CAP_RR
Description:
The CAP_RR table contains information on capitation receipt and reconciliation transactions.

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 RCPT_MEM_DOB DATETIME No
The date of birth of the received member.
12 RCPT_MEM_SEX_C_NAME VARCHAR No
The sex of the received member.
May contain organization-specific values: Yes
Category Entries:
Female
Male
Unknown
Nonbinary
X
Other
13 RCPT_SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
14 RCPT_CARRIER_ID VARCHAR No
The internal ID of the received carrier.
15 RCPT_CARRIER_ID_CARRIER_NAME VARCHAR No
The name of the carrier record.
16 RCPT_NETWORK_ID VARCHAR No
The internal ID of the received network.
17 RCPT_NETWORK_ID_NETWORK_NAME VARCHAR No
The name of the network.
18 RCPT_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
19 RCPT_PLAN_GRP_ID VARCHAR No
The internal ID of the received plan group.
20 RCPT_PLAN_GRP_ID_PLAN_GRP_NAME VARCHAR No
The name of the employer group record
21 RCPT_LOCATION_ID_LOC_NAME VARCHAR No
The name of the revenue location.
22 RCPT_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 RCPT_SUB_ID VARCHAR No
The ID of the received subscriber.
24 RCPT_ADJ_CODE_C_NAME VARCHAR No
The category value for the received adjustment code.
May contain organization-specific values: No
Category Entries:
Cancel
Add
25 RCPT_AMOUNT NUMERIC No
The amount received for the transaction.
26 CANCELED_BY_ID NUMERIC No
The internal ID of the transaction which cancels this transaction.
27 CANCELS_TX_ID NUMERIC No
The internal ID of the transaction cancelled by this transaction.
28 RCNCL_DISC_TYPE_C_NAME VARCHAR No
The category value of the reconciliation discrepancy type.
May contain organization-specific values: No
Category Entries:
No Match For Cancel Transaction
Duplicate Transaction
Incorrect Capitation Context or Amount
Effective Date Exceeds Retro Window
Member Not Eligible
Member Eligible, No Cap Received
Incorrect Monthly Net Amount
Formula Table Evaluation Error
29 RCNCL_MEM_DOB DATETIME No
The date of birth for the reconciled member.
30 RCNCL_SEX_C_NAME VARCHAR No
The sex of the reconciled member.
The category values for this column were already listed for column: RCPT_MEM_SEX_C_NAME
31 RCNCL_NETWORK_ID VARCHAR No
The internal ID of the reconciled network.
32 RCNCL_NETWORK_ID_NETWORK_NAME VARCHAR No
The name of the network.
33 RCNCL_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
34 RCNCL_PLAN_GRP_ID VARCHAR No
The internal ID of the reconciled plan group.
35 RCNCL_PLAN_GRP_ID_PLAN_GRP_NAME VARCHAR No
The name of the employer group record
36 RCNCL_LOCATION_ID_LOC_NAME VARCHAR No
The name of the revenue location.
37 RCNCL_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.
38 RCNCL_CVG_ID NUMERIC No
The internal ID of the reconciled coverage.
39 RCNCL_SUB_ID VARCHAR No
The ID of the reconciled subscriber.
40 RCNCL_AMOUNT NUMERIC No
The amount reconciled.
41 RCPT_MGRP_ID_MEM_GRP_NAME VARCHAR No
The name of the member group
42 RCPT_LOB_ID VARCHAR No
The capitation receipt line of business.
43 RCPT_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
44 RCPT_RKP_ID VARCHAR No
The unique ID of the risk panel used for capitation receipt.
45 RCPT_RKP_ID_RISK_PANEL_NAME VARCHAR No
The name of the risk panel.
46 RCNCL_LOB_ID VARCHAR No
The capitation reconciliation line of business.
47 RCNCL_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
48 RCNCL_RKP_ID VARCHAR No
The unique ID of the risk panel used for capitation reconciliation.
49 RCNCL_RKP_ID_RISK_PANEL_NAME VARCHAR No
The name of the risk panel.
50 RCPT_MEM_ID_CVG VARCHAR No
The member ID from an incoming capitation file.
51 RCNCL_MEMBER_ID_CVG VARCHAR No
The member ID used for reconciling incoming capitation.
52 RCPT_ADJ_TYPE_C_NAME VARCHAR No
Stores the type of the capitation payment adjustment.
May contain organization-specific values: Yes
No Entries Defined
53 RCNCL_DISC_DETAILS VARCHAR No
Stores additional information about the discrepancy that is logged for this transaction.
54 RCNCL_MONTHLY_AMT NUMERIC No
Stores the full monthly amount used when calculating the expected capitation payment amount prior to proration settings if the payment was calculated using a capitation age/sex rate table.
55 RCNCL_ELIG_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.
56 RCNCL_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.
57 CAP_RR_PRORATION_C_NAME VARCHAR No
Stores the proration method used during capitation reconciliation to calculate the expected amount for a capitation monthly payment.
May contain organization-specific values: No
Category Entries:
Eligibility Test Date
Daily Proration
Full Monthly Rate
Daily Proration with Test Date
Applicable Dates