| Dimensional Warehouse Model Data Model |
| Description | Analysis of utilization detail allows drill downs on specific aspects of utilization and medical costs. As a result of such analysis, the health plan may undertake member and/or provider education, initiate public health or health management programs, or take other actions to control utilization and costs. |
| Primary Key | |
Service Utilization Claim Detail Analysis PK |
|
| Dependencies | |
NONE |
|
| Reverse Dependencies | |
|
|
| Attribute Details |
Average Claim Payment Per Admission Amount
| Description | The average claim payment for each admission. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per DME Claim Amount
| Description | The average claim payment for each durable medical equipment (DME) claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per ER Visit Amount
| Description | The average claim payment for each emergency room visit. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Inpatient Day Amount
| Description | The average claim payment for each day of hospitalization. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Lab Claim Amount
| Description | The average claim payment for each lab claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Medical Claim Amount
| Description | The average claim payment for each medical claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Member Amount
| Description | Average amount paid for claims per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Member Using Mental Health Benefit Amount
| Description | Cost of all claims per member for those members using mental health benefit. This measure is important as research shows that total claims costs are higher for these members and be adversely affected by restricting mental health benefits. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Mental Health Claim Amount
| Description | The average payment for each mental health claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Outpatient Surgery Amount
| Description | The average payment for each outpatient surgery claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Pharmacy Claim Amount
| Description | The average payment for each pharmacy claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Provider Visit Amount
| Description | The average payment for each provider visit. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Service Amount
| Description | The average amount paid for each service provided. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Session Amount
| Description | The average payment for each session provided. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Claim Payment Per Substance Abuse Claim Amount
| Description | The average cost of each substance abuse claim. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average DME Claim Payment Per Member Amount
| Description | The average value of claim payments for durable medical equipment (DME) per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average ER Claim Payment Per Member Amount
| Description | The cost of emergency room visits per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Hospitalization Claim Payment Per Member Amount
| Description | The cost of inpatient services per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Lab Claim Payment Per Member Amount
| Description | Lab claim payments per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Length Of Stay Per Admission
| Description | The average number of days patients stayed in hospital. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| Data Type | Standards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
Average Medical Claim Payment Per Member Amount
| Description | The average amount paid for medical claims per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Mental Health Claim Payment Per Member Amount
| Description | Average mental health claim payments per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Outpatient Surgery Claim Payment Per Member Amount
| Description | The cost of outpatient surgery per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Pharmacy Claim Payment Per Member Amount
| Description | Average pharmacy claim payments per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Provider Visit Claim Payment Per Member Amount
| Description | The cost of provider visits per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
Average Substance Abuse Claim Payment Per Member Amount
| Description | Average substance abuse claim payments per member. Formula: [A/B] (see dependencies and their labels for measures used in the formula) |
| 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 |
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 | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Dk
| Description | A numeric surrogate key used to uniquely identify entities in the dimensional model. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG] |
| Is Part Of PrimaryKey | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Claim Payment Amount
| Description | The total amount of claim payments made to healthcare providers. |
| 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 Payments For Members With Claims Greater Than $50000
| Description | Sum of claim payments for members with claims greater than $50,000. |
| 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 Payments For Provider Visits Amount
| Description | The sum of the amounts paid for provider visits. |
| 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 Payments For Sessions Amount
| Description | The sum of the amounts paid for sessions. |
| 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 |
Condition 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 | false |
Cost Of Admissions Amount
| Description | The sum of the amounts paid for admissions. |
| 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 |
Cost Of Claims For Members With Mental Health Claims Amount
| Description | Overall cost of mental health 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 |
Cost Of Encounters Amount
| Description | The sum of the amounts paid for encounters. |
| 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 |
Crude Mortality Rate
