Entity Claims Processing Analysis

DescriptionThe analysis of claims handling activities so as to optimize provider networks, operational efficiency and member/provider satisfaction. Includes analysis of resource utilization and productivity.

Attributes
Average Claim Adjudication Turn-around TimeAverage Claim Adjudication Turn-around Time
Average Claim Age In DaysAverage Claim Age In Days
Average Claim Cleanup DurationAverage Claim Cleanup Duration
Average Claim Processing Cost AmountAverage Claim Processing Cost Amount
Average Claim Processing DurationAverage Claim Processing Duration
Average Claims Per Claim ProcessorAverage Claims Per Claim Processor
Average Claims Processing Cost Per Member AmountAverage Claims Processing Cost Per Member Amount
Average Days Incurred To ReceivedAverage Days Incurred To Received
Average Duration From Adjudication To PaymentAverage Duration From Adjudication To Payment
Average Number Of Claim Line Items Per ClaimAverage Number Of Claim Line Items Per Claim
Average Number Of Claims Per MemberAverage Number Of Claims Per Member
Average Reopened Claim Processing DurationAverage Reopened Claim Processing Duration
Calendar DkCalendar Dk
Claim Adjudication Cost AmountClaim Adjudication Cost Amount
Claim Adjudication Personnel Cost AmountClaim Adjudication Personnel Cost Amount
Claim Adjudication Turn-around TimeClaim Adjudication Turn-around Time
Claim Adjustments Cost AmountClaim Adjustments Cost Amount
Claim Adjustments Personnel Cost AmountClaim Adjustments Personnel Cost Amount
Claim Age In DaysClaim Age In Days
Claim Appeals RatioClaim Appeals Ratio
Claim Cleanup DurationClaim Cleanup Duration
Claim DkClaim Dk
Claim Overrides RatioClaim Overrides Ratio
Claim Processing DurationClaim Processing Duration
Claim Receipt Cost AmountClaim Receipt Cost Amount
Claim Receipt Personnel Cost AmountClaim Receipt Personnel Cost Amount
Claims Adjusted RatioClaims Adjusted Ratio
Claims Payment And Denials Cost AmountClaims Payment And Denials Cost Amount
Claims Payment And Denials Personnel Cost AmountClaims Payment And Denials Personnel Cost Amount
Claims Processing Personnel Cost AmountClaims Processing Personnel Cost Amount
Clean Claim RatioClean Claim Ratio
Days Incurred To ReceiptDays Incurred To Receipt
Days Of Claims InventoryDays Of Claims Inventory
Duration From Adjudication To PaymentDuration From Adjudication To Payment
First Pass RatioFirst Pass Ratio
Geographic Area DkGeographic Area Dk
Group DkGroup Dk
Health Plan Product DkHealth Plan Product Dk
Insurance Policy Dimension DkInsurance Policy Dimension Dk
Number Of Claim AppealsNumber Of Claim Appeals
Number Of Claim Line ItemsNumber Of Claim Line Items
Number Of Claim OverridesNumber Of Claim Overrides
Number Of Claim ProcessorsNumber Of Claim Processors
Number Of Claims AdjudicatedNumber Of Claims Adjudicated
Number Of Claims AdjustedNumber Of Claims Adjusted
Number Of Claims AuditedNumber Of Claims Audited
Number Of Claims Paid Or DeniedNumber Of Claims Paid Or Denied
Number Of Claims ProcessedNumber Of Claims Processed
Number Of Claims Processed In First PassNumber Of Claims Processed In First Pass
Number Of Claims ReceivedNumber Of Claims Received
Number Of Clean Claims ReceivedNumber Of Clean Claims Received
Number Of Fraudulent ClaimsNumber Of Fraudulent Claims
Number Of MembersNumber Of Members
Number Of Reopened ClaimsNumber Of Reopened Claims
Organization DkOrganization Dk
Percentage Open ClaimsPercentage Open Claims
Plan Member DkPlan Member Dk
Reopened Claim Processing DurationReopened Claim Processing Duration
Total Claims Processing Cost AmountTotal Claims Processing Cost Amount

Relationship
Claims Processing Analysis_Calendar Dimension_FKClaims Processing Analysis_Calendar Dimension_FK
Claims Processing Analysis_Geographic Area Dimension_FKClaims Processing Analysis_Geographic Area Dimension_FK
Claims Processing Analysis_Group Dimension_FKClaims Processing Analysis_Group Dimension_FK
Claims Processing Analysis_Claim Dimension_FKClaims Processing Analysis_Claim Dimension_FK
Claims Processing Analysis_Plan Member Dimension_FKClaims Processing Analysis_Plan Member Dimension_FK
Claims Processing Analysis_Health Plan Product Dimension_FKClaims Processing Analysis_Health Plan Product Dimension_FK
Claims Processing Analysis_Insurance Policy Dimension_FKClaims Processing Analysis_Insurance Policy Dimension_FK
Claims Processing Analysis_Organization Dimension_FKClaims Processing Analysis_Organization Dimension_FK

Primary Key
Claims Processing Analysis PKClaims Processing Analysis PK

Dependencies
 NONE

Reverse Dependencies
 

Attribute Details

 Average Claim Adjudication Turn-around Time
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claim Age In Days
DescriptionThe average age of each claim received.

Formula: [A/B]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claim Cleanup Duration
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claim Processing Cost Amount
DescriptionThe average cost of processing a claim.

Formula: [A/B]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claim Processing Duration
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claims Per Claim Processor
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Claims Processing Cost Per Member Amount
DescriptionThe average cost of processing claims per member.

