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
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
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	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	NUMERIC	No
	The internal ID of the received service area.
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	NUMERIC	No
	The internal ID of the received plan.
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	NUMERIC	No
	The internal ID of the received location.
22	RCPT_PCP_PROV_ID	VARCHAR	No
	The internal ID of the primary care provider (PCP) of the member associated with the transaction.
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
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	NUMERIC	No
	The internal ID of the reconciled plan.
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	NUMERIC	No
	The internal ID of the reconciled location.
37	RCNCL_PCP_PROV_ID	VARCHAR	No
	The internal ID of the reconciled primary care provider (PCP) of the member associated with the transaction.
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	VARCHAR	No
	The unique ID of the member group used for capitation receipt.
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	RCNCL_REGISTRY_ID	NUMERIC	No
	The ID of the patient registry determined during reconciliation.
51	RCNCL_REGISTRY_ID_REGISTRY_NAME	VARCHAR	No
	The name of the registry record.
52	RCPT_MEM_ID_CVG	VARCHAR	No
	The member ID from an incoming capitation file.
53	RCNCL_MEMBER_ID_CVG	VARCHAR	No
	The member ID used for reconciling incoming capitation.
54	RCPT_ADJ_TYPE_C_NAME	VARCHAR	No
	Stores the type of the capitation payment adjustment. May contain organization-specific values: Yes No Entries Defined