Entity Claim Dimension

DescriptionA request for reimbursement that a healthcare provider issues to a healthcare insurer in respect of services rendered to a patient who is a member of a health plan.

Attributes
Access Fee AmtAccess Fee Amt
Accident Fault Attribution CdAccident Fault Attribution Cd
Accident Fault Attribution Code DescrAccident Fault Attribution Code Descr
Accident Fault Attribution Code SkAccident Fault Attribution Code Sk
Adjusted Repriced Claim Reference NumAdjusted Repriced Claim Reference Num
Administration Fee AmtAdministration Fee Amt
Advanced Technology Operating AllowanceAdvanced Technology Operating Allowance
Affiliated Claim IndAffiliated Claim Ind
Affiliated Plan CdAffiliated Plan Cd
Affiliated Plan Code DescrAffiliated Plan Code Descr
Affiliated Plan Code SkAffiliated Plan Code Sk
Allowed AmtAllowed Amt
Amount Applied to Benefit LimitAmount Applied to Benefit Limit
Amount Applied to Out-of-pocket LimitAmount Applied to Out-of-pocket Limit
Approved AmtApproved Amt
Attachment Transmission CdAttachment Transmission Cd
Attachment Transmission Code SkAttachment Transmission Code Sk
Attachment Transmission DescrAttachment Transmission Descr
Attachment Type CdAttachment Type Cd
Attachment Type Code SkAttachment Type Code Sk
Attachment Type DescrAttachment Type Descr
Audit IndAudit Ind
AWM Load Info SkAWM Load Info Sk
Bill From DtBill From Dt
Billing Form CdBilling Form Cd
Billing Form Code SkBilling Form Code Sk
Billing Form DescrBilling Form Descr
Bill To DtBill To Dt
Capital Charge AmtCapital Charge Amt
Claim BkClaim Bk
Claim DkClaim Dk
Claim Filing Indicator CdClaim Filing Indicator Cd
Claim Filing Indicator Code SkClaim Filing Indicator Code Sk
Claim Filing Indicator DescrClaim Filing Indicator Descr
Claim NumClaim Num
Claim Pricing Method CdClaim Pricing Method Cd
Claim Pricing Method Code DescrClaim Pricing Method Code Descr
Claim Pricing Method Code SkClaim Pricing Method Code Sk
Claim Recovery Strategy CdClaim Recovery Strategy Cd
Claim Recovery Strategy Code DescrClaim Recovery Strategy Code Descr
Claim Recovery Strategy Code SkClaim Recovery Strategy Code Sk
Claim Size Category CdClaim Size Category Cd
Claim Size Category Code DescrClaim Size Category Code Descr
Claim Size Category Code SkClaim Size Category Code Sk
Claim SkClaim Sk
Claim Status CdClaim Status Cd
Claim Version CdClaim Version Cd
Claim Version Code DescrClaim Version Code Descr
Claim Version Code SkClaim Version Code Sk
Class Of Claim CdClass Of Claim Cd
Class Of Claim Code DescrClass Of Claim Code Descr
Class Of Claim Code SkClass Of Claim Code Sk
Clean Claim Receipt DtClean Claim Receipt Dt
Clearinghouse Trace NumClearinghouse Trace Num
CLIA NumCLIA Num
COB AmtCOB Amt
Contract AmtContract Amt
Contract Code NumContract Code Num
Contract PctContract Pct
Contract Type CdContract Type Cd
Contract Type Code SkContract Type Code Sk
Contract Type DescrContract Type Descr
Contract Version NumContract Version Num
Currency CdCurrency Cd
Currency Code SkCurrency Code Sk
Current IndCurrent Ind
DecisionsDecisions
Delay Reason CdDelay Reason Cd
Delay Reason Code SkDelay Reason Code Sk
Delay Reason DescrDelay Reason Descr
Demonstration Project NumDemonstration Project Num
Document Control NumDocument Control Num
DRG WeightingDRG Weighting
Dual Coverage IndDual Coverage Ind
DWM Load Info SkDWM Load Info Sk
Effective From DtEffective From Dt
Effective To DtEffective To Dt
EOB Requested IndEOB Requested Ind
Estimated Due AmtEstimated Due Amt
Extraordinary Capital AllowanceExtraordinary Capital Allowance
Extreme Care Capital AllowanceExtreme Care Capital Allowance
Extreme Care Days Covered CntExtreme Care Days Covered Cnt
Extreme Care Operating AllowanceExtreme Care Operating Allowance
FI Action CdFI Action Cd
FI Action Code SkFI Action Code Sk
FI Action DescrFI Action Descr
Financial Intermediary FeeFinancial Intermediary Fee
Government Reduction AmtGovernment Reduction Amt
HIPPS CdHIPPS Cd
HIPPS Code DescrHIPPS Code Descr
HIPPS Code SkHIPPS Code Sk
Home Plan CdHome Plan Cd
Home Plan Code DescrHome Plan Code Descr
Home Plan Code SkHome Plan Code Sk
Host Plan CdHost Plan Cd
Host Plan Code DescrHost Plan Code Descr
Host Plan Code SkHost Plan Code Sk
Incoming IndIncoming Ind
Incurred But Not Reported IndIncurred But Not Reported Ind
Indemnity PortionIndemnity Portion
In Plan Network IndIn Plan Network Ind
Investigational Device Exemption Identifier NumInvestigational Device Exemption Identifier Num
Last Worked DtLast Worked Dt
Low Utilization Adjustment CdLow Utilization Adjustment Cd
Low Utilization Adjustment Code SkLow Utilization Adjustment Code Sk
Low Utilization Adjustment DescrLow Utilization Adjustment Descr
Medical Education Capital AllowanceMedical Education Capital Allowance
Medical Education Operating AllowanceMedical Education Operating Allowance
Medicare A Covered Months CntMedicare A Covered Months Cnt