Formula: [A/B]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Days Incurred To Received
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Duration From Adjudication To Payment
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Number Of Claim Line Items Per Claim
DescriptionAverage number of line items in a claim

Formula: [A/B]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Number Of Claims Per Member
DescriptionThe average number of claims received from each member.

Formula: [A/B]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Average Reopened Claim Processing Duration
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Calendar Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Adjudication Cost Amount
DescriptionTotal cost of performing claim adjudication activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Adjudication Personnel Cost Amount
DescriptionThe total personnel cost required to perform claim adjudication activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Adjudication Turn-around Time
DescriptionThe total time, expressed in days, between the date when a claim is 'clean' and the date when a claim is adjudicated.
Data TypeStandards - Data Domains.ddm/Data Domains/Decimal Float [FLOAT(15)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Adjustments Cost Amount
DescriptionTotal cost for claim adjustment activities. This includes the costs of claim appeals, re-opening claims, and adjusting claims.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Adjustments Personnel Cost Amount
DescriptionThe total personnel cost required to perform the claim adjustment activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Age In Days
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Appeals Ratio
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Cleanup Duration
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Overrides Ratio
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Processing Duration
DescriptionFor 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Receipt Cost Amount
DescriptionThe total cost for claim receipt activities, including mail room, imaging, data entry, OCR and other claim pre-processing activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claim Receipt Personnel Cost Amount
DescriptionThe total personnel cost required to perform claim receipt activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claims Adjusted Ratio
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claims Payment And Denials Cost Amount
DescriptionTotal cost of performing the claim payment and denial activities. This includes issuing remittance advices to providers and explanations of benefits (EOB) to members.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claims Payment And Denials Personnel Cost Amount
DescriptionThe total personnel cost required to perform claim payment and denial activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Claims Processing Personnel Cost Amount
DescriptionThe total personnel cost required to perform the claims processing activities.
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Clean Claim Ratio
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Days Incurred To Receipt
DescriptionThe total number of days between when medical services occurred and when their respective claims were received.
Data TypeStandards - Data Domains.ddm/Data Domains/Number Integer [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Days Of Claims Inventory
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Duration From Adjudication To Payment
DescriptionThe sum of durations, expressed in days, between the date when claims are adjudicated and the date when claims are paid or denied.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 First Pass Ratio
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Geographic Area Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Group Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Health Plan Product Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Insurance Policy Dimension Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claim Appeals
DescriptionThe total number of claim appeals occurring during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claim Line Items
DescriptionThe total number of claim line items.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claim Overrides
DescriptionThe total amount of claim overrides occurring during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claim Processors
DescriptionThe total number of full time equivalent employees that process claims.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Adjudicated
DescriptionThe number of claims adjudicated during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Adjusted
DescriptionThe total number of claims adjusted during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Audited
DescriptionThe total number of claims that were audited during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Paid Or Denied
DescriptionThe total number of claims that were paid or denied during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Processed
DescriptionThe total number of claims that have been both received and adjudicated within the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Processed In First Pass
DescriptionThe total number of claims that were adjudicated without the need for human intervention to review, amend, or process the claim.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Claims Received
DescriptionNumber of claims received during the reference period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Clean Claims Received
DescriptionThe total number of claims received where no further modifications and/or resubmissions of claim information were required.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Fraudulent Claims
DescriptionTotal number of fraudulent claims discovered during the period.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Members
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Number Of Reopened Claims
DescriptionTotal number of claims in a specified period that had previously been closed but have subsequently been reopened.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Organization Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Percentage Open Claims
DescriptionThe 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 TypeStandards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Plan Member Dk
DescriptionA numeric surrogate key used to uniquely identify entities in the dimensional model.
Data TypeStandards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKeytrue
Is Requiredtrue
Is Derivedfalse
Is Surrogate Keyfalse



 Reopened Claim Processing Duration
DescriptionThe total time, expressed in days, between the date when claims are reopened and the date when claims are closed again.
Data TypeStandards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse



 Total Claims Processing Cost Amount
DescriptionTotal cost of the claims processing activities.

Formula: [A+B+C+D]
(see dependencies and their labels for measures used in the formula)
Data TypeStandards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKeyfalse
Is Requiredfalse
Is Derivedfalse
Is Surrogate Keyfalse

Relationship Details

 Claims Processing Analysis_Calendar Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableCalendar Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Geographic Area Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableGeographic Area Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Group Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableGroup Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Claim Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableClaim Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Plan Member Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_MANY
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TablePlan Member Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Health Plan Product Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_ONE
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableHealth Plan Product Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Insurance Policy Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_ONE
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableInsurance Policy Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE



 Claims Processing Analysis_Organization Dimension_FK
Is Identifying Relationshiptrue
Child TableClaims Processing Analysis
Child MultiplicityZERO_TO_ONE
Child Referential Integrity: On DeleteNONE
Child Referential Integrity: On InsertNONE
Child Referential Integrity: On UpdateNONE
Parent TableOrganization Dimension
Parent MultiplicityONE
Parent Referential Integrity: On DeleteNONE
Parent Referential Integrity: On InsertNONE
Parent Referential Integrity: On UpdateNONE

Primary Key Details

 Claims Processing Analysis PK
Key AttributeClaim Dk
Key AttributePlan Member Dk
Key AttributeHealth Plan Product Dk
Key AttributeInsurance Policy Dimension Dk
Key AttributeOrganization Dk
Key AttributeCalendar Dk
Key AttributeGeographic Area Dk
Key AttributeGroup Dk