Table Detail Report

PLAN_PLAN_RELTN



Column Section Relationship Section Top of Page


Table-level Detail

Description: Plan Plan Relation
Definition: This is a relation table that relates 2 plans to each other. An example would be a health plan related to an RX plan.
Table Type: REFERENCE





Column Detail - PLAN_PLAN_RELTN


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.
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 N 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.
END_EFFECTIVE_DT_TM DATETIME Y The date/time after which the row is no longer valid as active current data.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_1_ID DOUBLE N This is the identifier of the first plan in the relationship.
HEALTH_PLAN_2_ID DOUBLE N This is the identifier of the second plan in the relationship.
HEALTH_PLAN_RELTN_CD DOUBLE N This identifies how the health plans are related to each other. An example would be a medical plan related to an RX plan
PLAN_PLAN_RELTN_ID DOUBLE N This is the unique primary identifier of the plan_plan_reltn table. It is an internal system assigned number.
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_PLAN_RELTN


Child Column in PLAN_PLAN_RELTN(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_1_ID HEALTH_PLAN HEALTH_PLAN_ID
HEALTH_PLAN_2_ID HEALTH_PLAN HEALTH_PLAN_ID


PLAN_PROFILE_RELTN



Column Section Relationship Section Top of Page


Table-level Detail

Description: plan profile reltn
Definition: The plan-profile relationship table contains pointers to related profile in the profile table. The relationship defines how the profile and health plan are related.
Table Type: ACTIVITY





Column Detail - PLAN_PROFILE_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 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.
CONTRIB_SRV_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.
END_EFFECTIVE_DT 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 This is the value of the unique primary identifier of the health_plan table. It is an internal system assigned number.
LOGON_ID VARCHAR(8) Y Logon Id
NEW_PASSWORD VARCHAR(10) Y New Password
OLD_PASSWORD VARCHAR(10) Y Old Password
ORGANIZATION_ID DOUBLE N This is the value of the unique primary identifier of the organization table. It is an internal system assigned number.
PLAN_PROFILE_RELTN_ID DOUBLE N This is the value of the unique primary identifier of the Plan_profile_reltn table. It is an internal system assigned number.
PROFILE_ID DOUBLE N This is the value of the unique primary identifier of the profile table. It is an internal system assigned number.
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_PROFILE_RELTN


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


PROVIDER_ENROLLMENT



Column Section Relationship Section Top of Page


Table-level Detail

Description: Provider Enrollment
Definition: Stores a relationship between a provider/facility and a payer/health plan for the credentialing process. It also stores:- start and end dates of that process- effective dates of the provider/facility and payer/health plan relationship- Date for timely filing- participation statusThe credentialing process is how providers or whole facilities work with payers to be able to receive payments from them on all or some of their health plans.
Table Type: REFERENCE





Column Detail - PROVIDER_ENROLLMENT


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.
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 N 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.
BILL_TYPE_FLAG DOUBLE N Identifies the class (e.g. Claim, Letter, etc.) to which a bill record belongs. 0 - None, 1 - All, 2 - 1450 - Institutional Claim, 3 - 1500 Professional Claim
ENROLL_BEG_EFFECTIVE_DT_TM DATETIME Y The beginning date that the provider and/or facility is officially enrolled with the payer.
ENROLL_END_EFFECTIVE_DT_TM DATETIME Y The date that the official enrollment with the payer
HEALTH_PLAN_ID DOUBLE N The health plan for which the provider and/or facility is being enrolled.
LOCATION_CD DOUBLE N Generally a facility, but the location for the provider(s) that are being enrolled with the payer.
LOCATION_PRIORITY_SEQ DOUBLE N Contains the priority sequence for each facility.
PARTICIPATION_STATUS_CD DOUBLE N Indicates whether the provider and/or facility is participating or non-participating with the payer/health plan.
PAYER_ORG_ID DOUBLE N The organization with a type of INSCO which denotes a payer.
PROCESS_BEG_EFFECTIVE_DT_TM DATETIME Y The date that the process to get a provider and/or facility enrolled with a payer started.
PROCESS_END_EFFECTIVE_DT_TM DATETIME Y The estimated date that the process for getting the provider and/or facility enrolled with the payer will be finished.
PROVIDER_ENROLLMENT_ID DOUBLE N Unique generated number that identifies a single row on the PROVIDER_ENROLLMENT table.
PRSNL_ID DOUBLE N The provider that is being enrolled with the payer.
RECEIVED_BY_PAYER_DT_TM DATETIME Y The date/time that the enrollment request was submitted to the payer.
SUBMITTED_TO_PAYER_DT_TM DATETIME Y The date and time that the enrollment request was acknowledged as received by the payer.
TIMELY_FILING_DT_TM DATETIME Y The date that claims will need to be submitted to the payer to prevent timely filing issues.
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 - PROVIDER_ENROLLMENT


Child Column in PROVIDER_ENROLLMENT(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID
PAYER_ORG_ID ORGANIZATION ORGANIZATION_ID
PRSNL_ID PRSNL PERSON_ID




Parent Column in PROVIDER_ENROLLMENT (PK) Child Table Name Child Column Name
Children: PROVIDER_ENROLLMENT_ID PFT_BR_EDIT_FAILURE_DETAIL PROVIDER_ENROLLMENT_ID