Table Detail Report

ORG_PLAN_RELTN



Column Section Relationship Section Top of Page


Table-level Detail

Description: Organization Health Plan Relationship
Definition: The organization-health plan relationship table identifies the role of an organization related to ahealth plan. For example, an insurance company (organization) is the underwriter (relationship) forXYZ Medical Benefit Plan (health plan).
Table Type: REFERENCE





Column Detail - ORG_PLAN_RELTN


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 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 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.
CONTRACT_CODE VARCHAR(100) Y Insurance Plan Contract Code identifies a contract between a facility and an org_plan_relation.
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.
DATA_STATUS_CD DOUBLE N Data status indicates a level of authenticity of the row data. Typically this will either be AUTHENTICATED or UNAUTHENTICATED.
DATA_STATUS_DT_TM DATETIME Y The date and time that the data_status_cd was set.
DATA_STATUS_PRSNL_ID DOUBLE N The person who caused the data_status_cd to be set or change.
END_EFFECTIVE_DT_TM DATETIME N The date/time after which the row is no longer valid as active current data.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.
GROUP_NAME VARCHAR(200) Y Name of the group to which this plan belongs.
GROUP_NBR VARCHAR(100) Y The group number associated with the group name to which this plan belongs.
HEALTH_PLAN_ID DOUBLE N This is the value of the unique primary identifier of the health plan table. It is an internal system assigned number.
ORGANIZATION_ID DOUBLE N This is the value of the unique primary identifier of the organization table. It is an internal system assigned number.
ORG_PLAN_RELTN_CD DOUBLE N Identifies how the organization is related to the health plan (I.e.,sponsor, underwriter, medical review organization, plan administrator, etc.)
ORG_PLAN_RELTN_ID DOUBLE N This is the value of the unique primary identifier of the organization health plan relationship table. It is an internal system assigned number.
POLICY_NBR VARCHAR(100) Y Policy number associated with the plan.
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 - ORG_PLAN_RELTN


Child Column in ORG_PLAN_RELTN(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID
ORGANIZATION_ID ORGANIZATION ORGANIZATION_ID




Parent Column in ORG_PLAN_RELTN (PK) Child Table Name Child Column Name
Children: ORG_PLAN_RELTN_ID OMF_ENCNTR_ST OTHER_ORG_PLAN_RELTN_ID
OMF_ENCNTR_ST PRIM_ORG_PLAN_RELTN_ID
OMF_ENCNTR_ST SEC_ORG_PLAN_RELTN_ID


ORG_PROFILE



Column Section Top of Page


Table-level Detail

Description: This table holds the profile for contributor systems.
Definition: This table holds the profile for contributor systems.
Table Type: ACTIVITY





Column Detail - ORG_PROFILE


Column Name Type Null? Definition
BEG_POSITION DOUBLE Y Denotes the beginning position for a field in a flat text file.
CONTRIBUTOR_SYSTEM VARCHAR(100) N Name of the profile.
DELIMITER DOUBLE Y Delimiter used to delimit the text file.
FIELD_NAME VARCHAR(50) N The name of the field.
FIELD_ORDER DOUBLE Y The order of the field in the text file.
ITEMDATA DOUBLE Y Itemdata consists of the itemdata property corresponding to each field in the profile
ORG_PROFILE_ID DOUBLE N The unique identifier for each record in the table. It is a system generated number.
PROFILE_TYPE VARCHAR(40) Y Denotes the type of profile
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.


ORG_TIMELY_FILING



Column Section Relationship Section Top of Page


Table-level Detail

Description: Organization Timely Filing
Definition: Table used to store information regarding insurance payer's timely filing
Table Type: REFERENCE





Column Detail - ORG_TIMELY_FILING


Column Name Type Null? Definition
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.
AUTO_RELEASE_DAYS DOUBLE N The number of days in advance of timely filing days for the insurance payer organization in context on which the system should auto release the l claim holds for the health plan in context
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.
END_EFFECTIVE_DT_TM DATETIME N 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.
LIMIT_DAYS DOUBLE N The number of days from the date of service of the patient with in which the medical claims needs to be reaching the insurance for the insurance payer organization in context for reimbursement.
NOTIFY_DAYS DOUBLE N The number of days in advance of timely filing days on which the system should Notify the user about medical claims for the health plan in context being approaching the timely filing limit.
ORGANIZATION_ID DOUBLE N The organization that the filing record belongs to.
ORG_TIMELY_FILING_ID DOUBLE N Unique, generated numberr that identifies a single row on the ORG_TIMELY_FILING table.
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 - ORG_TIMELY_FILING


Child Column in ORG_TIMELY_FILING(FK) Parent Table Name Parent Column Name
Parents: ORGANIZATION_ID ORGANIZATION ORGANIZATION_ID


PLAN_CONTACT



Column Section Relationship Section Top of Page


Table-level Detail

Description: PLAN CONTACT
Definition: Stores contact information for health plans and carriers
Table Type: ACTIVITY





Column Detail - PLAN_CONTACT


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.
CARRIER_ID DOUBLE Y Identifier for an insurance carrier that owns this contact
DISPLAY_ORDER DOUBLE Y Defines the display sequence of the plan contacts
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.
HEALTH_PLAN_ID DOUBLE Y Identifies the health plan that owns this contact information
NAME_FIRST VARCHAR(100) Y This is the person's given first name.
NAME_LAST VARCHAR(100) Y This is the person's family name.
NAME_MIDDLE VARCHAR(100) Y This is the given middle name for the person.
PARENT_CONTACT_ID DOUBLE Y If this contact belongs to another contact, the ID of the owner
PERSON_ID DOUBLE Y This is the value of the unique primary identifier of the person table. It is an internal system assigned number.
PERSON_IND DOUBLE N Indicates whether the contact is a person or not
PLAN_CONTACT_ID DOUBLE N Unique identifier for this plan contact
TIER DOUBLE Y Define the nesting level of a contact
TITLE VARCHAR(100) Y Person's title
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 - PLAN_CONTACT


Child Column in PLAN_CONTACT(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID
CARRIER_ID ORGANIZATION ORGANIZATION_ID
PERSON_ID PERSON PERSON_ID


PLAN_NTWK_R



Column Section Relationship Section Top of Page


Table-level Detail

Description: Health Plan to Network(s) relationships
Definition: Stores the relationships between a health plan and provider networks that provide health care services for the plan.
Table Type: ACTIVITY





Column Detail - PLAN_NTWK_R


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 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 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.
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.
HEALTH_PLAN_ID DOUBLE N Foreign Key to the Health_Plan table. Defines a health plan that is related to the Network contained in the Network_ID field.
NETWORK_ID DOUBLE N Stores the Network that is related to the Health Plan contained in the Health_Plan_ID field.
NTWK_PRSNL_GROUP_RELTN_ID DOUBLE N Foreign key to the ntwk_prsnl_group_reltn table. Associates a network's prsnl group(s) to the plan_ntwk_r.
PLAN_NTWK_R_ID DOUBLE N Unique Identifier for the plan/network relationship record
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 - PLAN_NTWK_R


Child Column in PLAN_NTWK_R(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID