ABN_CROSS_REFERENCE
Column Section | Top of Page |
Table-level Detail
Description: | ABN Cross Reference |
Definition: | Cross references order catalog items with cpt-4 codes using the catalog_cd and the nomenclature_id. |
Table Type: | REFERENCE |
Column Detail - ABN_CROSS_REFERENCE
Column Name | Type | Null? | Definition |
---|---|---|---|
ABN_CROSS_REFERENCE_ID | DOUBLE | N | primary key |
ACTIVE_IND | DOUBLE | N | The table row is active or inactive. A row is generally active unless it is in an inactive state such as logically deleted, combined away, pending purge, etc. |
ACTIVE_STATUS_CD | DOUBLE | N | Indicates the status of the row itself (not the data in the row) such as active, inactive, combined away, pending purge, etc. |
ACTIVE_STATUS_DT_TM | DATETIME | Y | The date and time that the active_status_cd was set. |
ACTIVE_STATUS_PRSNL_ID | DOUBLE | N | The person who caused the active_status_cd to be set or change. |
BEG_EFFECTIVE_DT_TM | DATETIME | Y | The date and time for which this table row becomes effective. Normally, this will be the date and time the row is added, but could be a past or future date and time. |
CATALOG_CD | DOUBLE | N | Catalog Code from order_catalog and code_set that this row points to. |
CPT_NOMEN_ID | DOUBLE | N | nomenclature id of the associated cpt-4 code |
END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data. This may be valued with the date that the row became inactive. |
UPDT_APPLCTX | DOUBLE | N | The application context number from the record info block. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_CNT | DOUBLE | N | Set to 0 on insert. Incremented by 1 on update. Used to recognize update conflict where data in a row updated by one application is at risk of being lost by a second application attempting to update the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_DT_TM | DATETIME | N | The date and time the row was last inserted or updated. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_ID | DOUBLE | N | The person_id of the person from the personnel table (prsnl) that caused the last insert or update of the row in the table. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_TASK | DOUBLE | N | The registered (assigned) task number for the process that inserted or updated the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
ABN_RULE
Column Section | Relationship Section | Top of Page |
Table-level Detail
Description: | ABN RULE |
Definition: | Contains 'rules' around a particular icd-9/cpt-4 combination to determine if it's reimburseable. |
Table Type: | REFERENCE |
Column Detail - ABN_RULE
Column Name | Type | Null? | Definition |
---|---|---|---|
ABN_RULE_ID | DOUBLE | N | primary key for this table |
ACTION_CD | DOUBLE | N | Code value associated with a certain action. For example AD for added diagnosis code |
ACTION_CD_DT_TM | DATETIME | Y | date associated with the certain action code. |
ACTION_CODE | VARCHAR(200) | Y | Action Code |
ACTIVE_IND | DOUBLE | Y | The table row is active or inactive. A row is generally active unless it is in an inactive state such as logically deleted, combined away, pending purge, etc. |
ACTIVE_STATUS_CD | DOUBLE | N | Indicates the status of the row itself (not the data in the row) such as active, inactive, combined away, pending purge, etc. |
ACTIVE_STATUS_DT_TM | DATETIME | Y | The date and time that the active_status_cd was set. |
ACTIVE_STATUS_PRSNL_ID | DOUBLE | N | The person who caused the active_status_cd to be set or change. |
AGE_RESTRICTION_CODE | VARCHAR(50) | Y | Age restriction for the procedure. "<" means less than or equal to and ">" means greater than or equal to. For example, >50 means that a service is limited to someone 50 years of age or older. |
BEG_EFFECTIVE_DT_TM | DATETIME | Y | The date and time for which this table row becomes effective. Normally, this will be the date and time the row is added, but could be a past or future date and time. |
CARRIER_ID | DOUBLE | N | ID FOR THE INSURANCE CARRIER. Obsolete Column. Not used |
CONTRIBUTOR_SYSTEM_CD | DOUBLE | N | Contributor system identifies the source feed of data from which a row was populated. This is mainly used to determine how to update a set of data that may have originated from more than one source feed. |
CPT_NOMEN_ID | DOUBLE | N | Nomenclature id of the CPT-4 code. |
ENCNTR_GROUP_CD | DOUBLE | N | Encounter Group Code |