| Description | The mortality rate from all causes within a given population during a given period of time (generally one year). May be calculated against the population at the middle of the time period or against the average population during the time period. Expressed as rate per thousand. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
DME Claim Payment Amount
| Description | The sum of amounts paid for durable medical equipment (DME) 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 |
Eligible Population Count
| Description | The total number of individuals in group who were eligible to enroll. |
| 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 |
Enrollment Count
| Description | The number of members of a group who enroll in a health benefits plan. |
| 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 |
ER Visits Claim Payment Amount
| Description | The sum of the amounts paid for emergency room visits. |
| 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 |
Geographic Area 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 | false |
Group 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 | false |
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 | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Hospitalization Claim Payment Amount
| Description | The sum of the amounts paid for admissions. |
| 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 |
Lab Claim Payment Amount
| Description | The sum of amounts paid for lab 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 |
Medical Claim Payment Amount
| Description | Sum of amounts paid for medical 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 |
Mental Health Claim Payment Amount
| Description | The sum of amounts paid for mental health 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 |
Number Of Claims Per 1000 Members
| Description | Number of claims per member. Formula: [A/B * 1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Deaths
| Description | The mortality rate in the given population across the given time period, (typically a year). |
| 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 |
Number Of DME Claims
| Description | Total number of durable medical equipment (DME) claims. |
| 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 |
Number Of DME Claims Per 1000 Members
| Description | Number of durable medical equipment (DME) claims per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Emergency Room Visits
| Description | Total number or emergency room visits. |
| 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 |
Number Of Emergency Room Visits Per 1000 Members
| Description | Number of emergency room visits per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Encounters
| Description | The total number of encounters. |
| 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 |
Number Of Encounters Per 1000 Members
| Description | Number of encounters per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Inpatient Admissions
| Description | The number of number of inpatient admissions. The definition of an inpatient admission may vary by facility but typically involves 24 hours or more of clinical observation and nursing support. |
| 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 |
Number Of Inpatient Admissions Per 1000 Members
| Description | Number of admissions per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Inpatient Days
| Description | The number of days patients were in hospital. |
| 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 |
Number Of Interventions
| Description | The total number of interventions or interactions between participants and program staff. |
| 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 |
Number Of Interventions Per 1000 Members
| Description | Number of interventions per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Lab Claims
| Description | Total number of lab claims. |
| 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 |
Number Of Lab Claims Per 1000 Members
| Description | Number of lab claims per 1000 member. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Medical Claims
| Description | Total number of medical claims. |
| 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 |
Number Of Members
| Description | The total count of members, during the period of analysis. This may be the total number of people with one or more active memberships at a given point in time during the period, or the average number of people with active memberships over the full period. |
| 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 |
Number Of Members With 2 Or More ER Visits In One Year
| Description | Number of members with 2 or more ER visits in 12-month measurement period. |
| 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 |
Number Of Members With Claims Cost Greater Than $15000
| Description | Number of members with claims cost greater than $15,000. |
| 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 |
Number Of Members With Claims Cost Greater Than $50000
| Description | Number of members with claims cost greater than $50,000. |
| 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 |
Number Of Members With Mental Health Claims
| Description | The number of members who have one or more claims against mental health coverage. |
| 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 |
Number Of Mental Health Claims
| Description | Total number of mental health claims. |
| 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 |
Number Of Mental Health Claims Per 1000 Members
| Description | Number of mental health claims per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Outpatient Surgeries
| Description | Total number or outpatient surgeries. |
| 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 |
Number Of Outpatient Surgeries Per 1000 Members
| Description | Number of outpatient surgeries per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Pharmacy Claims
| Description | The number of pharmacy claims during the period. |
| 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 |
Number Of Prescriptions
| Description | The count of prescriptions for drugs or other treatments. A prescription is typically an order written by a healthcare professional for a drug or other treatment for a patient. |
| 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 |
Number Of Prescriptions Per 1000 Members
| Description | Number of prescriptions per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Procedures
