| Dimensional Warehouse Model Data Model |
| Description | A 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. |
| Primary Key | |
Claim Dimension PK |
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| Dependencies | |
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| Reverse Dependencies | |
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| 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 |
Accident Fault Attribution Cd
| Description | Indicates how the blame for an accident related to a claim is allocated to the claimant. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Accident Fault Attribution Code Descr
| Description | Indicates how the blame for an accident related to a claim is allocated to the claimant. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Accident Fault Attribution Code Sk
| Description | Indicates how the blame for an accident related to a claim is allocated to the claimant. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Adjusted Repriced Claim Reference Num
| Description | Identification number, assigned by a repricing organization, to identify an adjusted claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| 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 |
Advanced Technology Operating Allowance
| Description | The 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 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 Claim Ind
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Affiliated Plan Cd
| Description | A code that indicates the affiliation characteristics of the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Affiliated Plan Code Descr
| Description | A code that indicates the affiliation characteristics of the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Affiliated Plan Code Sk
| Description | A code that indicates the affiliation characteristics of the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Allowed Amt
| Description | The maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. |
| 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 |
Amount Applied to Benefit Limit
| Description | The portion of the claim health plan liability amount that is deductible from the member's benefit maximum amount. |
| 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 |
Amount Applied to Out-of-pocket Limit
| Description | The portion of the cost sharing amounts that are deductible from the member's out-of-pocket maximum amount. |
| 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 |
Approved Amt
| Description | Amount approved to be paid on 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 |
Attachment Transmission Cd
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Attachment Transmission Code Sk
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Attachment Transmission Descr
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Attachment Type Cd
| Description | Specifies the type of attachment that is related to the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Attachment Type Code Sk
| Description | Specifies the type of attachment that is related to the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Attachment Type Descr
| Description | Specifies the type of attachment that is related to the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Audit Ind
| Description | Indicates whether the claim was audited. For example: 0 = Claim Not Audited 1 = Claim Audited |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
AWM Load Info Sk
| Description | The surrogate key of the load information entry describing the details regarding the loading of the row in the atomic data warehouse. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Bill From Dt
| Description | Earliest date of services billed for on the claim. |
| 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 |
Billing Form Cd
| Description | NUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Billing Form Code Sk
| Description | NUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Billing Form Descr
| Description | NUBC 3 character Uniform Billing Claim Form Bill Type describing the type of medical facility and bill form. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Bill To Dt
| Description | Last service date billed for on the claim. |
| 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 |
Capital Charge Amt
| Description | Cost allocation against the claim in respect of the capital costs tied up in the organization's business. |
| 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 |
Claim Bk
| Description | Concatenated values of a set of business attributes that uniquely identify the row. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Business Key [VARCHAR(255)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Dk
| Description | A numeric surrogate key used to uniquely identify entities in the dimensional model. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG] |
| Is Part Of PrimaryKey | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | true |
Claim Filing Indicator Cd
| Description | Identifies 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Filing Indicator Code Sk
| Description | Identifies 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Filing Indicator Descr
| Description | Identifies 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Num
| Description | Number assigned by a processor to identify a claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Pricing Method Cd
| Description | Classifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Pricing Method Code Descr
| Description | Classifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Pricing Method Code Sk
| Description | Classifies claim according to the method used to determine the allowed amounts relating to all medical services or products rendered. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Recovery Strategy Cd
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Recovery Strategy Code Descr
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Recovery Strategy Code Sk
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Size Category Cd
| Description | A 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Size Category Code Descr
| Description | A 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Size Category Code Sk
| Description | A 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Sk
| Description | A numeric surrogate key used to uniquely identify entities in the atomic model. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Status Cd
| Description | Indicates the state of the claim in the life cycle of adjudication. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Version Cd
| Description | Classifies a submission cycle that a claim may have been involved in. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Version Code Descr
| Description | Classifies a submission cycle that a claim may have been involved in. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Version Code Sk
| Description | Classifies a submission cycle that a claim may have been involved in. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Class Of Claim Cd
| Description | Categorization 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Class Of Claim Code Descr
| Description | Categorization 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Class Of Claim Code Sk
| Description | Categorization 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Clean Claim Receipt Dt
| Description | Date 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 Type | Standards - Data Domains.ddm/Data Domains/Date [DATE] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Clearinghouse Trace Num
