Claims

Provisional schema

Reconstructed from application binaries (DataWindow bindings and embedded SQL), not from Oracle DDL. Column types are the application's declared types; constraints, indexes, triggers and exact server types are unknown until an Oracle DDL export is reconciled.

Key relationships (inferred from join usage)

Cardinality is indicative only; verify against DDL.

Tables

accident_claims

Used by modules: claims, clmsproc

Column	Declared type
accident_sys_key	decimal(0), number
claim_id	char(17)
member_sys_key	decimal(0), number

accident_diagnoses

Used by modules: claims, clmsproc

Column	Declared type
accident_sys_key	decimal(0)
diag_cd	char(7)
member_sys_key	decimal(0)

accident_members

Used by modules: claims, clmsproc

Column	Declared type
accident_sys_key	decimal(0)
member_sys_key	decimal(0)
other_policy_addr1	char(40)
other_policy_addr2	char(40)
other_policy_carrier	char(50)
other_policy_city	char(40)
other_policy_phone_no	char(13)
other_policy_policy_no	char(25)
other_policy_state	char(2)
other_policy_type_cd	char(10)
other_policy_zip	char(9)

accident_types

Used by modules: claims, homersys

Column	Declared type
accident_type_cd	char(10)
accident_type_desc	char(60)
create_dt	datetime
create_user_id	char(8)
updt_dt	datetime
updt_user_id	char(8)

accidents

Used by modules: claims, clmsproc

Column	Declared type
accident_dt	datetime
accident_how	char(255)
accident_sys_key	decimal(0), number
accident_type_cd	char(10)
accident_where	char(255)
action_cd	char(10)
attorney_addr1	char(40)
attorney_addr2	char(40)
attorney_city	char(40)
attorney_company_name	char(50)
attorney_f_name	char(25)
attorney_l_name	char(25)
attorney_m_name	char(25)
attorney_phone_no	char(13)
attorney_state	char(2)
attorney_zip	char(9)
cause_addr1	char(40)
cause_addr2	char(40)
cause_city	char(40)
cause_company_name	char(50)
cause_f_name	char(25)
cause_l_name	char(25)
cause_m_name	char(25)
cause_phone_no	char(13)
cause_state	char(2)
cause_zip	char(9)
policy1_addr1	char(40)
policy1_addr2	char(40)
policy1_carrier	char(50)
policy1_city	char(40)
policy1_phone_no	char(13)
policy1_policy_no	char(25)
policy1_state	char(2)
policy1_type_cd	char(10)
policy1_zip	char(9)
policy2_addr1	char(40)
policy2_addr2	char(40)
policy2_carrier	char(50)
policy2_city	char(40)
policy2_phone_no	char(13)
policy2_policy_no	char(25)
policy2_state	char(2)
policy2_type_cd	char(10)
policy2_zip	char(9)
subrogation_ind	char(1)
subrogation_interest_gen_dt	datetime
subrogation_reimb_gen_dt	datetime
subrogation_reimb_resp_recv_dt	datetime

audit_diagnosis_codes

Used by modules: claims

Column	Declared type
diag_cd	char(7)
from_dt	datetime
thru_dt	datetime

audit_examiners

Used by modules: claims

Column	Declared type
audit_pct	decimal(2)
claim_person_key	number
day_assigned	char(10)
dollar_limit	decimal(2)
from_dt	datetime
thru_dt	datetime

audit_groups

Used by modules: claims, funding

Column	Declared type
audit_all_claims_ind	char(1)
dollar_limit	decimal(2)
from_dt	datetime
group_id	char(15)
thru_dt	datetime
type_of_claim	char(10)

audit_members

Used by modules: claims

Column	Declared type
from_dt	datetime
member_sys_key	decimal(0)
thru_dt	datetime

audit_procedure_codes

Used by modules: claims

Column	Declared type
from_dt	datetime
proc_cd	char(13)
proc_cd_type	char(10)
thru_dt	datetime

audit_providers

Used by modules: claims

Column	Declared type
from_dt	datetime
provider_sys_key	decimal(0)
thru_dt	datetime

claim

Used by modules: claims, clmshare, clmsproc, clmutils

(referenced in SQL; no column details captured)

claim_entries

Used by modules: chkrundw, claims, clmentry, clmforms, clmprint, clmrpt, clmshare, clmsproc, clmutils, enrolrpt, funding, moon, reprint, sales, stoploss, um_maint