Medicare B Covered Months CntMedicare B Covered Months Cnt
Medicare Buyin Months Covered CntMedicare Buyin Months Covered Cnt
Medicare HMO Months Covered CntMedicare HMO Months Covered Cnt
Member Authorization Type CdMember Authorization Type Cd
Member Authorization Type Code DescrMember Authorization Type Code Descr
Member Authorization Type Code SkMember Authorization Type Code Sk
Minimal Care Cost Capital ReductionMinimal Care Cost Capital Reduction
Minimal Care Cost Operating ReductionMinimal Care Cost Operating Reduction
National Capital AllowanceNational Capital Allowance
National Operating AllowanceNational Operating Allowance
One Pass Process IndOne Pass Process Ind
Original Claim NumOriginal Claim Num
Out of Area Financial Administration Fee AmtOut of Area Financial Administration Fee Amt
Out of Area General Administration Fee AmtOut of Area General Administration Fee Amt
Out of Area Surcharge AmtOut of Area Surcharge Amt
Out-of-Network Reason CdOut-of-Network Reason Cd
Out-of-Network Reason Code DescrOut-of-Network Reason Code Descr
Out-of-Network Reason Code SkOut-of-Network Reason Code Sk
Participation Agreement CdParticipation Agreement Cd
Participation Agreement Code SkParticipation Agreement Code Sk
Participation Agreement DescrParticipation Agreement Descr
Patient Demographic Capital AllowancePatient Demographic Capital Allowance
Patient Demographic Operating AllowancePatient Demographic Operating Allowance
Patient Paid AmtPatient Paid Amt
Payer Paid AmtPayer Paid Amt
Pre-Authorization Exception Reason CdPre-Authorization Exception Reason Cd
Pre-Authorization Exception Reason Code DescrPre-Authorization Exception Reason Code Descr
Pre-Authorization Exception Reason Code SkPre-Authorization Exception Reason Code Sk
Primary Diagnosis CdPrimary Diagnosis Cd
Primary Diagnosis Code SkPrimary Diagnosis Code Sk
Primary Diagnosis DescrPrimary Diagnosis Descr
Prompt Payment Discount AmtPrompt Payment Discount Amt
Property Casualty Claim NumProperty Casualty Claim Num
Provider Assignment IndProvider Assignment Ind
Provider Capital AllowanceProvider Capital Allowance
Provider Operating AllowanceProvider Operating Allowance
Provider Signature IndProvider Signature Ind
Repriced Allowed AmtRepriced Allowed Amt
Repriced Approved Ambulatory Patient Group AmtRepriced Approved Ambulatory Patient Group Amt
Repriced Approved Ambulatory Patient Group Code IdRepriced Approved Ambulatory Patient Group Code Id
Repriced Claim Reference NumRepriced Claim Reference Num
Repriced Saving AmtRepriced Saving Amt
Reprice Exception CdReprice Exception Cd
Reprice Exception Code SkReprice Exception Code Sk
Reprice Exception DescrReprice Exception Descr
Reprice Policy Compliance CdReprice Policy Compliance Cd
Reprice Policy Compliance Code SkReprice Policy Compliance Code Sk
Reprice Policy Compliance DescrReprice Policy Compliance Descr
Reprice Rejection Reason CdReprice Rejection Reason Cd
Reprice Rejection Reason Code SkReprice Rejection Reason Code Sk
Reprice Rejection Reason DescrReprice Rejection Reason Descr
Repricing Flat Rate AmtRepricing Flat Rate Amt
Responsible Party Reason CdResponsible Party Reason Cd
Responsible Party Reason Code DescrResponsible Party Reason Code Descr
Responsible Party Reason Code SkResponsible Party Reason Code Sk
Retained Service AmtRetained Service Amt
Secondary Payer Pass-through AmtSecondary Payer Pass-through Amt
Secondary Payment IndSecondary Payment Ind
Service Authorization Exception CdService Authorization Exception Cd
Service Authorization Exception Code SkService Authorization Exception Code Sk
Service Authorization Exception DescrService Authorization Exception Descr
Settlement Currency CdSettlement Currency Cd
Settlement Currency Code DescrSettlement Currency Code Descr
Settlement Currency Code SkSettlement Currency Code Sk
Signature DtSignature Dt
Source CdSource Cd
Source Code DescrSource Code Descr
Source Code SkSource Code Sk
Source DescrSource Descr
Submission Clarification Type CdSubmission Clarification Type Cd
Submission Clarification Type Code DescrSubmission Clarification Type Code Descr
Submission Clarification Type Code SkSubmission Clarification Type Code Sk
Subrogation IndSubrogation Ind
Supporting Documentation IndSupporting Documentation Ind
Surcharge AmtSurcharge Amt
Tenant SkTenant Sk
Term Discount PctTerm Discount Pct
Total Adjustment Units of ServiceTotal Adjustment Units of Service
Total Claim Charge AmtTotal Claim Charge Amt
Total CostTotal Cost
Total Member Liability AmtTotal Member Liability Amt
Total Nonpayable Professional Fees AmtTotal Nonpayable Professional Fees Amt
Total Purchased Services AmtTotal Purchased Services Amt
Total Units of ServicesTotal Units of Services
Transaction Fee AmtTransaction Fee Amt
Type 4081 Claim IndType 4081 Claim Ind
Type CdType Cd
Type Code DescrType Code Descr
Type Code SkType Code Sk
Valid From TsValid From Ts
Valid To TsValid To Ts

