CAP_RR

Description: |
The CAP_RR table contains information on capitation receipt and reconciliation transactions.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | TX_ID | NUMERIC | No |
The internal ID of the transaction.
2 | TX_TYPE_C_NAME | VARCHAR | 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 | VARCHAR | 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 | SPECIAL_TX_TYPE_C_NAME | VARCHAR | No |
The special transaction type of the transaction.
May contain organization-specific values: Yes
Category Entries:
Manual
Retro
AP Claims Holdback
Paid By Carrier Claim
Withholding Payback
COB Savings Member Payout
Refund
Extra Refund
Remittance Recovery
Write-off Refund
HRA Remittance Recovery
Prepayment
Future Prepayment
Prepayment Recovery
Capitation Adjustment Recovery
MMR Capitation Payment
5 | EFFECTIVE_DATE | DATETIME | No |
The effective date of the transaction.
6 | POSTING_DATE | DATETIME | No |
The posting date of the transaction.
7 | ELIGIBILITY_DATE | DATETIME | No |
The eligibility date of the transaction.
8 | USER_ID | VARCHAR | No |
The ID of the user who created the transaction.
9 | USER_ID_NAME | VARCHAR | No |
The name of the user record. This name may be hidden.
10 | COMMENT_LINE | VARCHAR | No |
The free text comment of the transaction.
11 | RCPT_MEM_DOB | DATETIME | No |
The date of birth of the received member.
12 | RCPT_MEM_SEX_C_NAME | VARCHAR | No |
The sex of the received member.
May contain organization-specific values: Yes
Category Entries:
Female
Male
Unknown
Nonbinary
X
Other
13 | RCPT_SERV_AREA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
14 | RCPT_CARRIER_ID | VARCHAR | No |
The internal ID of the received carrier.
15 | RCPT_CARRIER_ID_CARRIER_NAME | VARCHAR | No |
The name of the carrier record.
16 | RCPT_NETWORK_ID | VARCHAR | No |
The internal ID of the received network.
17 | RCPT_NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
18 | RCPT_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
19 | RCPT_PLAN_GRP_ID | VARCHAR | No |
The internal ID of the received plan group.
20 | RCPT_PLAN_GRP_ID_PLAN_GRP_NAME | VARCHAR | No |
The name of the employer group record
21 | RCPT_LOCATION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
22 | RCPT_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.
23 | RCPT_SUB_ID | VARCHAR | No |
The ID of the received subscriber.
24 | RCPT_ADJ_CODE_C_NAME | VARCHAR | No |
The category value for the received adjustment code.
May contain organization-specific values: No
Category Entries:
Cancel
Add
25 | RCPT_AMOUNT | NUMERIC | No |
The amount received for the transaction.
26 | CANCELED_BY_ID | NUMERIC | No |
The internal ID of the transaction which cancels this transaction.
27 | CANCELS_TX_ID | NUMERIC | No |
The internal ID of the transaction cancelled by this transaction.
28 | RCNCL_DISC_TYPE_C_NAME | VARCHAR | No |
The category value of the reconciliation discrepancy type.
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
29 | RCNCL_MEM_DOB | DATETIME | No |
The date of birth for the reconciled member.
30 | RCNCL_SEX_C_NAME | VARCHAR | No |
The sex of the reconciled member.
The category values for this column were already listed for column: RCPT_MEM_SEX_C_NAME
31 | RCNCL_NETWORK_ID | VARCHAR | No |
The internal ID of the reconciled network.
32 | RCNCL_NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
33 | RCNCL_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
34 | RCNCL_PLAN_GRP_ID | VARCHAR | No |
The internal ID of the reconciled plan group.
35 | RCNCL_PLAN_GRP_ID_PLAN_GRP_NAME | VARCHAR | No |
The name of the employer group record
36 | RCNCL_LOCATION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
37 | RCNCL_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.
38 | RCNCL_CVG_ID | NUMERIC | No |
The internal ID of the reconciled coverage.
39 | RCNCL_SUB_ID | VARCHAR | No |
The ID of the reconciled subscriber.
40 | RCNCL_AMOUNT | NUMERIC | No |
The amount reconciled.
41 | RCPT_MGRP_ID_MEM_GRP_NAME | VARCHAR | No |
The name of the member group
42 | RCPT_LOB_ID | VARCHAR | No |
The capitation receipt line of business.
43 | RCPT_LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
44 | RCPT_RKP_ID | VARCHAR | No |
The unique ID of the risk panel used for capitation receipt.
45 | RCPT_RKP_ID_RISK_PANEL_NAME | VARCHAR | No |
The name of the risk panel.
46 | RCNCL_LOB_ID | VARCHAR | No |
The capitation reconciliation line of business.
47 | RCNCL_LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
48 | RCNCL_RKP_ID | VARCHAR | No |
The unique ID of the risk panel used for capitation reconciliation.
49 | RCNCL_RKP_ID_RISK_PANEL_NAME | VARCHAR | No |
The name of the risk panel.
50 | RCPT_MEM_ID_CVG | VARCHAR | No |
The member ID from an incoming capitation file.
51 | RCNCL_MEMBER_ID_CVG | VARCHAR | No |
The member ID used for reconciling incoming capitation.
52 | RCPT_ADJ_TYPE_C_NAME | VARCHAR | No |
Stores the type of the capitation payment adjustment.
May contain organization-specific values: Yes
No Entries Defined
53 | RCNCL_DISC_DETAILS | VARCHAR | No |
Stores additional information about the discrepancy that is logged for this transaction.
54 | RCNCL_MONTHLY_AMT | NUMERIC | No |
Stores the full monthly amount used when calculating the expected capitation payment amount prior to proration settings if the payment was calculated using a capitation age/sex rate table.
55 | RCNCL_ELIG_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 item will store the decimal value of the prorated portion.
56 | RCNCL_RATE_FACTOR | NUMERIC | No |
When the benefit plan associated with a member includes a capitation rate factor, this item will store the value so an accurate rate calculation can be reconstructed.
57 | CAP_RR_PRORATION_C_NAME | VARCHAR | No |
Stores the proration method used during capitation reconciliation to calculate the expected amount for a capitation monthly payment.
May contain organization-specific values: No
Category Entries:
Eligibility Test Date
Daily Proration
Full Monthly Rate
Daily Proration with Test Date
Applicable Dates