Column	Declared type
amount_prepaid	decimal(2)
attachment_ind	char(1)
attending_provider_addr1	char(40)
attending_provider_addr2	char(40)
attending_provider_city	char(40)
attending_provider_degree	char(10)
attending_provider_degree_2	char(10)
attending_provider_f_name	char(25)
attending_provider_f_name_2	char(25)
attending_provider_l_name	char(25)
attending_provider_l_name_2	char(25)
attending_provider_m_name	char(25)
attending_provider_m_name_2	char(25)
attending_provider_phone	char(13)
attending_provider_state	char(2)
attending_provider_tin	char(20)
attending_provider_tin_type	char(10)
attending_provider_zip	char(9)
attending_signature_dt	datetime
auto_accident_desc	char(80)
auto_accident_dt	datetime
auto_accident_ind	char(1)
auto_accident_state	char(2)
balance_due	decimal(2)
bill_provider_addr1	char(40)
bill_provider_addr1_2	char(40)
bill_provider_addr2	char(40), char(50)
bill_provider_addr2_2	char(40)
bill_provider_city	char(40)
bill_provider_city_2	char(40)
bill_provider_degree	char(10)
bill_provider_f_name	char(25)
bill_provider_f_name_2	char(25)
bill_provider_facility_name	char(50)
bill_provider_group_no	char(20)
bill_provider_l_name	char(25)
bill_provider_l_name_2	char(25)
bill_provider_m_name	char(25)
bill_provider_m_name_2	char(25)
bill_provider_phone	char(13)
bill_provider_pin	char(20)
bill_provider_state	char(2)
bill_provider_state_2	char(2)
bill_provider_tax_id	char(9)
bill_provider_tin	char(9)
bill_provider_tin_type	char(10)
bill_provider_zip	char(9)
bill_provider_zip_2	char(9)
claim_id	char(17)
claim_type	char(10)
cob_ind	char(1)
cob_ind_2	char(1)
comments	char(400)
create_dt	datetime
create_user_id	char(8)
curr_cond_start_dt	datetime
discount_pct	decimal(2)
employer_name	char(50)
employment_accident_desc	char(80)
employment_accident_dt	datetime
employment_accident_ind	char(1)
employment_accident_ind_2	char(1)
facility_addr1	char(40)
facility_addr2	char(40)
facility_city	char(40)
facility_dt	datetime
facility_name	char(50)
facility_state	char(2)
facility_zip	char(9)
first_consult_dt	datetime
hcn_sys_key	decimal(0), number
inpat_end_dt	datetime
inpat_start_dt	datetime
member_not_on_file_ind	char(1)
operative_notes_ind	char(1)
originator_id	char(20)
other_accident_date	datetime
other_accident_desc	char(80)
other_accident_ind	char(1)
other_accident_ind_2	char(1)
partially_disabled_from_dt	datetime
partially_disabled_thru_dt	datetime
patient_acct	char(20)
patient_acct_no	char(20)
patient_addr1	char(40)
patient_addr2	char(40)
patient_age	decimal(0), number
patient_city	char(40)
patient_dob	datetime
patient_employment_status	char(10)
patient_f_name	char(25)
patient_f_name_2	char(25)
patient_f_name_3	char(25)
patient_gender	char(1)
patient_l_name	char(25)
patient_l_name_2	char(25)
patient_l_name_3	char(25)
patient_m_name	char(25)
patient_m_name_2	char(25)
patient_m_name_3	char(25)
patient_marital_status	char(10)
patient_phone	char(13)
patient_relationship	char(10)
patient_relationship_other	char(10)
patient_school_addr1	char(40)
patient_school_addr2	char(40)
patient_school_city	char(40)
patient_school_name	char(50)
patient_school_state	char(2)
patient_school_zip	char(9)
patient_signature	char(1)
patient_signature_2	char(1)
patient_signature_dt	datetime
patient_state	char(2)
patient_student_status	char(10)
patient_under_care_ind	char(1)
patient_zip	char(9)
perf_provider_f_name	char(25)
perf_provider_f_signature	char(25)
perf_provider_l_name	char(25)
perf_provider_l_signature	char(25)
perf_provider_license	char(20)
perf_provider_license_2	char(20)
perf_provider_m_name	char(25)
perf_provider_m_signature	char(25)
perf_provider_name_degree	char(10)
perf_provider_signature_degree	char(10)
perf_provider_signature_dt	datetime
pregnancy_dt	datetime
pregnancy_ind	char(1)
prior_athorization_no	char(20)
provider_out_of_network_ind	char(1)
qmcso_flg	char(1)
received_dt	datetime
received_from	char(10)
received_method	char(10)
ref_provider_addr1	char(40)
ref_provider_addr2	char(40)
ref_provider_city	char(40)
ref_provider_degree	char(10)
ref_provider_f_name	char(25)
ref_provider_l_name	char(25)
ref_provider_m_name	char(25)
ref_provider_state	char(2)
ref_provider_tin	char(20)
ref_provider_tin_type	char(10)
ref_provider_zip	char(9)
repriced_amt	decimal(2)
repricing_method	char(10)
return_to_work_dt	datetime
return_to_work_dt_2	datetime
returned_to_work_dt	datetime
returned_to_work_ind	char(1)
seq_no_1	number
seq_no_2	number
seq_no_3	number
seq_no_4	number
similar_cond_ind	char(1)
similar_cond_start_desc	char(80)
similar_cond_start_dt	datetime
spouse_employed_ind	char(1)
spouse_employer_addr1	char(40)
spouse_employer_addr2	char(40)
spouse_employer_city	char(40)
spouse_employer_name	char(50)
spouse_employer_state	char(2)
spouse_employer_zip	char(9)
spouse_last_employed_dt	datetime
spouse_work_phone	char(13)
sub_addr1	char(40)
sub_addr1_2	char(40)
sub_addr2	char(40)
sub_addr2_2	char(40)
sub_city	char(40)
sub_city_2	char(40)
sub_dob	datetime
sub_employer_addr1	char(40)
sub_employer_addr2	char(40)
sub_employer_city	char(40)
sub_employer_name	char(50)
sub_employer_state	char(2)
sub_employer_zip	char(9)
sub_f_name	char(25)
sub_f_name_2	char(25)
sub_f_name_3	char(25)
sub_gender	char(1)
sub_id	char(20)
sub_l_name	char(25)
sub_l_name_2	char(25)
sub_l_name_3	char(25)
sub_m_name	char(25)
sub_m_name_2	char(25)
sub_m_name_3	char(25)
sub_phone	char(13)
sub_policy_group	char(20)
sub_policy_plan	char(50)
sub_signature	char(1)
sub_signature_dt	datetime
sub_state	char(2)
sub_state_2	char(2)
sub_zip	char(9)
sub_zip_2	char(9)
tax_id	char(9)
total_charges	decimal(2)
unavailable_to_work_from_dt	datetime
unavailable_to_work_thru_dt	datetime
updt_dt	datetime
updt_user_id	char(8)
value_amt_1	number
value_amt_10	number
value_amt_11	number
value_amt_12	number
value_amt_2	number
value_amt_3	number
value_amt_4	number
value_amt_5	number
value_amt_6	number
value_amt_7	number
value_amt_8	number
value_amt_9	number
wdi_ind	char(1)
workers_comp_ind	char(1)