ENCNTR_TYPE_CD | DOUBLE | N | Encounter type code that this rule qualifies for |
END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data. This may be valued with the date that the row became inactive. |
FIN_CLASS_CD | DOUBLE | N | Financial class code that this rule qualifies for |
FIN_GROUP_CD | DOUBLE | N | Financial Group Code |
FREQUENCY_REST_CODE | VARCHAR(50) | Y | Frequency restriction for a procedure. Standard format is one procedure per certain time period. For instance , no more than 2 x-rays per week/month/year etc. Written with number and time period, e.g. 11M means one procedure every eleven months. |
HEALTH_PLAN_ID | DOUBLE | N | Health plan id associated with the rule. |
ICD9_NOMEN_ID | DOUBLE | N | Nomenclature id for the diagnosis code |
INFOX_POLICY_NUMBER | VARCHAR(100) | Y | Info-X Policy Number |
LONG_TEXT_ID | DOUBLE | N | Long_text_id for the corresponding memo in the long text table. |
MEDICARE_POLICY_NUMBER | VARCHAR(100) | Y | Medicare Policy Number |
PARAMETER_CD | DOUBLE | N | Parameters or additional info related with abn_rule. For example, screening tests - no ICD-9 codes required, non-covered procedures, and non-covered diagnosis explicitly listed in policies. |
POLICY_DISCRIPTION | VARCHAR(200) | Y | A brief description of the policy. |
POLICY_NAME | VARCHAR(100) | Y | Policy name |
POLICY_NUMBER | DOUBLE | Y | Policy number |
SEX_RESTRICTION_CODE | VARCHAR(10) | Y | Sex restriction for the procedure. |
TYPE_CD | DOUBLE | N | Type or category. For example, anesthesiology, neurology, medications, and radiology etc. |
UPDT_APPLCTX | DOUBLE | N | The application context number from the record info block. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_CNT | DOUBLE | N | Set to 0 on insert. Incremented by 1 on update. Used to recognize update conflict where data in a row updated by one application is at risk of being lost by a second application attempting to update the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_DT_TM | DATETIME | N | The date and time the row was last inserted or updated. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_ID | DOUBLE | N | The person_id of the person from the personnel table (prsnl) that caused the last insert or update of the row in the table. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_TASK | DOUBLE | N | The registered (assigned) task number for the process that inserted or updated the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
URL | VARCHAR(100) | Y | WorldWideWeb (WWW) link if available for a given policy. |
VALID_DIAG_FLG | DOUBLE | Y | Tells if this diagnosis is, is not, or none are reimbursable on this CPT-4. |
Relationship Detail - ABN_RULE
Child Column in ABN_RULE(FK) | Parent Table Name | Parent Column Name | |
---|---|---|---|
Parents: | HEALTH_PLAN_ID | HEALTH_PLAN | HEALTH_PLAN_ID |
BENEFIT
Column Section | Relationship Section | Top of Page |
Table-level Detail
Description: | BENEFIT |
Definition: | A benefit related to a base health plan or to an employer-tailored plan |
Table Type: | REFERENCE |
Column Detail - BENEFIT
Column Name | Type | Null? | Definition |
---|---|---|---|
ACTIVE_IND | DOUBLE | Y | The table row is active or inactive. A row is generally active unless it is in an inactive state such as logically deleted, combined away, pending purge, etc. |
ACTIVE_STATUS_CD | DOUBLE | Y | Indicates the status of the row itself (not the data in the row) such as active, inactive, combined away, pending purge, etc. |
ACTIVE_STATUS_DT_TM | DATETIME | Y | The date and time that the active_status_cd was set. |
ACTIVE_STATUS_PRSNL_ID | DOUBLE | Y | The person who caused the active_status_cd to be set or change. |
BEG_EFFECTIVE_DT_TM | DATETIME | N | The date and time for which this table row becomes effective. Normally, this will be the date and time the row is added, but could be a past or future date and time. |
BENEFIT_ID | DOUBLE | N | Unique identifier for a benefit category |
BENEFIT_MOD_FLAG | DOUBLE | N | Indicates whether the benefit record adds to an existing benefit, nullifies an existing benefit, or changes an existing benefit |
BNFT_TYPE_CD | DOUBLE | N | Code value representing a benefit category (type of benefit) |
DX_CODE_MAX | VARCHAR(50) | Y | The highest diagnosis code of a range of codes for which this benefit applies |
DX_CODE_MIN | VARCHAR(50) | Y | The minimum diagnosis code of a range for which this benefit applies. |
