Pega Care Management 8.2 Data Model Overview
This article provides a data dictionary for the Pega Care Management application, which describes the structure of primary classes.
In Dev Studio, use the Data Visualizer tool to display a visual depiction of the relationships between a selected data type and its properties, and between the data type and other data types.
The following tables are described in this article:
- Account Role
- Accumulators - Family (Benefits)
- Accumulators - Individual (Benefits)
- Authorization details
- Business entity
- CareTeam contact
- Claim data
- Clinical Observation
- Conference type
- Contact
- Conversation logs
- Customer Address
- Customer Important Messages
- EndPointSettings
- Insurance Contract
- LOINC Codes
- LOINC units
- Medical History
- Member
- Member incident
- Member notes
- Member risk score
- Participant type
- Patient's Allergy information
- Patient's appointment information
- Policy
- Practitioner
- Prescription - Clinical
- Product - Benefits
- Provider - Group / Facility
- Provider affiliation
- Provider contract
- Subscriber (Policy Holder)
Account Role
Provides application access to account role data such as role type, role name, and roleId used by the Customer Service application.
Pega Internal Name: PegaCA-Interface-Roles
Active | Label: Active Type: Text |
AddressLine1 | Label: Address line one Type: Text |
City | Label: City Type: Text |
Country | Label: Country Type: Text |
CountryCode | Label: CountryCode Type: Text |
CustomerValue | Label: Customer Value Type: Text |
Description | Label: Description Type: Text |
Label: Email Type: Text | |
Language | Label: Language Type: Text |
PhoneNumber | Label: Phone Number Type: Text |
RoleDescription | Label: Role Description Type: Text |
RoleName | Label: Role name Type: Text |
RoleId | Label: RoleId Type: Text |
RoleType | Label: RoleType Type: Text |
SocialSecurityNumber | Label: Social security number Type: Text |
StateCode | Label: State Code Type: Text |
ZipCode | Label: Zip code Type: Text |
Accumulators - Family (Benefits)
PegaHC-Data-FamilyAccumulators data type is used to manage benefit accumulator data for a family. Benefits such as annual Out of pocket maximum, deductible have certain limits defined at family level. All these limits are tracked in accumulators. This data type help managing all such family accumulators.
Pega Internal Name: PegaHC-Data-FamilyAccumulators
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
Description | Label: Description Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
FamilyINOOPocketUsed | Label: Family IN OOP used Type: Double |
FamilyOONOOPocketLimit | Label: Family OON OOP limit Type: Double |
FamilyOOPocketLimitTotal | Label: Family OON OOP limit total Type: Double |
FamilyOONOOPocketRemain | Label: Family OON OOP remaining Type: Double |
FamilyOOPocketRemainTotal | Label: Family OON OOP remaining total Type: Double |
FamilyOOPocketUsedTotal | Label: Family OON OOP used total Type: Double |
PolicyID | Label: Family accumulator policy identifier Type: Text |
FamilyINDedLimit | Label: Family accumulator-accumulator family IN ded limit Type: Double |
FamilyINDedRemain | Label: Family accumulator-accumulator family IN ded remain Type: Double |
FamilyINDedUsed | Label: Family accumulator-accumulator family IN ded used Type: Double |
FamilyOONOOPocketUsed | Label: Family accumulator-accumulator family OON OO pocket used Type: Double |
FamilyOONDedLimit | Label: Family accumulator-accumulator family OON ded limit Type: Double |
FamilyOONDedRemain | Label: Family accumulator-accumulator family OON ded remain Type: Double |
FamilyOONDedUsed | Label: Family accumulator-accumulator family OON ded used Type: Double |
FamilyDedLimitTotal | Label: Family accumulator-accumulator family ded limit total Type: Double |
FamilyDedRemainTotal | Label: Family accumulator-accumulator family ded remain total Type: Double |
FamilyDedUsedTotal | Label: Family accumulator-accumulator family ded used total Type: Double |
AccPeriodBegin | Label: Family accumulator-accumulator period begin Type: Date |
AccPeriodEnd | Label: Family accumulator-accumulator period end Type: Date |
FamilyINOOPocketLimit | Label: Family in OOP limit Type: Double |
FamilyINOOPocketRemain | Label: Family in OOP remaining Type: Double |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
LISTING_SEQ_NO | Label: NDC codes listing sequence number Type: Integer |
NewVersionNote | Label: New version note Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
PatientID | Label: Patient identifier Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanID | Label: PlanID Type: Identifier |
PlanVersion | Label: PlanVersion Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status of the data instance Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
Code | Label: Test code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Accumulators - Individual (Benefits)
Accumulators- Individual(Benefits) data type is used to manage benefit accumulator data for an individual. Benefits such as annual Out of pocket maximum, deductible , annual physical exams have certain limits defined at individual level. All these limits are tracked in accumulators. This data type help managing all such individual accumulators.
Pega Internal Name: PegaHC-Data-IndividualAccumulators
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
Description | Label: Description Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
IndividualOONOOPocketRemain | Label: Ind OON OOP remaining Type: Double |
IndividualOOPocketLimitTotal | Label: Ind OON OOP total Type: Double |
IndividualOOPocketRemainTotal | Label: Ind OOP remaining total Type: Double |
IndividualOOPocketUsedTotal | Label: Ind OOP used total Type: Double |
PolicyID | Label: Individual accumulator policy identifier Type: Text |
IndividualINOOPocketLimit | Label: Individual accumulators IN OOP limit Type: Double |
IndividualINOOPocketRemain | Label: Individual accumulators IN OOP remain Type: Double |
IndividualINOOPocketUsed | Label: Individual accumulators IN OOP used Type: Double |
IndividualINDedLimit | Label: Individual accumulators IN ded limit Type: Double |
IndividualINDedRemain | Label: Individual accumulators IN ded remain Type: Double |
IndividualINDedUsed | Label: Individual accumulators IN ded used Type: Double |
IndividualOONOOPocketLimit | Label: Individual accumulators OON OOP limit Type: Double |
IndividualOONOOPocketUsed | Label: Individual accumulators OON OOP used Type: Double |
IndividualOONDedLimit | Label: Individual accumulators OON ded limit Type: Double |
IndividualOONDedRemain | Label: Individual accumulators OON ded remain Type: Double |
IndividualOONDedUsed | Label: Individual accumulators OON ded used Type: Double |
IndividualDedLimitTotal | Label: Individual accumulators ded limit total Type: Double |
IndividualDedRemainTotal | Label: Individual accumulators ded remain total Type: Double |
IndividualDedUsedTotal | Label: Individual accumulators ded used total Type: Double |
MemberID | Label: Individual accumulators member identifier Type: Text |
AccPeriodBegin | Label: Individual accumulators period begin Type: Date |
AccPeriodEnd | Label: Individual accumulators period end Type: Date |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
LISTING_SEQ_NO | Label: NDC codes listing sequence number Type: Integer |
NewVersionNote | Label: New version note Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
PatientID | Label: Patient identifier Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanID | Label: PlanID Type: Identifier |
PlanVersion | Label: PlanVersion Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status of the data instance Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
Code | Label: Test code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Authorization details
The Authorization Data Class holds authorization data as it is created from the Authorization flows. These could be inpatient, Outpatient, Referral or Pharmacy authorizations
Pega Internal Name: PegaHC-Data-Authorization
DiagnosisCodePointer | Label: ***DEPRECATED*** Type: Text |
ActionCode | Label: Action Code Type: Text |
AuthType | Label: Action type Type: Text |
AdmissionTypeCode | Label: Admission Type Code Type: Text |
APCDetails | Label: Ambulatory payment classification details Type: Object Of Type: APC Information |