claim_entry_diag_codes

Used by modules: claims, clmentry, clmprint, clmrpt, clmsproc, funding, sales, stoploss, um_cm, um_maint

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
description	char(50)
diag_cd	char(7)
diag_cd_type	char(10)
diagnosis	char(7)
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)

claim_eob_info_details

Used by modules: claims, clmentry, clmprint, clmshare, clmsproc

Column	Declared type
allowed_amt	decimal(2)
claim_id	char(17)
claim_seq	decimal(0), number
create_dt	datetime
create_user_id	char(8)
eob_sys_key	decimal(0), number
from_dt	datetime
payable_amt	decimal(2)
proc_cd	char(13)
seq_no	decimal(0), number
submitted_amt	decimal(2)
thru_dt	datetime
updt_dt	datetime
updt_user_id	char(8)
write_off_amt	decimal(2)

claim_eob_infos

Used by modules: claims

Column	Declared type
create_dt	datetime
create_user_id	char(8)
eob_sys_key	decimal(0), number
patient_f_name	char(25)
patient_l_name	char(25)
patient_m_name	char(25)
patient_sys_key	decimal(0), number
provider_company_name	char(50)
provider_f_name	char(25)
provider_l_name	char(25)
provider_m_name	char(25)
seq_no	number
updt_dt	datetime
updt_user_id	char(8)

claim_file

Used by modules: clmsproc

Column	Declared type
h_amount_added_to_bank	decimal(2)
h_amount_added_to_bank_sign	char(1)
h_claim_ssnumber	decimal(0)
h_claim_worksheet_no	decimal(0)
h_clm_amount_paid	decimal(2)
h_clm_amount_prepaid	decimal(2)
h_clm_amount_rejected1	decimal(2)
h_clm_amount_rejected2	decimal(2)
h_clm_amount_rejected3	decimal(2)
h_clm_basic_benefit	decimal(2)
h_clm_cob_savings	decimal(2)
h_clm_cob_savings_sign	char(1)
h_clm_coins_eligible	decimal(2)
h_clm_coins_withheld	decimal(2)
h_clm_dedut_withheld	decimal(2)
h_clm_hcn_syskey	decimal(0)
h_clm_majmed_eligible	decimal(2)
h_clm_payee	char(1)
h_clm_ppo_code	char(4)
h_clm_ppo_discount	decimal(2)
h_clm_prepayment_code	decimal(0)
h_clm_reject_code1	char(2)
h_clm_reject_code2	char(2)
h_clm_reject_code3	char(2)
h_clm_ucr_used	decimal(2)
h_med_line_prefix	char(1)
h_med_line_suffix	char(1)

claim_id

Used by modules: clmutils, provider

(referenced in SQL; no column details captured)

claim_letters_data

Used by modules: claims, reprint, system

(referenced in SQL; no column details captured)

claim_letters_hist

Used by modules: claims, reprint, system

Column	Declared type
archive_flg	—
claim_id	char(17)
claim_ltr_desc	char(200), char(240)
claim_ltr_sys_key	decimal(0), number
create_dt	datetime
create_user_id	char(8)
dist_group_id	—
dw_object	char(50)
format_type	char(240)
group_id	char(15)
last_request_dt	datetime
last_user_request_id	char(8)
orig_run_dt	datetime
print_group_id	—
prt_flg	char(1)
reissue_days	decimal(0)
report_cd	char(10)

claim_letters_hist_claims

Used by modules: claims, reprint, system

Column	Declared type
claim_id	char(17)
claim_ltr_sys_key	decimal(0)
closed_ind	char(1)
create_dt	datetime
create_user_id	char(8)
updt_dt	datetime
updt_user_id	char(8)

claim_line_accums

Used by modules: claims, clmrpt, clmsproc, clmutils, homersys

Column	Declared type
carryover_ind	char(1)
claim_line_accum_sys_key	number
claim_line_rule_sys_key	number
consider_amt	decimal(2)
member_accum_sys_key	number
qty	decimal(0)
retain_amt	decimal(2)
retain_qty	decimal(2)

