HEALTH_PLAN



Column Section Relationship Section Top of Page


Table-level Detail

Description: Health Plan
Definition: The health plan table is a reference of the managed care and indemnity health plans in the system. Examples of some types of health plans include Medicare, Medicaid, commercial indemnity, managed care, HMO, etc.
Table Type: REFERENCE





Column Detail - HEALTH_PLAN


Column Name Type Null? Definition
ACTIVE_IND NUMBER 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 NUMBER 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 DATE Y The date and time that the active_status_cd was set.
ACTIVE_STATUS_PRSNL_ID NUMBER N The person who caused the active_status_cd to be set or change.
BABY_COVERAGE_CD NUMBER N Baby coverage code identifies (Future Use)
BEG_EFFECTIVE_DT_TM DATE 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_SET_NAME VC2(255) Y This is the name of the formulary benefit set.
CLASSIFICATION_CD NUMBER Y The health plan classification type code.
COMB_BABY_BILL_CD NUMBER N Combine Baby Bill Code Value (Future Use)
CONSUMER_ADD_COVRG_ALLOW_IND NUMBER Y Indicator to track if adding coverage (a new person_plan_reltn or encntr_plan_reltn) with this health plan is allowed for patients who are users. A value of 1 means new coverage rows can be added.
CONSUMER_MODIFY_COVRG_DENY_IND NUMBER Y Indicator to track if modifying coverage (updates to person_plan_reltn or encntr_plan_reltn) with this health plan is allowed for patients who are users. A value of 1 means coverage rows can not be modified.
CONTRIBUTOR_SYSTEM_CD NUMBER 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 NUMBER N Data status indicates a level of authenticity of the row data. Typically this will either be AUTHENTICATED or UNAUTHENTICATED.
DATA_STATUS_DT_TM DATE Y The date and time that the data_status_cd was set.
DATA_STATUS_PRSNL_ID NUMBER N The person who caused the data_status_cd to be set or change.
END_EFFECTIVE_DT_TM DATE 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.
FB_BENEFIT_SET_UID VC2(255) N This is the UID that provides a link into the formulary & benefits data store.
FINANCIAL_CLASS_CD NUMBER N Financial class is a grouping for like payers which can determine billing cycles and other billing requirements.
FT_ENTITY_ID NUMBER N Primary key of the table row associated with a free text row.
FT_ENTITY_NAME VC2(32) Y Name of the table associated with a free text row.
GROUP_NAME VC2(200) Y Name of the group this plan belongs to
GROUP_NBR VC2(100) Y The group number associated with the group name that this plan belongs to
HEALTH_PLAN_ID NUMBER N This is the value of the unique primary identifier of the health plan table. It is an internal system assigned number.
LOGICAL_DOMAIN_ID NUMBER N The unique identifier for a logical domain. This identifier allows the data to be grouped by logical domain. For example, If you assign clients a logical_domain_id this would allow you to store data for multiple clients on this table.
PAT_BILL_PREF_FLAG NUMBER N determines patient billing preferences such as "don't bill patient", "allow concurrent patient billing", "allow sequential patient billing", "bill patient only when amount due"
PLAN_CATEGORY_CD NUMBER N Health plan category code identifies the category of the health plan (for example, generic). This value drives specific business logic within Millennium. This column may be moved to another table and should not be reported on.
PLAN_CLASS_CD NUMBER N Health plan class code identifies whether or not a health plan is in the reference list of health plans. i.e. Free Text Health Plan or Organization.
PLAN_DESC VC2(255) Y Text description of the health plan.
PLAN_NAME VC2(100) Y Name of the health plan.
PLAN_NAME_KEY CHAR(100) Y This is the plan's name all capitals with punctuation removed. This field is used for indexing and searching for a plan by name.
PLAN_NAME_KEY_A_NLS VC2(400) Y PLAN_NAME_KEY_A_NLS column
PLAN_NAME_KEY_NLS VC2(202) Y Plan Name Key converted to international for sorting purposes
PLAN_TYPE_CD NUMBER N Health plan type code identifies the type of health plan. (For example, PPO, HMW, Medicaid, Medicare, etc.)
POLICY_NBR VC2(100) Y Policy number associated with the plan
PRIORITY_RANKING_NBR NUMBER Y This field indicates the priority ranking of an associated health plan coverage relative to other coverages allocated to an encounter. This ranking is used when automatic coverage prioritization is turned on to establish the relative position of an allocated coverage compared to other allocated coverages on the encounter.
PRI_CONCURRENT_IND NUMBER N Setting the indicator to 1 means that primary and secondary payors to receive bills simultaneously. setting the indicator to 0 means that primary payor should be billed and pay before the secondary payor is billed
PRODUCT_CD NUMBER N The fields determines the product designation for a health plan (Commercial, Auto Insurance, etc.).
PROVIDER_AFFILIATION_TXT VC2(100) Y Allows for documentation of the provider entity(s) that are affiliated with the payer or health plan to assist with tracking contract associations.
SEC_CONCURRENT_IND NUMBER N Setting the indicator to 1 means that any other payors should receive bills simultaneously. setting the indicator to 0 means that we don't want any other payors to receive bills simultaneously.
SERVICE_TYPE_CD NUMBER N The type of service coverage.
UPDT_APPLCTX NUMBER 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 NUMBER 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 DATE 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 NUMBER 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 NUMBER 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 - HEALTH_PLAN


