Table Detail Report
ENCNTR_PLAN_ELIG_BENEFIT
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Encounter Health Plan Eligibility Benefit |
| Definition: | The encounter health plan eligibility benefit table contains information about the benefits that a patient is offered via their health plan for a particular eligibility. Information will typically be obtained from the payer via the X12 270/271 transaction but will also be added or modified directly by the end user. |
| Table Type: | ACTIVITY |
Column Detail - ENCNTR_PLAN_ELIG_BENEFIT
| 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. |
| BENEFIT_COMMENTS_LONG_TEXT_ID | DOUBLE | N | Comment identifier for free text stored on the LONG_TEXT table which representsadditional comments, description, or notes for the benefit. |
| BENEFIT_MONETARY_AMT | DOUBLE | Y | The monetary amount associated with the benefit. |
| BENEFIT_PCT | DOUBLE | Y | The numeric percentage associated with the benefit. |
| BENEFIT_QTY | DOUBLE | Y | The quantity associated with the benefit. |
| BENEFIT_QTY_QUAL_CD | DOUBLE | N | Qualifies the type of quantity associated with the benefit.Code Set: 26311 |
| BENEFIT_TIME_PERIOD_QUAL_CD | DOUBLE | N | Qualifies the time period of the benefits availability. Code Set: 26335 |
| BENEFIT_TYPE_CD | DOUBLE | N | Identifies the type of benefit for the benefit row.Code Set: 26307 |
| ENCNTR_PLAN_ELIGIBILITY_ID | DOUBLE | N | Identifies the row on the Encntr_plan_eligibility table that benefit is for. |
| ENCNTR_PLAN_ELIG_BENEFIT_ID | DOUBLE | N | This is the value of the unique primary identifier of this table. It is an internal system assigned number. |
| INFO_SOURCE_CD | DOUBLE | N | Represents from what information source the benefit data was obtained.Code Set: 4002563 |
| SELECTED_IND | DOUBLE | N | Indicates if the benefit has been selected as being directly applicable for the encounter. |
| TRANSACTION_SOURCE_IDENT | VARCHAR(50) | Y | The transaction identifier assigned by transaction services which was the source of the benefit data. |
| 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 - ENCNTR_PLAN_ELIG_BENEFIT
| Child Column in ENCNTR_PLAN_ELIG_BENEFIT(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | ENCNTR_PLAN_ELIGIBILITY_ID | ENCNTR_PLAN_ELIGIBILITY | ENCNTR_PLAN_ELIGIBILITY_ID |
| Parent Column in ENCNTR_PLAN_ELIG_BENEFIT (PK) | Child Table Name | Child Column Name | |
|---|---|---|---|
| Children: | ENCNTR_PLAN_ELIG_BENEFIT_ID | ENCNTR_PLAN_ELIG_BNFT_HIST | ENCNTR_PLAN_ELIG_BENEFIT_ID |
ENCNTR_PLAN_ELIG_BNFT_HIST
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Encounter Plan Eligibility Benefit History |
| Definition: | Table stores historical information on health plan eligibility benefit data for an encounter. |
| Table Type: | ACTIVITY |
Column Detail - ENCNTR_PLAN_ELIG_BNFT_HIST
| 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. |
| BENEFIT_COMMENTS_LONG_TEXT_ID | DOUBLE | N | Comment identifier for free text stored on the LONG_TEXT table which represents additional comments, description, or notes for the benefit. |
| BENEFIT_MONETARY_AMT | DOUBLE | Y | The monetary amount associated with the benefit. |
| BENEFIT_PCT | DOUBLE | Y | The numeric percentage associated with the benefit. |
| BENEFIT_QTY | DOUBLE | Y | The quantity associated with the benefit. |
| BENEFIT_QTY_QUAL_CD | DOUBLE | N | Qualifies the type of quantity associated with the benefit. |
| BENEFIT_TIME_PERIOD_QUAL_CD | DOUBLE | N | Qualifies the time period of the benefit's availablity |
| BENEFIT_TYPE_CD | DOUBLE | N | Identifies the type of benefit for the benefit row. |
| CHANGE_BIT | DOUBLE | N | Identifies which columns have had a change. |
| ENCNTR_PLAN_ELIGIBILITY_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_ELIGIBILITY table to which this benefit applies. |
| ENCNTR_PLAN_ELIG_BENEFIT_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_ELIG_BENEFIT table for which this history is maintained. |
| ENCNTR_PLAN_ELIG_BNFT_HIST_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_ELIG_BNFT_HIST table. |
| INFO_SOURCE_CD | DOUBLE | N | Designates the information source from which the benefit data was obtained. |
| PM_HIST_TRACKING_ID | DOUBLE | N | This is the value of the unique primary identifier of the pm_hist_tracking table. It is an internal system assigned number. |