DX_DESCRIPTION | VARCHAR(100) | Y | Description of the diagnosis for which this benefit applies. |
END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data. This may be valued with the date that the row became inactive. |
ORG_PLAN_RELTN_ID | DOUBLE | N | Foreign key to the org_plan_reltn table. Identifies the relationship to which this benefit is tied. |
PARENT_BNFT_ID | DOUBLE | Y | The ID of the benefit to which this benefit is related |
SOFT_BENEFIT_TEXT | VARCHAR(200) | Y | Text description of a benefit |
SPECIALTY_CD | DOUBLE | Y | The code value for the specialty for which this benefit applies if it is a specialty related benefit. |
SUB_TYPE_DISPLAY | VARCHAR(100) | Y | User-definable display value for the benefits subtype |
TYPE_DISPLAY | VARCHAR(100) | Y | User-definable display for the benefit type |
UPDT_APPLCTX | DOUBLE | N | The application context number from the record info block. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_CNT | DOUBLE | N | Set to 0 on insert. Incremented by 1 on update. Used to recognize update conflict where data in a row updated by one application is at risk of being lost by a second application attempting to update the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_DT_TM | DATETIME | N | The date and time the row was last inserted or updated. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_ID | DOUBLE | N | The person_id of the person from the personnel table (prsnl) that caused the last insert or update of the row in the table. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_TASK | DOUBLE | N | The registered (assigned) task number for the process that inserted or updated the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
Relationship Detail - BENEFIT
Parent Column in BENEFIT (PK) | Child Table Name | Child Column Name | |
---|---|---|---|
Children: | BENEFIT_ID | BENEFIT_DETAIL | BENEFIT_ID |
BENEFIT_DETAIL
Column Section | Relationship Section | Top of Page |
Table-level Detail
Description: | Defines details for a plan benefit, including quantity and scope of coverage |
Definition: | Deifnes details for a plan benefit, including quantity and scope of coverage |
Table Type: | REFERENCE |
Column Detail - BENEFIT_DETAIL
Column Name | Type | Null? | Definition |
---|---|---|---|
ACTIVE_IND | DOUBLE | Y | The table row is active or inactive. A row is generally active unless it is in an inactive state such as logically deleted, combined away, pending purge, etc. |
ACTIVE_STATUS_CD | DOUBLE | Y | Indicates the status of the row itself (not the data in the row) such as active, inactive, combined away, pending purge, etc. |
ACTIVE_STATUS_DT_TM | DATETIME | Y | The date and time that the active_status_cd was set. |
ACTIVE_STATUS_PRSNL_ID | DOUBLE | Y | The person who caused the active_status_cd to be set or change. |
BEG_EFFECTIVE_DT_TM | DATETIME | N | The date and time for which this table row becomes effective. Normally, this will be the date and time the row is added, but could be a past or future date and time. |
BENEFIT_DETAIL_ID | DOUBLE | N | Unique, system-generated identifier for the benefit detail record. |
BENEFIT_ID | DOUBLE | N | Foreign key to the benefit which this detail record describes. |
BNFT_EVENT_CD | DOUBLE | N | Defines the type of event described in the detail record. |
BNFT_EVENT_QTY | DOUBLE | Y | The number of benefits of this type that will be covered/excluded under the benefits of the plan |
BNFT_SCOPE_CD | DOUBLE | N | Defines the scope of coverage for the defined benefit event |
BNFT_SCOPE_VAL | DOUBLE | Y | The value that describes the magnitude of the scope of coverage. |
END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data. This may be valued with the date that the row became inactive. |
FT_BNFT_EVENT | VARCHAR(50) | Y | Text field for describing a benefit detail that cannot be defined by codes; must use the "OTHER" meaning in the bnft_event_cd field in conjunction with this field. |
UPDT_APPLCTX | DOUBLE | N | The application context number from the record info block. |
UPDT_CNT | DOUBLE | N | Set to 0 on insert. Incremented by 1 on update. Used to recognize update conflict where data in a row updated by one application is at risk of being lost by a second application attempting to update the row. |
UPDT_DT_TM | DATETIME | N | The date and time the row was last inserted or updated. |