Child Column in HEALTH_PLAN(FK) Parent Table Name Parent Column Name
Parents: LOGICAL_DOMAIN_ID LOGICAL_DOMAIN LOGICAL_DOMAIN_ID




Parent Column in HEALTH_PLAN (PK) Child Table Name Child Column Name
Children: HEALTH_PLAN_ID ABN_RULE HEALTH_PLAN_ID
AUTHORIZATION HEALTH_PLAN_ID
BATCH_TRANS_FILE HEALTH_PLAN_ID
BENEFIT_ORDER HEALTH_PLAN_ID
BILLING_ENTITY DEFAULT_SELFPAY_HP_ID
BO_HISTORY HEALTH_PLAN_ID
BO_HP_RELTN HEALTH_PLAN_ID
BT_COND_CRIT_GRP_RELTN HEALTH_PLAN_ID
BT_HP_RELTN HEALTH_PLAN_ID
CHARGE HEALTH_PLAN_ID
CHARGE_EVENT HEALTH_PLAN_ID
CHRG_GRP_EXCEPTION PRIMARY_HP_ID
CHRG_GRP_EXCEPTION SECONDARY_HP_ID
COOP_HP_RELTN HEALTH_PLAN_ID
COOP_HP_RELTN SEC_HEALTH_PLAN_ID
CT_RULESET_TIER HEALTH_PLAN_ID
DISPENSE_HX HEALTH_PLAN_ID
EEM_ABN_CHECK HEALTH_PLAN_ID
EEM_ABN_LINK HEALTH_PLAN_ID
EEM_AUTH_DETAIL HEALTH_PLAN_ID
EEM_BATCH HEALTH_PLAN_ID
EEM_BENEFIT_ALLOC HEALTH_PLAN_ID
EEM_ELIG_DETAIL HEALTH_PLAN_ID
EEM_JOB HEALTH_PLAN_ID
EEM_NOTIFICATION_DETAIL HEALTH_PLAN_ID
EEM_PROFILE HEALTH_PLAN_ID
EEM_RX_ELIG_DETAIL HEALTH_PLAN_ID
EEM_RX_MED_HIST_DETAIL HEALTH_PLAN_ID
ENCNTR_CARE_MGMT_COMM HEALTH_PLAN_ID
ENCNTR_PLAN_RELTN HEALTH_PLAN_ID
FILL_PRINT_ORD_HX HEALTH_PLAN_ID
GL_TRANS_QUALIFIER HEALTH_PLAN_ID
GL_TRANS_QUALIFIER PRIMARY_HEALTH_PLAN_ID
GS_MED_CLAIM PRESCRIPTION_HEALTH_PLAN_ID
HEALTH_PLAN_ALIAS HEALTH_PLAN_ID
HEALTH_PLAN_FIELD_FORMAT HEALTH_PLAN_ID
HEALTH_PLAN_INFO HEALTH_PLAN_ID
HEALTH_PLAN_TIMELY_FILING HEALTH_PLAN_ID
HP_ALIAS_POOL_RELTN HEALTH_PLAN_ID
HP_FINANCIAL HEALTH_PLAN_ID
HP_GROUP_RELTN HEALTH_PLAN_ID
OMF_ENCNTR_ST OTHER_HEALTH_PLAN_ID