| SELECTED_IND | DOUBLE | N | Indicates if the benefit has been selected as being directly applicable for the encounter. |
| TRACKING_BIT | DOUBLE | N | Identifies which columns are being tracked for history. |
| TRANSACTION_SOURCE_IDENT | VARCHAR(50) | Y | The identifier of the transaction that was the source of this elegibility benefit data when a transaction was used to verify eligibility for a patient. |
| 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 - ENCNTR_PLAN_ELIG_BNFT_HIST
| Child Column in ENCNTR_PLAN_ELIG_BNFT_HIST(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | ENCNTR_PLAN_ELIGIBILITY_ID | ENCNTR_PLAN_ELIGIBILITY | ENCNTR_PLAN_ELIGIBILITY_ID |
| ENCNTR_PLAN_ELIG_BENEFIT_ID | ENCNTR_PLAN_ELIG_BENEFIT | ENCNTR_PLAN_ELIG_BENEFIT_ID | |
| PM_HIST_TRACKING_ID | PM_HIST_TRACKING | PM_HIST_TRACKING_ID |
ENCNTR_PLAN_ELIG_HIST
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Encounter Plan Eligibility History |
| Definition: | Table stores historical information on health plan eligibility benefit data for an encounter. |
| Table Type: | ACTIVITY |
Column Detail - ENCNTR_PLAN_ELIG_HIST
| 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. |
| AUTH_REQUIRED_CD | DOUBLE | N | Indicates if an authorization is required for the given service per plan provisions. |
| CHANGE_BIT | DOUBLE | N | Identifies which columns have had a change. |
| COVERAGE_LEVEL_CD | DOUBLE | N | The coverage level for which the eligibility and any associated benefits apply, it identifies the types and number of entities that are covered by the insurance plan. |
| ELIGIBILITY_STATUS_CD | DOUBLE | N | The eligibility status of the patient. |
| ENCNTR_PLAN_ELIGIBILITY_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_ELIGIBILITY table for which this history is maintained. |
| ENCNTR_PLAN_ELIG_HIST_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_ELIG_HIST |
| ENCNTR_PLAN_RELTN_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_RELTN table. Identifies the health plan for which the patient's eligibility was verified. |
| INFO_SOURCE_CD | DOUBLE | N | Designates the information source from which the eligibility benefit data was obtained. |
| INSURANCE_TYPE_CD | DOUBLE | N | Type of insurance policy within a specific insurance program for which the eligibility and any associated benefits apply. |
| IN_PLAN_NETWORK_CD | DOUBLE | N | Indicates if the eligibility and associated benefits apply in network or out of network. |
| PAYER_PROV_PLAN_NAME | VARCHAR(100) | Y | The name of the health plan as provided by the payer (carrier). |
| PM_HIST_TRACKING_ID | DOUBLE | N | This is the value of the unique primary identifier of the pm_hist_tracking table. It is an internal system assigned number. |
| PROC_NOMEN_ID | DOUBLE | N | Unique generated number that identifies a single row on the NOMENCLATURE table. It identifies a hcpcs, cpt, icd-9-cm or icd-10-pcs procedure code for which the eligibility and any associated benefits apply. |
| SERVICE_TYPE_CD | DOUBLE | N | The type of service for which the eligibility and any associated benefits apply. |
| TRACKING_BIT | DOUBLE | N | Identifies which columns are being tracked for history. |
| 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 - ENCNTR_PLAN_ELIG_HIST
| Child Column in ENCNTR_PLAN_ELIG_HIST(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | ENCNTR_PLAN_ELIGIBILITY_ID | ENCNTR_PLAN_ELIGIBILITY | ENCNTR_PLAN_ELIGIBILITY_ID |
| ENCNTR_PLAN_RELTN_ID | ENCNTR_PLAN_RELTN | ENCNTR_PLAN_RELTN_ID | |
| PM_HIST_TRACKING_ID | PM_HIST_TRACKING | PM_HIST_TRACKING_ID |
ENCNTR_PLAN_RELTN
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Encounter Health Plan Relationship |
| Definition: | The encounter-health plan relation table contains pointers to health plans for a specific encounter. This table is similar to the person health plan relation table, except that the health plans relate to a specific encounter. |
| Table Type: | ACTIVITY |
Column Detail - ENCNTR_PLAN_RELTN
| Column Name | Type | Null? | Definition |
|---|---|---|---|
| ACCEPT_ASSIGNMENT_CD | DOUBLE | N | Provider acceptance for payment terms. |
| 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. |