Primary Key
Claim Dimension PKClaim Dimension PK

Dependencies
 
 

Reverse Dependencies
 

Attribute Details

 Access Fee Amt
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Accident Fault Attribution Cd
DescriptionIndicates how the blame for an accident related to a claim is allocated to the claimant.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Accident Fault Attribution Code Descr
DescriptionIndicates how the blame for an accident related to a claim is allocated to the claimant.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Accident Fault Attribution Code Sk
DescriptionIndicates how the blame for an accident related to a claim is allocated to the claimant.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Adjusted Repriced Claim Reference Num
DescriptionIdentification number, assigned by a repricing organization, to identify an adjusted claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Administration Fee Amt
DescriptionThe administrative expense allowance for out-of-area claims that is based on the type of provider and group size.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Advanced Technology Operating Allowance
DescriptionThe add-on operating payment amount paid to the healthcare provider in the context of this claim that is attributable to a treatment that uses new technologies.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Affiliated Claim Ind
DescriptionIndicates that the claim has been filed by a member for an out-of-area medical service such as a healthcare event rendered outside the service area of the healthcare insurer which enrolled the member.

For example:
0 = In Area Claim
1 = Out-Of-Area Claim
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Affiliated Plan Cd
DescriptionA code that indicates the affiliation characteristics of the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Affiliated Plan Code Descr
DescriptionA code that indicates the affiliation characteristics of the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Affiliated Plan Code Sk
DescriptionA code that indicates the affiliation characteristics of the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Allowed Amt
DescriptionThe maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Amount Applied to Benefit Limit
DescriptionThe portion of the claim health plan liability amount that is deductible from the member's benefit maximum amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Amount Applied to Out-of-pocket Limit
DescriptionThe portion of the cost sharing amounts that are deductible from the member's out-of-pocket maximum amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Approved Amt
DescriptionAmount approved to be paid on claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Transmission Cd
DescriptionIndicates the timing, transmission method or format by which an attachment report is to be sent or has been sent.

For example:
Previously Submitted to Payer
Certification Included in this Claim
Narrative Segment Included in this Claim
No Documentation is Required
Not Specified
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Transmission Code Sk
DescriptionIndicates the timing, transmission method or format by which an attachment report is to be sent or has been sent.

For example:
Previously Submitted to Payer
Certification Included in this Claim
Narrative Segment Included in this Claim
No Documentation is Required
Not Specified
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Transmission Descr
DescriptionIndicates the timing, transmission method or format by which an attachment report is to be sent or has been sent.

For example:
Previously Submitted to Payer
Certification Included in this Claim
Narrative Segment Included in this Claim
No Documentation is Required
Not Specified
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Type Cd
DescriptionSpecifies the type of attachment that is related to the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Type Code Sk
DescriptionSpecifies the type of attachment that is related to the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Attachment Type Descr
DescriptionSpecifies the type of attachment that is related to the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Audit Ind
DescriptionIndicates whether the claim was audited.

