CAP_PAY_REPL

Description: |
The CAP_PAY_REPL table contains information about capitation payments. This table has been replaced by CAP_PAYMENT.

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 | MEM_DOB | 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 | MEM_LIST_ID | NUMERIC | No |
The unique ID of the associated transaction member list. It is only populated for Specialty Capitation transactions.
14 | SERV_AREA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
15 | CARRIER_ID | VARCHAR | No |
The carrier ID of the transaction.
16 | CARRIER_ID_CARRIER_NAME | VARCHAR | No |
The name of the carrier record.
17 | NETWORK_ID | VARCHAR | No |
The network ID of the transaction.
18 | NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
19 | PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
20 | PLAN_GRP_ID | VARCHAR | No |
The employer group ID of the transaction.
21 | PLAN_GRP_ID_PLAN_GRP_NAME | VARCHAR | No |
The name of the employer group record
22 | LOCATION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
23 | 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.
24 | COVERAGE_ID | NUMERIC | No |
The coverage ID of the member in the transaction.
25 | SPECIALTY_C_NAME | VARCHAR | No |
The specialty of the transaction.
May contain organization-specific values: Yes
26 | SPEC_RATE | NUMERIC | No |
The rate for specialty of the transaction.
27 | VENDOR_ID_VENDOR_NAME | VARCHAR | No |
The name of the vendor.
28 | TX_CANC_TX_ID | NUMERIC | No |
The transaction ID which cancels this transaction.
29 | REPLACES_DTX | NUMERIC | No |
The transaction that this transaction replaces.
30 | REPLACED_BY_DTX | NUMERIC | No |
The transaction which replaced this transaction.
31 | RTRO_CNCL_BY_ID | NUMERIC | No |
The retro transaction ID that canceled this transaction.
32 | 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
33 | SPEC_MEMBER_MONTHS | INTEGER | No |
The specialty member months of the transaction.
34 | ADJ_AMOUNT | NUMERIC | No |
The amount of the adjustment transaction.
35 | ADJ_VENDOR_ID_VENDOR_NAME | VARCHAR | No |
The name of the vendor.
36 | ADJ_CLAIM_ID | NUMERIC | No |
The claim ID of this adjustment transaction.
37 | ADJU_CLAIM_LINE | INTEGER | No |
The claim line number of this adjustment transaction.
38 | ADJ_MEM_ID | VARCHAR | No |
The member ID associated with this adjustment transaction.
39 | ADJ_MEM_DOB | DATETIME | No |
The date of birth of the member in this adjustment transaction.
40 | ADJ_MEM_SEX_C_NAME | VARCHAR | No |
The sex of the member in this adjustment transaction.
The category values for this column were already listed for column: MEM_SEX_C_NAME
41 | ADJ_MEM_LIST_ID | NUMERIC | No |
The member list ID of this adjustment transaction.
42 | ADJ_PCP_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.
43 | ADJ_SPECIALTY_C_NAME | VARCHAR | No |
The specialty of this adjustment transaction.
The category values for this column were already listed for column: SPECIALTY_C_NAME
44 | ADJ_SERV_AREA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
45 | ADJ_CARRIER_ID | VARCHAR | No |
The carrier ID of this adjustment transaction.
46 | ADJ_CARRIER_ID_CARRIER_NAME | VARCHAR | No |
The name of the carrier record.
47 | ADJ_NETWORK_ID | VARCHAR | No |
The network ID of this adjustment transaction.
48 | ADJ_NETWORK_ID_NETWORK_NAME | VARCHAR | No |
The name of the network.
49 | ADJ_BEN_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
50 | DIST_LOB_ID | VARCHAR | No |
The capitation payment line of business.
51 | DIST_LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
52 | DIST_RKP_ID | VARCHAR | No |
The unique ID of the risk panel for capitation distribution.
53 | DIST_RKP_ID_RISK_PANEL_NAME | VARCHAR | No |
The name of the risk panel.
54 | DIST_MGRP_ID_MEM_GRP_NAME | VARCHAR | No |
The name of the member group
55 | CAP_RETRO_LEVEL | INTEGER | No |
Retro level capitation transactions.
56 | MEM_COUNT | INTEGER | No |
The number of members listed in the associated member list of the transaction. This data is only populated for Specialty Capitation transactions.
57 | 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
58 | CAP_COUNTY_C_NAME | VARCHAR | No |
The member's county used in outgoing capitation.
May contain organization-specific values: Yes
59 | PCP_AMOUNT | NUMERIC | No |
The amount for this transaction. This is only populated for PCP capitation transactions.
60 | MCARE_CONTRACT_NUM | VARCHAR | No |
The medicare advantage contract number that matches the Member Group's medicare advantage contract number.
61 | 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
62 | CAPITATION_CODE_C_NAME | VARCHAR | No |
The capitation code associated with the transaction.
May contain organization-specific values: Yes
63 | REGION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
64 | MEDICAL_GROUP_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
65 | PRODUCT_TYPE_C_NAME | VARCHAR | No |
The product type associated with the transaction.
May contain organization-specific values: Yes
66 | CAP_CVG_ATTRIBUTES_EXTERNAL | VARCHAR | No |
The coverage's attributes used in outgoing capitation formatted by category list CVG 2001.