| 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 | |
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Dependencies | |
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Reverse Dependencies | |
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Attribute Details |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
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 |
Key Attribute | Claim Dk |
| Dimensional Warehouse Model Data Model |