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Pega Sales Automation for Healthcare 8.2 data model

Updated on September 10, 2021

This article provides a data dictionary for the Pega Sales Automation for Healthcare application, which describes the structure of the database as well as the relationships between its elements.

In Dev Studio, use the Data Visualizer tool to display a visual depiction of the relationships between a selected data type and its properties, and between the data type and other data types.

The following tables are described in this article:

Benefit Coverage

Pega Internal Name: PegaHC-Data-Benefit-Coverage

 

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

ApplyDeductibleTier2

Label: ApplyDeductibleTier2

Type: TrueFalse

ApplyOOPMax

Label: Apply out-of-pocket maximum

Type: Text

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

AuthorizationDecision

Label: Authorization decision

Type: Text

Authorizations

Label: Authorizations

Type: List

Of Type: Authorization

ApplyDeductible

Label: Benefit apply deductible

Type: Text

ApplyDeductibleTier1

Label: Benefit apply deductible tier 1

Type: Text

BenefitCostShares

Label: Benefit Cost Shares

Type: List

Of Type: Embed-PegaHC-BenefitCostShare

BenefitCoverageID

Label: BenefitCoverageID

Type: Text

BenefitCoverageName

Label: BenefitCoverageName

Type: Text

BenefitDefinitionID

Label: Benefit Definition ID

Type: Identifier

BenefitDefinitionKey

Label: BenefitDefinitionKey

Type: Text

NetworkCoInsurance

Label: Benefit network co insurance

Type: Decimal

NetworkCoPay

Label: Benefit network co pay

Type: Decimal

NonNetworkCoInsurance

Label: Benefit non network co insurance

Type: Decimal

NonNetWorkCoPay

Label: Benefit non network co pay

Type: Decimal

CoverageDescription

Label: Benefit plan coverage description

Type: Text

ShortDescription

Label: Benefit short description

Type: Text

ValueStatement

Label: Benefit value statement

Type: Text

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

ClaimCostPMPM

Label: Claim cost per member per month

Type: Decimal

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

COBCalculationMethod

Label: COBCalculationMethod

Type: Text

COBSavingsEligible

Label: COBSavingsEligible

Type: Text

COBSavingsMax

Label: COBSavingsMax

Type: Text

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

CostShare

Label: CostShare

Type: List

Of Type: Embed-PegaHC-BenefitCostShare

CostShares

Label: CostShares

Type: List

Covered

Label: Covered

Type: Text

CreateDate

Label: CreateDate

Type: Date

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

DischargeLocation

Label: Discharge Location Code

Type: Text

EHB

Label: EHB

Type: TrueFalse

EHBVarianceReason

Label: EHB Variance Reason

Type: Text

EPSDTIndicator

Label: EPSDT indicator

Type: Text

Exclude

Label: Exclude

Type: Text

ExcludedFromOutOfNetworkMOOP

Label: Excluded from Out of Network MOOP

Type: TrueFalse

Exclusions

Label: Exclusions

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

IsThisBenefitCovered

Label: IsThisBenefitCovered

Type: Text

LimitQuantity

Label: Limit Quantity

Type: Text

Limits

Label: Limits

Type: List

Of Type: Limit

LimitUnit

Label: Limit Unit

Type: Text

MinimumStay

Label: Minimum Stay

Type: Text

Name

Label: Name

Type: Identifier

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

NetworkID

Label: NetworkID

Type: Text

NetworkName

Label: NetworkName

Type: Text

NetworkTier

Label: NetworkTier

Type: Text

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

ParentCoverageID

Label: ParentCoverageID

Type: Text

ParentDefinitionID

Label: ParentDefinitionID

Type: Text

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

PlanDedProratable

Label: PlanDedProratable

Type: Text

PlanID

Label: PlanID

Type: Identifier

PriceFrequency

Label: PriceFrequency

Type: Text

QuantitativeLimitOnService

Label: QuantitativeLimitOnService

Type: Text

Ranking

Label: Ranking

Type: Integer

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

AccidentDate

Label: Service accident date

Type: Date

ActionCode

Label: Service action code

Type: Text

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AdmissionTypeCode

Label: Service admission type code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

