Class: Healthcare_benefit_service

Description of: Healthcare_benefit_service

Class steward is Patient Administration
A level of coverage for a selected class of Healthcare services.

Attribute definitions for: Healthcare_benefit_service

access_protocol_desc

Description of the access protocol for the benefit service type.

capitation_ind

An indication that the benefit service is a capitated service.

coinsurance_ind

An indication that coinsurance is applicable for the benefit service.

coinsurance_pct

The coinsurance percentage for the benefit service.

copayment_amt

The copayment amount for the benefit service.

deductible_amt

The benefit service deductible amount.

lower_coverage_limit_amt

The lower coverage limit.

pay_cap_limit_amt

The payment limit on the benefit service.

pcp_referral_ind

An indicator that the benefit service provided by a non primary provider must have a referral from a primary care provider to be covered.

primary_care_provider_ind

An indicator that the benefit service must be provided by a primary care provider to be covered.

review_ind

A indication that the benefit service will be subject to review prior to payment.

|IN3^20^00521^Pre-Certification Req/Window|

upper_coverage_limit_amt

The upper limit of the benefit coverage.

Connection definitions for: Healthcare_benefit_service

provides_coverage_for (1,n) :: Master_service :: is_covered_by (0,n)

Whole-part definitions for: Healthcare_benefit_service

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