Dimensional Warehouse Model Data Model

Entity

Entity Coverage Eligibility Dimension

Description

An agreement that summarizes the particulars of an Insured's policy as known by the organization.

Attributes
Agreement Status Reason Cd
Agreement Status Reason Code Descr
Agreement Status Reason Code Sk
Agreement Type Cd
Agreement Type Code Sk
Agreement Type Descr
Assignment Of Benefits Cd
Assignment Of Benefits Code Sk
Assignment Of Benefits Descr
AWM Load Info Sk
Baby Coverage Ind
Blood Deductible
Bound Dt
Certification Required Ind
COBRA Ind
Coinsurance Amt
Combine Baby Bill Ind
Company Plan Cd
Company Plan Code Sk
Company Plan Descr
Confidentiality Ind
Coordination Of Benefits Cd
Coordination Of Benefits Code Sk
Coordination Of Benefits Descr
Coordination Of Benefits Priority Cnt
County Nm
Coverage Eligibility Bk
Coverage Eligibility Dk
Coverage Eligibility Sk
Coverage Type Cd
Coverage Type Code Sk
Coverage Type Descr
Currency Cd
Currency Code Sk
Current Ind
DWM Load Info Sk
Effective From Dt
Effective To Dt
ER Copay Amt
Group Num
Healthcare Insurer Dk
Healthcare Insurer Sk
Insurance Plan Num
IP Copay Amt
Line Of Business Cd
Line Of Business Code Descr
Line Of Business Code Sk
MCP Copay Amt
Medicaid Case Num
Next Renewal Dt
Next Review Dt
Notice Of Admission Ind
Office Visit Copay Amt
Part A Termination Reason Cd
Part A Termination Reason Code Sk
Part A Termination Reason Descr
Part B Termination Reason Cd
Part B Termination Reason Code Sk
Part B Termination Reason Descr
Pharmacy Copay Amt
Pharmacy Join Ind
Plan Effective Dt
Plan Expiration Dt
Plan Member Dk
Plan Member Sk
Planned End Dt
Plan Type Cd
Plan Type Code Sk
Plan Type Descr
Policy Num
Policy Scope Cd
Policy Scope Code Sk
Policy Scope Descr
Policy Source Cd
Policy Source Code Sk
Policy Source Descr
Policy Status Cd
Policy Status Code Descr
Policy Status Code Sk
Policy Type Cd
Policy Type Code Sk
Policy Type Descr
Prior Plan Code Num
Provider Dk
Provider Sk
Release Of Information Cd
Release Of Information Code Sk
Release Of Information Descr
Report Of Eligibility Ind
Room Coverage Amount Type Descr
Room Coverage Type Cd
Room Coverage Type Code Sk
Room Coverage Type Descr
Source Cd
Source Code Descr
Source Code Sk
Special Coverage Approval Title
State Nm
Tenant Sk
Type Cd
Type Code Descr
Type Code Sk
Valid From Ts
Valid To Ts

Relationship
Provider Patient Insurance_Provider_FK
Provider Patient Insurance_Healthcare Insurer_FK
Coverage Eligibility Dimension_Plan Member Dimension_FK

Primary Key
Coverage Eligibility Dimension PK

Dependencies

Reverse Dependencies

Attribute Details

Agreement Status Reason Cd

Description	Indicates the motivation or cause for changing the status of the coverage agreement. For example: Not eligible (if agreement rejected) Not taken up (if agreement rejected)
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Agreement Status Reason Code Descr

Description	Indicates the motivation or cause for changing the status of the coverage agreement. For example: Not eligible (if agreement rejected) Not taken up (if agreement rejected)
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Agreement Status Reason Code Sk

Description	Indicates the motivation or cause for changing the status of the coverage agreement. For example: Not eligible (if agreement rejected) Not taken up (if agreement rejected)
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Agreement Type Cd

Description	Used to further identify an insurance plan. For example: S - Standard U - Unified M - Maternity
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Agreement Type Code Sk

Description	Used to further identify an insurance plan. For example: S - Standard U - Unified M - Maternity
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Agreement Type Descr

Description	Used to further identify an insurance plan. For example: S - Standard U - Unified M - Maternity
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Assignment Of Benefits Cd