| ALT_MEMBER_NBR | VARCHAR(100) | Y | The alternate payer plan member number for the person. |
| ASSIGN_BENEFITS_CD | DOUBLE | N | Codified column representing the nature/status of benefit assignment for the use of the health plan on this encounter. |
| AUTH_REQUIRED_CD | DOUBLE | N | Documents whether or not authorization is required for given encounter health plan relation |
| BALANCE_TYPE_CD | DOUBLE | N | Status/Type of the billing balance for this encounter and this health plan. |
| 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. |
| BEG_EFFECTIVE_TZ | DOUBLE | Y | The time zone associated with the beg_effective_dt_tm column. |
| BENEFIT_VERIFY_DT_TM | DATETIME | Y | The data and time at which the health plan benefits were last verified. |
| CARD_CATEGORY_CD | DOUBLE | N | A categorization of the coverages and/or benefits available to the recipient. For some insurances this may be clearly identifiable based on characteristics of the beneficiary's coverage card. |
| CARD_ISSUE_NBR | DOUBLE | N | The card issue number is used to track the number of cards dispensed. The original card is typically issue number 00, with subsequent cards incremented. |
| 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. |
| COORD_BENEFITS_CD | DOUBLE | N | Codified value representing the coordination of benefits for this health plan for this encounter. |
| COVERAGE_COMMENTS_LONG_TEXT_ID | DOUBLE | N | An identifier that points to a row in the LONG_TEXT table where comments about the plan coverage are stored. |
| 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. |
| DEDUCT_AMT | DOUBLE | Y | Amount of health plan deductible applied to this encounter. |
| DEDUCT_MET_AMT | DOUBLE | Y | Amount of the deductible that has been met, or payed, by the subscriber. |
| DEDUCT_MET_DT_TM | DATETIME | Y | Date and time that the deductible amount was payed. |
| DENIAL_REASON_CD | DOUBLE | N | The reason for the denial. |
| ENCNTR_ID | DOUBLE | N | This is the value of the unique primary identifier of the encounter table. It is an internal system assigned number. |
| ENCNTR_PLAN_RELTN_ID | DOUBLE | N | This is the value of the unique primary identifier of the encounter health plan relationship table. It is an internal system assigned number. |
| 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. |
| END_EFFECTIVE_TZ | DOUBLE | Y | The time zone associated with the end_effective_dt_tm column. |
| EXT_PAYER_IDENT | VARCHAR(100) | Y | The primary identifier of the organization (that does not exist in the Millennium build) providing the insurance plan (carrier). |
| EXT_PAYER_NAME | VARCHAR(100) | Y | The name of the organization (that does not exist in the Millennium build) providing the insurance plan (carrier). |
| GENERIC_HEALTH_PLAN_NAME | VARCHAR(100) | Y | The name of the health plan when the health plan category is GENERIC. |
| GROUP_NAME | VARCHAR(200) | Y | Name of the health plan group used for this encounter (patient) and their association to the health plan through their sponsor (employer). |
| GROUP_NBR | VARCHAR(100) | Y | Number of the health plan group used for this encounter (patient) and their association to the health plan through their sponsor (employer). |
| HEALTH_CARD_EXPIRY_DT_TM | DATETIME | Y | The date and time for which this health card becomes ineffective or expired. |
| HEALTH_CARD_ISSUE_DT_TM | DATETIME | Y | The date and time for which this health card becomes effective or issued. |
| HEALTH_CARD_NBR | CHAR(100) | Y | The number on the subscriber's/patient's health card (generally used in non-US sites). |
| HEALTH_CARD_PROVINCE | CHAR(3) | Y | Province where the Health Card was issued (usually used in non-US sites such as Canada). |
| HEALTH_CARD_TYPE | VARCHAR(32) | Y | Type of health card which has a certain category or style. |
| HEALTH_CARD_VER_CODE | CHAR(3) | Y | Version code of the Health Card (usually used in non-U.S. sites such as Canada). |
| 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. |
| INSURED_CARD_NAME | VARCHAR(100) | Y | Subscriber's/Patient's name as printed on the insurance card. |
| INSURED_CARD_NAME_FIRST | VARCHAR(100) | Y | Person's first name as seen on the insurance card. |
| INSURED_CARD_NAME_LAST | VARCHAR(100) | Y | Person's last name as seen on the insurance card. |
