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 This table has been replaced by CAP_PAYMENT.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
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	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
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
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.