Description	Indicates the insured's elected assignment of benefits. If the insured agreed to assign the insurance benefits to the healthcare provider, the insurance will pay the provider directly.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Assignment Of Benefits Code Sk

Description	Indicates the insured's elected assignment of benefits. If the insured agreed to assign the insurance benefits to the healthcare provider, the insurance will pay the provider directly.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Assignment Of Benefits Descr

Description	Indicates the insured's elected assignment of benefits. If the insured agreed to assign the insurance benefits to the healthcare provider, the insurance will pay the provider directly.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

AWM Load Info Sk

Description	The surrogate key of the load information entry describing the details regarding the loading of the row in the atomic data warehouse.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Baby Coverage Ind

Description	Indicates whether or not the baby is included in the coverage. Y - baby coverage N - no baby coverage
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Blood Deductible

Description	Use this field instead of UB1-2 - Blood Deductible, as the blood deductible can be associated with the specific insurance plan via this field.
Data Type	Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Bound Dt

Description	The date upon which the coverage agreement is considered legally binding, or in force. Depending on the legislation the bound date can be the date when the coverage agreement is signed by both parties and/or when the first premium has been paid. Derived from the status related information.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Certification Required Ind

Description	Indicates whether certification is required. Y - certification required N - certification not required
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

COBRA Ind

Description	Indicates if this eligibility is being retained under COBRA program.
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coinsurance Amt

Description	The amount of insurance liability assumed by the Member.
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

Combine Baby Bill Ind

Description	Indicates whether or not to combine baby bill. Y - combine bill N - normal billing
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Company Plan Cd

Description	Optional information to further define the data in Insurance Company Id.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Company Plan Code Sk

Description	Optional information to further define the data in Insurance Company Id.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Company Plan Descr

Description	Optional information to further define the data in Insurance Company Id.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Confidentiality Ind

Description	Indicates whether or not this member's data is confidential.
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coordination Of Benefits Cd

Description	Identifies whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. For example: CO - Coordination IN - Independent
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coordination Of Benefits Code Sk

Description	Identifies whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. For example: CO - Coordination IN - Independent
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coordination Of Benefits Descr

Description	Identifies whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. For example: CO - Coordination IN - Independent
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coordination Of Benefits Priority Cnt

Description	If the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc.
Data Type	Standards - Data Domains.ddm/Data Domains/Small Counter [SHORT]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

County Nm

Description	Name of the county for the address.
Data Type	Standards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coverage Eligibility Bk

Description	Concatenated values of a set of business attributes that uniquely identify the row.
Data Type	Standards - Data Domains.ddm/Data Domains/Business Key [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	true
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	true

Coverage Eligibility Sk

Description	A numeric surrogate key used to uniquely identify entities in the atomic model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Coverage Type Cd

Description	Identifies the type of insurance coverage, or what types of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans that cover physician/professional charges.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coverage Type Code Sk

Description	Identifies the type of insurance coverage, or what types of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans that cover physician/professional charges.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Coverage Type Descr

Description	Identifies the type of insurance coverage, or what types of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans that cover physician/professional charges.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Currency Cd

Description	Indicates the currency used as the basis for all monetary amounts
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Currency Code Sk

Description	A surrogate key for a code that indicates the currency specified for charges, payments and balances on this account.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Current Ind

Description	Set to 'Y' if this is the most recent row of a group having the same Surrogate Key.
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

DWM Load Info Sk

Description	The surrogate key of the load information entry describing the details regarding the loading of the row.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Effective From Dt

Description	Establishes a period where a set of attributes are true according to the business.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Effective To Dt

Description	Ends a period of effectivity.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

ER Copay Amt

Description	Amount of the Copay for ER Visit expenses.
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

Group Num

Description	The group number of the insured's insurance.
Data Type	Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Healthcare Insurer 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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Healthcare Insurer Sk

Description	A numeric surrogate key used to uniquely identify entities in the atomic model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Insurance Plan Num

Description	A unique identifier for the insurance plan associated with this coverage eligibility record.
Data Type	Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

IP Copay Amt

Description	Amount of the Copay for Inpatient Visit expenses.
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

Line Of Business Cd

Description	Indicates the nature of commercial enterprise of the modeled organization.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Line Of Business Code Descr