ServiceDate

Label: Service Date

Type: Date

DaysofSupply

Label: Service days of supply

Type: Integer

ServiceDefinition

Label: ServiceDefinition

Type: List

Of Type: Service Definition - Benefit

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Diagnosis

Label: Service diagnosis

Type: List

Of Type: ***Deprecated***

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

Frequency

Label: Service frequency

Type: Text

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceFromDate

Label: Service from date

Type: Date

ServiceIdentificationCode

Label: Service identification code

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

IssueDate

Label: Service issue date

Type: Date

LastAdmissionPeriod

Label: Service last admission period

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

NumberofVisits

Label: Service number of visits

Type: Integer

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PeriodCount

Label: Service period count

Type: Decimal

PrescriptionDate

Label: Service prescription date

Type: Date

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrescriptionNumber

Label: Service prescription number

Type: Text

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

PriorIncorrectInsured

Label: Service prior incorrect insured

Type: Object

Of Type: Member

ProcedureCode

Label: Service procedure code

Type: Text

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifier

Label: Service procedure modifier

Type: Text

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

ReferringProviderList

Label: Service referring provider list

Type: List

Of Type: Provider

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

SurgeryDate

Label: Service surgery date

Type: Date

SurgicalProcedureCode

Label: Service surgical procedure code

Type: Text

TimePeriodQualifier

Label: Service time period qualifier

Type: Text

ServiceToDate

Label: Service to date

Type: Date

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceTypeCode

Label: Service type code

Type: Text

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

Source

Label: Source

Type: Text

StateRequiredBenefit

Label: StateRequiredBenefit

Type: TrueFalse

StopLossAmount

Label: StopLossAmount

Type: Text

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

Version

Label: Version

Type: Text

WaitingPeriod

Label: WaitingPeriod

Type: Text

WaitingPeriodBasis

Label: WaitingPeriodBasis

Type: Text

Benefit - Definition

Pega Internal Name: PegaHC-Data-Benefit-Definition

 