claim_line_diag_codes

Used by modules: claims, clmforms, clmsproc, clmutils, sales, um_main

Column	Declared type
claim_id	char(17)
claim_seq	—
diag_cd	char(7)
diag_cd_type	char(10)

claim_line_payments

Used by modules: clmsproc

Column	Declared type
claim_id	char(17)
claim_line_payment_sys_key	number
claim_seq	number
payable_amt	decimal(2)
payee_sys_key	number
payment_cd	char(10)
payment_type_cd	char(10)

claim_line_pricing_rules

Used by modules: chkrundw, claims, clmshare, funding, sales, um_maint

Column	Declared type
claim_id	char(17)
claim_line_pricing_sys_key	decimal(0)
claim_seq	decimal(0)
create_dt	datetime
create_user_id	char(8)
pricing_rule_sys_key	decimal(0)
pricing_savings_type_cd	char(10)
reason_sys_key	decimal(0)
savings_amt	decimal(2)
updt_dt	datetime
updt_user_id	char(8)

claim_line_rules

Used by modules: chkrundw, claims, clmentry, clmprint, clmrpt, clmshare, clmsproc, provider, sales, stoploss

Column	Declared type
benefit_rule_sys_key	number
claim_id	char(17)
claim_line_rule_sys_key	number
claim_seq	number
exclude_ind	char(1)
reason_sys_key	number
retain_amt	decimal(2), number
retain_qty	decimal(2)

claim_line_um_rules

Used by modules: clmsproc

Column	Declared type
claim_id	char(17)
claim_line_um_rule_sys_key	decimal(0)
claim_seq	number
um_category_cd	char(10)
um_rule_sys_key	number

claim_lines

Used by modules: base, chkrundw, claims, clmentry, clmprint, clmrpt, clmshare, clmsproc, clmutils, enrollutils, enrolrpt, funding, sales, stoploss, um_cm, um_main, um_maint

Column	Declared type
allowed	decimal(2)
allowed_after_coi_amt	decimal(2)
allowed_after_copay_amt	decimal(2)
allowed_after_ded_amt	decimal(2)
allowed_amt	decimal(2), number
benefit_amt	decimal(2)
benefit_def_sys_key	number
benefit_definition	char(15)
case_sys_key	char(16)
charge	decimal(2)
claim_id	char(17)
claim_line_status_cd	char(10)
claim_seq	number
claim_type	char(10)
claimant_age	number
claimant_f_name	char(25)
claimant_l_name	char(25)
claimant_m_name	char(25)
claimed_amt	decimal(2), number
claimlinenbr	number
cob_ind	char(1)
cobra_ind	—
code_review_ind	char(1)
considered_amt	decimal(2)
convert_to_claim_ind	char(1)
cpt	char(13)
create_dt	datetime
create_user_id	char(8)
days_supply	number
dea_number	char(15)
diagnosis_ref	char(20)
directions	char(50)
dosage	char(10)
duplicate_claim_line_ind	char(1)
emerg_room_treatment	char(10)
eob_found	char(1)
epsdt_plan	char(5)
facility_plan_pkg_sys_key	number
form	char(10)
from_dt	datetime
inpatient_ind	char(1)
medicare_prov_id	char(20)
mfg_name	char(50)
nbrservices	decimal(2)
non_cov_chg	decimal(2)
paid	decimal(2)
paid_by_other_sources_amt	decimal(2), number
payable_amt	decimal(2), number
place_of_service_cd	char(2)
plan_pkg_sys_key	number
previously_satisfied	number
proc_cd	char(13)
proc_cd_type	char(10)
proc_desc	char(60)
proc_modifier1	char(2)
proc_modifier2	char(2)
provider	char(40)
provider_tin	char(9)
rate_charged_amt	decimal(2), number
reason_sys_key	number
refill_ind	char(1)
reprice_allow_extended	decimal(2)
reprice_allow_per_unit	decimal(2)
reprice_discount_amt	decimal(2)
reprice_fee_sched	char(10)
revenue_cd	char(6)
rx_number	char(20)
strength	char(10)
surface	char(5)
thru_dt	datetime
tooth_from	char(2)
tooth_thru	char(2)
type_of_service_cd	char(1)
uc_100pct_consider_amt	number
uc_100pct_consider_qty	number
uc_writeoff_amt	number
units	decimal(2), number
unlabeled_49	char(20)
updt_dt	datetime
updt_user_id	char(8)

claim_lines_before

Used by modules: claims

Column	Declared type
claim_id	char(17)
code_review_status	char(35)
create_dt	datetime
create_user_id	char(8)
modifier1	char(2)
modifier2	char(2)
proc_cd	char(13)
run_date	datetime
seq	decimal(0)
updt_dt	datetime
updt_user_id	char(8)

claim_messages

Used by modules: chkrundw, claims, clmrpt, clmshare, clmsproc, clmutils, enrolrpt, funding, provider, sales, system, um_main