ApprovedPlaceOfService | Label: Approved Place Of Service Type: Text |
ApprovedLOS | Label: ApprovedLOS Type: Integer |
Attachments | Label: Attachments Type: List Of Type: Attachments |
AuthHistory | Label: Auth history Type: List Of Type: Embed-PegaHC-CMF-AuthHistory |
AuthList | Label: Auth list Type: List Of Type: Authorization details |
AuthorizationDecision | Label: Authorization decision Type: Text |
DrugCodeList | Label: Authorization drug code list Type: List Of Type: Drug Information |
FacilityName | Label: Authorization facility name Type: Text |
PrescriptionEndDate | Label: Authorization prescription end date Type: Date |
Procedure | Label: Authorization procedure Type: List Of Type: Service (Healthcare) |
RequesterEmployer | Label: Authorization requester employer Type: Object Of Type: Company |
RequesterPayer | Label: Authorization requester payer Type: Object Of Type: Payer |
RequesterTPA | Label: Authorization requester third-party administrator Type: Object Of Type: Contact |
ServiceProvider | Label: Authorization service provider Type: Object Of Type: Provider |
ServiceTraceNumber | Label: Authorization service trace number Type: Text |
Submitter | Label: Authorization submitter Type: Object Of Type: PegaHC-Data-Party |
Subscriber | Label: Authorization subscriber Type: Object Of Type: Member |
TraceAssigningEntityIdentifier | Label: Authorization trace assigning entity identifier Type: Text |
TraceAssigningEntityAdditionalIdentifier | Label: Authorization trace assigning entity primary identifier Type: Text |
UMGuidelineDescription | Label: Authorization um guideline description Type: Text |
UnitsUnused | Label: Authorization units unused Type: Integer |
UMO | Label: Authorization utilization management organization Type: Object Of Type: PegaHC-Data-Party |
AuthorizedAmount | Label: Authorized Amount Type: Double |
PricingDetails | Label: Capture pricing details from external pricing system Type: List Of Type: Response artifacts obtained from external pricing systems |
CertificationEffectiveDate | Label: Certification Effective Date Type: Date |
CertificationExpirationDate | Label: Certification Expiration Date Type: Date |
CertificationIssueDate | Label: Certification Issue Date Type: Date |
CertificationNumber | Label: Certification Number Type: Text |
CertificationTypeCode | Label: Certification Type Code Type: Text |
NonCoveredChargeAmount | Label: Claim line non covered charges amount Type: Decimal |
CodeCategory | Label: Code Category Type: Text |
ConditionCodeEPSDTReferral | Label: Condition code EPSDT referral Type: Text |
ContactChannel | Label: ContactChannel Type: Text |
CreateAuthorization | Label: Create Authorization Type: Text |
DecisionNote | Label: Decision Note Type: List Of Type: Embed-PegaHC-Notes |
DelayReasonCode | Label: Delay Reason Code Type: Text |
AuthDeniedDate | Label: Denied Date Type: Date |
Diagnosis | Label: Diagnosis Type: List Of Type: ***Deprecated*** |
DiagnosisCodeList | Label: DiagnosisCodeList Type: List Of Type: Diagnosis Information - Embedded |
DischargeLocation | Label: Discharge Location Code Type: Text |
EPSDTIndicator | Label: EPSDT indicator Type: Text |
EquipmentReasonDescription | Label: Equipment Reason Description Type: Text |
EstimatedBirthDate | Label: Estimated Birth Date Type: Date |
Facility | Label: Facility Type: Object Of Type: Provider - Group / Facility |
FacilityCodeQualifier | Label: Facility Code Qualifier Type: Text |
FacilityID | Label: FacilityID Type: Text |
Frequency | Label: Frequency Type: Text |
HomeHealthCertificationPeriod | Label: Home Health Certification Period Type: Text |
ICDVersion | Label: International classification of diseases version Type: Text |
LastAdmissionPeriod | Label: Last Admission Period Type: Date |
LastMenstrualPeriodDate | Label: Last Menstrual Period Date Type: Date |
LastVisitDate | Label: Last Visit Date Type: Date |
LengthOfStay | Label: LengthOfStay Type: Integer |
LevelOfServiceCode | Label: Level Of Service Code Type: Text |
MedicareCoverageIndicator | Label: Medicare Coverage Indicator Type: Text |
Member | Label: Member Type: Object Of Type: Member |
MemberFirstName | Label: MemberFirstName Type: Text |
MemberID | Label: MemberID Type: Text |
MemberLastName | Label: MemberLastName Type: Text |
MemberValid | Label: MemberValid Type: Text |
ModifiedProcedureCodeList | Label: Modify Procedure CodeList Type: List Of Type: Embed-PegaHC-Procedure |
NegotiatedRateFrequency | Label: Negotiated Rate Frequency Type: Text |
NegotiatedPrice | Label: NegotiatedPrice Type: Decimal |
NegotiatedRate | Label: NegotiatedRate Type: Decimal |
NumberofVisits | Label: Number of Visits Type: Integer |
NursingHomeResidentialStatusCode | Label: Nursing Home Residential Status Code Type: Text |
OnsetDate | Label: Onset Date Type: Date |
OralCavityDesignationCode | Label: OralCavityDesignationCode Type: Text |
OxygenDeliverySystemCode | Label: Oxygen Delivery System Code Type: Text |
OxygenEquipmentTypeCode | Label: Oxygen Equipment Type Code Type: Text |
OxygenUsePeriodHourCount | Label: Oxygen Use Period Hour Count Type: Integer |
PeriodCount | Label: Period Count Type: Integer |
PhysicianContactDate | Label: Physician Contact Date Type: Date |
PhysicianOrderDate | Label: Physician Order Date Type: Date |
PlaceOfProfessionalServiceCode | Label: Place of professional service code Type: Text |
PlaceofServiceCode | Label: PlaceofServiceCode Type: Text |
PolicyNumber | Label: PolicyNumber Type: Text |
PortableOxygenSystemFlowRate | Label: Portable Oxygen System Flow Rate Type: Text |
PreviousCertificationIdentifier | Label: Previous Certification Identifier Type: Text |
PriceFrequency | Label: PriceFrequency Type: Text |
PrimaryDiagnosis | Label: Primary Diagnosis Type: Text |
ProcedureCodeList | Label: ProcedureCodeList Type: List Of Type: Embed-PegaHC-Procedure |
PrognosisCode | Label: Prognosis Code Type: Text |
ProposedOrActualAdmissionDate | Label: Proposed Or Actual Admission Date Type: Date |
ProposedOrActualDischargeDate | Label: Proposed Or Actual Discharge Date Type: Date |
ProposedOrActualServiceDate | Label: Proposed Or Actual Service Date Type: Date |
ProposedOrActualSurgeryDate | Label: Proposed Or Actual Surgery Date Type: Date |
ProviderValid | Label: ProviderValid Type: Text |
RARCodes | Label: RAR Codes Type: List Of Type: Claim Remittance/Remark Codes |
ReferringProvider | Label: Referring Provider Type: Object Of Type: Provider |
ReferringProviderID | Label: ReferringProviderID Type: Text |
ReleaseofInformationCode | Label: Release of Information Code Type: Text |
RequestCategoryCode | Label: Request Category Code Type: Text |
RequestDate | Label: RequestDate Type: Date |
RequestedAmount | Label: Requested Amount Type: Decimal |
LOB | Label: Requested LOB Type: Text |
Requester | Label: Requester Type: Object Of Type: Provider |
RespiratoryTherapistOrderText | Label: Respiratory Therapist Order Text Type: Text |
SecondSurgicalOpinionIndicator | Label: Second Surgical Opinion Indicator Type: Text |
ServiceDate | Label: Service Date Type: Date |
AccidentDate | Label: Service accident date Type: Date |
ActivitiesPermittedCode | Label: Service activities permitted code Type: Text |
ActualAdmissionDate | Label: Service actual admission date Type: Date |
ActualDischargeDate | Label: Service actual discharge date Type: Date |
AcuteManifestationDate | Label: Service acute manifestation date Type: Date |
AdmissionDate | Label: Service admission date Type: Date |
AdmissionDiagnosis | Label: Service admission diagnosis Type: Text |
AdmissionSourceCode | Label: Service admission source code Type: Text |
AmbulanceDropOffCity | Label: Service ambulance drop off city Type: Text |
AmbulanceDropOffPostalCode | Label: Service ambulance drop off postal code Type: Text |
AmbulanceDropOffStateCode | Label: Service ambulance drop off state code Type: Text |
AmbulanceDropOff | Label: Service ambulance drop-off Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulancePickUpCity | Label: Service ambulance pick up city Type: Text |
AmbulancePickUpPostalCode | Label: Service ambulance pick up postal code Type: Text |
AmbulancePickUpStateCode | Label: Service ambulance pick up state code Type: Text |
AmbulancePickup | Label: Service ambulance pickup Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulanceTransportCode | Label: Service ambulance transport code Type: Text |
