
| 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 Recovery Approach
| Description | Classifies claim recovery according to the approach used to carry out the recovery. |
| 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 Recovery Basis
| Description | Indicates the reason or justification for undertaking a claim recovery. |
| 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 Recovery Status
| Description | Claim Recovery Status distinguishes between claim recoverys according to their current state. |
| 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 Recovery Status Reason
| Description | Indicates why a claim recovery is in its current state. |
| 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 |
Collection Method Ind
| Description | The way in which the healthcare insurer tries to recover the cost of the claim from a third party. For example: Direct Collection Use Of Collection Agency |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric Small [VARCHAR(6)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Delay Reason
| Description | Indicates the cause of any discrepancy between planned and actual end dates. |
| 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 |
Planned Duration
| Description | The time planned for the performing of the activity. This is the total elapsed time over which the activity is expected to be performed and not the planned labor hours. |
| 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 |
Planned End Date
| Description | Date upon which the activity is planned to end. |
| 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 |
Planned Manpower
| Description | The planned labor hours required for the activity. |
| 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 |
Planned Start Date
| Description | Date upon which the activity is planned to start. |
| 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 |
Potential Reinsurer Recovery Amt
| Description | The amount which the healthcare insurer still expects to obtain in respect of the claim or claim item under all reinsurance treaties. |
| 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 |
Potential Third Party Recovery Amt
| Description | The amount which the healthcare insurer still expects to obtain in respect of the claim or claim item from all third parties other than reinsurers. |
| 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 |
Potential Total Recovery Amt
| Description | The monetary value of covered charges that are considered to be recoverable from other parties. |
| 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 |
Recovery Party Role
| Description | Classifies claim recoverys according to the role of the party that the claim amount is being recovered from. |
| 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 |
Total Recovery Amt
| Description | The total amount recovered by the claim recovery activity from all sources. |
| 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 |
| Relationship Details |
Claim Recovery_Claim Line_FK
| Is Identifying Relationship | false |
| Child Table | Claim Recovery |
| 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 Multiplicity | ZERO_TO_MANY |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Claim Recovery_Claim_FK
| Is Identifying Relationship | false |
| Child Table | Claim Recovery |
| Child Role Name | is originated from |
| 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 | originates |
| Parent Multiplicity | ZERO_TO_ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Claim Recovery_Party_FK
| Is Identifying Relationship | false |
| Child Table | Claim Recovery |
| 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 |
| Parent Multiplicity | ZERO_TO_MANY |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Business Data Model Data Model |