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 This table has been replaced by CAP_PAYMENT.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
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 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
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.