CAP_RR_EXPECTED
Description:
This table contains information on capitation receipt and reconciliation expected charge transactions.

Primary Key
Column Name Ordinal Position
TX_ID 1

Column Information
Name Type Discontinued?
1 TX_ID NUMERIC No
The unique identifier (.1 item) for the transaction record.
2 TX_TYPE_C_NAME NUMERIC 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
Incoming Receipt Expected
3 TX_STATUS_C_NAME NUMERIC No
The status of the transaction.
May contain organization-specific values: No
Category Entries:
Loaded
Reconciled
Calculated
AP Batched
Paid
Void
New
Fully Invoiced
Error
4 EFFECTIVE_DATE DATETIME No
First of the month we are expecting payment for.
5 POST_DATE DATETIME No
Post date of the transaction.
6 ELIGIBILITY_DATE DATETIME No
Eligibility date used when calculating expected amounts.
7 MEMBER_GROUP_ID_MEM_GRP_NAME VARCHAR No
The name of the member group
8 SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
9 CARRIER_ID VARCHAR No
The carrier ID.
10 CARRIER_ID_CARRIER_NAME VARCHAR No
The name of the carrier record.
11 NETWORK_ID VARCHAR No
The network ID.
12 NETWORK_ID_NETWORK_NAME VARCHAR No
The name of the network.
13 BENEFIT_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
14 PLAN_GRP_ID VARCHAR No
The employer group ID.
15 PLAN_GRP_ID_PLAN_GRP_NAME VARCHAR No
The name of the employer group record
16 PRIMARY_LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.
17 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.
18 SUBSCRIBER_IDENT VARCHAR No
The subscriber ID for matching to a transaction on an incoming capitation file.
19 LOB_ID VARCHAR No
The line of business ID.
20 LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
21 RKP_ID VARCHAR No
The risk panel ID.
22 RKP_ID_RISK_PANEL_NAME VARCHAR No
The name of the risk panel.
23 EXPECTED_AMOUNT NUMERIC No
The amount expected to be received for capitation.
24 CANCELED_BY_TX_ID NUMERIC No
The internal ID of the transaction which cancels this transaction.
25 CANCELS_TX_ID NUMERIC No
The internal ID of the transaction canceled by this transaction.
26 DISCREPANCY_TYPE_C_NAME NUMERIC No
The type of discrepancy that led to this transcation getting canceled or replaced.
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
27 DISCREPANCY_DETAILS VARCHAR No
Additional information about the discrepancy that is logged for this transaction.
28 COVERAGE_ID NUMERIC No
The internal coverage ID.
29 FULL_MONTHLY_AMOUNT NUMERIC No
The full monthly amount used when calculating the expected capitation amount prior to proration settings if the amount was calculated using a capitation age/sex rate table.
30 ELIGIBLE_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 will store the decimal value of the prorated portion.
31 RATE_FACTOR NUMERIC No
When the benefit plan associated with a member includes a capitation rate factor, this will store the value so an accurate rate calculation can be reconstructed.
32 CAP_RR_PRORATION_C_NAME NUMERIC No
The proration method used when calculating the expected amount.
May contain organization-specific values: No
Category Entries:
Eligibility Test Date
Daily Proration
Full Monthly Rate
Daily Proration with Test Date
Applicable Dates
33 REPLACES_TX_ID NUMERIC No
The internal ID of the transaction replaced by this transaction.
34 REPLACED_BY_TX_ID NUMERIC No
The internal ID of the transaction replacing this transaction.
35 ADJUSTMENT_CODE_C_NAME NUMERIC No
Indicates the retro type of this transaction.
May contain organization-specific values: No
Category Entries:
Cancel
Add