CAP_PAYMENT

Description: |
The CAP_PAYMENT table contains information about capitation payments.

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
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
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 | MEM_DOB_DT | DATETIME | No |
The date of birth of the member in the transaction.
12 | MEM_SEX_C_NAME | VARCHAR | No |
The sex of the member in the transaction.
May contain organization-specific values: Yes
Category Entries:
Female
Male
Unknown
Nonbinary
X
Other
13 | SERV_AREA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
14 | CARRIER_ID | VARCHAR | No |
The carrier ID of the transaction.
15 | CARRIER_ID_CARRIER_NAME | VARCHAR | No |
The name of the carrier record.
16 | NETWORK_ID | VARCHAR | No |
The network ID of the transaction.
17 | NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
18 | PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
19 | PLAN_GRP_ID | VARCHAR | No |
The employer group ID of the transaction.
20 | PLAN_GRP_ID_PLAN_GRP_NAME | VARCHAR | No |
The name of the employer group record
21 | LOCATION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
22 | 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 | COVERAGE_ID | NUMERIC | No |
The coverage ID of the member in the transaction.
24 | SPECIALTY_C_NAME | VARCHAR | No |
The specialty of the transaction.
May contain organization-specific values: Yes
25 | SPEC_RATE | NUMERIC | No |
The rate for specialty of the transaction.
26 | VENDOR_ID_VENDOR_NAME | VARCHAR | No |
The name of the vendor.
27 | TX_CANC_TX_ID | NUMERIC | No |
The transaction ID which cancels this transaction.
28 | REPLACES_DTX_ID | NUMERIC | No |
The transaction that this transaction replaces.
29 | REPLACED_BY_DTX_ID | NUMERIC | No |
The transaction which replaced this transaction.
30 | RTRO_CNCL_BY_ID | NUMERIC | No |
The retro transaction ID that canceled this transaction.
31 | RTRO_CNCL_RSN_C_NAME | VARCHAR | No |
The category of the retro mismatch code.
May contain organization-specific values: No
Category Entries:
Duplicate Transaction
Member Not Eligible
Incorrect Capitation Context or Amount
Incorrect Commission Context or Amount
32 | SPEC_MEMBER_MONTHS | INTEGER | No |
The specialty member months of the transaction.
33 | DIST_LOB_ID | VARCHAR | No |
The capitation payment line of business.
34 | DIST_LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
35 | DIST_RKP_ID | VARCHAR | No |
The unique ID of the risk panel for capitation distribution.
36 | DIST_RKP_ID_RISK_PANEL_NAME | VARCHAR | No |
The name of the risk panel.
37 | DIST_MGRP_ID_MEM_GRP_NAME | VARCHAR | No |
The name of the member group
38 | CAP_RETRO_LEVEL | INTEGER | No |
Retro level capitation transactions.
39 | RELEASED_TO_AP_YN | VARCHAR | No |
Whether the transaction has been released to accounts payable (AP).
May contain organization-specific values: No
Category Entries:
No
Yes
40 | CAP_COUNTY_C_NAME | VARCHAR | No |
The member's county used in outgoing capitation.
May contain organization-specific values: Yes
41 | CAP_CVG_ATTRIBUTES_EXTERNAL | VARCHAR | No |
The coverage's attributes used in outgoing capitation formatted by category list CVG 2001.
42 | MCARE_CONTRACT_NUM | VARCHAR | No |
The medicare advantage contract number that matches the Member Group's medicare advantage contract number.
43 | WITHHOLD_REASON_C_NAME | VARCHAR | No |
The capitation payment withhold reason category ID for the transaction.
May contain organization-specific values: No
Category Entries:
Member Suspended
Member Limit Exceeded
Rate Element Used Default Value
Invalid Broker of Record
Partial Withhold Tiered Payment
Billing Account Suspended
44 | CAPITATION_CODE_C_NAME | VARCHAR | No |
The capitation code associated with the transaction.
May contain organization-specific values: Yes
45 | REGION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
46 | MEDICAL_GROUP_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
47 | PRODUCT_TYPE_C_NAME | VARCHAR | No |
The product type associated with the transaction.
May contain organization-specific values: Yes
48 | PCP_AMOUNT | NUMERIC | No |
The amount for this transaction. This is only populated for PCP capitation transactions.
49 | MEM_LIST_ID | NUMERIC | No |
The unique ID of the associated transaction member list. It is only populated for Specialty Capitation transactions that utilize a new member list.
50 | MEM_COUNT | INTEGER | No |
The number of members listed for the transaction. This data is only populated for Specialty Capitation transactions.
51 | ELIGIBILITY_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.
52 | 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.