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

ApplyDeductibleTier2

Label: ApplyDeductibleTier2

Type: TrueFalse

ApplyOOPMax

Label: Apply out-of-pocket maximum

Type: Text

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

AuthorizationDecision

Label: Authorization decision

Type: Text

ApplyDeductible

Label: Benefit apply deductible

Type: Text

ApplyDeductibleTier1

Label: Benefit apply deductible tier 1

Type: Text

BenefitCostShares

Label: Benefit Cost Shares

Type: List

Of Type: Embed-PegaHC-BenefitCostShare

BenefitCoverage

Label: BenefitCoverage

Type: Object

Of Type: Benefit Coverage

BenefitCoverageID

Label: BenefitCoverageID

Type: Text

BenefitCoverageName

Label: BenefitCoverageName

Type: Text

BenefitDefinitionID

Label: Benefit Definition ID

Type: Identifier

BenefitDefinitionKey

Label: BenefitDefinitionKey

Type: Text

BenefitDefinitionName

Label: BenefitDefinitionName

Type: Text

BenefitGroupID

Label: BenefitGroupID

Type: Identifier

NetworkCoInsurance

Label: Benefit network co insurance

Type: Decimal

NetworkCoPay

Label: Benefit network co pay

Type: Decimal

NonNetworkCoInsurance

Label: Benefit non network co insurance

Type: Decimal

NonNetWorkCoPay

Label: Benefit non network co pay

Type: Decimal

CoverageDescription

Label: Benefit plan coverage description

Type: Text

ShortDescription

Label: Benefit short description

Type: Text

ValueStatement

Label: Benefit value statement

Type: Text

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

ClaimCostPMPM

Label: Claim cost per member per month

Type: Decimal

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

CostShares

Label: CostShares

Type: List

CreateDate

Label: CreateDate

Type: Date

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

DischargeLocation

Label: Discharge Location Code

Type: Text

EHB

Label: EHB

Type: TrueFalse

EHBVarianceReason

Label: EHB Variance Reason

Type: Text

EPSDTIndicator

Label: EPSDT indicator

Type: Text

ExcludedFromOutOfNetworkMOOP

Label: Excluded from Out of Network MOOP

Type: TrueFalse

Exclusions

Label: Exclusions

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

IsThisBenefitCovered

Label: IsThisBenefitCovered

Type: Text

IsWellnessBenefit

Label: IsWellnessBenefit

Type: Text

LimitQuantity

Label: Limit Quantity

Type: Text

LimitUnit

Label: Limit Unit

Type: Text

MinimumStay

Label: Minimum Stay

Type: Text

Name

Label: Name

Type: Identifier

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

NetworkID

Label: NetworkID

Type: Text

NetworkName

Label: NetworkName

Type: Text

NetworkTier

Label: NetworkTier

Type: Text

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

ParentDefinitionID

Label: ParentDefinitionID

Type: Text

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

PlanID

Label: PlanID

Type: Identifier

PlanName

Label: PlanName

Type: Text

PriceFrequency

Label: PriceFrequency

Type: Text

QuantitativeLimitOnService

Label: QuantitativeLimitOnService

Type: Text

Ranking

Label: Ranking

Type: Integer

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

AccidentDate

Label: Service accident date

Type: Date

ActionCode

Label: Service action code

Type: Text

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AdmissionTypeCode

Label: Service admission type code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

ServiceDate

Label: Service Date

Type: Date

DaysofSupply

Label: Service days of supply

Type: Integer

ServiceDefinition

Label: ServiceDefinition

Type: List

Of Type: Service Definition - Benefit

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Diagnosis

Label: Service diagnosis

Type: List

Of Type: ***Deprecated***

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

Frequency

Label: Service frequency

Type: Text

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceFromDate

Label: Service from date

Type: Date

ServiceIdentificationCode

Label: Service identification code

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

IssueDate

Label: Service issue date

Type: Date

LastAdmissionPeriod

Label: Service last admission period

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

NumberofVisits

Label: Service number of visits

Type: Integer

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PeriodCount

Label: Service period count

Type: Decimal

PrescriptionDate

Label: Service prescription date

Type: Date

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrescriptionNumber

Label: Service prescription number

Type: Text

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

PriorIncorrectInsured

Label: Service prior incorrect insured

Type: Object

Of Type: Member

ProcedureCode

Label: Service procedure code

Type: Text

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifier

Label: Service procedure modifier

Type: Text

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

ReferringProviderList

Label: Service referring provider list

Type: List

Of Type: Provider

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

SurgeryDate

Label: Service surgery date

Type: Date

SurgicalProcedureCode

Label: Service surgical procedure code

Type: Text

TimePeriodQualifier

Label: Service time period qualifier

Type: Text

ServiceToDate

Label: Service to date

Type: Date

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceTypeCode

Label: Service type code

Type: Text

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

Source

Label: Source

Type: Text

StateRequiredBenefit

Label: StateRequiredBenefit

Type: TrueFalse

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

Version

Label: Version

Type: Text

Benefit summary

Holds the benefit mapping information as a PageList of PegaHC-Data-ServiceDefinition instances. Also includes cost share and variation details in the context of every network based on the configuration of the benefit in the plan. These details are stored in a page list called Networks of type Embed-PegaHC-Network.

Pega Internal Name: PegaHC-Data-BenefitSummary

 