| Description | Unique tracking number for the transaction assigned by a clearinghouse. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
CLIA Num
| Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
COB Amt
| Description | The coordination of benefits amount. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount Large [DECIMAL(20,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Amt
| Description | A fixed monetary amount that pertains to the contract. It is required if the service amounts are different than the claim level amount. |
| 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 |
Contract Code Num
| Description | The specific insurance contract, established by the payer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Pct
| Description | The percentage of charges that are payable under the contract. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Type Cd
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Type Code Sk
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Type Descr
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Contract Version Num
| Description | Identification of additional or supplemental contract provisions or identification of a particular version or modification of payer contract. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Currency Cd
| Description | Indicates the currency used as the basis for all monetary amounts. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Currency Code Sk
| Description | Indicates the currency used as the basis for all monetary amounts. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Current Ind
| Description | Set to 'Y' if this is the most recent row of a group having the same Surrogate Key. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Decisions
| Description | A 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 Type | Standards - Data Domains.ddm/Data Domains/Text Medium [VARCHAR(255)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Delay Reason Cd
| Description | Indicates the cause of any discrepancy between planned and actual end dates. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Delay Reason Code Sk
| Description | Indicates the cause of any discrepancy between planned and actual end dates. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Delay Reason Descr
| Description | Indicates the cause of any discrepancy between planned and actual end dates. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Demonstration Project Num
| Description | Identification number for a Medicare demonstration project. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Document Control Num
| Description | A reference number identifying this instance of the claim form. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
DRG Weighting
| Description | Factor applied to the standard cost for the diagnosis related group (DRG) with which the diagnosis is associated. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Decimal 9 [DECIMAL(19,9)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Dual Coverage Ind
| Description | Indicates that the claimed costs are covered by more than one insurance policy. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
DWM Load Info Sk
| Description | The surrogate key of the load information entry describing the details regarding the loading of the row. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Effective From Dt
| Description | Establishes a period where a set of attributes are true according to the business. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Date [DATE] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Effective To Dt
| Description | Ends a period of effectivity. |
| 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 |
EOB Requested Ind
| Description | Indicator of whether an explanation of benefits (EOB) is requested. For example: Yes No |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Estimated Due Amt
| Description | Amount calculated to be owed by patient. |
| 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 |
Extraordinary Capital Allowance
| Description | The 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 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 |
Extreme Care Capital Allowance
| Description | The add-on capital amount paid to the healthcare provider on this claim that relates to the exceptional nature of the claim case. |
| 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 |
Extreme Care Days Covered Cnt
| Description | The number of days that have been covered on this claim and that are attributable to the exceptional nature of the claim case. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Extreme Care Operating Allowance
| Description | The add-on operating amount paid to the healthcare provider on this claim that relates to the exceptional nature of the claim case. |
| 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 |
FI Action Cd
| Description | The type of action requested by the intermediary to be taken on an institutional claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
FI Action Code Sk
| Description | The type of action requested by the intermediary to be taken on an institutional claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
FI Action Descr
| Description | The type of action requested by the intermediary to be taken on an institutional claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| 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 |
Government Reduction Amt
| Description | Reduction in payment as legally defined by the governmental authorities to prevent overspending. |
| 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 |
HIPPS Cd
| Description | Health Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
HIPPS Code Descr
| Description | Health Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
HIPPS Code Sk
| Description | Health Insurance Prospective Payment System (HIPPS) rate codes represent the patient case mix groups on which payment determinations are made. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Home Plan Cd
| 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/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Home Plan Code Descr
| 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/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Home Plan Code Sk
| 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/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Host Plan Cd
| 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/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Host Plan Code Descr
| 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/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Host Plan Code Sk
| 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/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Incoming Ind
| Description | If 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Incurred But Not Reported Ind
| Description | Incurred 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Indemnity Portion
| Description | The part of the total cost of the claim that reimburses the loss. It excludes all fees and expenses. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
In Plan Network Ind
| Description | A 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Investigational Device Exemption Identifier Num
| Description | Number or reference identifying exemption assigned to an investigational device referenced in the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Last Worked Dt
| Description | The date upon which the patient last worked. |
| 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 |
Low Utilization Adjustment Cd