For example:
0 = Claim Not Audited
1 = Claim Audited
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 AWM Load Info Sk
DescriptionThe surrogate key of the load information entry describing the details regarding the loading of the row in the atomic data warehouse.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Bill From Dt
DescriptionEarliest date of services billed for on the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Billing Form Cd
DescriptionNUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Billing Form Code Sk
DescriptionNUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Billing Form Descr
DescriptionNUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Bill To Dt
DescriptionLast service date billed for on the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Capital Charge Amt
DescriptionCost allocation against the claim in respect of the capital costs tied up in the organization's business.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Bk
DescriptionConcatenated values of a set of business attributes that uniquely identify the row.
Data TypeStandards - Data Domains.ddm/Data Domains/Business Key [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keytrue



 Claim Filing Indicator Cd
DescriptionIdentifies the type of claim or expected adjudication process.

For example:
Self-pay
Central Certification
Other Non-Federal Programs
Preferred Provider Organization (PPO)
Point of Service (POS)
Exclusive Provider Organization (EPO)
Indemnity Insurance
Health Maintenance Organization (HMO) Medicare Risk
Automobile Medical
Blue Cross/Blue Shield
Champus
Commercial Insurance Co.
Disability
Health Maintenance Organization
Liability
Liability Medical
Medicare Part B
Medicaid
Other Federal Program
Title V
Veteran Administration Plan
Workers' Compensation Health Claim
Mutually Defined
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Filing Indicator Code Sk
DescriptionIdentifies the type of claim or expected adjudication process.

For example:
Self-pay
Central Certification
Other Non-Federal Programs
Preferred Provider Organization (PPO)
Point of Service (POS)
Exclusive Provider Organization (EPO)
Indemnity Insurance
Health Maintenance Organization (HMO) Medicare Risk
Automobile Medical
Blue Cross/Blue Shield
Champus
Commercial Insurance Co.
Disability
Health Maintenance Organization
Liability
Liability Medical
Medicare Part B
Medicaid
Other Federal Program
Title V
Veteran Administration Plan
Workers' Compensation Health Claim
Mutually Defined
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Filing Indicator Descr
DescriptionIdentifies the type of claim or expected adjudication process.

For example:
Self-pay
Central Certification
Other Non-Federal Programs
Preferred Provider Organization (PPO)
Point of Service (POS)
Exclusive Provider Organization (EPO)
Indemnity Insurance
Health Maintenance Organization (HMO) Medicare Risk
Automobile Medical
Blue Cross/Blue Shield
Champus
Commercial Insurance Co.
Disability
Health Maintenance Organization
Liability
Liability Medical
Medicare Part B
Medicaid
Other Federal Program
Title V
Veteran Administration Plan
Workers' Compensation Health Claim
Mutually Defined
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Num
DescriptionNumber assigned by a processor to identify a claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Pricing Method Cd
DescriptionClassifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Pricing Method Code Descr
DescriptionClassifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Pricing Method Code Sk
DescriptionClassifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Recovery Strategy Cd
DescriptionIndicates in which way the modeled organization will try to recover the cost of the claim from a third party.

For example:
Legal action against third party.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Recovery Strategy Code Descr
DescriptionIndicates in which way the modeled organization will try to recover the cost of the claim from a third party.

For example:
Legal action against third party.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Recovery Strategy Code Sk
DescriptionIndicates in which way the modeled organization will try to recover the cost of the claim from a third party.

For example:
Legal action against third party.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Size Category Cd
DescriptionA categorization of claims according to their monetary value. Typically, a banding approach is used to assign the claim to a claim size band, based on the amount of benefit that is requested, offered or paid.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Size Category Code Descr
DescriptionA categorization of claims according to their monetary value. Typically, a banding approach is used to assign the claim to a claim size band, based on the amount of benefit that is requested, offered or paid.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Size Category Code Sk
DescriptionA categorization of claims according to their monetary value. Typically, a banding approach is used to assign the claim to a claim size band, based on the amount of benefit that is requested, offered or paid.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Sk
DescriptionA numeric surrogate key used to uniquely identify entities in the atomic model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Status Cd
DescriptionIndicates the state of the claim in the life cycle of adjudication.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Version Cd
DescriptionClassifies a submission cycle that a claim may have been involved in.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Version Code Descr
DescriptionClassifies a submission cycle that a claim may have been involved in.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Version Code Sk
DescriptionClassifies a submission cycle that a claim may have been involved in.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Class Of Claim Cd
DescriptionCategorization of claims according to the coverage component against which the claim belongs. It is used by the reservation department for determining the applicable reservation strategy.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Class Of Claim Code Descr
DescriptionCategorization of claims according to the coverage component against which the claim belongs. It is used by the reservation department for determining the applicable reservation strategy.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Class Of Claim Code Sk
DescriptionCategorization of claims according to the coverage component against which the claim belongs. It is used by the reservation department for determining the applicable reservation strategy.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Clean Claim Receipt Dt
DescriptionDate on which the complete and correct claim was received by the health plan. This date may reflect modifications and resubmissions by the claim filer and/or development (contacting the member or provider for required information) by a claims unit.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Clearinghouse Trace Num
DescriptionUnique tracking number for the transaction assigned by a clearinghouse.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 CLIA Num
DescriptionThe CLIA Certificate of Waiver or the CLIA Certificate of Registration Identification Number assigned to the laboratory testing site that rendered the services on this claim. Used as a Pre-authorization number.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 COB Amt
DescriptionThe coordination of benefits amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount Large [DECIMAL(20,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Amt
DescriptionA fixed monetary amount that pertains to the contract. It is required if the service amounts are different than the claim level amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Code Num
DescriptionThe specific insurance contract, established by the payer.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Pct
DescriptionThe percentage of charges that are payable under the contract.
Data TypeStandards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Type Cd
DescriptionIndicates the contract type that is being claimed against. It is recommended that a contract type is always provided for capitated encounters.

