Domain Glossary

Terms as used inside HOMER's data model and screens.

Term	Meaning in HOMER
Group	An employer client whose self-funded benefit plan the TPA administers (groups, keyed by group_id; groups can roll up to a master_group_id).
Member	Any covered person — subscriber (employee) or dependent (members, keyed by member_sys_key; member_id is the external identifier).
Subscriber	The employee who holds the coverage (sub_member_sys_key columns).
Dependent	Spouse/child covered under a subscriber (dep_member_sys_key).
Eligibility	A member's date-bounded right to coverage under a group (member_eligibilities).
Election	A member's chosen enrollment in a plan option for a period (elections, election_coverages).
Claim	A request for payment for services (claims header, claim_lines service lines, claim_entries entry/adjudication records; claims carry a 17-char claim_id).
Adjudication	Applying benefit rules (benefit_rules) to a claim to determine payable amounts, member responsibility, and denials.
EOB	Explanation of Benefits — the statement produced for members/providers after adjudication.
UB92	Institutional (hospital) claim form; such claims carry extra data (claims_ub92_info, occurrence/condition/value codes).
COB	Coordination of Benefits — determining payment order when other insurance exists (coord_of_bens, claim_other_ins_infos).
Pre-ex	Pre-existing-condition limitation investigation (preex module).
Accum(ulator)	Running totals per member/family — deductible, out-of-pocket, benefit maxima (member_accums).
PPO / Repricing	Preferred-provider network discounts applied to billed charges (claims_reprice_info, pricing_rules, provider fee schedules).
Funding	Moving client money to pay adjudicated claims; producing checks (fund_register, fundtrans, check runs).
Check run	A batch that turns payable claims into printed checks and register entries.
Stop-loss	Insurance the employer buys against large claims — specific (per person) and aggregate (whole group) (sl_contracts, group_stoploss_parms).
COBRA	Continuation coverage after qualifying events; HOMER produces notices and bills participants (cobra_letters).
PBM	Pharmacy Benefit Manager (PCS/Caremark) — HOMER exchanges eligibility and claim files (drug_covr_*_trans, caremark_edi_table).
UM / UR / CM	Utilization Management / Utilization Review / Case Management — pre-certification and managed-care case tracking (um_cases, um_services, um_rules, cm_potentials).
TPA	Third-Party Administrator — the company operating HOMER.
Examiner	Claims staff member who processes claims (claim_examiner_userid).
1099-NEC	IRS form for provider payment reporting (print_1099s).
DataWindow	PowerBuilder's data-bound UI/report object; in this documentation, the concrete definition of a screen area or report including its SQL.