AmbulanceTransportReasonCode | Label: Service ambulance transport reason code Type: Text |
AmbulanceTripDestinationAddress | Label: Service ambulance trip destination address Type: Text |
AmbulanceTripOriginAddress | Label: Service ambulance trip origin address Type: Text |
AnesthesiaRelatedSurgicalProcedure | Label: Service anesthesia related surgical procedure Type: Text |
ArterialBloodGasQuantity | Label: Service arterial blood gas quantity Type: Decimal |
AssessmentDate | Label: Service assessment date Type: Date |
AssumedRelinqCareDate | Label: Service assumed or relinquished care date Type: Date |
AuthorizationReason | Label: Service authorization reason Type: Text |
AuthorizedUnitCount | Label: Service authorized service unit count Type: Integer |
BeginTherapyDate | Label: Service begin therapy date Type: Date |
BenefitAmount | Label: Service benefit amount Type: Decimal |
BenefitBeginDate | Label: Service benefit begin date Type: Date |
BenefitCoverageLevelCode | Label: Service benefit coverage level code Type: Text |
BenefitEndDate | Label: Service benefit end date Type: Date |
BenefitPercent | Label: Service benefit percent Type: Integer |
BenefitQuantity | Label: Service benefit quantity Type: Integer |
CertificationConditionIndicator | Label: Service certification condition indicator Type: Text |
CertificationPeriodProjVisitCount | Label: Service certification period projected visit count Type: Integer |
CertificationTypeCodeValues | Label: Service certification type code values Type: Text |
ClaimServicePeriod | Label: Service claim service period Type: Text |
CLIANumber | Label: Service clinical laboratory improvement amendment number Type: Text |
CodeListQualifierCode | Label: Service code list qualifier code Type: Text |
ComplicationIndicator | Label: Service complication indicator Type: Text |
ConditionAdditionalDescriptionPatient | Label: Service condition additional description patient Type: Text |
ConditionCode | Label: Service condition code Type: Text |
ConditionCodeAbortion | Label: Service condition code - abortion Type: Text |
ConditionCodeAmbulance | Label: Service condition code - ambulance transport Type: Text |
ConditionCodePatient | Label: Service condition code - patient Type: Text |
ConditionCodeVision | Label: Service condition code - vision Type: Text |
ConditionDescriptionPatient | Label: Service condition description - patient Type: Text |
CoveragePeriod | Label: Service coverage period Type: Date |
CoveredDaysorVisitsCount | Label: Service covered days or visits count Type: Integer |
CurrentHealthConditionCode | Label: Service current health condition code Type: Text |
DailyOxygenUseCount | Label: Service daily oxygen use count Type: Integer |
Date | Label: Service date Type: List Of Type: Embed-PegaHC-Date |
DaysofSupply | Label: Service days of supply Type: Integer |
DeliveryFrequencyCode | Label: Service delivery frequency code Type: Text |
DeliveryPatternTimeCode | Label: Service delivery pattern time code Type: Text |
Dose | Label: Service dose Type: Text |
DurationofVisitsNumberofUnits | Label: Service duration of visits number of units Type: Integer |
DurationofVisitsUnits | Label: Service duration of visits units Type: Integer |
EligibilityDate | Label: Service eligibility date Type: Date |
EligibilityOrBenefitInformation | Label: Service eligibility or benefit information Type: Text |
ServiceFacilityLocationSecondaryIdentifier | Label: Service facility location secondary identifier Type: Text |
ServiceFacilityName | Label: Service facility name Type: Text |
FacilityTypeCode | Label: Service facility type code Type: Text |
FileInformation | Label: Service file information Type: List Of Type: Embed-PegaHC-FileInformation |
FrequencyCount | Label: Service frequency count Type: Integer |
FrequencyPeriod | Label: Service frequency period Type: Text |
ServiceFromDate | Label: Service from date Type: Date |
ServiceIdentificationCode | Label: Service identification code Type: Text |
InPlanNetworkIndicator | Label: Service in plan network indicator Type: Text |
InitialTreatmentDate | Label: Service initial treatment date Type: Date |
IssueDate | Label: Service issue date Type: Date |
ServiceLineDate | Label: Service line date Type: Date |
ServiceLineRate | Label: Service line rate Type: Text |
ServiceLineRevenueCode | Label: Service line revenue code Type: Text |
MonthlyTreatmentCount | Label: Service monthly treatment count Type: Integer |
Notes | Label: Service notes Type: List Of Type: Embed-PegaHC-Notes |
OnsetofCurrentIllnessorInjury | Label: Service onset of current illness or injury Type: Date |
OrderDate | Label: Service order date Type: Date |
OriginalUnitsofServiceCount | Label: Service original units of service count Type: Integer |
OtherOperatingPhysician | Label: Service other operating physician Type: Object Of Type: Provider |
OxygenFlowRate | Label: Service oxygen flow rate Type: Text |
OxygenSaturationQuantity | Label: Service oxygen saturation quantity Type: Decimal |
OxygenSaturationTestDate | Label: Service oxygen saturation test date Type: Date |
OxygenTestConditionCode | Label: Service oxygen test condition code Type: Text |
OxygenTestFindingsCode | Label: Service oxygen test findings code Type: Text |
PatientStatusCode | Label: Service patient status code Type: Text |
PendCodes | Label: Service pend codes Type: List Of Type: PegaHC-Data-ClaimPendCodes |
PrescriptionDate | Label: Service prescription date Type: Date |
PrescriptionFillNumber | Label: Service prescription fill number Type: Integer |
PrescriptionNumber | Label: Service prescription number Type: Text |
PrincipalDiagnosis | Label: Service principal diagnosis Type: Text |
PrincipalDiagnosisDate | Label: Service principal diagnosis date Type: Date |
PriorIncorrectInsured | Label: Service prior incorrect insured Type: Object Of Type: Member |
ProcedureCode | Label: Service procedure code Type: Text |
ProcedureCodeDescription | Label: Service procedure code description Type: Text |
ProcedureCodeQualifier | Label: Service procedure code qualifier Type: Text |
ProcedureDate | Label: Service procedure date Type: Date |
ProcedureModifier | Label: Service procedure modifier Type: Text |
ProcedureModifiers | Label: Service procedure modifiers Type: Text |
ProcedureQuantity | Label: Service procedure quantity Type: Integer |
ProductCode | Label: Service product code Type: Text |
ProposedAdmissionDate | Label: Service proposed admission date Type: Date |
ProposedDischargeDate | Label: Service proposed discharge date Type: Date |
QuantityDispensed | Label: Service quantity dispensed Type: Text |
QuantityQualifier | Label: Service quantity qualifier Type: Text |
ReferringProviderList | Label: Service referring provider list Type: List Of Type: Provider |
CausesCode | Label: Service related causes code Type: Text |
RelatedCausesCode | Label: Service related causes code Type: Text |
RepricedApprovedServiceUnitCount | Label: Service repriced approved service unit count Type: Integer |
RoundTripPurposeDescription | Label: Service round trip purpose description Type: Text |
SampleSelectionModulus | Label: Service sample selection modulus Type: Text |
ShipDeliveryorCalendarPatternCode | Label: Service ship delivery or calendar pattern code Type: Text |
StretcherPurposeDescription | Label: Service stretcher purpose description Type: Text |
SubluxationLevelCode | Label: Service subluxation level code Type: Text |
SurgeryDate | Label: Service surgery date Type: Date |
SurgicalProcedureCode | Label: Service surgical procedure code Type: Text |
ServiceToDate | Label: Service to date Type: Date |
TransportDistance | Label: Service transport distance Type: Integer |
TreatmentCount | Label: Service treatment count Type: Integer |
TreatmentPeriodCount | Label: Service treatment period count Type: Integer |
TreatmentSeriesNumber | Label: Service treatment series number Type: Integer |
ServiceTypeCode | Label: Service type code Type: Text |
ServiceUnitCount | Label: Service unit count Type: Integer |
UnitorBasisforMeasurementCode | Label: Service unit or basis for measurement code Type: Text |
ServiceValid | Label: Service valid Type: Text |
ServiceProviderID | Label: ServiceProviderID Type: Text |
ServicingCounty | Label: ServicingCounty Type: Text |
ServicingZipCode | Label: ServicingZipCode Type: Text |
ShowDiagErrMess | Label: Show Diagnosis Error Message Type: Text |