For example:
Per Diem
Variable Per Diem
Flat
Capitated
Percent
Other
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Type Code Sk
DescriptionIndicates the contract type that is being claimed against. It is recommended that a contract type is always provided for capitated encounters.

For example:
Per Diem
Variable Per Diem
Flat
Capitated
Percent
Other
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Type Descr
DescriptionIndicates the contract type that is being claimed against. It is recommended that a contract type is always provided for capitated encounters.

For example:
Per Diem
Variable Per Diem
Flat
Capitated
Percent
Other
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Contract Version Num
DescriptionIdentification of additional or supplemental contract provisions or identification of a particular version or modification of payer contract.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Currency Cd
DescriptionIndicates the currency used as the basis for all monetary amounts.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Currency Code Sk
DescriptionIndicates the currency used as the basis for all monetary amounts.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Current Ind
DescriptionSet to 'Y' if this is the most recent row of a group having the same Surrogate Key.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Decisions
DescriptionA free-text statement used to capture the decisions made by the healthcare insurer when assessing this claim.

For example:
A decision may be taken to grant coverage to a loyal customer, even though some of the coverage conditions are not fulfilled.
Data TypeStandards - Data Domains.ddm/Data Domains/Text Medium [VARCHAR(255)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Delay Reason Cd
DescriptionIndicates the cause of any discrepancy between planned and actual end dates.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Delay Reason Code Sk
DescriptionIndicates the cause of any discrepancy between planned and actual end dates.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Delay Reason Descr
DescriptionIndicates the cause of any discrepancy between planned and actual end dates.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Demonstration Project Num
DescriptionIdentification number for a Medicare demonstration project.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Document Control Num
DescriptionA reference number identifying this instance of the claim form.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 DRG Weighting
DescriptionFactor applied to the standard cost for the diagnosis related group (DRG) with which the diagnosis is associated.
Data TypeStandards - Data Domains.ddm/Data Domains/Decimal 9 [DECIMAL(19,9)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Dual Coverage Ind
DescriptionIndicates that the claimed costs are covered by more than one insurance policy.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 DWM Load Info Sk
DescriptionThe surrogate key of the load information entry describing the details regarding the loading of the row.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Effective From Dt
DescriptionEstablishes a period where a set of attributes are true according to the business.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Effective To Dt
DescriptionEnds a period of effectivity.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 EOB Requested Ind
DescriptionIndicator of whether an explanation of benefits (EOB) is requested.

For example:
Yes
No
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Estimated Due Amt
DescriptionAmount calculated to be owed by patient.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Extraordinary Capital Allowance
DescriptionThe add-on amount paid in the context of this claim to the healthcare provider for extraordinary circumstances that require an unanticipated major capital expenditure.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Extreme Care Capital Allowance
DescriptionThe add-on capital amount paid to the healthcare provider on this claim that relates to the exceptional nature of the claim case.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Extreme Care Days Covered Cnt
DescriptionThe number of days that have been covered on this claim and that are attributable to the exceptional nature of the claim case.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Extreme Care Operating Allowance
DescriptionThe add-on operating amount paid to the healthcare provider on this claim that relates to the exceptional nature of the claim case.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 FI Action Cd
DescriptionThe type of action requested by the intermediary to be taken on an institutional claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 FI Action Code Sk
DescriptionThe type of action requested by the intermediary to be taken on an institutional claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 FI Action Descr
DescriptionThe type of action requested by the intermediary to be taken on an institutional claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Financial Intermediary Fee
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Government Reduction Amt
DescriptionReduction in payment as legally defined by the governmental authorities to prevent overspending.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 HIPPS Cd
DescriptionHealth Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 HIPPS Code Descr
DescriptionHealth Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 HIPPS Code Sk
DescriptionHealth Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Home Plan Cd
DescriptionIdentifies the health plan that enrolled the member who has received out-of-area medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Home Plan Code Descr
DescriptionIdentifies the health plan that enrolled the member who has received out-of-area medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Home Plan Code Sk
DescriptionIdentifies the health plan that enrolled the member who has received out-of-area medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Host Plan Cd
DescriptionIdentifies 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 TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Host Plan Code Descr
DescriptionIdentifies 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 TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Host Plan Code Sk
DescriptionIdentifies 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 TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Incoming Ind
DescriptionIf true, indicates that the claim is an incoming claim i.e. the claim is made by another party against the modeled organization.
If false, indicates that the claim is an outgoing claim i.e. the claim is made by the modeled organization against another party.
The value is derived from the party role in the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Incurred But Not Reported Ind
DescriptionIncurred but not reported claim. Indicates that the claim is a provision for a cost that has been incurred but is not yet reported to the insurance company.

