Dimensional Warehouse Model Data Model

Entity

Entity Claim Adjustment Fact

Description

A modification that is made to a claim after it is adjudicated. An adjustment may occur at the service or line item level or at the claim level.

Attributes
Adjusted Units of Service
Adjustment Amt
Adjustment Dt
Adjustment Reason Cd
Adjustment Reason Code Sk
AWM Load Info Sk
Calendar Dk
Calendar Sk
Claim Adjustment Fact Bk
Claim Adjustment Fact Dk
Claim Adjustment Fact Sk
Claim Adjustment Status Cd
Claim Adjustment Status Code Sk
Claim Adjustment Type Cd
Claim Adjustment Type Code Sk
Claim Dk
Claim Line Dk
Claim Line Sk
Claim Sk
Current Ind
DWM Load Info Sk
Effective From Dt
Effective To Dt
Encounter Dk
Encounter Sk
Patient Dk
Patient Sk
Plan Member Dk
Plan Member Sk
Practitioner Dk
Practitioner Sk
Source Cd
Source Code Sk
Tenant Sk
Type Cd
Type Code Sk
Valid From Ts
Valid To Ts

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

Primary Key
Claim Adjustment Fact PK

Dependencies

Reverse Dependencies

Attribute Details

Adjusted Units of Service

Description	The number of units by which the claimed units of service is being adjusted.
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

Adjustment Amt

Description	The monetary amount by which the claim is being adjusted. For post payment adjustments this may be the amount by which the claim paid amount is adjusted. For overpayments this will be a negative amount while for underpayments this will be a positive amount.
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

Adjustment Dt

Description	The date upon which the adjustment was made.
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

Adjustment Reason Cd

Description	Indicates why a claim was adjusted. For example: Additional documentation provided CMO override Contractual obligations Corrected miscoded diagnosis Corrected miscoded procedure Duplicate claim Incorrectly calculated Incorrectly coded diagnostic Incorrectly denied Predetermination, anticipated payment upon completion of services. Severity adjustment
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

Adjustment Reason Code Sk

Description	Indicates why a claim was adjusted. For example: Additional documentation provided CMO override Contractual obligations Corrected miscoded diagnosis Corrected miscoded procedure Duplicate claim Incorrectly calculated Incorrectly coded diagnostic Incorrectly denied Predetermination, anticipated payment upon completion of services. Severity adjustment
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

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

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 Adjustment 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 Adjustment 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 Adjustment 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 Adjustment Status Cd

Description	Indicates the status of the adjustment to the claim. For example: Completed Pending Reversed
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 Adjustment Status Code Sk

Description	Indicates the status of the adjustment to the claim. For example: Completed Pending Reversed
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 Adjustment Type Cd

Description	Indicates the nature of an modification made to a previously adjudicated or finalized claim. For example: Co-insurance Adjustment Non Covered Days/ Room Charge Adjustment
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 Adjustment Type Code Sk

Description	Indicates the nature of an modification made to a previously adjudicated or finalized claim. For example: Co-insurance Adjustment Non Covered Days/ Room Charge Adjustment
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 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 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

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

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

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

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

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 Adjustment Fact_Claim Line Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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 Adjustment Fact_Plan Member Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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 Adjustment Fact_Practitioner Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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 Adjustment Fact_Calendar Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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 Adjustment Fact_Encounter Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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 Adjustment Fact_Claim Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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

Claim Adjustment Fact_Patient Dimension_FK

Is Identifying Relationship	false
Child Table	Claim Adjustment 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

Primary Key Details

Claim Adjustment Fact PK

Key Attribute

Claim Adjustment Fact Dk

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