SkilledNursingFacilityIndicator | Label: Skilled Nursing Facility Indicator Type: Text |
Source | Label: Source Type: Text |
SourceFileID | Label: Source File ID Type: Text |
StateCode | Label: State Code Type: Text |
TimePeriodQualifier | Label: Time Period Qualifier Type: Text |
UnitOrBasisForMeasurementCodeForService | Label: Unit or basis for measurement code for service Type: Text |
ValidRequestIndicator | Label: Valid Request Indicator Type: Text |
ValidService | Label: Valid service Type: TrueFalse |
ValidMember | Label: ValidMember Type: TrueFalse |
ValidRequestor | Label: ValidRequestor Type: TrueFalse |
ValidServiceProvider | Label: ValidServiceProvider Type: TrueFalse |
ValidSubscriber | Label: ValidSubscriber Type: TrueFalse |
Business entity
Data Class to hold Business Entity attributes such as NPI , billing address
Pega Internal Name: PegaHC-Data-Party-BusinessEntity
BankAccountInformation | Label: BankAccountInformation Type: Object Of Type: Bank Account |
isAffiliationActive | Label: Business entity active affiliation? Type: TrueFalse |
IsContractActive | Label: Business entity active contract? Type: Text |
isProviderActive | Label: Business entity active provider? Type: TrueFalse |
IsBusinessEntityActive | Label: Business entity active? Type: TrueFalse |
BusinessType | Label: Business entity business type Type: Text |
Contract | Label: Business entity contract Type: Object Of Type: Provider contract |
BEHoldingContractTIN | Label: Business entity contract TIN Type: Text |
IsContractEntity | Label: Business entity contract entity? Type: TrueFalse |
ContractID | Label: Business entity contract identifier Type: Text |
ContractName | Label: Business entity contract name Type: Text |
CurrencyCode | Label: Business entity currency code Type: Text |
Description | Label: Business entity description Type: Text |
EffectiveDate | Label: Business entity effective date Type: Date |
EndDate | Label: Business entity end date Type: Date |
FederalTaxID | Label: Business entity federal tax identifier Type: Text |
BEHoldingContract | Label: Business entity holding contract Type: Text |
BEHoldingContractID | Label: Business entity holding contract ID Type: Text |
LOBs | Label: Business entity line of business Type: List Of Type: Embed-HC-BusinessEntity-LOB |
Locations | Label: Business entity locations Type: List Of Type: Embed-PegaHC-BEAddress |
Name | Label: Business entity name Type: Text |
NationalProviderIdentifier | Label: Business entity national provider identifier Type: Text |
IsOnlyContractEntity | Label: Business entity only contract entity? Type: TrueFalse |
PracticeAddress | Label: Business entity practice address Type: List Of Type: Common |
PrimaryContact | Label: Business entity primary contact Type: List Of Type: Contact Information - Embedded |
ProviderCode | Label: Business entity provider code Type: Text |
TaxIdentificationNumber | Label: Business entity tax identification number Type: Text |
TaxIdentifierQualifer | Label: Business entity tax identifier qualifier Type: Text |
Versions | Label: Business entity versions Type: List Of Type: Business entity |
CountContracts | Label: CountContracts Type: Text |
HierarchicalParentIDNumber | Label: Hierarchical parent identifier number Type: Text |
AccountNumber | Label: Party account number Type: Text |
AdditionalName | Label: Party additional name Type: Text |
AddressLine1 | Label: Party address line 1 Type: Text |
AddressLine2 | Label: Party address line 2 Type: Text |
Age | Label: Party age Type: Text |
BankAccountNumber | Label: Party bank account number Type: Text |
BankIDNumber | Label: Party bank identifier number Type: Text |
Contact | Label: Party contact Type: List Of Type: Contact |
ContactFunctionCode | Label: Party contact function code Type: Text |
DateOfBirth | Label: Party date of birth Type: Date |
DateOfDeath | Label: Party date of death Type: Date |
EntityIdentifierCode | Label: Party entity identifier code Type: Text |
EntityTypeQualifier | Label: Party entity type qualifier Type: Text |
UCASEFirstName | Label: Party first name - uppercase Type: Text |
FlowType | Label: Party flow type Type: Text |
GroupName | Label: Party group name Type: Text |
GroupNumber | Label: Party group number Type: Text |
HierarchicalIDNumber | Label: Party hierarchical ID number Type: Text |
HierarchicalChildCode | Label: Party hierarchical child code Type: Text |
HierarchicalLevelCode | Label: Party hierarchical level code Type: Text |
IdentificationCode | Label: Party identification code Type: Text |
IdentificationCodeQualifier | Label: Party identification code qualifier Type: Text |
IndividualIdentifier | Label: Party individual identifier Type: Text |
UCASELastName | Label: Party last name - uppercase Type: Text |
MiddleName | Label: Party middle name Type: Text |
NewTaxonomyCode | Label: Party new taxonomy code Type: Text |
PriorityNote | Label: Party priority note Type: Text |
ReceivingDFIIdentifier | Label: Party receiving DFI identifier Type: Text |
SecondaryID | Label: Party secondary identifier Type: List Of Type: Embed-PegaHC-Reference |
PaymentCode | Label: PaymentCode Type: Text |
ProviderContracts | Label: ProviderContracts Type: List Of Type: Provider contract |
Source | Label: Source Type: Text |
MemberID | Label: Subscriber member ID Type: Text |
CareTeam contact
Data class to hold the member contacts information (Contact name, Care team type, Address, Flag for Is Primary)
Pega Internal Name: PegaHCCMF-Data-Party-Contact
Active | Label: Active Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AddressLine3 | Label: AddressLine3 Type: Text |
AddressLine4 | Label: AddressLine4 Type: Text |
AddressLine5 | Label: AddressLine5 Type: Text |
CareTeamPrimaryEmail | Label: CareTeamPrimaryEmail Type: Text |
CareTeamPrimaryFax | Label: CareTeamPrimaryFax Type: Text |
CareTeamPrimaryPhoneNumber | Label: CareTeamPrimaryPhoneNumber Type: Text |
CareTeamPrimaryPhoneNumberExtension | Label: CareTeamPrimaryPhoneNumberExtension Type: Text |
CareTeamPrimaryRoleDescription | Label: CareTeamPrimaryRoleDescription Type: Text |
CareTeamType | Label: CareTeamType Type: Text |
CaseSpecific | Label: CaseSpecific Type: TrueFalse |
Category | Label: Category Type: Text |
Class | Label: Class Type: Text |
CommunicationId | Label: CommunicationId Type: Text |
ConsentDate | Label: Consent date Type: DateTime |
ConsentShare | Label: Consent share Type: Text |
ContactString | Label: ContactString Type: Text |
Country | Label: Country Type: Text |
CountryCode | Label: CountryCode Type: Text |
CurrentDate | Label: CurrentDate Type: Date |
Description | Label: Description Type: Text |
InActiveDateRange | Label: InActiveDateRange Type: List Of Type: Unavailable period |
IsActiveBeforeInactiveDateRange | Label: IsActiveBeforeInactiveDateRange Type: TrueFalse |
IsEligibleForPCM | Label: IsEligibleForPCM Type: TrueFalse |
IsInterestedParty | Label: IsInterestedParty Type: TrueFalse |
IsPrimary | Label: IsPrimary Type: TrueFalse |
IsRemove | Label: IsRemove Type: TrueFalse |
Key | Label: Key Type: Text |
NPI | Label: NPI Type: Text |
NextDate | Label: NextDate Type: Date |
OperatorCountList | Label: Operator Membercount List Type: List Of Type: CareTeam contact |
OperatorID | Label: OperatorID Type: Text |
OwnerID | Label: OwnerID Type: Text |
PrimaryAddress | Label: PrimaryAddress Type: Text |
RecentDate | Label: RecentDate Type: Date |
RecentNextDate | Label: RecentNextDate Type: Date |
RecentNextToDate | Label: RecentNextToDate Type: Date |
RecentToDate | Label: RecentToDate Type: Date |
Relationship | Label: Relationship Type: Text |
Relationships | Label: Relationships Type: Text |
ResponsibleParty | Label: ResponsibleParty Type: Text |
Role | Label: Role Type: List Of Type: Embed-CMF-Role |
SecondarySpeciality | Label: Secondary Speciality Type: Text |
Skills | Label: Skills Type: List Of Type: Operator skills |
Source | Label: Source Type: Text |
Speciality | Label: Speciality Type: Text |
TopThreeSkills | Label: TopThreeSkills Type: Text |
Type | Label: Type Type: Text |
Value | Label: Value Type: Text |
ZipCode | Label: ZipCode Type: Text |
Claim data
The Claim Data Class holds Claims data as it is utilized within the application. In most cases this will be either medical or pharmacy claims. Claims is detailed invoice containing details of services provided, and is sent by service providers such as hospitals to Payers.