For example:
False
True
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Indemnity Portion
DescriptionThe part of the total cost of the claim that reimburses the loss. It excludes all fees and expenses.
Data TypeStandards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 In Plan Network Ind
DescriptionA code that indicates whether or not a claim is for medical services performed by a healthcare provider who is within a network recognized by the insurer or out of network.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Investigational Device Exemption Identifier Num
DescriptionNumber or reference identifying exemption assigned to an investigational device referenced in the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Last Worked Dt
DescriptionThe date upon which the patient last worked.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Low Utilization Adjustment Cd
DescriptionIndicates an adjustment to estimated payment has occurred due to four or fewer visits being provided during a 60 day episode; Medicare therefore pays a per-visit amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Low Utilization Adjustment Code Sk
DescriptionIndicates an adjustment to estimated payment has occurred due to four or fewer visits being provided during a 60 day episode; Medicare therefore pays a per-visit amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Low Utilization Adjustment Descr
DescriptionIndicates an adjustment to estimated payment has occurred due to four or fewer visits being provided during a 60 day episode; Medicare therefore pays a per-visit amount.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medical Education Capital Allowance
DescriptionThe add-on capital amount paid to the healthcare provider on this claim that reflects the higher indirect patient care costs of a teaching healthcare provider relative to a non-teaching healthcare provider. The adjustment represented by the medical education capital allowance may be based on different factors, such as the measured effect of teaching intensity on hospitals' costs.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medical Education Operating Allowance
DescriptionThe add-on operating amount paid to the healthcare provider on this claim that reflects the higher indirect patient care costs of a teaching healthcare provider relative to a non-teaching healthcare provider. The adjustment represented by the medical education operating allowance may be based on different factors, such as the hospital's number of residents trained per inpatient bed.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medicare A Covered Months Cnt
DescriptionNumber of months covered by Medicare Part A.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medicare B Covered Months Cnt
DescriptionNumber of months covered by Medicare Part B.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medicare Buyin Months Covered Cnt
DescriptionNumber of months covered by Medicare buy-in coverage.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Medicare HMO Months Covered Cnt
DescriptionNumber of months covered by Medicare HMO.
Data TypeStandards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Member Authorization Type Cd
DescriptionIndicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Member Authorization Type Code Descr
DescriptionIndicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Member Authorization Type Code Sk
DescriptionIndicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Minimal Care Cost Capital Reduction
DescriptionReduction in the capital payment amount paid to the healthcare provider on this claim that relates to different factors, such as a shorter inpatient stay than usually expected.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Minimal Care Cost Operating Reduction
DescriptionReduction in the operating payment amount paid to the healthcare provider on this claim that relates to different factors, such as a shorter inpatient stay than usually expected.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 National Capital Allowance
DescriptionAdd-on capital claim payment amount paid to the healthcare provider based on specific national factors, such as the cost-of-living factor.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 National Operating Allowance
DescriptionAdd-on operating claim payment amount paid to the healthcare provider based on specific national factors, such as the cost-of-living factor.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 One Pass Process Ind
DescriptionIndicates whether or not the claim was processed in the 'first pass' without the need for human intervention to review, amend, or process the claim.

