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END_EFFECTIVE_DT_TM | DATETIME | N | The date/time after which the row is no longer valid as active current data.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