CAP_PAY
Description:
The CAP_PAY 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
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
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
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 NUMERIC No
The service area ID of the transaction.
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 NUMERIC No
The benefit ID of the transaction.
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 NUMERIC No
The primary location ID of the transaction.
23 PCP_PROV_ID VARCHAR No
The primary care provider ID of the transaction.
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 VARCHAR No
The vendor ID of the transaction.
28 VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
29 TX_CANC_TX_ID NUMERIC No
The transaction ID which cancels this transaction.
30 REPLACES_DTX NUMERIC No
The transaction that this transaction replaces.
31 REPLACED_BY_DTX NUMERIC No
The transaction which replaced this transaction.
32 RTRO_CNCL_BY_ID NUMERIC No
The retro transaction ID that canceled this transaction.
33 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
34 SPEC_MEMBER_MONTHS INTEGER No
The specialty member months of the transaction.
35 ADJ_AMOUNT NUMERIC No
The amount of the adjustment transaction.
36 ADJ_VENDOR_ID VARCHAR No
The vendor ID of this adjustment transaction.
37 ADJ_VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
38 ADJ_CLAIM_ID NUMERIC No
The claim ID of this adjustment transaction.
39 ADJU_CLAIM_LINE INTEGER No
The claim line number of this adjustment transaction.
40 ADJ_MEM_ID VARCHAR No
The member ID associated with this adjustment transaction.
41 ADJ_MEM_DOB DATETIME No
The date of birth of the member in this adjustment transaction.
42 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
43 ADJ_MEM_LIST_ID NUMERIC No
The member list ID of this adjustment transaction.
44 ADJ_PCP_ID VARCHAR No
The primary care provider ID of this adjustment transaction.
45 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
46 ADJ_SERV_AREA_ID NUMERIC No
The service area ID of this adjustment transaction.
47 ADJ_CARRIER_ID VARCHAR No
The carrier ID of this adjustment transaction.
48 ADJ_CARRIER_ID_CARRIER_NAME VARCHAR No
The name of the carrier record.
49 ADJ_NETWORK_ID VARCHAR No
The network ID of this adjustment transaction.
50 ADJ_NETWORK_ID_NETWORK_NAME VARCHAR No
The name of the network.
51 ADJ_BEN_PLAN_ID NUMERIC No
The benefit plan ID of this adjustment transaction.
52 DIST_LOB_ID VARCHAR No
The capitation payment line of business.
53 DIST_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
54 DIST_RKP_ID VARCHAR No
The unique ID of the risk panel for capitation distribution.
55 DIST_RKP_ID_RISK_PANEL_NAME VARCHAR No
The name of the risk panel.
56 DIST_MGRP_ID VARCHAR No
The unique ID of the member group for capitation distribution.
57 CAP_RETRO_LEVEL INTEGER No
Retro level capitation transactions.
58 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.
59 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
60 CAP_COUNTY_C_NAME VARCHAR No
The member's county used in outgoing capitation.
May contain organization-specific values: Yes
61 PCP_AMOUNT NUMERIC No
The amount for this transaction. This is only populated for PCP capitation transactions.
62 MCARE_CONTRACT_NUM VARCHAR No
The medicare advantage contract number that matches the Member Group's medicare advantage contract number.
63 WITHHOLD_REASON_C_NAME VARCHAR No
The PCP 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
64 CAPITATION_CODE_C_NAME VARCHAR No
The capitation code associated with the transaction.
May contain organization-specific values: Yes
65 REGION_ID NUMERIC No
The region ID of the transaction.
66 MEDICAL_GROUP_ID NUMERIC No
The medical group ID of the transaction.
67 PRODUCT_TYPE_C_NAME VARCHAR No
The product type associated with the transaction.
May contain organization-specific values: Yes