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Low Utilization Adjustment Code Sk
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Low Utilization Adjustment Descr
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Medical Education Capital Allowance
| Description | The 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 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 |
Medical Education Operating Allowance
| Description | The 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 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 |
Medicare A Covered Months Cnt
| Description | Number of months covered by Medicare Part A. |
| 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 |
Medicare B Covered Months Cnt
| Description | Number of months covered by Medicare Part B. |
| 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 |
Medicare Buyin Months Covered Cnt
| Description | Number of months covered by Medicare buy-in coverage. |
| 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 |
Medicare HMO Months Covered Cnt
| Description | Number of months covered by Medicare HMO. |
| 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 |
Member Authorization Type Cd
| Description | Indicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Member Authorization Type Code Descr
| Description | Indicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Member Authorization Type Code Sk
| Description | Indicates how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Minimal Care Cost Capital Reduction
| Description | Reduction 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 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 |
Minimal Care Cost Operating Reduction
| Description | Reduction 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 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 |
National Capital Allowance
| Description | Add-on capital claim payment amount paid to the healthcare provider based on specific national factors, such as the cost-of-living factor. |
| 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 |
National Operating Allowance
| Description | Add-on operating claim payment amount paid to the healthcare provider based on specific national factors, such as the cost-of-living factor. |
| 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 |
One Pass Process Ind
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Original Claim Num
| Description | In 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 Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Out of Area Financial Administration Fee Amt
| Description | The 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 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 |
Out of Area General Administration Fee Amt
| Description | The 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 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 |
Out of Area Surcharge Amt
| Description | A surcharge imposed on the claim because it was out of area. |
| 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 |
Out-of-Network Reason Cd
| Description | Indicates why a service was rendered outside the provider network. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Out-of-Network Reason Code Descr
| Description | Indicates why a service was rendered outside the provider network. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Out-of-Network Reason Code Sk
| Description | Indicates why a service was rendered outside the provider network. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Participation Agreement Cd
| Description | Code indicating a participating claim submitted by a non-participating provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Participation Agreement Code Sk
| Description | Code indicating a participating claim submitted by a non-participating provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Participation Agreement Descr
| Description | Code indicating a participating claim submitted by a non-participating provider. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Patient Demographic Capital Allowance
| Description | The add-on capital amount paid to the healthcare provider on this claim to compensate a high-percentage of low-income patients treated. |
| 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 |
Patient Demographic Operating Allowance
| Description | The add-on operating amount paid to the healthcare provider on this claim to compensate a high-percentage of low-income patients treated. |
| 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 |
Patient Paid Amt
| Description | The amount the provider has received from the patient (or insured) toward payment of a claim or claim line. |
| 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 |
Payer Paid Amt
| Description | The amount paid by the payer on this claim or claim line. |
| 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 |
Pre-Authorization Exception Reason Cd
| Description | Indicates why expected authorization is waived in a given context. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Pre-Authorization Exception Reason Code Descr
| Description | Indicates why expected authorization is waived in a given context. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Pre-Authorization Exception Reason Code Sk
| Description | Indicates why expected authorization is waived in a given context. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Primary Diagnosis Cd
| Description | Surrogate key for the link between a claim and a patient diagnosis |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Primary Diagnosis Code Sk
| Description | Surrogate key for the link between a claim and a patient diagnosis |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Primary Diagnosis Descr
| Description | Surrogate key for the link between a claim and a patient diagnosis |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Prompt Payment Discount Amt
| Description | The amount discounted from the health plan liability amount for prompt payment of the claim, as per provider agreement specifications. |
| 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 |
Property Casualty Claim Num
| Description | Identification number for property casualty claim associated with the services identified on the bill. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Provider Assignment Ind
| Description | An indicator showing whether or not the provider accepts assignment for the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Provider Capital Allowance
| Description | The part of capital payment amount paid to the healthcare provider in the context of this claim that relates to labor costs. |
| 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 |
Provider Operating Allowance
| Description | The part of operating payment amount paid to the healthcare provider in the context of this claim that relates to labor costs. |
| 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 |
Provider Signature Ind
| Description | Indicates whether a signature is on file from the provider of the service acknowledging that they performed the service and therefore authorizing payment. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Repriced Allowed Amt
| Description | The 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 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 |
Repriced Approved Ambulatory Patient Group Amt
| Description | The monetary amount of payment by the repricer for the referenced ambulatory patient group. |
| 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 |
Repriced Approved Ambulatory Patient Group Code Id