| INSURED_CARD_NAME_MIDDLE | VARCHAR(100) | Y | Person's middle name as seen on the insurance card. |
| INSURED_CARD_NAME_SUFFIX | VARCHAR(100) | Y | Person's name suffix as seen on the insurance card. |
| INSUR_SOURCE_INFO_CD | DOUBLE | N | Codified value representing the source from which the insurance information for this health plan and encounter was obtained. |
| INS_CARD_COPIED_CD | DOUBLE | N | A y/n field indicating whether a copy of the subscriber's insurance card has been obtained. |
| INS_OFFICE_ORG_ID | DOUBLE | N | Identifier from the organization table of the health plan's insurance office. |
| LIFE_RSV_DAILY_DED_AMT | DOUBLE | N | The daily deductible amount that is applicable when reserve days are used for coverage. |
| LIFE_RSV_DAILY_DED_QUAL_CD | DOUBLE | N | The qualifier describing the amount entered in the Lifetime reserve daily deductible. |
| LIFE_RSV_DAYS | DOUBLE | N | The predetermined number of coverage days held "in reserve" for use if needed. The reserve days can be used when all the days under a given service have been used, but continued coverage/care is needed. This number is static for the lifetime of the subscriber. |
| LIFE_RSV_REMAIN_DAYS | DOUBLE | N | A static, manual-entry field obtained from taking the Lifetime reserve days and subtracting any days used from that reserve for coverage. |
| MEMBER_NBR | VARCHAR(100) | Y | Patient's member number for this health plan. |
| MEMBER_PERSON_CODE | VARCHAR(100) | Y | An additional attribute that the payer can use to uniquely identify the subscriber and their dependents within the context of a particular policy. The policy number in conjunction with the member person code typically comprise the member number. |
| MILITARY_BASE_LOCATION | VARCHAR(100) | Y | Textual location of the military base on which the subscriber/patient resides. |
| MILITARY_RANK_CD | DOUBLE | N | Military ranking of the subscriber/patient. |
| MILITARY_SERVICE_CD | DOUBLE | N | The branch of military service through which the health plan coverage is being offered to the subscriber due to their current or past service. Examples may include, Army, Navy, Air Force, etc. |
| MILITARY_STATUS_CD | DOUBLE | N | Military status of the subscriber/patient. |
| NOTIFY_DT_TM | DATETIME | Y | Date and time the inpatient 278 Notification took place. |
| NOTIFY_PRSNL_ID | DOUBLE | N | Personnel that ran the inpatient 278 Notification. |
| NOTIFY_SOURCE_CD | DOUBLE | N | Source the inpatient 278 Notification came from. e.g. Phone, Electronic, etc. |
| ON_FILE_ADMIN_SEX_CD | DOUBLE | N | The person's gender code as it appears on file with the carrier. |
| ON_FILE_BIRTH_DT_ISO | VARCHAR(10) | Y | The patient's date of birth as it appears on the file with the carrier. Stored in standard ISO format. |
| ORGANIZATION_ID | DOUBLE | N | Identifier from the organization table of the health plan's carrier. |
| ORIG_PRIORITY_SEQ | DOUBLE | Y | This is a numeric number used to represent the order in which to considered this health plan for reimbursement, if the person is a member of more than one health plan. This is the original number from the person health plan relation table. |
| PERSON_ID | DOUBLE | N | This is the value of the unique primary identifier of the person table. It is an internal system assigned number. |
| PERSON_ORG_RELTN_ID | DOUBLE | N | This this the ID from the PERSON_ORG_RELTN table for the person and the organization that are related to this ENCNTR_PLAN_RELTN row. |
| PERSON_PLAN_RELTN_ID | DOUBLE | N | This is the ID from the PERSON_PLAN_RELTN row relating the PERSON and the HEALTH_PLAN to this ENCNTR_PLAN_RELTN row. For an encounter, a corresponding row can be maintained at the person level with the same information. |
| PLAN_CLASS_CD | DOUBLE | N | The classification/grouping of the health plan. Generally indicates whether or not the plan is free text. |
| PLAN_TYPE_CD | DOUBLE | N | Value that signifies the type/grouping of the health plan. Examples may include Medicare, Commercial, Champus, HMO, others. |
| POLICY_NBR | VARCHAR(100) | Y | The policy number of the subscriber's health plan at the time of the visit. The policy number in conjunction with the member person code typically comprise the member number. Sometimes the individual's member number is referred to as their policy number so care should be taken in order to make sure that the correct field is being used given a particular use case. |