| Description | Number of procedures performed. |
| 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 |
Number Of Procedures Per 1000 Members
| Description | Number of procedures per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Provider Visits
| Description | Number of visits to providers. |
| 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 |
Number Of Provider Visits Per 1000 Members
| Description | Number of provider visits per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Services
| Description | The total number of services. |
| 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 |
Number Of Services Per 1000 Members
| Description | Number of services per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Number Of Sessions
| Description | The total number of sessions. |
| 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 |
Number Of Substance Abuse Claims
| Description | Total number of substance abuse claims. |
| 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 |
Number Of Substance Abuse Claims Per 1000 Members
| Description | Number of substance abuse claims per 1000 members. Formula: [(A/B)*1000] (see dependencies and their labels for measures used in the formula) |
| 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 |
Outpatient Surgery Claim Payment Amount
| Description | The sum of the amounts paid for outpatient surgery. |
| 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 |
Payments For Medical Services Amount
| Description | The sum of the amounts paid for medical 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 |
Percentage Of Eligible Population Enrollment
| Description | The percentage of number eligible individuals of a group who enroll in a health benefits plan. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Percentage Of Total Claims Attributable To Members With Claims Greater Than $50000
| Description | Claim payments for members with claims greater than $50,000 as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Pharmacy Claim Payment Amount
| Description | Sum of amounts paid for pharmacy 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 |
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 | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
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 | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Procedure Code 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 | false |
Proportion Of DME Total Claim Cost
| Description | Durable medical equipment (DME) claim payments as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of ER Visit Total Claim Cost
| Description | Cost of emergency room visits as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Hospitalization Total Claim Cost
| Description | Hospitalization costs as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Lab Total Claim Cost
| Description | Lab claim payments as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Medical Total Claim Cost
| Description | Medical claim payments as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Mental Health Total Claim Cost
| Description | Cost of mental health claims as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Outpatient Surgery Total Claim Cost
| Description | Cost of outpatient surgery as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Pharmacy Total Claim Cost
| Description | Cost of pharmacy claims as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Provider Visit Total Claim Cost
| Description | Cost of provider visits as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
Proportion Of Substance Abuse Total Claim Cost
| Description | Cost of substance abuse claims as percent of total claim payments. Formula: [(A/B)*100] (see dependencies and their labels for measures used in the formula) |
| 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 |
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 | true |
| Is Required | true |
| Is Derived | false |
| Is Surrogate Key | false |
Service 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 | false |
Substance Abuse Claim Payment Amount
| Description | The sum of amounts paid for substance abuse claim payments. |
| Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
| Relationship Details |
Service Utilization Claim Detail Analysis_Calendar Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
Service Utilization Claim Detail Analysis_Geographic Area Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 | Geographic Area Dimension |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Service Utilization Claim Detail Analysis_Plan Member Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
Service Utilization Claim Detail Analysis_Condition Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 | Condition Dimension |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Service Utilization Claim Detail Analysis_Group Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 | Group Dimension |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Service Utilization Claim Detail Analysis_Provider Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
Service Utilization Claim Detail Analysis_Practitioner Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
Service Utilization Claim Detail Analysis_Claim Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
Service Utilization Claim Detail Analysis_Service Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 | Service Dimension |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Service Utilization Claim Detail Analysis_Procedure Code Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 | Procedure Code Dimension |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
Service Utilization Claim Detail Analysis_Health Plan Product Dimension_FK
| Is Identifying Relationship | true |
| Child Table | Service Utilization Claim Detail Analysis |
| 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 |
| Primary Key Details |
Service Utilization Claim Detail Analysis PK
| Key Attribute | Calendar Dk |
| Key Attribute | Geographic Area Dk |
| Key Attribute | Plan Member Dk |
| Key Attribute | Condition Dk |
| Key Attribute | Group Dk |
| Key Attribute | Provider Dk |
| Key Attribute | Practitioner Dk |
| Key Attribute | Claim Dk |
| Key Attribute | Service Dk |
| Key Attribute | Procedure Code Dk |
| Key Attribute | Health Plan Product Dk |
| Dimensional Warehouse Model Data Model |