Description	Indicates the nature of commercial enterprise of the modeled organization.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Line Of Business Code Sk

Description	Indicates the nature of commercial enterprise of the modeled organization.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

MCP Copay Amt

Description	Amount of the Copay for Managed Care Program.
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

Medicaid Case Num

Description	The Medicaid case number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's Medicaid policy.
Data Type	Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Next Renewal Dt

Description	The next date at which the enforce status of the coverage agreement must be re-evaluated or re-conducted.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Next Review Dt

Description	The date upon which a review of the coverage agreement is planned.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Notice Of Admission Ind

Description	Indicates whether or not the insurance company requires a written notice of admission from the healthcare provider. Y - written notice of admission required N - no notice required
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Office Visit Copay Amt

Description	Amount of the Copay for Office Visit expenses.
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

Part A Termination Reason Cd

Description	Indicates the reason that the Medicare Part A coverage ended for the plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Part A Termination Reason Code Sk

Description	Indicates the reason that the Medicare Part A coverage ended for the plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Part A Termination Reason Descr

Description	Indicates the reason that the Medicare Part A coverage ended for the plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Part B Termination Reason Cd

Description	Indicates the reason that the Medicare Part B coverage ended for plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Part B Termination Reason Code Sk

Description	Indicates the reason that the Medicare Part B coverage ended for plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Part B Termination Reason Descr

Description	Indicates the reason that the Medicare Part B coverage ended for plan member.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Pharmacy Copay Amt

Description	Amount of the Copay for Pharmacy expenses.
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

Pharmacy Join Ind

Description	Indicates whether or not the plan member has joined a pharmacy program.
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Effective Dt

Description	The date upon which the coverage agreement first starts. For renewable coverage agreements, this date represents the date of the original coverage agreement before any renewal. Derived from the status related information.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Expiration Dt

Description	The date upon which the coverage agreement actually terminates. This may pre- or post-date the Planned End Date. For example, early termination of a contract due to poor performance. The termination date of the coverage agreement is also represented in the status date for the terminated status.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
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	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Member Sk

Description	A numeric surrogate key used to uniquely identify entities in the atomic model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Planned End Dt

Description	The date upon which the end of the coverage agreement is planned.
Data Type	Standards - Data Domains.ddm/Data Domains/Date [DATE]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Type Cd

Description	Indicates the type of health plan associated with this coverage eligibility record. For example: Medicare Medicaid Blue Cross HMO
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Type Code Sk

Description	Indicates the type of health plan associated with this coverage eligibility record. For example: Medicare Medicaid Blue Cross HMO
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Type Descr

Description	Indicates the type of health plan associated with this coverage eligibility record. For example: Medicare Medicaid Blue Cross HMO
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Num

Description	The individual policy number of the insured to uniquely identify this patient's plan.
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

Policy Scope Cd

Description	Identifies the extent of the coverage for a participating member. For example: Single Family
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Scope Code Sk

Description	Identifies the extent of the coverage for a participating member. For example: Single Family
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Scope Descr

Description	Identifies the extent of the coverage for a participating member. For example: Single Family
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Source Cd

Description	Indicates how or from what source the policy information was established.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Source Code Sk

Description	Indicates how or from what source the policy information was established.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Source Descr

Description	Indicates how or from what source the policy information was established.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Status Cd

Description	Indicates the coverage agreement's current status. For Example: Active Cancelled Expired Final In Force In Process Initial Lapsed Not taken up Offered Rejected Suspended Terminated Under Negotiation
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Status Code Descr

Description	Indicates the coverage agreement's current status. For Example: Active Cancelled Expired Final In Force In Process Initial Lapsed Not taken up Offered Rejected Suspended Terminated Under Negotiation
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Status Code Sk

Description	Indicates the coverage agreement's current status. For Example: Active Cancelled Expired Final In Force In Process Initial Lapsed Not taken up Offered Rejected Suspended Terminated Under Negotiation
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Type Cd

Description	Indicates the type of the policy covered by the insurance. For example: Ancillary Major medical
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Type Code Sk

Description	Indicates the type of the policy covered by the insurance. For example: Ancillary Major medical
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Policy Type Descr

Description	Indicates the type of the policy covered by the insurance. For example: Ancillary Major medical
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Prior Plan Code Num

