Dimensional Warehouse Model Data Model

Entity

Entity Claim Recovery Analysis

Description

The analysis of the activities a health plan carries out in order to recover claim payment amounts from reinsurers, coinsurers, providers, members and other third parties. This includes analysis of the amounts deemed recoverable, actually recovered and written off.

Attributes
Actual Claim Recovery Ratio
Average Number Of Payment Requests Issued Per Recovery
Average Recovery Activity Personnel Utilization
Average Recovery Cost Amount
Average Recovery Duration
Average Recovery Payment Lag
Calendar Dk
Claim Dk
Claim Paid Amount
Claim Recoverable Amount
Claim Recovered Amount
Claim Recovery Personnel Utilization
Geographic Area Dk
Group Dk
Health Plan Product Dk
Number Of Claims
Number Of Members
Number Of Payment Requests Issued
Number Of Recoveries
Number Of Recovery Payments
Outstanding Recovery Amount
Recovered Amount Per Claim
Recovered Amount Per Member
Recovery Cost Amount
Recovery Duration
Recovery Payment Lag
Targeted Claim Recovery Ratio
Write Off Amount
Write Off Percentage

Relationship
Claim Recovery Analysis_Calendar Dimension_FK
Claim Recovery Analysis_Geographic Area Dimension_FK
Claim Recovery Analysis_Group Dimension_FK
Claim Recovery Analysis_Claim Dimension_FK
Claim Recovery Analysis_Health Plan Product Dimension_FK

Primary Key
Claim Recovery Analysis PK

Dependencies
NONE

Reverse Dependencies

Attribute Details

Actual Claim Recovery Ratio

Description	Ratio of claim payment amounts paid, that are recovered. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Average Number Of Payment Requests Issued Per Recovery

Description	The average number of communications issued requesting the recoverable amount. Enables payers to identify organizations that typically require additional attention in order to process recoveries. 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 Recovery Activity Personnel Utilization

Description	The average amount of effort, measured in full time equivalent (FTE) days, required to complete a claim recovery. 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 Recovery Cost Amount

Description	The average cost of a claim recovery activity. 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 Recovery Duration

Description	The average length of time, measured in days, from when claim recovery activities commence to when they complete. 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 Recovery Payment Lag

Description	The average length of time, measured in days, taken from when a claim recovery payment is requested and the time it is received. 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

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 Paid Amount

Description	The total amount paid in respect 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

Claim Recoverable Amount

Description	The total amount of claim payments that have been recognized as recoverable.
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 Recovered Amount

Description	The total of incoming payments from claim recoveries.
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 Recovery Personnel Utilization

Description	The total amount of effort, measured in full time equivalent (FTE) days, required to complete claim recoveries.
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

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

Number Of Claims

Description	Total number of healthcare 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 Payment Requests Issued

Description	The total number of recovery payment requests issued during the claim recovery process.
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 Recoveries

Description	The total number of claim recoveries.
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 Recovery Payments

Description	The total number of recovery payments received.
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

Outstanding Recovery Amount

Description	The total value of claim amounts deemed recoverable but not yet recovered. 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

Recovered Amount Per Claim

Description	The average amount recovered per 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

Recovered Amount Per Member

Description	The average claim amount recovered 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

Recovery Cost Amount

Description	The total cost of recovering the claim 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

Recovery Duration

Description	The total duration, measured in days, from when a claim payment recovery is initiated to the time it is recovered and closed.
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

Recovery Payment Lag

Description	The total length of time between the time recovery payments are requested and the time payment is received.
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

Targeted Claim Recovery Ratio

Description	Ratio of claim payment amounts that are recoverable. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Write Off Amount

Description	The total recoverable amount that has been written off. Claim recoveries may be written off in part or in total where the organization believes the cost of recovery will exceed the value to be recovered or where the amount is in dispute and the organization is not confident of a positive outcome.
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

Write Off Percentage

Description	The percentage of recoverable claim payment amounts that are explicitly written off. 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

Relationship Details

Claim Recovery Analysis_Calendar Dimension_FK

Is Identifying Relationship	true
Child Table	Claim Recovery 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

Claim Recovery Analysis_Geographic Area Dimension_FK

Is Identifying Relationship	true
Child Table	Claim Recovery 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

Claim Recovery Analysis_Group Dimension_FK

Is Identifying Relationship	true
Child Table	Claim Recovery 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

Claim Recovery Analysis_Claim Dimension_FK

Is Identifying Relationship	true
Child Table	Claim Recovery 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

Claim Recovery Analysis_Health Plan Product Dimension_FK

Is Identifying Relationship	true
Child Table	Claim Recovery Analysis
Child Multiplicity	ZERO_TO_ONE
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

Claim Recovery Analysis PK

Key Attribute	Calendar Dk
Key Attribute	Geographic Area Dk
Key Attribute	Group Dk
Key Attribute	Claim Dk
Key Attribute	Health Plan Product Dk

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