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
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
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.