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Pega Sales Automation for Healthcare 8.2 data model
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
- Benefit - Definition
- Benefit summary
- CMS Table
- Map old plans to new plans
- Market segment
- Member
- Plan
- Policy
- Postal (ZIP) Codes
- Product
- Rating Area Plan Match
- Rating Area - Sales
- Seminar
- Standard Industry Codes (SIC) - Factor
- Subscriber (Policy Holder)
- Time period
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 |