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

ApplyDeductibleTier2

Label: ApplyDeductibleTier2

Type: TrueFalse

ApplyOOPMax

Label: Apply out-of-pocket maximum

Type: Text

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

AuthorizationDecision

Label: Authorization decision

Type: Text

ApplyDeductible

Label: Benefit apply deductible

Type: Text

ApplyDeductibleTier1

Label: Benefit apply deductible tier 1

Type: Text

BenefitCategory

Label: BenefitCategory

Type: Text

BenefitCostShares

Label: Benefit Cost Shares

Type: List

Of Type: Embed-PegaHC-BenefitCostShare

BenefitCoverageID

Label: BenefitCoverageID

Type: Text

BenefitCoverageName

Label: BenefitCoverageName

Type: Text

BenefitDefinitionID

Label: Benefit Definition ID

Type: Identifier

BenefitDefinitionKey

Label: BenefitDefinitionKey

Type: Text

NetworkCoInsurance

Label: Benefit network Co insurance

Type: Decimal

NetworkCoPay

Label: Benefit network co pay

Type: Decimal

NonNetworkCoInsurance

Label: Benefit non network co insurance

Type: Decimal

NonNetWorkCoPay

Label: Benefit non network co pay

Type: Decimal

CoverageDescription

Label: Benefit plan coverage description

Type: Text

ShortDescription

Label: Benefit short description

Type: Text

ValueStatement

Label: Benefit value statement

Type: Text

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

ClaimCostPMPM

Label: Claim cost per member per month

Type: Decimal

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

CostShares

Label: CostShares

Type: List

CreateDate

Label: CreateDate

Type: Date

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

DischargeLocation

Label: Discharge Location Code

Type: Text

EHB

Label: EHB

Type: TrueFalse

EHBVarianceReason

Label: EHB Variance Reason

Type: Text

EPSDTIndicator

Label: EPSDT indicator

Type: Text

ExcludedFromOutOfNetworkMOOP

Label: Excluded from Out of Network MOOP

Type: TrueFalse

Exclusions

Label: Exclusions

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

IsThisBenefitCovered

Label: IsThisBenefitCovered

Type: Text

LimitQuantity

Label: Limit Quantity

Type: Text

LimitUnit

Label: Limit Unit

Type: Text

MinimumStay

Label: Minimum Stay

Type: Text

Name

Label: Name

Type: Identifier

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

NetworkID

Label: NetworkID

Type: Text

NetworkName

Label: NetworkName

Type: Text

NetworkTier

Label: NetworkTier

Type: Text

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

ParentDefinitionID

Label: ParentDefinitionID

Type: Text

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

PlanID

Label: PlanID

Type: Identifier

PriceFrequency

Label: PriceFrequency

Type: Text

QuantitativeLimitOnService

Label: QuantitativeLimitOnService

Type: Text

Ranking

Label: Ranking

Type: Integer

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

AccidentDate

Label: Service accident date

Type: Date

ActionCode

Label: Service action code

Type: Text

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AdmissionTypeCode

Label: Service admission type code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

ServiceDate

Label: Service Date

Type: Date

DaysofSupply

Label: Service days of supply

Type: Integer

ServiceDefinition

Label: ServiceDefinition

Type: List

Of Type: Service Definition - Benefit

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Diagnosis

Label: Service diagnosis

Type: List

Of Type: ***Deprecated***

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

Frequency

Label: Service frequency

Type: Text

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceFromDate

Label: Service from date

Type: Date

ServiceIdentificationCode

Label: Service identification code

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

IssueDate

Label: Service issue date

Type: Date

LastAdmissionPeriod

Label: Service last admission period

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

NumberofVisits

Label: Service number of visits

Type: Integer

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PeriodCount

Label: Service period count

Type: Decimal

PrescriptionDate

Label: Service prescription date

Type: Date

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrescriptionNumber

Label: Service prescription number

Type: Text

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

PriorIncorrectInsured

Label: Service prior incorrect insured

Type: Object

Of Type: Member

ProcedureCode

Label: Service procedure code

Type: Text

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifier

Label: Service procedure modifier

Type: Text

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

ReferringProviderList

Label: Service referring provider list

Type: List

Of Type: Provider

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

SurgeryDate

Label: Service surgery date

Type: Date

SurgicalProcedureCode

Label: Service surgical procedure code

Type: Text

TimePeriodQualifier

Label: Service time period qualifier

Type: Text

ServiceToDate

Label: Service to date

Type: Date

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceTypeCode

Label: Service type code

Type: Text

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

Source

Label: Source

Type: Text

StateRequiredBenefit

Label: StateRequiredBenefit

Type: TrueFalse

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

Version

Label: Version

Type: Text

CMS Table

Pega Internal Name: PegaHCSPM-Data-CMSTable

 

CMSCode

Label: CMSCode

Type: Text

CMSCounty

Label: CMSCounty

Type: Text

FivePcntBonus

Label: FivePcntBonus

Type: Double

PartsAandB

Label: PartsAandB

Type: Double

Source

Label: Source

Type: Text

State

Label: State

Type: Text

ThreePcntBonus

Label: ThreePcntBonus

Type: Double

ZeroPcntBonus

Label: ZeroPcntBonus

Type: Double

Map old plans to new plans

Pega Internal Name: PegaHC-Data-PlanMapping

 

CurrentPlanEffectiveDate

Label: Current Plan Effective Date

Type: DateTime

CurrentPlanEndDate

Label: Current Plan End Date

Type: DateTime

CurrentPlanGFStatus

Label: Current Plan Grandfather Status

Type: Text

CurrentPlanID

Label: Current Plan ID

Type: Text

CurrentPlanName

Label: Current Plan Name

Type: Text

NewPlanEffectiveDate

Label: New Plan Effective Date

Type: DateTime

NewPlanEndDate

Label: New Plan End Date

Type: DateTime

NewPlanID

Label: New Plan ID

Type: Text

NewPlanName

Label: New Plan Name

Type: Text

Source

Label: Source

Type: Text

Market segment

A class for Market segments.

