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END_EFFECTIVE_DT_TM DATETIME Y The date/time after which the row is no longer valid as active current data.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