Dimensional Warehouse Model Data Model

Entity

Entity Claim Fact

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.

Attributes
Access Fee Amt
Administration Fee Amt
Advanced Technology Operating Allowance
Affiliated Health Plan Product Dk
Affiliated Health Plan Product Sk
Allowed Amt
Amount Applied to Benefit Limit
Amount Applied to Out-of-pocket Limit
Approved Amt
AWM Load Info Sk
Bill From Calendar Dk
Billing Practitioner Dk
Billing Practitioner Sk
Capital Charge Amt
Claim Bk
Claim Cnt
Claim Dk
Claim Fact Dk
Claim Sk
COB Amt
Contract Amt
Contract Pct
Current Ind
DRG Weighting
DWM Load Info Sk
Effective From Dt
Effective To Dt
Encounter Dk
Encounter Sk
Estimated Due Amt
Extraordinary Capital Allowance
Extreme Care Capital Allowance
Extreme Care Days Covered Cnt
Extreme Care Operating Allowance
Facility Dk
Facility Sk
Financial Intermediary Fee
Government Reduction Amt
Guarantor Dk
Guarantor Sk
Home Health Plan Product Dk
Home Health Plan Product Sk
Host Health Plan Product Dk
Host Health Plan Product Sk
Indemnity Portion
Medical Education Capital Allowance
Medical Education Operating Allowance
Medicare A Covered Months Cnt
Medicare B Covered Months Cnt
Medicare Buyin Months Covered Cnt
Medicare HMO Months Covered Cnt
Minimal Care Cost Capital Reduction
Minimal Care Cost Operating Reduction
National Capital Allowance
National Operating Allowance
Operating Charge Amt
Out of Area Financial Administration Fee Amt
Out of Area General Administration Fee Amt
Out of Area Surcharge Amt
Patient Demographic Capital Allowance
Patient Demographic Operating Allowance
Patient Dk
Patient Paid Amt
Patient Sk
Payer Paid Amt
Pay To Practitioner Dk
Pay To Practitioner Sk
Plan Member Dk
Plan Member Sk
Primary Healthcare Insurer Dk
Primary Healthcare Insurer Sk
Prompt Payment Discount Amt
Provider Capital Allowance
Provider Dk
Provider Operating Allowance
Provider Sk
Rendering Practitioner Dk
Rendering Practitioner Sk
Repriced Allowed Amt
Repriced Approved Ambulatory Patient Group Amt
Repriced Saving Amt
Repricing Flat Rate Amt
Retained Service Amt
Secondary Payer Pass-through Amt
Source Cd
Source Code Sk
Supervising Practitioner Dk
Supervising Practitioner Sk
Surcharge Amt
Tenant Sk
Term Discount Pct
Total Adjustment Units of Service
Total Claim Charge Amt
Total Cost
Total Member Liability Amt
Total Nonpayable Professional Fees Amt
Total Purchased Services Amt
Total Units of Services
Total Visits Rendered Cnt
Transaction Fee Amt
Type Code Sk
Valid From Ts
Valid To Ts

Relationship
Claim Detail_Claim_FK
Claim Detail_Provider_FK
Claim Detail Billing Practitioner_FK
Claim Detail Pay To Practitioner_FK
Claim Detail Rendering Practitioner_FK
Claim Detail Supervising Practitioner_FK
Claim Detail_Patient_FK
Claim Detail_Encounter_FK
Claim Fact_Calendar Dimension_FK
Claim Fact_Healthcare Insurer Dimension_FK
Claim Fact_Plan Member Dimension_FK
Claim Fact_Home Health Plan Product Dimension_FK
Claim Fact_Host Health Plan Product Dimension_FK
Claim Fact_Affiliated Health Plan Product Dimension_FK
Claim Fact_Point Of Care Location Dimension_FK
Claim Fact_Party Role Dimension_FK

Primary Key
Claim Fact PK

Dependencies

Reverse Dependencies

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

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 Health Plan Product 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Affiliated Health Plan Product 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

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

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 Calendar 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Billing Practitioner 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Billing Practitioner 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

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 Cnt

Description	Counts the number of Claim Fact rows. Set to 1 by ETL.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Default Value	1
Is Part Of PrimaryKey	false
Is Required	false
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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Claim Fact 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 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

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 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

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

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

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

Encounter 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Encounter 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

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

Facility 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Facility 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

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

Guarantor 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Guarantor 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

Home Health Plan Product 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Home Health Plan Product 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

Host Health Plan Product 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Host Health Plan Product 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

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

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

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

Operating Charge Amt

Description	Cost allocation against the claim in respect of the operating cost directly attributable to the procedures and services provided.
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 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

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 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	false
Is Required	true
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

Patient 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

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

Pay To Practitioner 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Pay To Practitioner 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

Plan Member 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Plan Member 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	false
Is Derived	false
Is Surrogate Key	false

Primary Healthcare Insurer 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Primary Healthcare Insurer 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

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

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 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	false
Is Required	true
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 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

Rendering Practitioner 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Rendering Practitioner 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

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 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

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

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

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 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

Supervising Practitioner 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Supervising Practitioner 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

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

Total Visits Rendered Cnt

Description	A count of visits on this bill rendered prior to re-certification date.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [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 Code Sk

Description	Identifies the detail entity represented by the anchor row.
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

Relationship Details

Claim Detail_Claim_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Claim Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail_Provider_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Provider Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail Billing Practitioner_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Role Name	Billing
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail Pay To Practitioner_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Role Name	pay to
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail Rendering Practitioner_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Role Name	Rendering
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail Supervising Practitioner_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Role Name	Supervising
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail_Patient_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Patient Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Detail_Encounter_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Encounter Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Calendar Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Calendar Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Healthcare Insurer Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Healthcare Insurer Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Plan Member Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Plan Member Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Home Health Plan Product Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Health Plan Product Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Host Health Plan Product Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Health Plan Product Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Affiliated Health Plan Product Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Health Plan Product Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Point Of Care Location Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Point Of Care Location Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Fact_Party Role Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Party Role Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

Claim Fact PK

Key Attribute

Claim Fact Dk

Overview

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Package

Entity

Dimensional Warehouse Model Data Model