| PRICING_AGENCY_CD | DOUBLE | N | A Pricing Agency is an entity that applies a discount to a claim based on a contract that the entity has negotiated with both providers and claims payers on behalf of the network. |
| PRIORITY_SEQ | DOUBLE | Y | This is a numeric number used to represent the order in which to consider this health plan for reimbursement, if the person is a member of more than one health plan. This number may change from the original number depending on the encounter. |
| PROGRAM_STATUS_CD | DOUBLE | N | Represents the set of coverages and/or benefits available to the recipient based on the recipient's reason for eligibility. |
| PROP_CASUALTY_CLAIM_NBR_TXT | VARCHAR(100) | Y | This is the claim number the health plan has to the P&C claim. This number is submitted to the health plan along with, or in a place of, the policy number. |
| RESUBMIT_278N_CD | DOUBLE | N | This field stores the responses for resubmitting eligibility. |
| RX_PLAN_COB_SEQ | DOUBLE | N | Indicates the order in which a health plan is considered for pharmacy coordination of benefits for a particular encounter. |
| SIGNATURE_DT_TM | DATETIME | Y | Patient signature date/time for claim form. |
| SIGNATURE_ON_FILE_CD | DOUBLE | N | Indicates whether a patient's signature for insurance has been obtained |
| SIGNATURE_SOURCE_CD | DOUBLE | N | Description of what claim form the patient signed. |
| SPONSOR_PERSON_ORG_RELTN_ID | DOUBLE | N | Pointer to the relationship between the subscriber and their employer/sponsor organization. |
| SUBSCRIBER_TYPE_CD | DOUBLE | N | Value that represents the type of subscriber being used for this health plan. Not used at this time. |
| SUBS_INSURED_CARD_FIRST_NAME | VARCHAR(100) | Y | The Subscriber's first name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_LAST_NAME | VARCHAR(100) | Y | The Subscriber's last name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_MIDDLE_NAME | VARCHAR(100) | Y | The Subscriber's middle name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_SUFFIX_NAME | VARCHAR(100) | Y | The Subscriber's suffix name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_MEMBER_NBR | VARCHAR(100) | Y | The member number of the subscriber to the health plan. |
| SUBS_ON_FILE_ADMIN_SEX_CD | DOUBLE | N | The subscriber's gender code as it appears on file with the carrier. |
| SUBS_ON_FILE_BIRTH_DT_ISO | VARCHAR(10) | Y | The subscriber's date of birth as it appears on file with the carrier. Stored in ISO format. |
| 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. |
| VERIFY_DT_TM | DATETIME | Y | Time that the row was last verified. |
| VERIFY_PRSNL_ID | DOUBLE | N | Id of the prsnl who last updated the row. |
| VERIFY_SOURCE_CD | DOUBLE | N | The source by which the row was verified. |
| VERIFY_STATUS_CD | DOUBLE | N | The last verified status entered. |
Relationship Detail - ENCNTR_PLAN_RELTN
| Child Column in ENCNTR_PLAN_RELTN(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | ENCNTR_ID | ENCOUNTER | ENCNTR_ID |
| HEALTH_PLAN_ID | HEALTH_PLAN | HEALTH_PLAN_ID | |
| COVERAGE_COMMENTS_LONG_TEXT_ID | LONG_TEXT | LONG_TEXT_ID | |
| INS_OFFICE_ORG_ID | ORGANIZATION | ORGANIZATION_ID | |
| ORGANIZATION_ID | ORGANIZATION | ORGANIZATION_ID | |
| PERSON_ID | PERSON | PERSON_ID | |
| PERSON_ORG_RELTN_ID | PERSON_ORG_RELTN | PERSON_ORG_RELTN_ID | |
| SPONSOR_PERSON_ORG_RELTN_ID | PERSON_ORG_RELTN | PERSON_ORG_RELTN_ID | |
| PERSON_PLAN_RELTN_ID | PERSON_PLAN_RELTN | PERSON_PLAN_RELTN_ID | |
| NOTIFY_PRSNL_ID | PRSNL | PERSON_ID |
| Parent Column in ENCNTR_PLAN_RELTN (PK) | Child Table Name | Child Column Name | |
|---|---|---|---|
| Children: | ENCNTR_PLAN_RELTN_ID | ENCNTR_BENEFIT_R | ENCNTR_PLAN_RELTN_ID |
| ENCNTR_PLAN_AUTH_R | ENCNTR_PLAN_RELTN_ID | ||
| ENCNTR_PLAN_AUTH_R_HIST | ENCNTR_PLAN_RELTN_ID | ||
| ENCNTR_PLAN_COB_RELTN | ENCNTR_PLAN_RELTN_ID | ||
| ENCNTR_PLAN_ELIGIBILITY | ENCNTR_PLAN_RELTN_ID | ||
| ENCNTR_PLAN_ELIG_HIST | ENCNTR_PLAN_RELTN_ID | ||
| ENCNTR_PLAN_RELTN_HIST | ENCNTR_PLAN_RELTN_ID | ||
| TRANSACTION_ADMIT_NOTIFY | ENCNTR_PLAN_RELTN_ID | ||