Pega Internal Name: PegaHC-Data-Claim
DiagnosisCodePointer | Label: ***DEPRECATED*** Type: Text |
AdjRepricedClaimRefNumber | Label: Adjusted repriced claim reference number Type: Text |
AdmissionTypeCode | Label: Admission Type Code Type: Text |
AdmissionHour | Label: AdmissionHour Type: Text |
APCDetails | Label: Ambulatory payment classification details Type: Object Of Type: APC Information |
ApprovedPlaceOfService | Label: Approved Place Of Service Type: Text |
AuthorizationDecision | Label: Authorization decision Type: Text |
BillingEntity | Label: Billing entity Type: Object Of Type: Business entity |
PricingDetails | Label: Capture pricing details from external pricing system Type: List Of Type: Response artifacts obtained from external pricing systems |
CheckStatus | Label: Check Status Type: Text |
COB | Label: Claim COB Type: List Of Type: Payer |
DRGInformation | Label: Claim DRG information Type: Object Of Type: PegaHC-Data-InformationCodes |
AdjudOrPaymentDate | Label: Claim adjudication or payment date Type: Text |
ClaimAdjustmentGroupCode | Label: Claim adjustment group code Type: Text |
AdjustmentQuantity | Label: Claim adjustment quantity Type: Integer |
AdjustmentReasonCode | Label: Claim adjustment reason code Type: Text |
AdmissionDateFormatQualifier | Label: Claim admission date format qualifier Type: Text |
AdmissionDateTime | Label: Claim admission date time Type: DateTime |
AdmittingDiagnosis | Label: Claim admitting diagnosis Type: Object Of Type: PegaHC-Data-InformationCodes |
AmbulanceCertification | Label: Claim ambulance certification Type: List Of Type: Embed-PegaHC-Condition |
AmbulatoryPatientGroupNumber | Label: Claim ambulatory patient group number Type: Text |
AssumedOrRelinquishedCareDate | Label: Claim assumed or relinquished care date Type: Date |
AssumedOrRelinquishedCareDateQualifier | Label: Claim assumed or relinquished care date qualifier Type: Text |
Attachments | Label: Claim attachments Type: List Of Type: Attachments |
AttendingPhysician | Label: Claim attending physician Type: Object Of Type: Provider |
AutoAccidentStateCode | Label: Claim auto accident state code Type: Text |
BenefitAssignmentCertificationIndicator | Label: Claim benefit assignment certification indicator Type: Text |
BillClassification | Label: Claim bill classification Type: Text |
BillType | Label: Claim bill type Type: Text |
BillingNoteText | Label: Claim billing note text Type: Text |
CarePlanOversightNumber | Label: Claim care plan oversight number Type: Text |
CodeCategory | Label: Claim code category Type: Text |
ConditionInformation | Label: Claim condition information Type: List Of Type: PegaHC-Data-InformationCodes |
ContractCode | Label: Claim contract code Type: Text |
ContractPercentage | Label: Claim contract percentage Type: Decimal |
ContractType | Label: Claim contract type Type: Text |
ContractVersion | Label: Claim contract version Type: Text |
CostReportDayCount | Label: Claim cost report day count Type: Integer |
ReceivedDate | Label: Claim date claim was received Type: Date |
DelayReasonCode | Label: Claim delay reason code Type: Text |
DemonstrationProjectIdentifier | Label: Claim demonstration project identifier Type: Text |
DeviceExemption | Label: Claim device exemption Type: List Of Type: Embed-PegaHC-Reference |
DisabilityDateFormatQualifier | Label: Claim disability date format qualifier Type: Text |
DisabilityDateQualifier | Label: Claim disability date qualifier Type: Text |
DisabilityFromDate | Label: Claim disability from date Type: Date |
DisabilityToDate | Label: Claim disability to date Type: Date |
DischargedDate | Label: Claim discharge date Type: Date |
DischargeDateTime | Label: Claim discharge date time Type: DateTime |
ExceptionCode | Label: Claim exception code Type: Text |
ExternalCauseOfInjury | Label: Claim external cause of injury Type: Object Of Type: PegaHC-Data-InformationCodes |
FacilityCodeQualifier | Label: Claim facility code qualifier Type: Text |
FacilityType | Label: Claim facility type Type: Text |
ClaimFilingIndicatorCode | Label: Claim filing indicator code Type: Text |
FixedFormatInformation | Label: Claim fixed format information Type: Text |
ClaimFormType | Label: Claim form type Type: Text |
ClaimFrequencyCode | Label: Claim frequency code Type: Text |
HierarchicalStructureCode | Label: Claim hierarchical structure code Type: Text |
HomeboundIndicator | Label: Claim homebound indicator Type: Text |
ImageNumber | Label: Claim image number Type: Text |
IndustryCode | Label: Claim industry code Type: Text |
InterChangeControlNumber | Label: Claim interchange control number Type: Text |
ICDType | Label: Claim international classification of diseases type Type: Text |
LastMenstrualPeriodDate | Label: Claim last menstrual period date Type: Date |
LastSeenDate | Label: Claim last seen date Type: Date |
LastWorkedDate | Label: Claim last worked date Type: Date |
LastXRayDate | Label: Claim last x-ray date Type: Date |
LifetimePsychiatricDaysCount | Label: Claim lifetime psychiatric days count Type: Integer |
ClaimLine | Label: Claim line Type: List Of Type: Claim Line |
NonCoveredChargeAmount | Label: Claim line non covered charges amount Type: Decimal |
MammographyCertificationNumber | Label: Claim mammography certification number Type: Text |
ClaimMediaType | Label: Claim media type Type: Identifier |
MedicalRecordNumber | Label: Claim medical record number Type: Text |
MedicareSection4081Indicator | Label: Claim medicare section 4081 indicator Type: Text |
NationalProviderIdentifier | Label: Claim national provider identifier Type: Text |
OccurrenceInformation | Label: Claim occurrence information Type: List Of Type: PegaHC-Data-InformationCodes |
OccurrenceSpanInformation | Label: Claim occurrence span information Type: List Of Type: PegaHC-Data-InformationCodes |
OperatingPhysician | Label: Claim operating physician Type: Object Of Type: Provider |
ClaimOrEncounterIdentifier | Label: Claim or encounter identifier Type: Text |
OriginalReferenceNumber | Label: Claim original reference number Type: Text |
OtherDiagnosisInformation | Label: Claim other diagnosis information Type: List Of Type: PegaHC-Data-InformationCodes |
OtherProcedureInformation | Label: Claim other procedure information Type: List Of Type: PegaHC-Data-InformationCodes |
PACDateOfFirstContact | Label: Claim pac date of first contact Type: Date |
Patient | Label: Claim patient Type: Object Of Type: Member |
PatientDateOfBirth | Label: Claim patient date of birth Type: Date |
PatientLastName | Label: Claim patient last name Type: Text |
PatientPaidAmount | Label: Claim patient paid amount Type: Decimal |
PatientSignatureSourceCode | Label: Claim patient signature source code Type: Text |
PatientVisionCondition | Label: Claim patient vision condition Type: List Of Type: Embed-PegaHC-Condition |
PayToPlan | Label: Claim pay to plan Type: Object Of Type: Payer |
PayToProvider | Label: Claim pay to provider Type: Object Of Type: Provider |
Payer | Label: Claim payer Type: List Of Type: Payer |
PayerClaimControlNumber | Label: Claim payer claim control number Type: Text |
PayerName | Label: Claim payer name Type: Text |
PayerResponsibilitySequenceNumberCode | Label: Claim payer responsibility sequence number code Type: Text |
Payment | Label: Claim payment Type: Object Of Type: Payment Information |
PeerReviewAuthorizationNumber | Label: Claim peer review authorization number Type: Text |
PolicyComplianceCode | Label: Claim policy compliance code Type: Text |
PolicyNumber | Label: Claim policy number Type: Text |
PredeterminationOfBenefitsIdentifier | Label: Claim predetermination of benefits identifier Type: Text |
PregnancyIndicator | Label: Claim pregnancy indicator Type: Text |
Prescription | Label: Claim prescription Type: List Of Type: Prescription - Clinical |
PrescriptionDate | Label: Claim prescription date Type: Date |
PricingMethodology | Label: Claim pricing methodology Type: Text |
PrincipalDiagnosisInfo | Label: Claim principal diagnosis information Type: Object Of Type: PegaHC-Data-InformationCodes |
PrincipalProcedureInformation | Label: Claim principal procedure information Type: Object Of Type: PegaHC-Data-InformationCodes |
PriorAuthorizationNumber | Label: Claim prior authorization number Type: Text |
PropertyCasualtyClaimNumber | Label: Claim property casualty claim number Type: Text |
ProviderAcceptAssignmentCode | Label: Claim provider accept assignment code Type: Text |
ProviderOrSupplierSignatureIndicator | Label: Claim provider or supplier signature indicator Type: Text |
PurchasedServiceProvider | Label: Claim purchased service provider Type: Object Of Type: Provider |
ReasonForVisit | Label: Claim reason for visit Type: Object Of Type: PegaHC-Data-InformationCodes |
Receiver | Label: Claim receiver Type: Object Of Type: PegaHC-Data-Party |
ReferralNumber | Label: Claim referral number Type: Text |
ReferringProvider | Label: Claim referring provider Type: Object Of Type: Provider |
ReferringProviderList | Label: Claim referring provider list Type: List Of Type: Provider |
ReimbursementRate | Label: Claim reimbursement rate Type: Text |
ReleaseofInformationCode | Label: Claim release of information code Type: Text |
RenderingProvider | Label: Claim rendering provider Type: Object Of Type: Provider |
RepricedApprovedAPGGroupCode | Label: Claim repriced approved apg code Type: Text |
RepricedApprovedRevenueCode | Label: Claim repriced approved revenue code Type: Text |
RepricedClaimReferenceNumber | Label: Claim repriced claim reference number Type: Text |
RepricerReceivedDate | Label: Claim repricer received date Type: Date |
RepricingOrganizationIdentifier | Label: Claim repricing organization identifier Type: Text |
ServiceAuthorizationExceptionCode | Label: Claim service authorization exception code Type: Text |
ServiceFacility | Label: Claim service facility Type: Object Of Type: Provider |
ServiceFromDate | Label: Claim service from date Type: Date |
ServiceToDate | Label: Claim service to date Type: Date |