For example:
0 = Unable To Process In A Single Pass
1 = Only One Pass Required
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Original Claim Num
DescriptionIn the case where the payer had received the original claim and for some reason has asked the provider to resubmit the claim, giving the provider the payer's claim identification number. In this case the payer is expecting the provider to give them back the claim number so that the payer can match it in their adjudication system, avoiding a duplicate claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out of Area Financial Administration Fee Amt
DescriptionThe amount that is charged 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 TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out of Area General Administration Fee Amt
DescriptionThe administrative expense allowance for out-of-area claims that is based on the type of provider and group size. The fee charged for routing the claim transaction.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out of Area Surcharge Amt
DescriptionA surcharge imposed on the claim because it was out of area.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out-of-Network Reason Cd
DescriptionIndicates why a service was rendered outside the provider network.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out-of-Network Reason Code Descr
DescriptionIndicates why a service was rendered outside the provider network.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Out-of-Network Reason Code Sk
DescriptionIndicates why a service was rendered outside the provider network.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Participation Agreement Cd
DescriptionCode indicating a participating claim submitted by a non-participating provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Participation Agreement Code Sk
DescriptionCode indicating a participating claim submitted by a non-participating provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Participation Agreement Descr
DescriptionCode indicating a participating claim submitted by a non-participating provider.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Patient Demographic Capital Allowance
DescriptionThe add-on capital amount paid to the healthcare provider on this claim to compensate a high-percentage of low-income patients treated.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Patient Demographic Operating Allowance
DescriptionThe add-on operating amount paid to the healthcare provider on this claim to compensate a high-percentage of low-income patients treated.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Patient Paid Amt
DescriptionThe amount the provider has received from the patient (or insured) toward payment of a claim or claim line.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Payer Paid Amt
DescriptionThe amount paid by the payer on this claim or claim line.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Pre-Authorization Exception Reason Cd
DescriptionIndicates why expected authorization is waived in a given context.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Pre-Authorization Exception Reason Code Descr
DescriptionIndicates why expected authorization is waived in a given context.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Pre-Authorization Exception Reason Code Sk
DescriptionIndicates why expected authorization is waived in a given context.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Primary Diagnosis Cd
DescriptionSurrogate key for the link between a claim and a patient diagnosis
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Primary Diagnosis Code Sk
DescriptionSurrogate key for the link between a claim and a patient diagnosis
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Primary Diagnosis Descr
DescriptionSurrogate key for the link between a claim and a patient diagnosis
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Prompt Payment Discount Amt
DescriptionThe amount discounted from the health plan liability amount for prompt payment of the claim, as per provider agreement specifications.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Property Casualty Claim Num
DescriptionIdentification number for property casualty claim associated with the services identified on the bill.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Provider Assignment Ind
DescriptionAn indicator showing whether or not the provider accepts assignment for the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Provider Capital Allowance
DescriptionThe part of capital payment amount paid to the healthcare provider in the context of this claim that relates to labor costs.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Provider Operating Allowance
DescriptionThe part of operating payment amount paid to the healthcare provider in the context of this claim that relates to labor costs.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Provider Signature Ind
DescriptionIndicates whether a signature is on file from the provider of the service acknowledging that they performed the service and therefore authorizing payment.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repriced Allowed Amt
DescriptionThe maximum monetary amount determined by the repricer as being allowable under the provisions of the contract prior to the determination of the actual payment.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repriced Approved Ambulatory Patient Group Amt
DescriptionThe monetary amount of payment by the repricer for the referenced ambulatory patient group.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repriced Approved Ambulatory Patient Group Code Id
DescriptionIdentifier for ambulatory patient group assigned to the claim by the repricer.
Data TypeStandards - Data Domains.ddm/Data Domains/Identifier [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repriced Claim Reference Num
DescriptionIdentification number, assigned by a repricing organization, to identify the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repriced Saving Amt
DescriptionThe monetary value of savings related to third party organization repricing of claims.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Exception Cd
DescriptionException code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Exception Code Sk
DescriptionException code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Exception Descr
DescriptionException code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Policy Compliance Cd
DescriptionSpecifies facility's medical policy compliance.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Policy Compliance Code Sk
DescriptionSpecifies facility's medical policy compliance.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Policy Compliance Descr
DescriptionSpecifies facility's medical policy compliance.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Rejection Reason Cd
DescriptionA code assigned by issuer to identify reason for rejection.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Rejection Reason Code Sk
DescriptionA code assigned by issuer to identify reason for rejection.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Reprice Rejection Reason Descr
DescriptionA code assigned by issuer to identify reason for rejection.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Repricing Flat Rate Amt
DescriptionThe amount used to determine the flat rate or per diem price by the repricing organization.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Responsible Party Reason Cd
DescriptionThe reason why the insured cannot represent themselves and why assistance from a responsible party is required to authorize or enable the execution of the request for payment in respect of the claimed medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Responsible Party Reason Code Descr
DescriptionThe reason why the insured cannot represent themselves and why assistance from a responsible party is required to authorize or enable the execution of the request for payment in respect of the claimed medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Responsible Party Reason Code Sk
DescriptionThe reason why the insured cannot represent themselves and why assistance from a responsible party is required to authorize or enable the execution of the request for payment in respect of the claimed medical services.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Retained Service Amt
DescriptionAdministered fee from payer.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount Large [DECIMAL(20,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Secondary Payer Pass-through Amt
DescriptionThe amount resulting from, under special conditions, the payers primary to the modeled health insurer being exempt from fulfilling all the financial obligations of their primary payer role. This amount is derivable from the Amount in Money Provision Element Part and its Money Provision Element Part Type.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Secondary Payment Ind
DescriptionSecondary Payment Indicator.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Service Authorization Exception Cd
DescriptionIndicates the reason or circumstances under which services were provided without prior authorization.