OMF_ENCNTR_ST PRIM_HEALTH_PLAN_ID
OMF_ENCNTR_ST SEC_HEALTH_PLAN_ID
ORDER_DIAG_CONFIG HEALTH_PLAN_ID
ORDER_DISPENSE HEALTH_PLAN_ID
ORDER_HEALTH_PLAN HEALTH_PLAN_ID
ORDER_HEALTH_PLAN_DETAIL HEALTH_PLAN_ID
ORG_PLAN_RELTN HEALTH_PLAN_ID
PERSON_PLAN_RELTN HEALTH_PLAN_ID
PERSON_RX_PLAN_RELTN HEALTH_PLAN_ID
PFT_AR_CONV_TRANS HEALTH_PLAN_ID
PFT_BENEFIT_ORDER HEALTH_PLAN_ID
PFT_ENCNTR_FACT PRIMARY_HP_ID
PFT_ENCNTR_FACT SECONDARY_HP_ID
PFT_ENCNTR_FACT TERTIARY_HP_ID
PFT_EXPCT_ACTUAL_DEF HEALTH_PLAN_ID
PFT_HP_COV_SCH_RELTN HEALTH_PLAN_ID
PFT_PRORATION HEALTH_PLAN_ID
PFT_PROVIDER_NBR HEALTH_PLAN_ID
PFT_PRSNL_ALIAS HEALTH_PLAN_ID
PFT_REG_MOD HEALTH_PLAN_ID
PFT_REVENUE_SUMMARY HEALTH_PLAN_ID
PHA_BATCH_REPORT_ACT_DTL HEALTH_PLAN_ID
PHA_DISP_OBS_ST HEALTH_PLAN_ID
PHA_ORD_ACT_OBS_ST HEALTH_PLAN_ID
PHA_PROD_DISP_OBS_ST HEALTH_PLAN_ID
PLAN_CONTACT HEALTH_PLAN_ID
PLAN_NTWK_R HEALTH_PLAN_ID
PLAN_PLAN_RELTN HEALTH_PLAN_1_ID
PLAN_PLAN_RELTN HEALTH_PLAN_2_ID
PLAN_PROFILE_RELTN HEALTH_PLAN_ID
PROCEDURE_CODE_TIER HEALTH_PLAN_ID
PROVIDER_ENROLLMENT HEALTH_PLAN_ID
RCM_FACILITY_PLAN_RELTN HEALTH_PLAN_ID
RC_CLOUD_SYNC HEALTH_PLAN_ID
RC_SLA_ACTIVITY HEALTH_PLAN_ID
RC_SLA_RULE HEALTH_PLAN_ID
REV_CODE_EXCEPTION HEALTH_PLAN_ID
RXA_HP_CLAIM_EXCEPTION HEALTH_PLAN_ID
RXA_ORD_DISP_HP_OBS_ST RXA_HEALTH_PLAN_ID
RX_CLAIM HEALTH_PLAN_ID
RX_CLAIM_OVERRIDE HEALTH_PLAN_ID
RX_HEALTH_PLAN HEALTH_PLAN_ID
RX_HEALTH_PLAN_SWITCH_R HEALTH_PLAN_ID
RX_INPT_CLAIM_HX HEALTH_PLAN_ID
STATEMENT_CYCLE_RELTN HEALTH_PLAN_ID
TRANSACTION_ELIGIBILITY HEALTH_PLAN_ID
TRANS_ELIG_AUTO_PLAN HEALTH_PLAN_ID