SimilarIllnessOrSymptomDate | Label: Claim similar illness or symptom date Type: Date |
SpecialProgramIndicator | Label: Claim special program indicator Type: Text |
StatementFromDate | Label: Claim statement from date Type: Date |
StatementToDate | Label: Claim statement to date Type: Date |
ClaimStatus | Label: Claim status Type: Text |
ClaimSubmissionType | Label: Claim submission type Type: Identifier |
Submitter | Label: Claim submitter Type: Object Of Type: PegaHC-Data-Party |
SubmitterNumber | Label: Claim submitter number Type: Text |
Subscriber | Label: Claim subscriber Type: Object Of Type: Member |
SubscriberDateOfBirth | Label: Claim subscriber date of birth Type: Date |
SubscriberLastName | Label: Claim subscriber last name Type: Text |
SubscriberPrimaryIdentifier | Label: Claim subscriber primary identifier Type: Text |
SupervisingProvider | Label: Claim supervising provider Type: Object Of Type: Provider |
SurchargeFactor | Label: Claim surcharge factor Type: Decimal |
TermsDiscountPercentage | Label: Claim terms discount percentage Type: Decimal |
TotalClaimAllowedAmount | Label: Claim total allowed amount Type: Decimal |
TotalClaimApprovedAmount | Label: Claim total approved amount Type: Decimal |
TotalClaimCoinsuranceAmount | Label: Claim total coinsurance amount Type: Decimal |
TotalClaimCopayAmount | Label: Claim total copay amount Type: Decimal |
TotalClaimDeductibleAmount | Label: Claim total deductible amount Type: Decimal |
TraceNumber | Label: Claim trace number Type: Text |
TransactionSetCreationDate | Label: Claim transaction set creation date Type: Date |
TransactionSetCreationTime | Label: Claim transaction set creation time Type: Text |
TransactionSetPurposeCode | Label: Claim transaction set purpose code Type: Text |
TransactionType | Label: Claim transaction type Type: Text |
TreatmentCodeInfo | Label: Claim treatment code information Type: List Of Type: PegaHC-Data-InformationCodes |
TestClaimType | Label: Claim type Type: Text |
Type | Label: Claim type Type: Text |
CE_HeaderStatus | Label: ClaimStatus Type: Text |
ConditionCodeEPSDTReferral | Label: Condition code EPSDT referral Type: Text |
pyCountry | Label: Country Code Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DischargeHour | Label: Discharge Hour Type: Text |
DischargeLocation | Label: Discharge Location Code Type: Text |
EPSDT | Label: EPSDT Type: Object Of Type: EPSDT Referral |
EPSDTIndicator | Label: EPSDT indicator Type: Text |
Frequency | Label: Frequency Type: Text |
GracePeriod | Label: GracePeriod Type: Integer |
ImplementationGuideVersionName | Label: ImplementationGuideVersionName Type: Text |
IndividualDeathDate | Label: IndividualDeathDate Type: Text |
ICDVersion | Label: International classification of diseases version Type: Text |
LatePaymentInterest | Label: LatePaymentInterest Type: Decimal |
LatePaymentInterestPercent | Label: LatePaymentInterestPercent Type: Decimal |
NegotiatedPrice | Label: NegotiatedPrice Type: Decimal |
OralCavityDesignationCode | Label: OralCavityDesignationCode Type: Text |
OutOfStateIndicator | Label: Out of State Indicator Type: TrueFalse |
PatientCalculatedAmount | Label: PatientCalculatedAmount Type: Text |
PatientStatus | Label: PatientStatus Type: Text |
RepricedAllowedAmount | Label: Payment repriced allowed amount Type: Decimal |
RepricedApprovedAPGAmount | Label: Payment repriced approved ambulatory patient group amount Type: Decimal |
RepricedSavingAmount | Label: Payment repriced saving amount Type: Decimal |
RepricingPerDiemOrFlatRateAmount | Label: Payment repricing per diem or flat rate amount Type: Decimal |
PlaceOfProfessionalServiceCode | Label: Place of professional service code Type: Text |
PlaceofServiceCode | Label: PlaceofServiceCode Type: Text |
PriceFrequency | Label: PriceFrequency Type: Text |
RARCodes | Label: RAR Codes Type: List Of Type: Claim Remittance/Remark Codes |
RejectReasonCode | Label: Reject Reason Code Type: Text |
ResolvedInSANP | Label: ResolvedInSANP Type: TrueFalse |
AccidentDate | Label: Service accident date Type: Date |
ActionCode | Label: Service action code Type: Text |
ActivitiesPermittedCode | Label: Service activities permitted code Type: Text |
ActualAdmissionDate | Label: Service actual admission date Type: Date |
ActualDischargeDate | Label: Service actual discharge date Type: Date |
AcuteManifestationDate | Label: Service acute manifestation date Type: Date |
AdmissionDate | Label: Service admission date Type: Date |
AdmissionDiagnosis | Label: Service admission diagnosis Type: Text |
AdmissionSourceCode | Label: Service admission source code Type: Text |
AmbulanceDropOffCity | Label: Service ambulance drop off city Type: Text |
AmbulanceDropOffPostalCode | Label: Service ambulance drop off postal code Type: Text |
AmbulanceDropOffStateCode | Label: Service ambulance drop off state code Type: Text |
AmbulanceDropOff | Label: Service ambulance drop-off Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulancePickUpCity | Label: Service ambulance pick up city Type: Text |
AmbulancePickUpPostalCode | Label: Service ambulance pick up postal code Type: Text |
AmbulancePickUpStateCode | Label: Service ambulance pick up state code Type: Text |
AmbulancePickup | Label: Service ambulance pickup Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulanceTransportCode | Label: Service ambulance transport code Type: Text |
AmbulanceTransportReasonCode | Label: Service ambulance transport reason code Type: Text |
AmbulanceTripDestinationAddress | Label: Service ambulance trip destination address Type: Text |
AmbulanceTripOriginAddress | Label: Service ambulance trip origin address Type: Text |
AnesthesiaRelatedSurgicalProcedure | Label: Service anesthesia related surgical procedure Type: Text |
ArterialBloodGasQuantity | Label: Service arterial blood gas quantity Type: Decimal |
AssessmentDate | Label: Service assessment date Type: Date |
AssumedRelinqCareDate | Label: Service assumed or relinquished care date Type: Date |
AuthorizationReason | Label: Service authorization reason Type: Text |
AuthorizedUnitCount | Label: Service authorized service unit count Type: Integer |
BeginTherapyDate | Label: Service begin therapy date Type: Date |
BenefitAmount | Label: Service benefit amount Type: Decimal |
BenefitBeginDate | Label: Service benefit begin date Type: Date |
BenefitCoverageLevelCode | Label: Service benefit coverage level code Type: Text |
BenefitEndDate | Label: Service benefit end date Type: Date |
BenefitPercent | Label: Service benefit percent Type: Integer |
BenefitQuantity | Label: Service benefit quantity Type: Integer |
CertificationConditionIndicator | Label: Service certification condition indicator Type: Text |
CertificationPeriodProjVisitCount | Label: Service certification period projected visit count Type: Integer |
CertificationTypeCodeValues | Label: Service certification type code values Type: Text |
ClaimServicePeriod | Label: Service claim service period Type: Text |
CLIANumber | Label: Service clinical laboratory improvement amendment number Type: Text |
CodeListQualifierCode | Label: Service code list qualifier code Type: Text |
ComplicationIndicator | Label: Service complication indicator Type: Text |
ConditionAdditionalDescriptionPatient | Label: Service condition additional description patient Type: Text |
ConditionCode | Label: Service condition code Type: Text |
ConditionCodeAbortion | Label: Service condition code - abortion Type: Text |
ConditionCodeAmbulance | Label: Service condition code - ambulance transport Type: Text |
ConditionCodePatient | Label: Service condition code - patient Type: Text |
ConditionCodeVision | Label: Service condition code - vision Type: Text |
ConditionDescriptionPatient | Label: Service condition description - patient Type: Text |
CoveragePeriod | Label: Service coverage period Type: Date |
CoveredDaysorVisitsCount | Label: Service covered days or visits count Type: Integer |
CurrentHealthConditionCode | Label: Service current health condition code Type: Text |
DailyOxygenUseCount | Label: Service daily oxygen use count Type: Integer |
Date | Label: Service date Type: List Of Type: Embed-PegaHC-Date |
DaysofSupply | Label: Service days of supply Type: Integer |
DeliveryFrequencyCode | Label: Service delivery frequency code Type: Text |
DeliveryPatternTimeCode | Label: Service delivery pattern time code Type: Text |
Diagnosis | Label: Service diagnosis Type: List Of Type: ***Deprecated*** |
Dose | Label: Service dose Type: Text |
DurationofVisitsNumberofUnits | Label: Service duration of visits number of units Type: Integer |
DurationofVisitsUnits | Label: Service duration of visits units Type: Integer |
EligibilityDate | Label: Service eligibility date Type: Date |
EligibilityOrBenefitInformation | Label: Service eligibility or benefit information Type: Text |
ServiceFacilityLocationSecondaryIdentifier | Label: Service facility location secondary identifier Type: Text |
ServiceFacilityName | Label: Service facility name Type: Text |
FacilityTypeCode | Label: Service facility type code Type: Text |
FileInformation | Label: Service file information Type: List Of Type: Embed-PegaHC-FileInformation |
FrequencyCount | Label: Service frequency count Type: Integer |
FrequencyPeriod | Label: Service frequency period Type: Text |
ServiceIdentificationCode | Label: Service identification code Type: Text |
InPlanNetworkIndicator | Label: Service in plan network indicator Type: Text |
InitialTreatmentDate | Label: Service initial treatment date Type: Date |
IssueDate | Label: Service issue date Type: Date |
LastAdmissionPeriod | Label: Service last admission period Type: Date |
ServiceLineDate | Label: Service line date Type: Date |
ServiceLineRate | Label: Service line rate Type: Text |
ServiceLineRevenueCode | Label: Service line revenue code Type: Text |
MonthlyTreatmentCount | Label: Service monthly treatment count Type: Integer |
Notes | Label: Service notes Type: List Of Type: Embed-PegaHC-Notes |
NumberofVisits | Label: Service number of visits Type: Integer |
OnsetofCurrentIllnessorInjury | Label: Service onset of current illness or injury Type: Date |