| TRANSACTION_ELIGIBILITY | ENCNTR_PLAN_RELTN_ID |
ENCNTR_PLAN_RELTN_HIST
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Encounter Plan Relation History |
| Definition: | Used for tracking history of certain columns on the encntr_plan_reltn table. |
| Table Type: | ACTIVITY |
Column Detail - ENCNTR_PLAN_RELTN_HIST
| Column Name | Type | Null? | Definition |
|---|---|---|---|
| ACCEPT_ASSIGNMENT_CD | DOUBLE | N | Indicates the provider's acceptance for payment terms. |
| 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. |
| ALT_MEMBER_NBR | VARCHAR(100) | Y | The alternate payer plan member number for the person. |
| ASSIGN_BENEFITS_CD | DOUBLE | N | codified column representing the nature/status of benefit assignment for the use of the health plan on this encounter. |
| AUTH_REQUIRED_CD | DOUBLE | N | Documents whether or not authorization is required for given encounter health plan relation. |
| BALANCE_TYPE_CD | DOUBLE | N | The type of balance |
| 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. |
| BEG_EFFECTIVE_TZ | DOUBLE | Y | The time zone associated with the beg_effective_dt_tm column. |
| BENEFIT_VERIFY_DT_TM | DATETIME | Y | The data and time at which the health plan benefits were last verified. |
| CARD_CATEGORY_CD | DOUBLE | N | A categorization of the coverages and/or benefits available to the recipient. For some insurances this may be clearly identifiable based on characteristics of the beneficiary's coverage card. |
| CARD_ISSUE_NBR | DOUBLE | N | The card issue number is used to track the number of cards dispensed. The original card is typically issue number 00, with subsequent cards incremented. |
| CHANGE_BIT | DOUBLE | N | Identifies which columns have had a change. |
| 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. |
| COORD_BENEFITS_CD | DOUBLE | N | codified value representing the coordination of benefits for this health plan for this encounter. |
| COVERAGE_COMMENTS_LONG_TEXT_ID | DOUBLE | N | An identifier that points to a row in the LONG_TEXT table where comments about the plan coverage are stored. |
| 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. |
| DEDUCT_AMT | DOUBLE | Y | The amount of health plan deductible applied to this encounter. |
| DEDUCT_MET_AMT | DOUBLE | Y | The amount of the deductible that has been met, or payed, by the subscriber. |
| DEDUCT_MET_DT_TM | DATETIME | Y | The date and time that the deductible amount was payed. |
| DENIAL_REASON_CD | DOUBLE | N | The code value for the reason the claim was denied. |
| ENCNTR_ID | DOUBLE | N | this is the value of the unique primary identifier of the encounter table. it is an internal system assigned number. |
| ENCNTR_PLAN_RELTN_HIST_ID | DOUBLE | N | Unique generated number that identifies a single row on the ENCNTR_PLAN_RELTN_HIST table. |
| ENCNTR_PLAN_RELTN_ID | DOUBLE | N | This is the value of the unique primary identifier of the parent table encntr_plan_reltn |
| 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. |
| END_EFFECTIVE_TZ | DOUBLE | Y | The time zone associated with the end_effective_dt_tm column. |
| EXT_PAYER_IDENT | VARCHAR(100) | Y | The primary identifier of the organization (that does not exist in the Millennium build) providing the insurance plan (carrier). |
| EXT_PAYER_NAME | VARCHAR(100) | Y | The name of the organization (that does not exist in the Millennium build) providing the insurance plan (carrier). |
| GENERIC_HEALTH_PLAN_NAME | VARCHAR(100) | Y | The name of the health plan when the health plan category is GENERIC. |
| GROUP_NAME | VARCHAR(200) | Y | The group name of the plan. |
| GROUP_NBR | VARCHAR(100) | Y | The group number of the plan. |
| HEALTH_CARD_EXPIRY_DT_TM | DATETIME | Y | the date and time for which this health card becomes ineffective or expired. |
| HEALTH_CARD_ISSUE_DT_TM | DATETIME | Y | the date and time for which this health card becomes effective or issued. |
| HEALTH_CARD_NBR | CHAR(100) | Y | the number on the subscriber's/patient's health card (generally used in non-us sites). |
| HEALTH_CARD_PROVINCE | CHAR(3) | Y | province where the health card was issued (usually used in non-us sites such as Canada). |
| HEALTH_CARD_TYPE | VARCHAR(32) | Y | type of health card which has a certain category or style. |
