Class: Healthcare_benefit_product

Description of: Healthcare_benefit_product

Class steward is Patient Administration
A collection of health benefits

Attribute definitions for: Healthcare_benefit_product

assignment_of_benefits_ind

An indication as to whether the insured agreed to assign the insurance benefits to the healthcare provider.

EXTREF: This onformation is reported on UB92 FL 53.

|IN1^20^00445^Assignment of Benefits|

benefit_plan_nm

The name of the benefit plan.

|FT1^14^00368^Insurance Plan ID| |IN1^2^00368^Insurance Plan ID|

benefit_plan_type_cd

A code classifying the benefit plan type (e.g., commercial, Medicare, Medicaid, . . .).

|DRG^8^00770^DRG Payor| |IN1^15^00440^Plan Type|

benefit_product_desc

A description of the healtcare benefit. For example, Healthpol-Plus is a health insurance offering of xyz company that offers additional vison and dental benefits over the standard Healthpol product.

Rationale: Clarify attribute name and definition.

OpenIssue: PAFM needs to continue to work on this definition since it is still to fuzzy. Need additional explicit examples. Committee will continue to work on definition and consult with Information Management.

benefits_coordination_ind

An indication as to whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient.

|IN1^21^00446^Coordination of Benefits|

cob_priority_amt

The priority sequence for an insurance plan that works in conjunction with other insurance.

|IN1^22^00447^Coord of Ben. Priority|

combine_baby_bill_ind

An indication as to whether charges for a baby should be combined with charges for the mother.

|IN2^20^00491^Combine Baby Bill|

effective_dt

The date the healthcare coverage first becomes effective.

|IN1^12^00437^Plan Effective Date|

eligibility_source_cd

A code depicting the source of information about the insured's eligibility for benefits (e.g., insurance company, employer, insured presented policy, insured presented card, signed statement on file, verbal information, none, . . .).

|IN2^27^00498^Eligibility Source|

group_benefit_ind

A indication as to whether the healthcare coverage is a group contract.

id

An identifier for the healthcare coverage benefit plan.

Rationale: Duplicate of Healthcare_benefit_plan.benefit_plan_ID

OpenIssue: For CQ to resolve: we must have a data type for this that covers the instance identifier, the identifier type, and the assigning authority ID. This is a repeatable attribute.

|IN1^35^00460^Company Plan Code| |IN1^36^00461^Policy Number| |IN1^46^00471^Prior Insurance Plan ID|

mail_claim_party_cd

A code indicating the party to which the claim should be mailed (e.g., employer, guarantor, insurance company, patient, . . .).

|IN2^5^00476^Mail Claim Party|

policy_source_cd

A code indicating how the policy information was obtained.

|IN2^60^00800^Policy Source | |SCH^22^00800^Policy Source |

release_information_cd

A code describing what information, if any, a provider can release about a patient.

EXTREF: This information is reported on UB92 FL 52.

|IN1^27^00452^Release Information Code|

status_cd

A code depicting the status of the healthcare coverage.

|IN2^16^00487^Champus Status|

termination_dt

The last date of service that the insurance will cover or be responsible for.

|IN1^13^00438^Plan Expiration Date|

Association definitions for: Healthcare_benefit_product

governs (0,n) :: Preferred_provider_participation :: is_governed_by (0,1)

is_validated_by (0,n) :: Insurance_certification :: provides_validation_for (1,1)

is_for (1,1) :: Patient :: has (0,n)

is_associated_with (0,n) :: Financial_transaction :: is_associated_with (0,1)

is_offered_by (1,1) :: Insurer :: offers (0,n)

has_as_purchaser (1,1) :: Health_benefit_plan_purchaser :: is_the_purchaser_of (0,n)

Whole-part definitions for: Healthcare_benefit_product

has_parts (0,n) :: Healthcare_benefit_coverage :: is_part_of (1,1)