OrderDate | Label: Service order date Type: Date |
OriginalUnitsofServiceCount | Label: Service original units of service count Type: Integer |
OtherOperatingPhysician | Label: Service other operating physician Type: Object Of Type: Provider |
OxygenFlowRate | Label: Service oxygen flow rate Type: Text |
OxygenSaturationQuantity | Label: Service oxygen saturation quantity Type: Decimal |
OxygenSaturationTestDate | Label: Service oxygen saturation test date Type: Date |
OxygenTestConditionCode | Label: Service oxygen test condition code Type: Text |
OxygenTestFindingsCode | Label: Service oxygen test findings code Type: Text |
PatientStatusCode | Label: Service patient status code Type: Text |
PendCodes | Label: Service pend codes Type: List Of Type: PegaHC-Data-ClaimPendCodes |
PeriodCount | Label: Service period count Type: Decimal |
PrescriptionFillNumber | Label: Service prescription fill number Type: Integer |
PrescriptionNumber | Label: Service prescription number Type: Text |
PrincipalDiagnosis | Label: Service principal diagnosis Type: Text |
PrincipalDiagnosisDate | Label: Service principal diagnosis date Type: Date |
ProcedureCode | Label: Service procedure code Type: Text |
ProcedureCodeDescription | Label: Service procedure code description Type: Text |
ProcedureCodeQualifier | Label: Service procedure code qualifier Type: Text |
ProcedureDate | Label: Service procedure date Type: Date |
ProcedureModifier | Label: Service procedure modifier Type: Text |
ProcedureModifiers | Label: Service procedure modifiers Type: Text |
ProcedureQuantity | Label: Service procedure quantity Type: Integer |
ProductCode | Label: Service product code Type: Text |
ProposedAdmissionDate | Label: Service proposed admission date Type: Date |
ProposedDischargeDate | Label: Service proposed discharge date Type: Date |
QuantityDispensed | Label: Service quantity dispensed Type: Text |
QuantityQualifier | Label: Service quantity qualifier Type: Text |
CausesCode | Label: Service related causes code Type: Text |
RelatedCausesCode | Label: Service related causes code Type: Text |
RepricedApprovedServiceUnitCount | Label: Service repriced approved service unit count Type: Integer |
RoundTripPurposeDescription | Label: Service round trip purpose description Type: Text |
SampleSelectionModulus | Label: Service sample selection modulus Type: Text |
ShipDeliveryorCalendarPatternCode | Label: Service ship delivery or calendar pattern code Type: Text |
StretcherPurposeDescription | Label: Service stretcher purpose description Type: Text |
SubluxationLevelCode | Label: Service subluxation level code Type: Text |
TimePeriodQualifier | Label: Service time period qualifier Type: Text |
TransportDistance | Label: Service transport distance Type: Integer |
TreatmentCount | Label: Service treatment count Type: Integer |
TreatmentPeriodCount | Label: Service treatment period count Type: Integer |
TreatmentSeriesNumber | Label: Service treatment series number Type: Integer |
ServiceUnitCount | Label: Service unit count Type: Integer |
UnitorBasisforMeasurementCode | Label: Service unit or basis for measurement code Type: Text |
ServiceValid | Label: Service valid Type: Text |
ServiceTypeCode | Label: ServiceTypeCode Type: Text |
ServicingCounty | Label: ServicingCounty Type: Text |
ServicingZipCode | Label: ServicingZipCode Type: Text |
Source | Label: Source Type: Text |
SubmittedDate | Label: SubmittedDate Type: Date |
SubmitterName | Label: SubmitterName Type: Text |
SurchargeAmount | Label: SurchargeAmount Type: Decimal |
TotalPatientCOB | Label: TotalPatientCOB Type: Decimal |
TotalPayerCOB | Label: TotalPayerCOB Type: Decimal |
TransactionSegmentCount | Label: TransactionSegmentCount Type: Text |
TransactionSetControlNumber | Label: TransactionSetControlNumber Type: Text |
TransactionSetIdentifierCode | Label: TransactionSetIdentifierCode Type: Text |
UnitOrBasisForMeasurementCodeForService | Label: Unit or basis for measurement code for service Type: Text |
ValidService | Label: Valid service Type: TrueFalse |
ValueAddedNetworkTrace | Label: Value added network trace number Type: Text |
ValueInformation | Label: Value information Type: List Of Type: PegaHC-Data-InformationCodes |
WorkReturnDate | Label: Work return date
Type: Date |
Clinical observation
The Observation data class holds data related to Clinical Observations related to the patient. These observations can come from a variety of sources, IoT, EMR, Patient, Internal User.
Pega Internal Name: PegaHC-Data-Observation
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
Code | Label: Code Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
Description | Label: Description Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
LISTING_SEQ_NO | Label: NDC codes listing sequence number Type: Integer |
NewVersionNote | Label: New version note Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
PatientID | Label: PatientID Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanVersion | Label: PlanVersion Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Conference type
Data class to hold the conference type value. Case conference can be launched from Admission case, Auth request, Patient 360. On the basis of different launch points from the application, the value conference type varies. This class holds all the different launch points and corresponding conference types.
Pega Internal Name: PegaHC-Data-ConferenceType
ConferenceType | Label: ConferenceType Type: Identifier |
LaunchPoint | Label: Launch point Type: Identifier |
Source | Label: Source Type: Text |
Provides application access to contact data such as the name, phone numbers, email address, account roles, social ID’s, and other key data.
Pega Internal Name: PegaCA-Interface-Contact
Active | Label: Active Type: Text |
AddressLine1 | Label: Address line one Type: Text |
Addresses | Label: Addresses Type: List Of Type: Customer address |
AssistantEmail | Label: Assistant email Type: Text |
AssistantName | Label: Assistant name Type: Text |
AssistantPhone | Label: Assistant phone Type: Text |
BestTimeToCall | Label: Best time to call Type: Text |
ChildContacts | Label: Child Contacts Type: List Of Type: Contact to contact relationship |
City | Label: City Type: Text |
CommPreferenceByEmail | Label: Communication preference by Email Type: Text |
CommPreferenceByFax | Label: Communication preference by Fax Type: Text |
CommPreferenceByMail | Label: Communication preference by Mail Type: Text |
CommPreferenceByPhone | Label: Communication preference by Phone Type: Text |
CompanyName | Label: Company name Type: Text |
ContactId | Label: Contact identifier Type: Identifier |
ContactType | Label: Contact type Type: Text |
ContactFullName | Label: ContactFullName Type: Text |
Country | Label: Country Type: Text |
CountryCode | Label: CountryCode Type: Text |
CustomerValue | Label: Customer Value Type: Text |
DateOfBirth | Label: Date of birth Type: Date |
DepartmentName | Label: Department name Type: Text |
Label: Email Type: Text | |
FacebookID | Label: Facebook ID Type: Text |
FacebookURL | Label: Facebook URL Type: Text |
Fax | Label: Fax Type: Text |
FirstName | Label: First Name Type: Text |
Gender | Label: Gender Type: Text |
HomeContactNumber | Label: Home Contact Number Type: Text |
JobTitle | Label: Job title Type: Text |
Language | Label: Language Type: Text |
LanguagePreference | Label: Language preference Type: Text |
LastName | Label: Last Name Type: Text |
LinkedinURL | Label: Linkedin URL Type: Text |
LinkedinId | Label: Linkedin identifier Type: Text |
MaritalStatus | Label: Marital status Type: Text |
MarketingByEmail | Label: Marketing by email Type: Text |
MarketingByMail | Label: Marketing by mail Type: Text |
MarketingByPhone | Label: Marketing by phone Type: Text |
MiddleName | Label: Middle name Type: Text |
MobilePhone | Label: Mobile Phone Type: Text |
NationalId | Label: National identifier Type: Text |
ParentContactId | Label: Parent contact identifier Type: Text |
PhoneNumber | Label: Phone Number Type: Text |
PrimaryEmailType | Label: Primary Email Type Type: Text |
PrimaryPhoneType | Label: Primary Phone Type Type: Text |
PrimaryPhoneNumber | Label: Primary phone number Type: Text |
PrimaryEmail | Label: PrimaryEmail Type: Text |
PriorityNote | Label: Priority note Type: Text |
RoleDescription | Label: Role Description Type: Text |
RoleName | Label: Role name Type: Text |
SecondaryEmailType | Label: Secondary Email Type Type: Text |
SecondaryPhoneType | Label: Secondary Phone Type Type: Text |
SecondaryPhoneNumber | Label: Secondary phone number Type: Text |
SecondaryEmail | Label: SecondaryEmail Type: Text |
SocialSecurityNumber | Label: Social security number Type: Text |
StateCode | Label: State Code Type: Text |
Suffix | Label: Suffix Type: Text |
TerritoryId | Label: Territory ID Type: Text |
TertiaryPhoneNumber | Label: Tertiary Phone Number Type: Text |
TertiaryPhoneType | Label: Tertiary Phone Type Type: Text |
TimeZone | Label: TimeZone Type: Text |
TwitterID | Label: Twitter ID Type: Text |
TwitterURL | Label: Twitter URL Type: Text |
ZipCode | Label: Zip code Type: Text |
Conversation logs
Data class to hold all the type of conversation happened with member. This class stores conversation instances for Program enrolled, Task, and Pulse Communication
Pega Internal Name: PegaHC-Data-ConversationsLog
CallDateAndTime | Label: Call date and time Type: DateTime |
CallNotes | Label: Call notes Type: Text |
CallOwner | Label: Call owner Type: Text |
ConversationID | Label: Conversation ID Type: Identifier |
InstanceKey | Label: InstanceKey Type: Text |
Source | Label: Source Type: Text |
Subject | Label: Subject Type: Text |
TaskDetails | Label: TaskDetails Type: Text |
WorkID | Label: WorkID Type: Text |
Customer Address
Provides application access to customer address data such as address details (address lines1-5, city, state, province, country, postal code), and related contact info such as contact ID, first and last name, and other customer address data.
