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 | 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 | N | 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 | 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| END_EFFECTIVE_DT_TM | DATE | Y | The date/time after which the row is no longer valid as active current data.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_1_ID | NUMBER | N | This is the identifier of the first plan in the relationship. |
| HEALTH_PLAN_2_ID | NUMBER | N | This is the identifier of the second plan in the relationship. |
| HEALTH_PLAN_RELTN_CD | NUMBER | 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 | NUMBER | N | This is the unique primary identifier of the plan_plan_reltn table. It is an internal system assigned number. |
| 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 - 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 | 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 | 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. |
| CONTRIB_SRV_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 | 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. |
| LOGON_ID | VC2(8) | Y | Logon Id |
| NEW_PASSWORD | VC2(10) | Y | New Password |
| OLD_PASSWORD | VC2(10) | Y | Old Password |
| ORGANIZATION_ID | NUMBER | 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 | NUMBER | 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 | NUMBER | N | This is the value of the unique primary identifier of the profile table. It is an internal system assigned number. |
| 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 - 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 | 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 | N | 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. |
| BILL_TYPE_FLAG | NUMBER | 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 | DATE | Y | The beginning date that the provider and/or facility is officially enrolled with the payer. |
| ENROLL_END_EFFECTIVE_DT_TM | DATE | Y | The date that the official enrollment with the payer |
| HEALTH_PLAN_ID | NUMBER | N | The health plan for which the provider and/or facility is being enrolled. |
| LOCATION_CD | NUMBER | N | Generally a facility, but the location for the provider(s) that are being enrolled with the payer. |
| LOCATION_PRIORITY_SEQ | NUMBER | N | Contains the priority sequence for each facility. |
| PARTICIPATION_STATUS_CD | NUMBER | N | Indicates whether the provider and/or facility is participating or non-participating with the payer/health plan. |
| PAYER_ORG_ID | NUMBER | N | The organization with a type of INSCO which denotes a payer. |
| PROCESS_BEG_EFFECTIVE_DT_TM | DATE | Y | The date that the process to get a provider and/or facility enrolled with a payer started. |
| PROCESS_END_EFFECTIVE_DT_TM | DATE | Y | The estimated date that the process for getting the provider and/or facility enrolled with the payer will be finished. |
| PROVIDER_ENROLLMENT_ID | NUMBER | N | Unique generated number that identifies a single row on the PROVIDER_ENROLLMENT table. |
| PRSNL_ID | NUMBER | N | The provider that is being enrolled with the payer. |
| RECEIVED_BY_PAYER_DT_TM | DATE | Y | The date/time that the enrollment request was submitted to the payer. |
| SUBMITTED_TO_PAYER_DT_TM | DATE | Y | The date and time that the enrollment request was acknowledged as received by the payer. |
| TIMELY_FILING_DT_TM | DATE | Y | The date that claims will need to be submitted to the payer to prevent timely filing issues. |
| 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 - 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 |