Column	Declared type
claim_id	char(17)
claim_id_clm_msg	char(17)
clm_msg_seq_no	decimal(0), number
close_dt	datetime
closed_by_id	char(8)
create_dt	datetime
create_user_id	char(8)
expected	number
field_name	char(50)
message_comment	char(255)
message_seq_no	decimal(0), number
message_seq_no_clm_msg	decimal(0), number
open_dt	datetime
open_msg_ind	—
system_comment	char(2000)
updt_dt	datetime
updt_user_id	char(8)

claim_missing_teeth

Used by modules: clmshare

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
tooth	char(2)
updt_dt	datetime
updt_user_id	char(8)

claim_other_ins_infos

Used by modules: clmentry, clmprint, clmshare

Column	Declared type
authorization_code	char(25)
balance_due	decimal(2)
carrier_addr1	char(40)
carrier_addr2	char(40)
carrier_city	char(40)
carrier_state	char(2)
carrier_zip	char(9)
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
employer_addr1	char(40)
employer_addr2	char(40)
employer_city	char(40)
employer_name	char(50)
employer_phone	char(13)
employer_state	char(2)
employer_zip	char(9)
patient_relationship	char(10)
patient_signature_ind	char(1)
payer	char(10), char(30)
prepaid_amt	decimal(2)
provider_no	char(20)
seqno	decimal(0), number
sub_dob	datetime
sub_employment_status	char(10)
sub_f_name	char(25)
sub_gender	char(10)
sub_id	char(20)
sub_l_name	char(25)
sub_m_name	char(25)
sub_policy_group_name	char(50)
sub_policy_group_no	char(20)
sub_signature_ind	char(1)
updt_dt	datetime
updt_user_id	char(8)

claim_persons

Used by modules: claims

Column	Declared type
claim_person_key	—
claim_person_user_id	—
name	char(8)

claim_precert_stub

Used by modules: clmsproc

Column	Declared type
claim_id	char(17)

claim_referral_stub

Used by modules: clmsproc

Column	Declared type
claim_id	char(17)

claim_status_order

Used by modules: claims, clmforms, clmrpt, clmshare, clmsproc, clmutils, enrollutils, funding, provider, stoploss

Column	Declared type
claim_status_cd	char(10)
display_status	char(25)
screen_status_cd	char(15)
seq_no	decimal(0), number

claim_statuses

Used by modules: claims, clmrpt, clmsproc, clmutils, funding, provider, stoploss, system

Column	Declared type
claim_id	char(17)
claim_status_cd	char(10)
create_dt	datetime
group_id	char(15)
l_name_init	—
open_msg_ind	char(1)
status	char(10)
sub_member_sys_key	—
type_of_claim	char(10)

claim_statuses_history

Used by modules: claims, clmrpt, clmsproc, clmutils, funding

Column	Declared type
claim_id	—
claim_status_cd	char(10)
create_dt	datetime
create_user_id	char(8)

claim_ub92_conditions

Used by modules: clmentry, clmprint, clmshare, clmutils

Column	Declared type
claim_id	char(17)
condition_cd	char(6)
create_dt	datetime
create_user_id	char(8)
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)

claim_ub92_occurrences

Used by modules: clmprint, clmshare, clmsproc, clmutils

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
document_control_no_1	number
document_control_no_2	number
document_control_no_3	number
occurrence_cd_1	char(6)
occurrence_cd_2	char(6)
occurrence_cd_3	char(6)
occurrence_cd_4	char(6)
occurrence_cd_dt_1	datetime
occurrence_cd_dt_2	datetime
occurrence_cd_dt_3	datetime
occurrence_cd_dt_4	datetime
occurrence_span_cd	char(6)
occurrence_span_from_dt	datetime
occurrence_span_to_dt	datetime
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)

claim_ub92_procedures

Used by modules: clmentry, clmprint, clmshare, clmutils

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
proc_cd	char(6)
proc_cd_dt	datetime
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)

claim_ub92_values

Used by modules: clmentry, clmprint, clmshare, clmutils

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)
value_amt	number
value_cd	char(3)

claim_wdi_lines

Used by modules: clmentry, clmprint

Column	Declared type
claim_id	char(17)
claim_seq	number
create_dt	datetime
create_user_id	char(8)
from_dt	datetime
place_of_service_cd	char(2)
proc_cd	char(13)
proc_cd_desc	char(60)

claims

Used by modules: base, chkrundw, claims, clmentry, clmforms, clmprint, clmrpt, clmshare, clmsproc, clmutils, enrollutils, enrolrpt, funding, homersys, moon, provider, reprint, sales, stoploss, system, um_cm, um_main, um_maint