| HEALTH_CARD_VER_CODE | CHAR(3) | Y | version code of the health card (usually used in non-u.s. sites such as Canada). |
| 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. |
| INSURED_CARD_NAME | VARCHAR(100) | Y | Person's Name as seen on the insurance card. |
| INSURED_CARD_NAME_FIRST | VARCHAR(100) | Y | Person's first name as seen on the insurance card. |
| INSURED_CARD_NAME_LAST | VARCHAR(100) | Y | Person's last name as seen on the insurance card. |
| INSURED_CARD_NAME_MIDDLE | VARCHAR(100) | Y | Person's middle name as seen on the insurance card. |
| INSURED_CARD_NAME_SUFFIX | VARCHAR(100) | Y | Person's name suffix as seen on the insurance card. |
| INSUR_SOURCE_INFO_CD | DOUBLE | N | codified value representing the source from which the insurance information for this health plan and encounter was obtained. |
| INS_CARD_COPIED_CD | DOUBLE | N | a y/n field indicating whether a copy of the subscriber's insurance card has been obtained. |
| INS_OFFICE_ORG_ID | DOUBLE | N | Identifier from the organization table of the health plan's insurance office. |
| LIFE_RSV_DAILY_DED_AMT | DOUBLE | N | The daily deductible amount that is applicable when reserve days are used for coverage. |
| LIFE_RSV_DAILY_DED_QUAL_CD | DOUBLE | N | The qualifier describing the amount entered in the Lifetime reserve daily deductible. |
| LIFE_RSV_DAYS | DOUBLE | N | The predetermined number of coverage days held ""in reserve"" for use if needed. The reserve days can be used when all the days under a given service have been used, but continued coverage/care is needed. This number is static for the lifetime of the subscriber. |
| LIFE_RSV_REMAIN_DAYS | DOUBLE | N | A static, manual-entry field obtained from taking the Lifetime reserve days and subtracting any days used from that reserve for coverage. |
| MEMBER_NBR | VARCHAR(100) | Y | The plan member number for the person. |
| MEMBER_PERSON_CODE | VARCHAR(100) | Y | An additional attribute that the payer can use to uniquely identify the subscriber and their dependents within the context of a particular policy. The policy number in conjunction with the member person code typically comprise the member number. |
| MILITARY_BASE_LOCATION | VARCHAR(100) | Y | textual location of the military base on which the subscriber/patient resides. |
| MILITARY_RANK_CD | DOUBLE | N | military ranking of the subscriber/patient. |
| MILITARY_SERVICE_CD | DOUBLE | N | The branch of military service through which the health plan coverage is being offered to the subscriber due to their current or past service. Examples may include, Army, Navy, Air Force, etc. |
| MILITARY_STATUS_CD | DOUBLE | N | military status of the subscriber/patient. |
| NOTIFY_DT_TM | DATETIME | Y | Date and time the inpatient 278 Notification took place. |
| NOTIFY_PRSNL_ID | DOUBLE | N | Personnel that ran the inpatient 278 Notification. |
| NOTIFY_SOURCE_CD | DOUBLE | N | Source the inpatient 278 Notification came from. e.g. Phone, Electronic, etc. |
| ON_FILE_ADMIN_SEX_CD | DOUBLE | N | The person's gender code as it appears on file with the carrier. |
| ON_FILE_BIRTH_DT_ISO | VARCHAR(10) | Y | The patient's date of birth as it appears on the file with the carrier. Stored in standard ISO format. |
| ORGANIZATION_ID | DOUBLE | N | The ID of the organization providing the insurance plan. |
| ORIG_PRIORITY_SEQ | DOUBLE | Y | this is a numeric number used to represent the order in which to considered this health plan for reimbursement, if the person is a member of more than one health plan. this is the original number from the person health plan relation table. |
| PERSON_ID | DOUBLE | N | This is the value of the unique primary identifier of the person table. It is an internal system assigned number. |
| PERSON_ORG_RELTN_ID | DOUBLE | N | This is the value of the unique primary identifier of the person organization relationship table. It is an internal system assigned number. |
| PERSON_PLAN_RELTN_ID | DOUBLE | N | This is the value of the unique primary identifier of the parent table Person_plan_reltn |
| PLAN_CLASS_CD | DOUBLE | N | Code value that indicates if the health plan is in the reference list of health plans or not. FREETEXT indicates it is not in the list, HEALTHPLAN indicates it is. |