HEALTH_PLAN_ALIAS



Column Section Relationship Section Top of Page


Table-level Detail

Description: HEALTH PLAN ALIAS
Definition: Table holding the Aliases for a particular Health Plan
Table Type: REFERENCE





Column Detail - HEALTH_PLAN_ALIAS


Column Name Type Null? Definition
ACTIVE_IND NUMBER 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 NUMBER 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 DATE Y The date and time that the active_status_cd was set.
ACTIVE_STATUS_PRSNL_ID NUMBER N The person who caused the active_status_cd to be set or change.
ALIAS VC2(100) Y The alias is an identifier for a health plan. The alias may be unique or non-unique depending on the type of alias.
ALIAS_KEY VC2(100) Y This is the plan's alias in all capitals with punctuation removed. This field is used for indexing and searching for a plan by alias.
ALIAS_KEY_A_NLS VC2(400) Y This column is used as the key column for non English sites.
ALIAS_POOL_CD NUMBER N Alias pool code identifies a unique set or list of person identifiers (I.e., numbers). The alias pool code also determines the accept/display format for the unique set of identifiers.
BEG_EFFECTIVE_DT_TM DATE 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.
CHECK_DIGIT NUMBER Y This is the value of the check digit calculated according to the check_digit_method_cd. If the check digit is stored as part of the alias number, which is typical, then the check digit field may be NULL.
CHECK_DIGIT_METHOD_CD NUMBER N The check digit method code identifies a specific routine, using the alias field, to calculate a check digit.
CONTRIBUTOR_SYSTEM_CD NUMBER 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 NUMBER N Data status indicates a level of authenticity of the row data. Typically this will either be AUTHENTICATED or UNAUTHENTICATED.
DATA_STATUS_DT_TM DATE Y The date and time that the data_status_cd was set.
DATA_STATUS_PRSNL_ID NUMBER N The person who caused the data_status_cd to be set or change.
END_EFFECTIVE_DT_TM DATE 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.
HEALTH_PLAN_ALIAS_ID NUMBER N This is the value of the unique primary identifier of the health plan alias table. It is an internal system assigned number.
HEALTH_PLAN_ID NUMBER N This is the value of the unique primary identifier of the health plan table. It is an internal system assigned number.
LOGICAL_DOMAIN_ID NUMBER N Uniquely identifies the related logical domain.
PLAN_ALIAS_SUB_TYPE_CD NUMBER N Alias sub type.
PLAN_ALIAS_TYPE_CD NUMBER N Type of alias
UPDT_APPLCTX NUMBER N The application context number from the record info block.
UPDT_CNT NUMBER 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 DATE N The date and time the row was last inserted or updated.
UPDT_ID NUMBER 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 NUMBER N The registered (assigned) task number for the process that inserted or updated the row.



Relationship Detail - HEALTH_PLAN_ALIAS


Child Column in HEALTH_PLAN_ALIAS(FK) Parent Table Name Parent Column Name
Parents: PLAN_ALIAS_SUB_TYPE_CD CODE_VALUE CODE_VALUE
PLAN_ALIAS_TYPE_CD CODE_VALUE CODE_VALUE
HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID


HEALTH_PLAN_INFO



Column Section Relationship Section Top of Page


Table-level Detail

Description: Health Plan Information
Definition: Table used to store generic Health Plan Information.
Table Type: REFERENCE





