Table Detail Report
HP_FINANCIAL
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | To Be Dropped in Rev 7.9 |
| Definition: | Stores financial data for plans, benefits, and procedure benefits for a plan. |
| Table Type: | REFERENCE |
Column Detail - HP_FINANCIAL
| 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. |
| COINSURANCE | DOUBLE | Y | Value of coinsurance amount (percent, i.e. 80 percent) |
| COPAY | DOUBLE | Y | Value of benefits copay amount (in dollars) |
| DEDUCTIBLE | DOUBLE | Y | Value of benefit s deductible (in dollars) |
| END_EFFECTIVE_DT_TM | DATETIME | Y | The date/time after which the row is no longer valid as active current data.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 to which this financial information belongs. |
| HP_FINANCIAL_ID | DOUBLE | N | Unique identifier for this health plan financial record. |
| LIFETIME_MAX_BNFT | DOUBLE | Y | The lifetime maximum benefit (in dollars) for the related benefit or plan. |
| LOCATION_CD | DOUBLE | N | Stores location, if financial info varies according to location where benefit is received. |
| MAX_FAM_OUT_POCKET | DOUBLE | Y | Value, in dollars, representing the max amount that the covered family would be required to pay out of pocket for covered benefits. |
| MAX_OUT_POCKET | DOUBLE | Y | Value, in dollars, representing the max amount that the covered individual would be required to pay out of pocket for covered benefits. |
| PARENT_ENTITY_ID | DOUBLE | N | Foreign key to the parent entity table record to which this financial record is related. |
| PARENT_ENTITY_NAME | VARCHAR(50) | N | Name of the parent entity table, to which this financial record is related. |
| REMARKS | VARCHAR(200) | Y | Remarks |
| SPECIALTY_CD | DOUBLE | N | Used to store the specialty_cd value if this financial record is related to a specialty type benefit. |
| 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 - HP_FINANCIAL
| Child Column in HP_FINANCIAL(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | HEALTH_PLAN_ID | HEALTH_PLAN | HEALTH_PLAN_ID |
| LOCATION_CD | LOCATION | LOCATION_CD |
NETWORK
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Health Plan Provider Network |
| Definition: | Stores data for a health plan's network(s) of providers. This table stores the network's basic information such as name and effective and expiration dates. |
| Table Type: | REFERENCE |
Column Detail - NETWORK
| 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. |
| CARRIER_ID | DOUBLE | N | CARRIER_ID is the foreign key to an ORGANIZATION record that identifies the ORGANIZATION of type 'INSCO' (stored in the org_type_reltn table) that owns/contracts the provider network identified by the record. |
| 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. |
| NETWORK_DESCRIPTION | VARCHAR(200) | Y | Stores a more complete description of the health plan provider network referenced in a record. |
| NETWORK_ID | DOUBLE | N | Network Identifier - this is the unique, Oracle-generated key for the network record. |
| NETWORK_NAME | VARCHAR(100) | N | NETWORK_NAME stores a text string that defines the name of a health plan provider network. The name must be unique. |
| 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 - NETWORK
| Child Column in NETWORK(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | CARRIER_ID | ORGANIZATION | ORGANIZATION_ID |
| Parent Column in NETWORK (PK) | Child Table Name | Child Column Name | |
|---|---|---|---|
| Children: | NETWORK_ID | ORG_NTWK_PRVDR | NETWORK_ID |
NTWK_PRSNL_GROUP_RELTN
| Column Section | Top of Page |
Table-level Detail
| Description: | NTWK PRSNL GROUP RELTN |
| Definition: | stores a relationship between networks and prsnl groups |
| Table Type: | REFERENCE |
Column Detail - NTWK_PRSNL_GROUP_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 | 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. |
| 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 | 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. |
| NETWORK_ID | DOUBLE | N | Unique identifier of the Network table |
| NTWK_PRSNL_GROUP_RELTN_ID | DOUBLE | N | unique identifier for the ntwk_prsnl_group_reltn table |
| NTWK_SPCLTY_RELTN_ID | DOUBLE | N | unique identifier of the ntwk_spclty_reltn table |
| PRSNL_GROUP_ID | DOUBLE | N | unique identifier of the prsnl_group table |
| 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. |
NTWK_SPCLTY_RELTN
| Column Section | Top of Page |
Table-level Detail
| Description: | NTWK SPCLTY RELTN |
| Definition: | Makes one to many relationship between a network and specialties. |
| Table Type: | REFERENCE |
Column Detail - NTWK_SPCLTY_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 | 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. |
| 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 | 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. |
| NETWORK_ID | DOUBLE | N | unique identifier for the network table |
| NTWK_SPCLTY_RELTN_ID | DOUBLE | N | Unique Identifier for the ntwk_spclty_reltn table |
| SPECIALTY_CD | DOUBLE | N | Code value that describes a person_provider's specialty within a specified provider |
| 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_NTWK_PRVDR
| Column Section | Relationship Section | Top of Page |
Table-level Detail
| Description: | Health Plan Network Providers that are of type "Organization" |
| Definition: | This table stores organizations that are health care providers for a given provider network. It stores begin and end effective dates, and specialty codes for the provider as well. |
| Table Type: | ACTIVITY |
Column Detail - ORG_NTWK_PRVDR
| 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 | 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. |
| NETWORK_ID | DOUBLE | Y | Pointer to a record in the NETWORK table for which this org provider applies |
| ORGANIZATION_ID | DOUBLE | N | Stores a pointer to an organization record in the ORGANIZATION table |
| ORG_NTWK_PRVDR_ID | DOUBLE | N | Unique, ORACLE-generated primary key for the record |
| SPECIALTY_CD | DOUBLE | Y | Describes a provider's specialty in the health care process, such as cardiologist, home health, hospital, etc. |
| 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_NTWK_PRVDR
| Child Column in ORG_NTWK_PRVDR(FK) | Parent Table Name | Parent Column Name | |
|---|---|---|---|
| Parents: | NETWORK_ID | NETWORK | NETWORK_ID |
| ORGANIZATION_ID | ORGANIZATION | ORGANIZATION_ID |