For example:
Immediate/Urgent Care
Services Rendered in a Retroactive Period
Emergency Care
Client as Temporary Medicaid
Request from County for Second Opinion to Recipient
Request for Override Pending
Special Handling
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Service Authorization Exception Code Sk
DescriptionIndicates the reason or circumstances under which services were provided without prior authorization.

For example:
Immediate/Urgent Care
Services Rendered in a Retroactive Period
Emergency Care
Client as Temporary Medicaid
Request from County for Second Opinion to Recipient
Request for Override Pending
Special Handling
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Service Authorization Exception Descr
DescriptionIndicates the reason or circumstances under which services were provided without prior authorization.

For example:
Immediate/Urgent Care
Services Rendered in a Retroactive Period
Emergency Care
Client as Temporary Medicaid
Request from County for Second Opinion to Recipient
Request for Override Pending
Special Handling
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Settlement Currency Cd
DescriptionIndicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Settlement Currency Code Descr
DescriptionIndicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Settlement Currency Code Sk
DescriptionIndicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Signature Dt
DescriptionIdentifies the date on which the submitter signs the request for reimbursement from the payor.
Data TypeStandards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Source Cd
DescriptionThe code that corresponds to the Source Code Sk.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Source Code Descr
DescriptionThe description that corresponds to the Source Type Cd.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Source Code Sk
DescriptionThe origin of the data identifying the actual load source, vendor, manual key entry, or context of the data in a specific row in the database.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Source Descr
DescriptionSource of the data for this row. For Claims and related data the source could be a Patient Administration feed, Lab System Feed, Claims System feed, or some other related feed. This code can be used to indicate the relative data quality of the row represented. eg: For a claim: this should identify pre adjudicated [provider] or post adjudicated [payor].
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Submission Clarification Type Cd
DescriptionIndicates that the provider or practitioner is clarifying the submission.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Submission Clarification Type Code Descr
DescriptionIndicates that the provider or practitioner is clarifying the submission.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Submission Clarification Type Code Sk
DescriptionIndicates that the provider or practitioner is clarifying the submission.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Subrogation Ind
DescriptionIndicates whether or not there exist subrogation rights on the claim which may be used to recover money from a third party.

For example:
0 = No subrogation
1 = Subrogation exists
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Supporting Documentation Ind
DescriptionIndicates whether necessary or expected claim supporting documentation has been submitted with the claim.

For example:
1 documentation submitted
0 documentation not submitted
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Surcharge Amt
DescriptionA surcharge imposed on the claim transaction.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Tenant Sk
DescriptionThe surrogate key of the entry identifying the legal owner of the data.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Term Discount Pct
DescriptionThe discount percentage available to the payer for payment within a specific time period.
Data TypeStandards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Adjustment Units of Service
DescriptionThe quantity of units of service being adjusted.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Claim Charge Amt
DescriptionThe sum of all charges included within this claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Cost
DescriptionThe total cost of this claim to the healthcare insurer.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Member Liability Amt
DescriptionThe total amount on a healthcare claim that a member is liable for. This would include unpaid claim amounts and any claim amounts previously paid by the member.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Nonpayable Professional Fees Amt
DescriptionTotal professional fees billed but not payable by the healthcare insurer.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Purchased Services Amt
DescriptionAmount of charges associated with the claim attributable to purchased services.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Units of Services
DescriptionThe quantity of additional items associated with the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Transaction Fee Amt
DescriptionThe fee charged for routing the claim transaction.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Type 4081 Claim Ind
DescriptionIndicating whether or not Medicare Section 4081 applies.
Data TypeStandards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Type Cd
DescriptionThe code that corresponds to the Type Code Sk.
Data TypeStandards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Type Code Descr
DescriptionThe description that corresponds to the Type Cd.
Data TypeStandards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Type Code Sk
DescriptionThe code identifying the actual type of the entity as per the type hierarchy defined in the analysis data model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Valid From Ts
DescriptionEstablishes a period where a set of attributes are true in the source system. This would be populated with the transaction timestamp and would be used for the snapshot date.
Data TypeStandards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKeyfalse
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Valid To Ts
DescriptionEnds a period of validity.
Data TypeStandards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse

Primary Key Details

 Claim Dimension PK
Key AttributeClaim Dk