Column	Declared type
claim	char(17)
claim_examiner_sys_key	decimal(0)
claim_examiner_userid	char(16)
claim_form_type	char(20)
claim_id	char(17)
claim_status_cd	char(10)
claim_total_charges	decimal(2)
claim_type	char(10)
claimed	decimal(2)
claimed_amt	decimal(2)
claimnbr	char(17)
client_claim_number	char(17)
code_review_changed_ind	char(1)
code_review_done_ind	char(1)
code_review_ind	char(1)
coverage	char(10)
create_dt	datetime
create_user_id	char(8)
dos	datetime
drg	char(3)
drg_code	char(3)
drg_number	char(3)
earliest_from_dt	datetime
electronically_paid	—
entered	datetime
examiner	char(16)
ext_claim_id	char(20)
facility_provider_addr_no	decimal(0)
facility_provider_sys_key	decimal(0), number
foreign_claim_ind	char(1)
form	char(20)
from_date	datetime
fund_page_sys_key	decimal(0)
group	char(15)
group_id	char(15)
incurred_dt	datetime
initial_payee	char(10)
latest_thru_dt	datetime
lock_dt	datetime
lock_seq_no	decimal(0), number
lock_user_id	char(8)
paid_amount	decimal(2)
patient_group_id	char(15)
patient_sys_key	decimal(0), number
patientid	number
payable	decimal(2)
pcs_fund_page_sys_key	decimal(0)
related_claim_id	char(17)
repriced_ind	char(1)
service_provider_addr_no	decimal(0), number
service_provider_sys_key	decimal(0), number
status	char(10)
sub_member_sys_key	decimal(0), number
through_date	datetime
total_claimed_amt	decimal(2)
total_payable_amt	decimal(2)
type_of_claim	char(10)
updt_dt	datetime
updt_user_id	char(8)
wdi_tax_fund_page_sys_key	decimal(0)

claims_anesthesia

Used by modules: claims, clmentry, clmprint, clmshare

Column	Declared type
anesthesia_indicator	char(17)
base_units	decimal(0)
claim_id	char(17)
claim_seq	decimal(0)
elapsed_time	decimal(0)
end_time_dt	datetime
modifier_units	decimal(0)
start_time_dt	datetime
time_units	decimal(0)
total_time	decimal(0), number
total_units	decimal(0)
unit_conversion	decimal(0)

claims_dental_info

Used by modules: clmentry, clmprint, clmshare, clmutils

Column	Declared type
carrier_addr1	char(40)
carrier_addr2	char(40)
carrier_city	char(40)
carrier_name	char(50)
carrier_state	char(2)
carrier_zip	char(9)
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
employee_signature	char(1)
first_appliance_dt	datetime
initial_placement_ind	char(1)
number_of_xrays	decimal(0), number
orthodontic_purposes_ind	char(1)
replacement_proc_cd	char(13)
replacement_proc_cd_dt	datetime
replacement_reason	char(80)
submission_reason	char(10)
total_fees	decimal(2)
treatment_from_dt	datetime
treatment_remaining_months	decimal(0), number
treatment_thru_dt	datetime
updt_dt	datetime
updt_user_id	char(8)
xray_included_ind	char(1)

claims_hcfa_info

Used by modules: clmentry, clmprint, clmshare, clmutils

Column	Declared type
accept_assignment_ind	char(1)
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
facility_dt	datetime
mcaid_resub_code	char(20)
mcaid_resub_ref	char(20)
other_insurance_by_cat	char(25)
outside_lab_chgs	decimal(2)
outside_lab_chgs_2	decimal(2)
outside_lab_ind	char(1)
updt_dt	datetime
updt_user_id	char(8)

claims_reimb_info

Used by modules: clmentry, clmprint, clmshare

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
dental_ind	char(1)
hearing_ind	char(1)
medical_ind	char(1)
receipt_attached_ind	char(1)
total_requested	decimal(2)
updt_dt	datetime
updt_user_id	char(8)
vision_ind	char(1)

claims_reprice_detail

Used by modules: clmentry, clmprint, clmshare, clmsproc

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
from_dt	datetime
hcn_provider_status_cd	char(10)
non_cert	decimal(2)
payment_explanation	char(80)
per_diem_amt	decimal(2)
responsible_for_payment	char(40)
seq	decimal(0), number
thru_dt	datetime
total_cert	decimal(2)
updt_dt	datetime
updt_user_id	char(8)

claims_reprice_info

Used by modules: claims, clmentry, clmprint, clmshare, clmutils

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
days_allowed	decimal(0), number
discount_pct	decimal(2)
discount_pct_2	decimal(2)
drg_code	char(3)
from_dt	datetime
grand_total_allow_amt	decimal(2)
grand_total_disc_amt	decimal(2)
hcn_enter_dt	datetime
hcn_print_dt	datetime
hcn_recv_dt	datetime
hcn_sys_key	decimal(0), number
increase_over_perdiem	decimal(2)
max_discount_pct	decimal(2)
member_not_on_file_ind	char(1)
member_not_on_file_ind_2	char(1)
patient_owes_amt	decimal(2)
payer_owes_amt	decimal(2)
perdiem_allowed_other	decimal(2)
perdiem_allowed_room	decimal(2)
perdiem_due_from_payer	decimal(2)
perdiem_not_allowed	decimal(2)
perdiem_per_day	decimal(2)
perdiem_total	decimal(2)
provider_out_of_network_ind	char(1)
provider_out_of_network_ind_2	char(1)
resp_pay	char(240)
thru_dt	datetime
total_allow_amt	decimal(2)
total_chg_not_covered	decimal(2)
total_disc_amt	decimal(2)
total_hosp	decimal(2)
updt_dt	datetime
updt_user_id	char(8)

claims_sso_diagnosis

Used by modules: clmentry, clmprint, clmshare

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
description	char(80)
diag_cd	char(7)
seq_no	decimal(0), number
updt_dt	datetime
updt_user_id	char(8)