| PLAN_TYPE_CD | DOUBLE | N | Code value that indicates the type of health plan. Examples are Medicaid, self pay, commercial, etc. |
| PM_HIST_TRACKING_ID | DOUBLE | N | This is the value of the unique primary identifier of the pm_hist_tracking table. It is an internal system assigned number. |
| POLICY_NBR | VARCHAR(100) | Y | The policy number of the subscriber's health plan at the time of the visit. The policy number in conjunction with the member person code typically comprise the member number. Sometimes the individual's member number is referred to as their policy number so care should be taken in order to make sure that the correct field is being used given a particular use case. |
| PRICING_AGENCY_CD | DOUBLE | N | a pricing agency is an entity that applies a discount to a claim based on a contract that the entity has negotiated with both providers and claims payers on behalf of the network. |
| PRIORITY_SEQ | DOUBLE | Y | this is a numeric number used to represent the order in which to consider this health plan for reimbursement, if the person is a member of more than one health plan. this number may change from the original number depending on the encounter. |
| PROGRAM_STATUS_CD | DOUBLE | N | Represents the set of coverages and/or benefits available to the recipient based on the recipient's reason for eligibility. |
| PROP_CASUALTY_CLAIM_NBR_TXT | VARCHAR(100) | Y | this is the claim number the health plan has to the p&c claim. this number is submitted to the health plan along with, or in a place of, the policy number. |
| RESUBMIT_278N_CD | DOUBLE | N | This field stores the responses for resubmitting eligibility. |
| RX_PLAN_COB_SEQ | DOUBLE | N | indicates the order in which a health plan is considered for pharmacy coordination of benefits for a particular encounter. |
| SIGNATURE_DT_TM | DATETIME | Y | patient signature date/time for claim form. |
| SIGNATURE_ON_FILE_CD | DOUBLE | N | indicates whether a patient's signature for insurance has been obtained |
| SIGNATURE_SOURCE_CD | DOUBLE | N | description of what claim form the patient signed. |
| SPONSOR_PERSON_ORG_RELTN_ID | DOUBLE | N | pointer to the relationship between the subscriber and their employer/sponsor organization. |
| SUBSCRIBER_TYPE_CD | DOUBLE | N | value that represents the type of subscriber being used for this health plan. not used at this time. |
| SUBS_INSURED_CARD_FIRST_NAME | VARCHAR(100) | Y | The Subscriber's first name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_LAST_NAME | VARCHAR(100) | Y | The Subscriber's last name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_MIDDLE_NAME | VARCHAR(100) | Y | The Subscriber's middle name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_INSURED_CARD_SUFFIX_NAME | VARCHAR(100) | Y | The Subscriber's suffix name as seen on the insurance card or as it appears on file with the carrier. |
| SUBS_MEMBER_NBR | VARCHAR(100) | Y | the member number of the subscriber to the health plan. |
| SUBS_ON_FILE_ADMIN_SEX_CD | DOUBLE | N | The subscriber's gender code as it appears on file with the carrier. |
| SUBS_ON_FILE_BIRTH_DT_ISO | VARCHAR(10) | Y | The subscriber's date of birth as it appears on file with the carrier. Stored in ISO format. |
| TRACKING_BIT | DOUBLE | N | Identifies which columns are being tracked for history. |
| TRANSACTION_DT_TM | DATETIME | Y | More aptly named activity_dt_tm; holds the current date and time of the system when the row was inserted. This will match the create_dt_tm from the corresponding pm_hist_tracking row. |
| 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. |
| VERIFY_DT_TM | DATETIME | Y | The date and time the verification took place. |
| VERIFY_PRSNL_ID | DOUBLE | N | id of the prsnl who last updated the row. |
| VERIFY_SOURCE_CD | DOUBLE | N | The source by which the row was verified. |
| VERIFY_STATUS_CD | DOUBLE | N | The status of the verification. Examples are Yes and No. |
Relationship Detail - ENCNTR_PLAN_RELTN_HIST
| Child Column in ENCNTR_PLAN_RELTN_HIST(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | ENCNTR_PLAN_RELTN_ID | ENCNTR_PLAN_RELTN | ENCNTR_PLAN_RELTN_ID |
| PM_HIST_TRACKING_ID | PM_HIST_TRACKING | PM_HIST_TRACKING_ID | |
| NOTIFY_PRSNL_ID | PRSNL | PERSON_ID |