| Description | Identifier for ambulatory patient group assigned to the claim by the repricer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Identifier [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Repriced Claim Reference Num
| Description | Identification number, assigned by a repricing organization, to identify the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Repriced Saving Amt
| Description | The monetary value of savings related to third party organization repricing of claims. |
| 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 |
Reprice Exception Cd
| Description | Exception code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Exception Code Sk
| Description | Exception code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Exception Descr
| Description | Exception code generated by the third party organization. Used only by repricers as needed. This information is specific to the destination payer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Policy Compliance Cd
| Description | Specifies facility's medical policy compliance. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Policy Compliance Code Sk
| Description | Specifies facility's medical policy compliance. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Policy Compliance Descr
| Description | Specifies facility's medical policy compliance. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Rejection Reason Cd
| Description | A code assigned by issuer to identify reason for rejection. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Rejection Reason Code Sk
| Description | A code assigned by issuer to identify reason for rejection. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Reprice Rejection Reason Descr
| Description | A code assigned by issuer to identify reason for rejection. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Repricing Flat Rate Amt
| Description | The amount used to determine the flat rate or per diem price by the repricing organization. |
| 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 |
Responsible Party Reason Cd
| Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Responsible Party Reason Code Descr
| Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Responsible Party Reason Code Sk
| Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Retained Service Amt
| Description | Administered fee from payer. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount Large [DECIMAL(20,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Secondary Payer Pass-through Amt
| Description | The 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 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 |
Secondary Payment Ind
| Description | Secondary Payment Indicator. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Service Authorization Exception Cd
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Service Authorization Exception Code Sk
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Service Authorization Exception Descr
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Settlement Currency Cd
| Description | Indicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Settlement Currency Code Descr
| Description | Indicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Settlement Currency Code Sk
| Description | Indicates the currency selected by the customer to be used for all benefit claim payments and all monetary information related to this claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Signature Dt
| Description | Identifies the date on which the submitter signs the request for reimbursement from the payor. |
| 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 |
Source Cd
| Description | The code that corresponds to the Source Code Sk. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Source Code Descr
| Description | The description that corresponds to the Source Type Cd. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Source Code Sk
| Description | The 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 Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Source Descr
| Description | Source 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 Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Submission Clarification Type Cd
| Description | Indicates that the provider or practitioner is clarifying the submission. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Submission Clarification Type Code Descr
| Description | Indicates that the provider or practitioner is clarifying the submission. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Submission Clarification Type Code Sk
| Description | Indicates that the provider or practitioner is clarifying the submission. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Subrogation Ind
| Description | Indicates 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 Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Supporting Documentation Ind
| Description | Indicates whether necessary or expected claim supporting documentation has been submitted with the claim. For example: 1 documentation submitted 0 documentation not submitted |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
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 |
Tenant Sk
| Description | The surrogate key of the entry identifying the legal owner of the data. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Term Discount Pct
| Description | The discount percentage available to the payer for payment within a specific time period. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Total Adjustment Units of Service
| Description | The quantity of units of service being adjusted. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Total Claim Charge Amt
| Description | The sum of all charges included within this 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 |
Total Cost
| Description | The total cost of this claim to the healthcare insurer. |
| 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 |
Total Member Liability Amt
| Description | The 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 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 |
Total Nonpayable Professional Fees Amt
| Description | Total professional fees billed but not payable by the healthcare insurer. |
| 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 |
Total Purchased Services Amt
| Description | Amount of charges associated with the claim attributable to purchased services. |
| 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 |
Total Units of Services
| Description | The quantity of additional items associated with the claim. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
| 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 |
Type 4081 Claim Ind
| Description | Indicating whether or not Medicare Section 4081 applies. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Type Cd
| Description | The code that corresponds to the Type Code Sk. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Type Code Descr
| Description | The description that corresponds to the Type Cd. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Type Code Sk
| Description | The code identifying the actual type of the entity as per the type hierarchy defined in the analysis data model. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Valid From Ts
| Description | Establishes 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 Type | Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP] |
| Is Part Of PrimaryKey | false |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Valid To Ts
| Description | Ends a period of validity. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
| Primary Key Details |
Claim Dimension PK
| Key Attribute | Claim Dk |
| Dimensional Warehouse Model Data Model |