claims_sso_info

Used by modules: clmentry, clmprint, clmshare

Column	Declared type
affiliated_ind	char(1)
board_certified_ind	char(1)
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
opinion_level	decimal(0), number
seq_no_1	number
seq_no_2	number
seq_no_3	number
seq_no_4	number
specialty	char(10)
surgeon_addr1	char(40)
surgeon_addr2	char(40)
surgeon_city	char(40)
surgeon_degree	char(10)
surgeon_dt_signed	datetime
surgeon_f_name	char(25)
surgeon_l_name	char(25)
surgeon_m_name	char(25)
surgeon_phone	char(13)
surgeon_state	char(2)
surgeon_tin	char(9)
surgeon_tin_type	char(10)
surgeon_zip	char(9)
surgery_description	char(255)
surgery_recommended_ind	char(1)
updt_dt	datetime
updt_user_id	char(8)

claims_sso_procedure

Used by modules: clmprint, clmshare

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
description	char(80)
part	decimal(0)
proc_cd	char(13)
seq_no	decimal(0)
updt_dt	datetime
updt_user_id	char(8)

claims_ub92_info

Used by modules: clmentry, clmprint, clmrpt, clmshare, clmsproc, clmutils, funding, sales, um_maint

Column	Declared type
admit_diag_code	char(7)
admit_hr	decimal(0), number
admit_src	char(1)
admit_type	char(1)
bill_type	decimal(0), number
claim_end_dt	datetime
claim_id	char(17)
claim_start_dt	datetime
coins_days	decimal(0), number
cov_days	decimal(0), number
create_dt	datetime
create_user_id	char(8)
date_send	datetime
diag_e_code	char(7)
disch_hr	decimal(0), number
disch_status	char(10)
document_control_no	decimal(0), number
lifersrv_days	decimal(0), number
medical_record_number	char(17)
non_cov_days	decimal(0), number
other_phys_f_name_1	char(25)
other_phys_f_name_2	char(25)
other_phys_id_1	char(20)
other_phys_id_2	char(20)
other_phys_l_name_1	char(25)
other_phys_l_name_2	char(25)
other_phys_m_name_1	char(25)
other_phys_m_name_2	char(25)
proc_code_type	char(10)
prov_rep	char(30)
remarks	char(192)
ubbilltype	number
unlabeled_11	char(20)
unlabeled_2	char(20)
unlabeled_31	char(20)
unlabeled_56	char(20)
unlabeled_57	char(20)
unlabeled_78	char(20)
updt_dt	datetime
updt_user_id	char(8)

claims_ub92_itemized

Used by modules: clmentry, clmshare

Column	Declared type
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
description	char(50)
extended_price	decimal(2)
proc_cd	char(13)
quantity	decimal(0)
revenue_cd	char(13)
seq	decimal(0)
service_dt	datetime
updt_dt	datetime
updt_user_id	char(8)

claims_vision_info

Used by modules: clmentry, clmprint, clmshare

Column	Declared type
auto_ins_coverage_ind	char(1)
bifocal_lens_ind	char(1)
claim_id	char(17)
comments	char(200)
contact_lens_ind	char(1)
conventional_lens_ind	char(1)
coverage_addr1	char(40)
coverage_addr2	char(40)
coverage_city	char(40)
coverage_name	char(50)
coverage_state	char(2)
coverage_zip	char(9)
create_dt	datetime
create_user_id	char(8)
dispenser_addr1	char(40)
dispenser_addr2	char(40)
dispenser_city	char(40)
dispenser_name	char(50)
dispenser_phone	char(13)
dispenser_signature	char(25)
dispenser_signature_date	datetime
dispenser_state	char(2)
dispenser_tin	char(9)
dispenser_type	char(10)
dispenser_zip	char(9)
examination_dt	datetime
frame_manufacturer	char(50)
frame_name	char(50)
glass_lens_ind	char(1)
gradient_amt	decimal(2)
gradient_ind	char(1)
half_pair_lens_ind	char(1)
keratometric_ind	char(1)
lens_amt	decimal(2)
lens_manufacturer	char(50)
lens_style	char(25)
lens_trade_name	char(50)
lenticular_lens_ind	char(1)
nature_of_disorder	char(50)
od_add	char(10)
od_axis	char(10)
od_cylinder	char(10)
od_prism	char(10)
od_sphere	char(10)
ophthamologist_ind	char(1)
os_add	char(10)
os_axis	char(10)
os_cylinder	char(10)
os_prism	char(10)
os_sphere	char(10)
other_additive	char(40)
other_additive_amt	decimal(2)
other_additive_ind	char(1)
other_coverage_ind	char(1)
other_group_ind	char(1)
other_plan_ind	char(1)
oversized_amt	decimal(2)
oversized_ind	char(1)
parts	char(10)
photochromic_amt	decimal(2)
photochromic_ind	char(1)
plastic_lens_ind	char(1)
prescription_reason	char(10)
service_dt	datetime
single_vision_ind	char(1)
tax	decimal(2)
tint_amt	decimal(2)
tint_ind	char(1)
tint_number	decimal(2)
total_frame_charge	decimal(2)
total_lens_charge	decimal(2)
trifocal_lens_ind	char(1)
updt_dt	datetime
updt_user_id	char(8)

