Dimensional Warehouse Model Data Model

Entity

Entity Claim Recovery Fact

Description

An activity that a health plan organization undertakes to charge a proportion of claimed benefits onwards to a third party, reinsurer or coinsurer.

Attributes
Actual End Dt
Actual Labor Hours
Actual Start Dt
Actual Time Spent
AWM Load Info Sk
Business Activity Type Cd
Business Activity Type Code Sk
Calendar Dk
Calendar Sk
Claim Dk
Claim Line Dk
Claim Line Sk
Claim Recovery Approach Cd
Claim Recovery Approach Code Sk
Claim Recovery Basis Cd
Claim Recovery Basis Code Sk
Claim Recovery Fact Bk
Claim Recovery Fact Dk
Claim Recovery Fact Sk
Claim Recovery Status Cd
Claim Recovery Status Code Sk
Claim Recovery Status Reason Cd
Claim Recovery Status Reason Code Sk
Claim Recovery Type Cd
Claim Recovery Type Code Sk
Claim Sk
Collection Method Ind
Current Ind
Delay Reason Cd
Delay Reason Code Sk
DWM Load Info Sk
Effective From Dt
Effective To Dt
Encounter Dk
Encounter Sk
Patient Dk
Patient Sk
Plan Member Dk
Plan Member Sk
Planned Duration
Planned End Dt
Planned Manpower
Planned Start Dt
Potential Reinsurer Recovery Amt
Potential Third Party Recovery Amt
Potential Total Recovery Amt
Practitioner Dk
Practitioner Sk
Recovery Party Role Cd
Recovery Party Role Code Sk
Source Cd
Source Code Sk
Tenant Sk
Total Recovery Amt
Type Cd
Type Code Sk
Valid From Ts
Valid To Ts

Relationship
Claim Recovery Fact_Claim Line Dimension_FK
Claim Recovery Fact_Plan Member Dimension_FK
Claim Recovery Fact_Practitioner Dimension_FK
Claim Recovery Fact_Patient Dimension_FK
Claim Recovery Fact_Calendar Dimension_FK
Claim Recovery Fact_Encounter Dimension_FK
Claim Recovery Fact_Claim Dimension_FK

Primary Key
Claim Recovery Fact PK

Dependencies

Reverse Dependencies

Attribute Details

Actual End Dt

Description	Actual date upon which the activity was completed.
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

Actual Labor Hours

Description	Actual number hours that it took to perform the activity.
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

Actual Start Dt

Description	The actual date upon which the activity was started.
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

Actual Time Spent

Description	The actual time spent performing the activity. This differs from the labor hours by describing the elapsed time over which the labor hours were spread. For example, an activity may involve 4 hours actual work over 3 days.
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)]
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

Business Activity Type Cd

Description	Classifies a Claim Recovery according to its type.
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

Business Activity Type Code Sk

Description	Classifies a Claim Recovery according to its type.
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

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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Calendar 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

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	false
Is Required	true
Is Derived	false
Is Surrogate Key	false

Claim Line 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

Claim Line 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

Claim Recovery Approach Cd

Description	Classifies claim recovery according to the approach used to carry out the recovery.
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

Claim Recovery Approach Code Sk

Description	Classifies claim recovery according to the approach used to carry out the recovery.
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

Claim Recovery Basis Cd

Description	Indicates the reason or justification for undertaking a claim recovery.
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

Claim Recovery Basis Code Sk

Description	Indicates the reason or justification for undertaking a claim recovery.
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

Claim Recovery Fact 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

Claim Recovery Fact 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

Claim Recovery Fact 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

Claim Recovery Status Cd

Description	Claim Recovery Status distinguishes between claim recoverys according to their current state.
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

Claim Recovery Status Code Sk

Description	Claim Recovery Status distinguishes between claim recoverys according to their current state.
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

Claim Recovery Status Reason Cd

Description	Indicates why a claim recovery is in its current state.
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

Claim Recovery Status Reason Code Sk

Description	Indicates why a claim recovery is in its current state.
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

Claim Recovery Type Cd

Description	Indicates the nature of a claim recovery.
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

Claim Recovery Type Code Sk

Description	Indicates the nature of a claim recovery.
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

Claim 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

Collection Method Ind

Description	Indicates the way in which the healthcare insurer will try to recover the cost of the claim from a third party. For example: Direct Collection Use Of Collection Agency
Data Type	Standards - Data Domains.ddm/Data Domains/Alphanumeric Small [VARCHAR(6)]
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

Delay Reason Cd

Description	Indicates the cause of any discrepancy between planned and actual end dates.
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

Delay Reason Code Sk

Description	Indicates the cause of any discrepancy between planned and actual end dates.
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

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

Encounter 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

Encounter 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

Patient 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

Patient 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

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	true
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 Duration

Description	The time planned for the performing of the activity. This is the total elapsed time over which the activity is expected to be performed and not the planned labor hours.
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Planned End Dt

Description	Date upon which the activity is planned to end.
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

Planned Manpower

Description	The planned labor hours required for the activity.
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal Large [DECIMAL(15,6)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Planned Start Dt

Description	Date upon which the activity is planned to start.
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

Potential Reinsurer Recovery Amt

Description	The amount which the healthcare insurer still expects to obtain in respect of the claim or claim item under all reinsurance treaties.
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

Potential Third Party Recovery Amt

Description	The amount which the healthcare insurer still expects to obtain in respect of the claim or claim item from all third parties other than reinsurers.
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

Potential Total Recovery Amt

Description	The monetary value of covered charges that are considered to be recoverable from other parties.
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

Practitioner 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

Practitioner 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

Recovery Party Role Cd

Description	Classifies claim recoverys according to the role of the party that the claim amount is being recovered from.
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

Recovery Party Role Code Sk

Description	Classifies claim recoverys according to the role of the party that the claim amount is being recovered from.
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

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 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

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

Total Recovery Amt

Description	The total amount recovered by the claim recovery activity from all sources.
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

Type Cd

Description	Identifies the actual type of the entry based on the entity type hierarchy defined in the business data model.
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 Sk

Description	Identifies the actual type of the entry based on the entity type hierarchy defined in the business 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

Claim Recovery Fact_Claim Line Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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 Line Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Recovery Fact_Plan Member Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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

Claim Recovery Fact_Practitioner Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Recovery Fact_Patient Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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	Patient Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Recovery Fact_Calendar Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Calendar Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Recovery Fact_Encounter Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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	Encounter Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Claim Recovery Fact_Claim Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Recovery Fact
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

Primary Key Details

Claim Recovery Fact PK

Key Attribute

Claim Recovery Fact Dk

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