Column Detail - HEALTH_PLAN_INFO


Column Name Type Null? Definition
ACTIVE_IND NUMBER 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 NUMBER 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 DATE Y The date and time that the active_status_cd was set.
ACTIVE_STATUS_PRSNL_ID NUMBER N The person who caused the active_status_cd to be set or change.
BEG_EFFECTIVE_DT_TM DATE 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.
CHARTABLE_IND NUMBER Y Determines whether this information can be charted.
CONTRIBUTOR_SYSTEM_CD NUMBER 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_TM DATE 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 NUMBER N This is the value of the unique primary identifier of the health plan table. It is an internal system assigned number.
HEALTH_PLAN_INFO_ID NUMBER N This is the value of the unique primary identifier of the health plan information table. It is an internal system assigned number.
HP_INFO_SUB_TYPE_CD NUMBER N Health Plan Information Sub Type Code identifies the category if additional information contained in the row. (For Example: Number of Children, Clerical Contact, etc.)
HP_INFO_TYPE_CD NUMBER N Health Plan Information Type Code identifies the type of the information. (For Example: Comment, General Announcement, etc.)
LONG_TEXT_ID NUMBER N Foreign key from LONG_TEXT table. Ties free text comments to a health plan information row.
UPDT_APPLCTX NUMBER N The application context number from the record info block.
UPDT_CNT NUMBER 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 DATE N The date and time the row was last inserted or updated.
UPDT_ID NUMBER 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 NUMBER N The registered (assigned) task number for the process that inserted or updated the row.
VALUE_DT_TM DATE Y A Date and Time value representing the information in the health plan information row.
VALUE_NUMERIC NUMBER Y A numeric value representing the information in the health plan information row.



Relationship Detail - HEALTH_PLAN_INFO


Child Column in HEALTH_PLAN_INFO(FK) Parent Table Name Parent Column Name
Parents: HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID
LONG_TEXT_ID LONG_TEXT LONG_TEXT_ID


HEALTH_PLAN_TIMELY_FILING



Column Section Relationship Section Top of Page


Table-level Detail

Description: Health Plan Timely Filing
Definition: Table used to store information regarding health plan timely filing.
Table Type: REFERENCE





Column Detail - HEALTH_PLAN_TIMELY_FILING


Column Name Type Null? Definition
AUTO_RELEASE_DAYS NUMBER N *** OBSOLETE ***
HEALTH_PLAN_ID NUMBER N *** OBSOLETE ***
HEALTH_PLAN_TIMELY_FILING_ID NUMBER N *** OBSOLETE ***
LIMIT_DAYS NUMBER N *** OBSOLETE ***
NOTIFY_DAYS NUMBER N *** OBSOLETE ***
PAYER_ID NUMBER N *** OBSOLETE ***
UPDT_APPLCTX NUMBER 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 NUMBER 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 DATE 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 NUMBER 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 NUMBER 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 - HEALTH_PLAN_TIMELY_FILING


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


HP_ALIAS_POOL_RELTN



Column Section Relationship Section Top of Page


Table-level Detail

Description: HP ALIAS POOL RELTN
Definition: This table will allow us to tie allias_pools to health_plans without orgs.
Table Type: ACTIVITY





Column Detail - HP_ALIAS_POOL_RELTN


Column Name Type Null? Definition
ACTIVE_IND NUMBER 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 NUMBER 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 DATE Y The date and time that the active_status_cd was set.
ALIAS_POOL_CD NUMBER N Alias pool code identifies a unique set or list of health_plan identifiers.
ALIAS_TYPE_CD NUMBER N Sequence reference.
BEG_EFFECTIVE_DT_TM DATE 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 DATE 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 NUMBER N Primary key of health plan.
HP_ALIAS_POOL_RELTN_ID NUMBER N Primary Key.
LOCATION_CD NUMBER N Location code is written here.
UPDT_APPLCTX NUMBER N The application context number from the record info block.
UPDT_CNT NUMBER 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 DATE N The date and time the row was last inserted or updated.
UPDT_ID NUMBER 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 NUMBER N The registered (assigned) task number for the process that inserted or updated the row.



Relationship Detail - HP_ALIAS_POOL_RELTN


Child Column in HP_ALIAS_POOL_RELTN(FK) Parent Table Name Parent Column Name
Parents: LOCATION_CD CODE_VALUE CODE_VALUE
HEALTH_PLAN_ID HEALTH_PLAN HEALTH_PLAN_ID