Pega Internal Name: PegaHC-Data-MarketSegment

 

MarketSegment

Label: Market Segment

Type: Text

Source

Label: Source

Type: Text

Member

The Member data class holds member data as it is utilized within the application. Member data includes Member ID, member name, policy details, and PCP information.

Pega Internal Name: PegaHC-Data-Party-Member

 

Address

Label: Address

Type: List

Of Type: Common

DateOfBirth

Label: Date of Birth

Type: Date

Employee

Label: Employee

Type: Text

Employment

Label: Employment

Type: List

Of Type: Employment Information

GenderCode

Label: Gender Code

Type: Text

Guardian

Label: Guardian

Type: Object

Of Type: Guardian Information

GuardianList

Label: Guardian List

Type: List

Of Type: Guardian Information

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

Languages

Label: Languages

Type: List

Of Type: Languages

Age

Label: Member age

Type: Integer

BirthSequenceNumber

Label: Member birth sequence number

Type: Integer

CitizenshipStatusCode

Label: Member citizenship status code

Type: Text

Communication

Label: Member communication

Type: List

Of Type: Communication - Phone-Email-Social

DateOfDeath

Label: Member date of death

Type: Date

Disability

Label: Member disability

Type: List

Of Type: Disability Information

Height

Label: Member height

Type: Text

MaritalStatusCode

Label: Member marital status code

Type: Text

MiddleName

Label: Member middle name

Type: Text

NamePrefix

Label: Member name prefix

Type: Text

MemberPolicy

Label: Member policy

Type: List

Of Type: Policy

PregnancyIndicator

Label: Member pregnancy indicator

Type: TrueFalse

PreviousNames

Label: Member previous names

Type: List

Of Type: Embed-PegaHC-Member

RaceOrEthnicityCode

Label: Member race or ethnicity code

Type: Text

SitusState

Label: Member situs state

Type: Text

SocialSecurityNumber

Label: Member social security number

Type: Text

Weight

Label: Member weight

Type: Integer

pyNameSuffix

Label: Name Suffix

Type: Text

NumberOfChildren

Label: Number Of Children

Type: Integer

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

NationalProviderIdentifier

Label: Party national provider identifier

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

pyWorkPartyUri

Label: Payer identifier

Type: Text

PaymentCode

Label: PaymentCode

Type: Text

PrimaryContact

Label: primary contact

Type: List

Of Type: Contact Information - Embedded

PrivacyRestricted

Label: PrivacyRestricted

Type: TrueFalse

pyFirstName

Label: pyFirstName

Type: Text

pyLastName

Label: pyLastName

Type: Text

School

Label: School

Type: List

Of Type: School Information

Source

Label: Source

Type: Text

VIP

Label: VIP

Type: Text

Plan

Pega Internal Name: PegaHC-Data-Plan

 

AdditionalLimitations

Label: AdditionalLimitations

Type: Text

BeginPrimaryCareCostSharingAfterASetNumberOfVisits

Label: BeginPrimaryCareCost-SharingAfterASetNumberOfVisits

Type: Text

BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays

Label: BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays

Type: Text

ChildOnlyOffering

Label: Child-Only Offering

Type: Text

ChildOnlyPlanID

Label: Child Only Plan ID

Type: Text

COBCalculationMethod

Label: COBCalculationMethod

Type: Text

COBSavingsEligible

Label: COBSavingsEligible

Type: Text

COBSavingsMax

Label: COBSavingsMax

Type: Text

CompositeRating

Label: CompositeRating

Type: Text

CostShare

Label: CostShare

Type: List

Of Type: Embed-PegaHC-PlanCostShare

CoverageLevel

Label: CoverageLevel

Type: Text

CreateProduct

Label: CreateProduct

Type: Text

DiseaseManagementProgramsOffered

Label: Disease Management Programs Offered

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EHBApportionmentForPediatricDental

