| Dimensional Warehouse Model Data Model |
Description | The analysis of claims handling activities so as to optimize provider networks, operational efficiency and member/provider satisfaction. Includes analysis of resource utilization and productivity. |
Primary Key | |
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Dependencies | |
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Reverse Dependencies | |
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Attribute Details |
Description | The average time, expressed in days, between the date when a claim is 'clean' and the date when a claim is adjudicated. 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 |
Description | The average age of each claim 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 |
Description | The average time, expressed in days, between the date when the claim has been received and the date when the claim is 'clean'. This would include any time spent for data entry or scanning and data correction as well as any time spent 'developing' the claim by contacting the member or provider for additional information. 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 |
Description | The average cost of processing a 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 |
Description | The average time, expressed in days, between the date when a claim is received and the date when a claim is paid or denied. 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 |
Description | The average number of claims that are processed by each claim processor, whether the claim processor be an employee or a claims processing engine. Formula: [A/B] (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 |
Description | The average cost of processing 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 |
Description | The average number of days between when medical services occurred and when their respective claims were 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 |
Description | The average time, expressed in days, between the date when the claim has been adjudicated and the date when the claim is paid or denied. 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 |
Description | Average number of line items in a claim 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 |
Description | The average number of claims received from each member. 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 |
Description | The average time, expressed in days, between the date when the claim has been re-opened and the date when the claim is closed. 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 |
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 |
Description | Total cost of performing claim adjudication activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total personnel cost required to perform claim adjudication activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total time, expressed in days, between the date when a claim is 'clean' and the date when a claim is adjudicated. |
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 |
Description | Total cost for claim adjustment activities. This includes the costs of claim appeals, re-opening claims, and adjusting claims. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total personnel cost required to perform the claim adjustment activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total age of all claims received, expressed in days where claim age is defined as the number of days that the claim spends in the claims process before closure, i.e. from receipt to payment. |
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 |
Description | The number of claims appealed compared to the number of claims processed. 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 |
Description | The total time, expressed in days, between the date when claims are received and the date when the claims are 'clean'. This would include any time spent for data entry or scanning and data correction as well as any time spent 'developing' the claim by contacting the member or provider for additional information. |
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 |
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 |
Description | The number of claims overridden compared to the number of claims processed. 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 |
Description | For claims that have been closed within the reference period, the total time, expressed in days, between the date when claims are received and the date when claims are 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 |
Description | The total cost for claim receipt activities, including mail room, imaging, data entry, OCR and other claim pre-processing activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total personnel cost required to perform claim receipt activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The number of claims adjusted compared to the number of claims processed. 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 |
Description | Total cost of performing the claim payment and denial activities. This includes issuing remittance advices to providers and explanations of benefits (EOB) to members. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total personnel cost required to perform claim payment and denial activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The total personnel cost required to perform the claims processing activities. |
Data Type | Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The number of claims received 'clean' compared with the total number of claims received. 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 |
Description | The total number of days between when medical services occurred and when their respective claims were received. |
Data Type | Standards - Data Domains.ddm/Data Domains/Number Integer [INTEGER] |
Is Part Of PrimaryKey | false |
Is Required | false |
Is Derived | false |
Is Surrogate Key | false |
Description | The number of days it would take to process all unprocessed claims, considering normal processing capacity and throughput. Formula: [(A-B)*C] (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 |
Description | The sum of durations, expressed in days, between the date when claims are adjudicated and the date when claims are paid or denied. |
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 |
Description | The ratio of all claims closed during their first pass through the claim handling process to total claims processed. 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 |
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 |
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 |
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 |
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 |
Description | The total number of claim appeals occurring during the reference 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 |
Description | The total number of claim line items. |
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 |
Description | The total amount of claim overrides occurring during the reference 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 |
Description | The total number of full time equivalent employees that process 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 |
Description | The number of claims adjudicated during the reference 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 |
Description | The total number of claims adjusted during the reference 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 |
Description | The total number of claims that were audited during the reference 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 |
Description | The total number of claims that were paid or denied during the reference 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 |
Description | The total number of claims that have been both received and adjudicated within the reference 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 |
Description | The total number of claims that were adjudicated without the need for human intervention to review, amend, or process the claim. |
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 |
Description | Number of claims received during the reference 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 |
Description | The total number of claims received where no further modifications and/or resubmissions of claim information were required. |
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 |
Description | Total number of fraudulent claims discovered 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 |
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 |
Description | Total number of claims in a specified period that had previously been closed but have subsequently been reopened. |
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 |
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 |
Description | The percentage of received claims that have not been paid or denied. Formula: [(1-(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 |
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 |
Description | The total time, expressed in days, between the date when claims are reopened and the date when claims are closed again. |
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 |
Description | Total cost of the claims processing activities. Formula: [A+B+C+D] (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 |
Relationship Details |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 | Insurance Policy Dimension |
Parent Multiplicity | ONE |
Parent Referential Integrity: On Delete | NONE |
Parent Referential Integrity: On Insert | NONE |
Parent Referential Integrity: On Update | NONE |
Is Identifying Relationship | true |
Child Table | Claims Processing 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 | Organization 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 |
Key Attribute | Claim Dk |
Key Attribute | Plan Member Dk |
Key Attribute | Health Plan Product Dk |
Key Attribute | Insurance Policy Dimension Dk |
Key Attribute | Organization Dk |
Key Attribute | Calendar Dk |
Key Attribute | Geographic Area Dk |
Key Attribute | Group Dk |
| Dimensional Warehouse Model Data Model |