UPDT_ID | DOUBLE | N | The person_id of the person from the personnel table (prsnl) that caused the last insert or update of the row in the table. |
UPDT_TASK | DOUBLE | N | The registered (assigned) task number for the process that inserted or updated the row. |
Relationship Detail - BENEFIT_DETAIL
Child Column in BENEFIT_DETAIL(FK) | Parent Table Name | Parent Column Name | |
---|---|---|---|
Parents: | BENEFIT_ID | BENEFIT | BENEFIT_ID |
EEM_ABN_ACTION
Column Section | Relationship Section | Top of Page |
Table-level Detail
Description: | EEM ABN Action |
Definition: | This table is used to track the actions performed on an ABN. |
Table Type: | ACTIVITY |
Column Detail - EEM_ABN_ACTION
Column Name | Type | Null? | Definition |
---|---|---|---|
ABN_ACTION_CD | DOUBLE | N | The action taken on the ABN. For example: Check, Print, Signed, Not Signed, View, etc. |
ABN_ACTION_ID | DOUBLE | N | The unique primary key of this table. |
ABN_CHECK_ID | DOUBLE | N | The ABN check associated with the ABN action. A foreign key to the EEM_ABN_CHECK table. |
ABN_FORM_ID | DOUBLE | N | The ABN form associated to the ABN action. A foreign key to the EEM_ABN_CHECK table. |
ABN_STATE_CD | DOUBLE | N | The state of the ABN. For example: Checked, Signed, Printed, Not Signed, etc. |
ACTION_DT_TM | DATETIME | N | The date and time the action was performed. |
ACTION_MEANING | VARCHAR(12) | N | A 12-char description corresponding to the Action Code. |
ACTION_PRSNL_ID | DOUBLE | N | The ID of the personnel that performed the action. |
ACTIVE_IND | DOUBLE | Y | The table row is active or inactive. A row is generally active unless it is in an inactive state such as logically deleted, combined away, pending purge, etc. |
ACTIVE_STATUS_CD | DOUBLE | N | Indicates the status of the row itself (not the data in the row) such as active, inactive, combined away, pending purge, etc. |
ACTIVE_STATUS_DT_TM | DATETIME | Y | The date and time that the active_status_cd was set. |
ACTIVE_STATUS_PRSNL_ID | DOUBLE | N | The person who caused the active_status_cd to be set or change. |
APPLICATION_NUMBER | DOUBLE | N | The Application Number of the Application that the update was performed from. |
BEG_EFFECTIVE_DT_TM | DATETIME | Y | The date and time for which this table row becomes effective. Normally, this will be the date and time the row is added, but could be a past or future date and time. |
CONVERSATION_ID | DOUBLE | N | Scheduling Conversation Identifier. This identifier is used to track all the abn checks which happened in the same transaction. This field makes debugging much easier |
END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data. This may be valued with the date that the row became inactive. |
FORM_ACTION_ID | DOUBLE | N | Form Action Identifier |
STATE_MEANING | VARCHAR(12) | N | A 12-char description corresponding to the ABN State Code. |
UPDT_APPLCTX | DOUBLE | N | The application context number from the record info block. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_CNT | DOUBLE | N | Set to 0 on insert. Incremented by 1 on update. Used to recognize update conflict where data in a row updated by one application is at risk of being lost by a second application attempting to update the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_DT_TM | DATETIME | N | The date and time the row was last inserted or updated. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_ID | DOUBLE | N | The person_id of the person from the personnel table (prsnl) that caused the last insert or update of the row in the table. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
UPDT_TASK | DOUBLE | N | The registered (assigned) task number for the process that inserted or updated the row. The UPDT family of columns are typically used for housekeeping and external system process and should never be depended on for solution specific logic. |
Relationship Detail - EEM_ABN_ACTION
Child Column in EEM_ABN_ACTION(FK) | Parent Table Name | Parent Column Name | |
---|---|---|---|
Parents: | ABN_ACTION_CD | CODE_VALUE | CODE_VALUE |
ABN_STATE_CD | CODE_VALUE | CODE_VALUE | |
ABN_CHECK_ID | EEM_ABN_CHECK | ABN_CHECK_ID | |
ABN_FORM_ID | EEM_ABN_FORM | ABN_FORM_ID | |
FORM_ACTION_ID | EEM_ACTION | EEM_ACTION_ID | |
ACTION_PRSNL_ID | PRSNL | PERSON_ID |
Parent Column in EEM_ABN_ACTION (PK) | Child Table Name | Child Column Name | |
---|---|---|---|
Children: | ABN_ACTION_ID | EEM_ABN_FORM | ABN_FORM_ID |