Label: EHB Apportionment for Pediatric Dental

Type: Text

EHBTotalPremium

Label: EHBTotalPremium

Type: Decimal

EndDate

Label: End date

Type: Date

FormularyID

Label: FormularyID

Type: Text

Grandfathered

Label: Grandfathered

Type: TrueFalse

GuaranteedVsEstimatedRate

Label: GuaranteedVsEstimated Rate

Type: Text

HIOSProductID

Label: HIOSProductID

Type: Text

HPID

Label: HPID

Type: Text

HSAEligible

Label: HSA Eligible

Type: Text

HSAHRAEmployerContribution

Label: HSA/HRA Employer Contribution

Type: TrueFalse

HSAHRAEmployerContributionAmount

Label: HSA/HRA Employer Contribution Amount

Type: Text

IsAReferralRequiredForSpecialist

Label: Is a Referral Required for Specialist

Type: TrueFalse

LimitedCostSharingPlanVariationEstAdvancedPayment

Label: Limited Cost Sharing Plan Variation - Est Advanced Payment

Type: Text

Limits

Label: Limits

Type: List

Of Type: Limit

LineOfBusiness

Label: LineOfBusiness

Type: Text

Logos

Label: Logos

Type: List

Of Type: URL

MarketSegment

Label: MarketSegment

Type: Text

MaxNoOfDaysForChargingAnInpatientCopay

Label: MaxNoOfDaysForChargingAnInpatientCopay

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MetalLevel

Label: Metal Level

Type: Text

NationalNetwork

Label: National Network

Type: TrueFalse

Networks

Label: Networks

Type: List

Of Type: Network

NetworksList

Label: NetworksList

Type: List

Of Type: Embed-PegaHC-networks

NewOrExistingPlan

Label: NewOrExisting Plan

Type: Text

NoticeForPregnancy

Label: NoticeForPregnancy

Type: Text

OfficeVisitCopayOON

Label: Office visit copay out of network

Type: Decimal

OtherID

Label: OtherID

Type: List

Of Type: otherID

OtherName

Label: Other Names

Type: List

Of Type: Other names

OutOfCountryCoverage

Label: Out of Country Coverage

Type: TrueFalse

OutOfCountryCoverageDescription

Label: Out of Country Coverage Description

Type: Text

OutOfServiceAreaCoverage

Label: Out of Service Area Coverage

Type: TrueFalse

OutOfServiceAreaCoverageDescription

Label: Out of Service Area Coverage Description

Type: Text

ParentID

Label: ParentID

Type: Text

PlanAttributes

Label: PlanAttributes

Type: Object

Of Type: PlanAttributes

PlanBrochure

Label: Plan Brochure

Type: Text

PlanCostShares

Label: PlanCostShares

Type: List

Of Type: Embed-PegaHC-PlanCostShare

PlanDedProratable

Label: PlanDedProratable

Type: Text

PlanID

Label: PlanID

Type: Identifier

PlanLevelExclusions

Label: Plan Level Exclusions

Type: Text

PlanName

Label: Plan name

Type: Text

Availability

Label: Product availability

Type: Text

Benefit

Label: Product benefit

Type: List

Of Type: Service (Healthcare)

