Dimensional Warehouse Model Data Model

Entity

Entity Coordination Of Benefits Analysis

Description

The analysis of coordination of benefits (COB) activities and the resultant impact on the health plan organization's claim costs.

Attributes
Average COB Claim Processing Cost Amount
Average COB Claim Processing Cycle Time
Average COB Claim Processing Personnel Cost Amount
Average Number Of COB Claim Communications
Calendar Dk
Claim Dk
Claim Payments For COB Claims Amount
COB Cost Savings Ratio
COB Processing Cost Amount
COB Processing Cycle Time
COB Processing Personnel Cost Amount
COB Savings Amount
COB Savings Per Claim Amount
COB Savings Per Member Amount
Coverage Eligibility Dk
Geographic Area Dk
Group Dk
Health Plan Product Dk
Number Of COB Claims
Number Of COB Communications
Number Of Members
Other Payer Non COB Equivalent Amount
Other Payer Paid Amount
Plan Member Dk

Relationship
Coordination Of Benefits Analysis_Calendar Dimension_FK
Coordination Of Benefits Analysis_Geographic Area Dimension_FK
Coordination Of Benefits Analysis_Group Dimension_FK
Coordination Of Benefits Analysis_Claim Dimension_FK
Coordination Of Benefits Analysis_Plan Member Dimension_FK
Coordination Of Benefits Analysis_Coverage Eligibility Dimension_FK
Coordination Of Benefits Analysis_Health Plan Product Dimension_FK

Primary Key
Coordination Of Benefits Analysis PK

Dependencies
NONE

Reverse Dependencies

Attribute Details

Average COB Claim Processing Cost Amount

Description	The average cost of implementing coordination of benefits provisions on 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

Average COB Claim Processing Cycle Time

Description	The average cycle time required to carry out order of benefits determination (OBD) and other coordination of benefits (COB) specific activities on 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

Average COB Claim Processing Personnel Cost Amount

Description	The average cost of personnel consumed by coordination of benefit (COB) activities. These activities may include investigating the National Association of Insurance Carriers (NAIC) regulation or contacting other insurance carriers, providers or members in relation to coverage details. 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 Number Of COB Claim Communications

Description	The average number of communications occurring between the Health Plan Organization and other payers, providers, members or other parties, in relation to order of benefits determinations (OBD) and other coordination of benefits (COB) activities on 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

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 Payments For COB Claims Amount

Description	The total amount of claim payments by the Health Plan Organization for coordination of benefits (COB) 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

COB Cost Savings Ratio

Description	The ratio of total coordination of benefits savings to total coordination of benefits (COB) processing costs. 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

COB Processing Cost Amount

Description	The total cost of implementing coordination of benefits (COB) provisions on 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

COB Processing Cycle Time

Description	The total cycle time required to carry out order of benefits determinations (OBD) and other coordination of benefits (COB) specific activities on 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

COB Processing Personnel Cost Amount

Description	The total personnel cost of coordination of benefit activities, be it investigating the National Association of Insurance Carriers (NAIC) regulation or contacting other insurance carriers, providers or members in relation to coordination of benefits (COB) and coverage details.
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

COB Savings Amount

Description	The total amount of savings achieved by the Health Plan Organization through implementing coordination of benefits (COB) provisions. This may be calculated on several bases depending on the adjudication rules of the payer. For example, variations in adjudication may exist such as: - non-primary payer reimburses the difference between other payer covered amounts and 100% of allowable expenses - non-primary payer reimburses the difference between other payer covered amounts and 100% of allowable expenses after applying a relevant coinsurance percentage - non-primary payer reimburses the difference between what it would have covered as a primary payer and the other payer covered amount 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

COB Savings Per Claim Amount

Description	The average amount of savings achieved by the Health Plan Organization through implementing coordination of benefits (COB) provisions on 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

COB Savings Per Member Amount

Description	The average amount of savings achieved by the Health Plan Organization through implementing coordination of benefits (COB) 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

Coverage Eligibility 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

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 COB Claims

Description	The total number of claims where coordination of benefits (COB) applies.
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 COB Communications

Description	The total number of communications occurring between the Health Plan Organization and other payers, providers, members or other parties, in relation to order of benefits determinations (OBD) and other coordination of benefits (COB) activities on 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

Other Payer Non COB Equivalent Amount

Description	The total amount that the health plan organization would have paid if the health plan was the primary payer instead of secondary or tertiary.
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

Other Payer Paid Amount

Description	The total amount other health plan organizations have paid in respect of allowable expenses on claims where coordination of benefits (COB) applies.
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

Relationship Details

Coordination Of Benefits Analysis_Calendar Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis_Geographic Area Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis_Group Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis_Claim Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis_Plan Member Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis_Coverage Eligibility Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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	Coverage Eligibility Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Coordination Of Benefits Analysis_Health Plan Product Dimension_FK

Is Identifying Relationship	true
Child Table	Coordination Of Benefits 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

Coordination Of Benefits Analysis PK

Key Attribute	Claim Dk
Key Attribute	Plan Member Dk
Key Attribute	Coverage Eligibility Dk
Key Attribute	Health Plan Product Dk
Key Attribute	Calendar Dk
Key Attribute	Geographic Area Dk
Key Attribute	Group Dk

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