claim

The claim table is related to the Claim resource that is available via the FHIR API.

Claims are used by providers and insurers to exchange the financial information, and supporting clinical information, regarding the provision of health care services and for reporting to regulatory bodies and firms which provide data analytics.

See also:

Source Concepts

  • HIEBus claims
  • HIEBus claimcaregiverrelationships

Table Schema

Name Type Description
personid VARCHAR(38) GUID

Unique identifier representing a unique person that may include data from several sources that have been linked. This identifier is the person_id of a HIEBus recordgroup.

claimid VARCHAR(38) GUID

Internal identifier assigned to the claim by HIEBus.

identifier VARCHAR

External identifier used by the source system to uniquely identify the claim.

datasource VARCHAR

The name of the data source. Commonly determined from the namespace of the source terminology.

status VARCHAR

Mapped by Rosetta. The administrative state of the claim. For example: Pended, Final, Canceled. This is the preferred mapped concept determined by the Rosetta Terminology Service.

statuscode VARCHAR

Mapped by Rosetta. Coded Value. The administrative state of the claim. For example: Pended, Final, Canceled. This is the preferred mapped concept determined by the Rosetta Terminology Service.

statustermid INTEGER

Reference to HIEBus terminology properties for the claim.

type VARCHAR

Mapped by Rosetta. Category or discipline. This is the preferred mapped concept determined by the Rosetta Terminology Service.

typecode VARCHAR

Mapped by Rosetta. Coded Value. Category or discipline. This is the preferred mapped concept determined by the Rosetta Terminology Service.

typetermid INTEGER

Reference to HIEBus terminology properties for the claim.

subtype VARCHAR

Mapped by Rosetta. More granualar claim type; represents claim bill class. CMS Bill Type Code, described here. This is the preferred mapped concept determined by the Rosetta Terminology Service.

subtypecode VARCHAR

Mapped by Rosetta. Coded Value. More granualar claim type; represents claim bill class. CMS Bill Type Code, described here. This is the preferred mapped concept determined by the Rosetta Terminology Service.

subtypetermid INTEGER

Reference to HIEBus terminology properties for the claim.

facilitytype VARCHAR

Mapped by Rosetta. Primary place of service for the claim. See CMS POS Codes, described here. This is the preferred mapped concept determined by the Rosetta Terminology Service.

facilitytypecode VARCHAR

Mapped by Rosetta. Coded Value. Primary place of service for the claim. See CMS POS Codes, described here. This is the preferred mapped concept determined by the Rosetta Terminology Service.

facilitytypetermid INTEGER

Reference to HIEBus terminology properties for the claim.

program VARCHAR

Values: Facility (i.e. CMS Part A, or Institutional), Professional (i.e. CMS Part B, or Professional Service), Pharmacy (i.e. CMS Part D, or Medications).

startdate TIMESTAMP

The start date for the claim.

enddate TIMESTAMP

The end date for the claim.

admitdate TIMESTAMP

If the claim is related to a bed-assigned inpatient encounter, the admit date of the encounter.

dischargedate TIMESTAMP

If the claim is related to a bed-assigned inpatient encounter, the discharge date of the encounter.

total DECIMAL

Total claim cost.

drg VARCHAR

DRG for the claim.

provideridentifier VARCHAR

The identifier assigned to the primary provider associated with the claim.

providername VARCHAR

The name of the primary provider associated with the claim.

primarycaresetting VARCHAR

Computed. A normalized description of the primary place of service for the claim.

primarycaresettingreason VARCHAR

Computed. For traceability, an explanation for the primarycaresetting assignment.

isderivedencounteranchor BOOLEAN

Computed. Claim will be used as a primary claim to constructed derived encounters.

secondarycaresettings VARCHAR

Computed. A comma delimited string of other care settings (for example ED or observation activity on an inpatient claim) determined for the claim.

primaryspecialty VARCHAR

Computed. The specialty associated with the claim or the primary provider.

annotations VARCHAR

Computed. A comma delimited set of strings that represent computed features of the claim.

lastupdated TIMESTAMP

System generated timestamp indicating the most recent change to this data row. Used for differential operations. Managed in UTC.


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