BenefitGroup

Label: Product benefit group

Type: List

Of Type: PegaHC-Data-BenefitGroup

Category

Label: Product category

Type: Text

CertificationConditionIndicator

Label: Product certification condition indicator

Type: Text

ClaimCostPMPM

Label: Product claim cost per member per month

Type: Decimal

CoInsurance

Label: Product coinsurance

Type: Decimal

CoInsuranceOON

Label: Product co insurance out of network

Type: Decimal

DependentEligibilityAgeMax

Label: Product dependent eligibility age max

Type: Integer

FamilyDeductible

Label: Product family deductible

Type: Integer

FamilyDeductibleMultiplier

Label: Product family deductible multiplier

Type: Integer

FamilyDeductibleMultiplierOON

Label: Product family deductible multiplier out of network

Type: Integer

FamilyDeductibleOON

Label: Product family deductible out of network

Type: Integer

FamilyOOPMax

Label: Product family out-of-pocket maximum

Type: Double

FamilyOOPMaxMultiplier

Label: Product family out-of-pocket maximum multiplier

Type: Integer

FamilyOOPMaxMultiplierOON

Label: Product family out-of-pocket maximum multiplier OON

Type: Integer

FamilyOOPMaxOON

Label: Product family out-of-pocket maximum out of network

Type: Double

GroupSizeHigh

Label: Product group size high

Type: Integer

IndividualDeductible

Label: Product individual deductible

Type: Integer

IndividualDeductibleOON

Label: Product individual deductible out of network

Type: Integer

IndividualOOPMax

Label: Product individual out-of-pocket maximum

Type: Integer

IndividualOOPMaxOON

Label: Product individual out-of-pocket maximum out of network

Type: Integer

InsuranceLineCode

Label: Product insurance line code

Type: Text

LifeTimeMax

Label: Product life time max

Type: Integer

LifeTimeMaxOON

Label: Product life time max out of network

Type: Integer

ProductList

Label: Product list

Type: List

Of Type: Product - Benefits

MaximumGroupSize

Label: Product maximum group size

Type: Integer

MemberOOP

Label: Product member out-of-pocket

Type: Text

ProductName

Label: Product name

Type: Text

NetworkRestriction

Label: Product network restriction

Type: Text

OfficeVisitCopay

Label: Product office visit copay

Type: Decimal

OutOfNetworkIndicator

Label: Product out of network indicator

Type: Text

PerformanceFlag

Label: Product performance flag

Type: Text

PlanCoverageDescription

Label: Product plan coverage description

Type: Text

PlanNumber

Label: Product plan number

Type: Text

ProductNumber

Label: Product plan number

Type: Text

PCPRequired

Label: Product primary care physician required

Type: Text

RateEffectiveDate

Label: Product rate effective date

Type: Date

RateTermDate

Label: Product rate term date

Type: Date

ShortDescription

Label: Product short description

Type: Text

StudentEligibilityAgeMax

Label: Product student eligibility age maximum

Type: Integer

ValueStatement

Label: Product value statement

Type: Text

QHP

Label: QHP

Type: Object

Of Type: QHP

QHPOrNonQHP

Label: QHPOrNonQHP

Type: Text

ServiceAreas

Label: ServiceAreas

Type: List

Of Type: Service Area

Source

Label: Source

Type: Text

SpecialistsRequiringAReferral

Label: Specialist(s) Requiring a Referral

Type: Text

StopLossAmount

Label: StopLossAmount

Type: Text

TempSubscriberName

Label: TempSubscriberName

Type: Object

Of Type: PegaHC-X12-Data-N271-Loop2100CSubscriberName

TobaccoWellnessProgramOffered

Label: Tobacco Wellness Program Offered

Type: TrueFalse

UniquePlanDesign

Label: UniquePlanDesign

Type: TrueFalse

URLForEnrollmentPayment

Label: URL for Enrollment Payment

Type: Text

URLForSummaryOfBenefitsAndCoverage

Label: URL for Summary of BenefitsAndCoverage

Type: Text

URLs

Label: URLs

Type: List

Of Type: URL

Policy

The Membership Policy data class holds membership data specifically related to the policies held by the member. A Medical Policy is a contract that defines medical benefits available to a subscriber as long as the premium is being paid.

Pega Internal Name: PegaHC-Data-Policy

 

BenefitCoverageLevelCode

Label: Policy benefit coverage level code

Type: Text

ContractID

Label: Policy contract ID

Type: Text

EffectiveDate

Label: Policy effective date

Type: Date

PolicyNumber

Label: Policy number

Type: Identifier

PlanNumber

Label: Policy plan number

Type: Text

TermDate

Label: Policy term date

Type: Date

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

Postal (ZIP) Codes

Pega Internal Name: PegaHC-Data-ZipCode

 

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

City

Label: City

Type: Identifier

County

Label: County

Type: Text

CountyCode

Label: CountyCode

Type: Text

CountyName

Label: CountyName

Type: Text

CustomID

Label: CustomID

Type: Text

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2StartDate

Label: Gap2 start date

Type: Date

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

PatientID

Label: Patient identifier

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: Procedure code type

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

RatingArea

Label: RatingArea

Type: Text

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject reason code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

StateName

Label: StateName

Type: Identifier

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

ZipCode

Label: ZipCode

Type: Identifier

Product

Definition of a product item and metadata.

Pega Internal Name: PegaCRM-Data-Product

 

Description

Label: Description

Type: Text

FiscalYear

Label: Fiscal Year

Type: Text

isActive

Label: Is active?