Description	Uniquely identifies the prior insurance plan when the plan ID changes.
Data Type	Standards - Data Domains.ddm/Data Domains/Alphanumeric [VARCHAR(80)]
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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Provider Sk

Description	A numeric surrogate key used to uniquely identify entities in the atomic model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Release Of Information Cd

Description	Indicates whether the provider has a signed statement on file permitting the release of medical data to other organizations. For example: - Appropriate Release of Information on File at Health Care Service Provider or at Utilization Review Organization - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes - The Provider has Limited or Restricted Ability to Release Data Related to a Claim - No, Provider is Not Allowed to Release Data - On file at Payor or at Plan Sponsor - Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Release Of Information Code Sk

Description	Indicates whether the provider has a signed statement on file permitting the release of medical data to other organizations. For example: - Appropriate Release of Information on File at Health Care Service Provider or at Utilization Review Organization - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes - The Provider has Limited or Restricted Ability to Release Data Related to a Claim - No, Provider is Not Allowed to Release Data - On file at Payor or at Plan Sponsor - Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Release Of Information Descr

Description	Indicates whether the provider has a signed statement on file permitting the release of medical data to other organizations. For example: - Appropriate Release of Information on File at Health Care Service Provider or at Utilization Review Organization - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes - The Provider has Limited or Restricted Ability to Release Data Related to a Claim - No, Provider is Not Allowed to Release Data - On file at Payor or at Plan Sponsor - Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Report Of Eligibility Ind

Description	Indicates whether or not this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits. Y - eligibility report is sent N - no eligibility report is sent
Data Type	Standards - Data Domains.ddm/Data Domains/Boolean Indicator [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Room Coverage Amount Type Descr

Description	Indicates the type of amount covered by the insurance. For example: Limit Percentage
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Room Coverage Type Cd

Description	Indicates the room type covered by the insurance. For example: Private Semi-private
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Room Coverage Type Code Sk

Description	Indicates the room type covered by the insurance. For example: Private Semi-private
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Room Coverage Type Descr

Description	Indicates the room type covered by the insurance. For example: Private Semi-private
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Source Cd

Description	The code that corresponds to the Source Code Sk.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Source Code Descr

Description	The description that corresponds to the Source Type Cd.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Source Code Sk

Description	The origin of the data identifying the actual load source, vendor, manual key entry, or context of the data in a specific row in the database.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Special Coverage Approval Title

Description	The title of the person who approves special coverage.
Data Type	Standards - Data Domains.ddm/Data Domains/String [VARCHAR(255)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

State Nm

Description	The state of a country in which the insurance policy is underwritten.
Data Type	Standards - Data Domains.ddm/Data Domains/Area Name [VARCHAR(50)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Tenant Sk

Description	The surrogate key of the entry identifying the legal owner of the data.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Type Cd

Description	The code that corresponds to the Type Code Sk.
Data Type	Standards - Data Domains.ddm/Data Domains/Tenant Common Code [VARCHAR(80)]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Type Code Descr

Description	The description that corresponds to the Type Cd.
Data Type	Standards - Data Domains.ddm/Data Domains/Description [VARCHAR(250)]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Type Code Sk

Description	The code identifying the actual type of the entity as per the type hierarchy defined in the analysis data model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key [INTEGER]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Valid From Ts

Description	Establishes a period where a set of attributes are true in the source system. This would be populated with the transaction timestamp and would be used for the snapshot date.
Data Type	Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKey	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Valid To Ts

Description	Ends a period of validity.
Data Type	Standards - Data Domains.ddm/Data Domains/Timestamp [TIMESTAMP]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Relationship Details

Provider Patient Insurance_Provider_FK

Is Identifying Relationship	false
Child Table	Coverage Eligibility Dimension
Child Role Name	insured by
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

Provider Patient Insurance_Healthcare Insurer_FK

Is Identifying Relationship	false
Child Table	Coverage Eligibility Dimension
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	Healthcare Insurer Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Coverage Eligibility Dimension_Plan Member Dimension_FK

Is Identifying Relationship	false
Child Table	Coverage Eligibility Dimension
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	ZERO_TO_ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

Coverage Eligibility Dimension PK

Key Attribute

Coverage Eligibility Dk

Overview

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Entity

Dimensional Warehouse Model Data Model