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
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
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
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
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.