Type: TrueFalse

BaseCost

Label: List Price

Type: Decimal

Name

Label: Name

Type: Text

ParentID

Label: Parent ID

Type: Text

objID

Label: Product ID

Type: Text

Quarter

Label: Quarter

Type: Text

Revenue

Label: Revenue

Type: Decimal

SellingMode

Label: SellingMode

Type: Text

Type

Label: Type

Type: Text

ProductURL

Label: URL for product spec

Type: Text

Rating Area Plan Match

Pega Internal Name: PegaHC-Data-PlanRatingArea

 

ClaimCostPMPM

Label: Claim Cost PMPM

Type: Decimal

County

Label: County

Type: Text

EffectiveDate

Label: Effective Date

Type: Date

EndDate

Label: End Date

Type: Date

MarketSegment

Label: MarketSegment

Type: Text

PlanID

Label: PlanID

Type: Identifier

RatingArea

Label: Rating Area

Type: Integer

Source

Label: Source

Type: Text

State

Label: State

Type: Text

Rating Area - Sales

Pega Internal Name: PegaHC-Data-RatingAreaConfig

 

RatingArea

Label: ID

Type: Text

Source

Label: Source

Type: Text

StatesCovered

Label: States

Type: Text

Seminar

Pega Internal Name: PegaHCSPM-Data-Seminar

 

Contact

Label: Contact

Type: Text

Location

Label: Location

Type: Text

MeetingType

Label: Meeting type

Type: Text

Region

Label: Region

Type: Text

County

Label: SCounty

Type: Text

SeminarDate

Label: Seminar date

Type: Text

SeminarID

Label: SeminarID

Type: Integer

SeminarTime

Label: Seminar time

Type: Text

Source

Label: Source

Type: Text

Status

Label: Status

Type: Text

Type

Label: Type

Type: Text

Standard Industry Codes (SIC) - Factor

Pega Internal Name: PegaHC-Data-SICFactor

 

Description

Label: Description

Type: Text

DivisionID

Label: DivisionID

Type: Integer

EffectiveDate

Label: EffectiveDate

Type: Date

ExpressionProperty

Label: ExpressionProperty

Type: Text

Factor

Label: Factor

Type: Decimal

GroupID

Label: GroupID

Type: Integer

SICHigh

Label: SICHigh

Type: Text

SICLow

Label: SICLow

Type: Text

Source

Label: Source

Type: Text

TerminationDate

Label: TerminationDate

Type: Date

Subscriber (Policy Holder)

The subscriber Policy data class holds membership data specifically related to the policies held by the subscriber of the policy. The subscriber is the person who pays the premium for insurance. All other members on the policy are known as dependents of that subscriber.

Pega Internal Name: PegaHC-Data-Party-Subscriber

 

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

IRCTest

Label: IRCTest

Type: Text

Member

Label: Member

Type: Object

Of Type: Member

MemberReasonCode

Label: Member reason code

Type: Text

OldPCP

Label: OldPCP

Type: Text

OldTermDate

Label: OldTermDate

Type: Date

AccountNumber

Label: Party account number

Type: Text

AdditionalName

Label: Party additional name

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

Age

Label: Party age

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

DateOfBirth

Label: Party date of birth

Type: Date

DateOfDeath

Label: Party date of death

Type: Date

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

GroupNumber

Label: Party group number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

MiddleName

Label: Party middle name

Type: Text

NationalProviderIdentifier

Label: Party national provider identifier

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

PaymentCode

Label: PaymentCode

Type: Text

PCP

Label: PCP

Type: Text

PCPEffectiveDate

Label: PCPEffectiveDate

Type: Date

PCPEndDate

Label: PCPEndDate

Type: Date

PcpReasonCode

Label: pcp reason code

Type: Text

PrimaryContact

Label: primary contact

Type: List

Of Type: Contact Information - Embedded

ProviderName

Label: ProviderName

Type: Text

Source

Label: Source

Type: Text

FirstName

Label: Subscriber first name

Type: Text

IndividualRelationshipCode

Label: Subscriber individual relationship code

Type: Text

LastName

Label: Subscriber last name

Type: Text

MemberID

Label: Subscriber member ID

Type: Text

MemberKey

Label: Subscriber member key

Type: Text

MemberNumber

Label: Subscriber member number

Type: Identifier

MemberStatus

Label: Subscriber member status

Type: Text

PlanType

Label: Subscriber plan type

Type: Text

PolicyNumber

Label: Subscriber policy number

Type: Text

TaxonomyCode

Label: TaxonomyCode

Type: Text

Time period

Definition of date ranges to track sales performance.

Pega Internal Name: PegaCRM-Data-TimePeriod

 

EndDate

Label: End Date

Type: DateTime

FiscalYear

Label: Fiscal Year

Type: Text

isActive

Label: isActive

Type: TrueFalse

Active

Label: Is active?

Type: Text

Quarter

Label: Quarter

Type: Text

StartDate

Label: Start Date

Type: DateTime

TPID

Label: Time Period ID

Type: Identifier

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