claims_wdi_info

Used by modules: chkrundw, clmentry, clmprint, clmshare

Column	Declared type
benefit_amt	decimal(2)
claim_id	char(17)
create_dt	datetime
create_user_id	char(8)
effective_dt	datetime
employee_occupation	char(25)
employee_occupation2	char(25)
employer_signature_dt	datetime
employer_signature_f_name	char(25)
employer_signature_l_name	char(25)
employer_signature_m_name	char(25)
employer_signature_title	char(25)
exemption_amt	decimal(0)
exemption_type_cd	char(1)
fica_tax_pct	decimal(5)
fica_tax_withheld	decimal(2)
first_treatment_dt	datetime
fit_tax_pct	decimal(5)
fit_tax_withheld	decimal(2)
hire_dt	datetime
hours_worked	decimal(2)
last_worked_dt	datetime
local_tax_pct	decimal(5)
local_tax_withhled	decimal(2)
misc_amt_cd	char(10)
misc_amt_withheld	decimal(2)
override_waiting_days	decimal(0)
state_tax_pct	decimal(5)
state_tax_withheld	decimal(2)
termination_dt	datetime
unemployment_tax_pct	decimal(5)
unemployment_tax_withheld	decimal(2)
updt_dt	datetime
updt_user_id	char(8)
weekly_salary	decimal(2)

claims_xref

Used by modules: clmsproc

Column	Declared type
claim_id	—
claim_seq	—
clm_detail_seq	decimal(0)
clm_revenue_seq	decimal(0)
clm_ssnumber	—
clm_worksheet	—

coord_of_bens

Used by modules: clmsproc, cob, enrolaud, enroll, enrolrpt, homersys, mailobj, um_cm

Column	Declared type
audit_eff_dt	datetime
benefit_coverage_type_cd	char(10)
carrier	char(50)
create_dt	datetime
create_user_id	—
dep_member_sys_key	decimal(0), number
edit_mode	number
eff_dt	datetime
employer_addr_no	number
employer_name	char(50)
employer_phone	char(13)
exp_dt	datetime
min_audit_dt	datetime
other_sub_addr_no	number
other_sub_f_name	char(25)
other_sub_l_name	char(25)
other_sub_m_name	char(25)
other_sub_phone	char(13)
plan_addr_no	number
plan_phone	char(13)
plan_type	char(10)
policy_no	char(40)
rownum	number
status	char(10)
status_reason	char(10)
sub_member_sys_key	decimal(0), number

diagnosis_code_groups

Used by modules: bensupport, clmsproc

Column	Declared type
diag_cd	char(7)
diag_group_sys_key	decimal(0)

diagnosis_codes

Used by modules: benplans, bensupport, claims, clmentry, clmforms, clmprint, clmutils, preex, pricing, sales, stoploss, um_cm, um_main, um_maint, um_ur

Column	Declared type
approved_units	number
diag_cd	char(10), char(7)
diag_cd_desc	char(150), char(80)
diag_cd_los_group	char(5)
diag_cd_mdc	char(2)
diag_cd_short_desc	char(25), char(80)
diag_cd_type	char(10)
gender_cd	char(10)
member_id	char(17)
other_coverage	number
patient_sys_key	decimal(0)
report_from_dt	datetime
report_thru_dt	datetime
service_sys_key	char(40)
union_divider	number

diagnosis_groups

Used by modules: benplans, bensupport, clmsproc, pricing, um_main, um_ur

Column	Declared type
create_dt	datetime
create_user_id	char(8)
diag_group_cd	char(10)
diag_group_desc	char(80)
diag_group_sys_key	decimal(0), number
esrd_ind	char(1)
pre_existing_ind	char(1)
updt_dt	datetime
updt_user_id	char(8)

hcn_contacts

Used by modules: provider

Column	Declared type
contact_no	number
hcn_sys_key	number
rownum	number

hcn_pricing

Used by modules: provider

Column	Declared type
eff_dt	datetime
exp_dt	datetime
hcn_sys_key	number
pricing_plan_sys_key	number

hcn_withholds

Used by modules: provider

Column	Declared type
eff_dt	datetime
exp_dt	datetime
exp_reason	char(10)
hcn_sys_key	number
vendor_sys_key	number
withhold_flg	char(1)
withhold_pct	decimal(3)
withhold_type	char(10)

pre_existing_conditions

Used by modules: preex

Column	Declared type
create_dt	datetime
create_user_id	char(8)
dep_member_sys_key	number
diag_cd	char(3)
eff_dt	datetime
end_dt	datetime
pre_ex_ind	char(1)
sub_member_sys_key	number

reason_codes

Used by modules: base, benplans, bensupport, chkrundw, claims, client, clmentry, clmprint, clmrpt, clmshare, clmsproc, clmutils, pricing, provider, reprint, sales, stoploss

Column	Declared type
accum	char(10)
accumulator	char(10)
cas_cd	char(5)
description	char(200), char(40)
legend_cd	char(4), char(5)
narrative	char(400)
reason	char(10)
reason_cd	char(10)
reason_sys_key	decimal(0), number
reason_type_cd	char(10)