CAP_RR_EXPECTED

Description: |
This table contains information on capitation receipt and reconciliation expected charge transactions.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
TX_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | TX_ID | NUMERIC | No |
The unique identifier (.1 item) for the transaction record.
2 | TX_TYPE_C_NAME | NUMERIC | No |
The type of the transaction.
May contain organization-specific values: No
Category Entries:
Incoming Receipt
PCP Capitation
Specialty Capitation
AP Claims Adjustment
Withhold Adjustment
General Adjustment
Other Reimbursement
PCP Capitation Adjustment
Specialty Capitation Adjustment
Employer Group Reimbursement
Incoming Receipt Adjustment
Broker Commission
Commission Adjustment
Incoming Receipt Expected
3 | TX_STATUS_C_NAME | NUMERIC | No |
The status of the transaction.
May contain organization-specific values: No
Category Entries:
Loaded
Reconciled
Calculated
AP Batched
Paid
Void
New
Fully Invoiced
Error
4 | EFFECTIVE_DATE | DATETIME | No |
First of the month we are expecting payment for.
5 | POST_DATE | DATETIME | No |
Post date of the transaction.
6 | ELIGIBILITY_DATE | DATETIME | No |
Eligibility date used when calculating expected amounts.
7 | MEMBER_GROUP_ID_MEM_GRP_NAME | VARCHAR | No |
The name of the member group
8 | SERV_AREA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
9 | CARRIER_ID | VARCHAR | No |
The carrier ID.
10 | CARRIER_ID_CARRIER_NAME | VARCHAR | No |
The name of the carrier record.
11 | NETWORK_ID | VARCHAR | No |
The network ID.
12 | NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
13 | BENEFIT_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
14 | PLAN_GRP_ID | VARCHAR | No |
The employer group ID.
15 | PLAN_GRP_ID_PLAN_GRP_NAME | VARCHAR | No |
The name of the employer group record
16 | PRIMARY_LOC_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
17 | PCP_PROV_ID_PROV_NAME | VARCHAR | No |
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
18 | SUBSCRIBER_IDENT | VARCHAR | No |
The subscriber ID for matching to a transaction on an incoming capitation file.
19 | LOB_ID | VARCHAR | No |
The line of business ID.
20 | LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
21 | RKP_ID | VARCHAR | No |
The risk panel ID.
22 | RKP_ID_RISK_PANEL_NAME | VARCHAR | No |
The name of the risk panel.
23 | EXPECTED_AMOUNT | NUMERIC | No |
The amount expected to be received for capitation.
24 | CANCELED_BY_TX_ID | NUMERIC | No |
The internal ID of the transaction which cancels this transaction.
25 | CANCELS_TX_ID | NUMERIC | No |
The internal ID of the transaction canceled by this transaction.
26 | DISCREPANCY_TYPE_C_NAME | NUMERIC | No |
The type of discrepancy that led to this transcation getting canceled or replaced.
May contain organization-specific values: No
Category Entries:
No Match For Cancel Transaction
Duplicate Transaction
Incorrect Capitation Context or Amount
Effective Date Exceeds Retro Window
Member Not Eligible
Member Eligible, No Cap Received
Incorrect Monthly Net Amount
Formula Table Evaluation Error
27 | DISCREPANCY_DETAILS | VARCHAR | No |
Additional information about the discrepancy that is logged for this transaction.
28 | COVERAGE_ID | NUMERIC | No |
The internal coverage ID.
29 | FULL_MONTHLY_AMOUNT | NUMERIC | No |
The full monthly amount used when calculating the expected capitation amount prior to proration settings if the amount was calculated using a capitation age/sex rate table.
30 | ELIGIBLE_PORTION | NUMERIC | No |
If a member is only eligible for capitation for a portion of a computed month and the member group is configured to prorate capitation, this will store the decimal value of the prorated portion.
31 | RATE_FACTOR | NUMERIC | No |
When the benefit plan associated with a member includes a capitation rate factor, this will store the value so an accurate rate calculation can be reconstructed.
32 | CAP_RR_PRORATION_C_NAME | NUMERIC | No |
The proration method used when calculating the expected amount.
May contain organization-specific values: No
Category Entries:
Eligibility Test Date
Daily Proration
Full Monthly Rate
Daily Proration with Test Date
Applicable Dates
33 | REPLACES_TX_ID | NUMERIC | No |
The internal ID of the transaction replaced by this transaction.
34 | REPLACED_BY_TX_ID | NUMERIC | No |
The internal ID of the transaction replacing this transaction.
35 | ADJUSTMENT_CODE_C_NAME | NUMERIC | No |
Indicates the retro type of this transaction.
May contain organization-specific values: No
Category Entries:
Cancel
Add