Pega Internal Name: PegaCA-Interface-Address
Active | Label: Active Type: Text |
AddressId | Label: Address Identifier Type: Text |
AddressType | Label: Address Type Type: Text |
Address1 | Label: Address line 1 Type: Text |
Address2 | Label: Address line 2 Type: Text |
Address3 | Label: Address line 3 Type: Text |
Address4 | Label: Address line 4 Type: Text |
Address5 | Label: Address line 5 Type: Text |
City | Label: City Type: Text |
pyCity | Label: City Type: Text |
DomainId | Label: Contact Id Type: Identifier |
Country | Label: Country Type: Text |
CustomerValue | Label: Customer Value Type: Text |
DomainType | Label: Domain type Type: Identifier |
Label: Email Type: Text | |
FromDate | Label: From date Type: DateTime |
IsPrimary | Label: Is primary Type: TrueFalse |
Language | Label: Language Type: Text |
pyPostalCode | Label: Postal Code Type: Text |
PostalCode | Label: Postal code Type: Text |
ProductName | Label: Product Name Type: Text |
Comments | Label: Property for Comments Type: Text |
RoleDescription | Label: Role Description Type: Text |
RoleName | Label: Role name Type: Text |
RoleType | Label: RoleType Type: Text |
SocialSecurityNumber | Label: Social security number Type: Text |
State | Label: State Type: Text |
pyState | Label: State Type: Identifier |
Status | Label: Status Type: Text |
pyStreet | Label: Street Type: Text |
SubRegion | Label: Sub region Type: Text |
ToDate | Label: To date Type: DateTime |
ZipCode | Label: Zip code Type: Text |
Customer Important Messages
It is used to handle customer important messages
Pega Internal Name: Data-ImportantMessages
CustomerID | Label: Customer ID Type: Text |
EndDateTime | Label: End Date Time Type: DateTime |
ImportantMessage | Label: Important Message Type: Text |
ShortMessage | Label: Short Message Type: Text |
SourceID | Label: Source ID Type: Text |
SourceName | Label: Source Name Type: Text |
SourceClass | Label: Source class Type: Text |
StartDateTime | Label: Start Date Time Type: DateTime |
StatusOnWeb | Label: Status On Web Type: Text |
StatusOnMobile | Label: Status on Mobile Type: Text |
EndPointSettings
Pega Internal Name: PegaHC-Data-EndPointSettings
EndPointURL | Label: Endpoint URL Type: Text |
ProductionLevel | Label: Production level Type: Text |
ServiceName | Label: Service name Type: Text |
Source | Label: Source Type: Text |
The data class holds data related to contract. Contract is written between the employer group/individual and the Payer. Contract defines benefits, premium, covered entities, plans. Effective dates . Contract ID. Covered lives.
Pega Internal Name: PegaHC-Data-Contract
ContractedEntity | Label: Contract contracted entity Type: Object Of Type: Company |
CoveredProducts | Label: Contract covered products Type: List Of Type: Product - Benefits |
ContractID | Label: Contract identifier Type: Identifier |
Payer | Label: Contract payer Type: Object Of Type: Payer |
ContractType | Label: Contract type Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EndDate | Label: End date Type: Date |
Source | Label: Source Type: Text |
Status | Label: Status of the data instance Type: Text |
LOINC Codes
Pega Internal Name: PegaHealth-Codes-Data-LOINC
ActiveIngredUnit | Label: Active ingred unit Type: Text |
ActiveNumeratorStrength | Label: Active numerator strength Type: Text |
Annotation | Label: Annotation Type: Text |
ApplicationNumber | Label: Application number Type: Text |
ApproximateFlag | Label: Approximate flag Type: Text |
COMPONENT | Label: COMPONENT Type: Text |
Category | Label: Category Type: Text |
Category1 | Label: Category 1 Type: Text |
Category2 | Label: Category 2 Type: Text |
Category3 | Label: Category 3 Type: Text |
Category4 | Label: Category 4 Type: Text |
Category5 | Label: Category 5 Type: Text |
ChoiceListsFlag | Label: Choice lists flag Type: Text |
Code | Label: Code Type: Text |
CodeSetType | Label: CodeSetType Type: Text |
CombinationFlag | Label: Combination flag Type: Text |
Deaschedule | Label: Dea schedule Type: Text |
Description | Label: Description Type: Text |
DescriptionFrom | Label: Description from Type: Text |
DescriptionTo | Label: Description to Type: Text |
Disorder | Label: Disorder Type: Text |
DosageFormName | Label: Dosage form name Type: Text |
EffectiveDate | Label: Effective date Type: DateTime |
EffectiveDate_String | Label: Effective date string Type: Text |
EndMarketingDate | Label: End marketing date Type: Date |
ExpirationDate | Label: Expiration date Type: DateTime |
ExpirationDate_String | Label: Expiration date string Type: Text |
Full_Description | Label: Full description Type: Text |
FullDescription | Label: Full description1 Type: Text |
InstructionDescription | Label: Instruction description Type: Text |
LOINC_NUM | Label: LOINC_NUM Type: Text |
LabelerName | Label: Labeler name Type: Text |
LastModifiedDate | Label: Last modified date Type: Date |
LastModifiedDate_String | Label: Last modified date string Type: Text |
LISTING_SEQ_NO | Label: Listing sequence number Type: Identifier |
LongDescription | Label: Long description Type: Text |
Long_Description | Label: Long description Type: Text |
MarketingCategoryName | Label: Marketing category name Type: Text |
Name | Label: Name Type: Text |
NDCPackageCode | Label: National drug codes package code Type: Text |
NoMapFlag | Label: No map flag Type: Text |
NonProprietaryName | Label: Non proprietary name Type: Text |
NormalizedNDCPackageCode | Label: Normalized National drug codes package code Type: Text |
Notes | Label: Notes Type: Text |
OrderNumber | Label: OrderNumber Type: Text |
PackageDescription | Label: Package description Type: Text |
PharmClasses | Label: Pharm classes Type: Text |
ProductID | Label: Product id Type: Identifier |
ProductNDC | Label: Product national drug codes Type: Text |
ProductTypeName | Label: Product type name Type: Text |
ProprietaryName | Label: Proprietary name Type: Text |
ProprietaryNameSuffix | Label: Proprietary name suffix Type: Text |
RouteName | Label: Route name Type: Text |
ScenarioFlag | Label: Scenario flag Type: Text |
ShortDescription | Label: Short description Type: Text |
SourceDescription | Label: Source description Type: Text |
StartMarketingDate | Label: Start marketing date Type: Date |
Status | Label: Status Type: Text |
SubstanceName | Label: Substance name Type: Text |
TargetCode | Label: Target code Type: Text |
TargetDescription | Label: Target description Type: Text |
Type | Label: Type Type: Text |
Validity | Label: Validity Type: Text |
LOINC units
Data class to hold the measurement unit for loinc code.
Pega Internal Name: PegaHC-Data-LoincUnits
DefaultUnitFlag | Label: Default unit flag Type: TrueFalse |
LOINC_NUM | Label: LOINC_NUM Type: Identifier |
Source | Label: Source Type: Text |
Medical History
Medical History data class holds patient and family historical data related to medical conditions identified by the patient and or Care Team.
Pega Internal Name: PegaHC-Data-MedicalHistory
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
Description | Label: Medical history description Type: Text |
LISTING_SEQ_NO | Label: Medical history listing sequence number Type: Integer |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
NewVersionNote | Label: New version note Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
PatientID | Label: Patient identifier Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanVersion | Label: PlanVersion Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status of the data instance Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
Code | Label: Test code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Member
The Member Data Class holds member data as it is utilized within the application. Member data includes Member ID , member name, policy details, PCP information.
Pega Internal Name: PegaHC-Data-Party-Member
Address | Label: Address Type: List Of Type: Common |
DateOfBirth | Label: Date of Birth Type: Date |
Employee | Label: Employee Type: Text |
Employment | Label: Employment Type: List Of Type: Employment Information |
GenderCode | Label: Gender Code Type: Text |
Guardian | Label: Guardian Type: Object Of Type: Guardian Information |
GuardianList | Label: Guardian List Type: List Of Type: Guardian Information |
HierarchicalParentIDNumber | Label: Hierarchical parent identifier number Type: Text |
Languages | Label: Languages Type: List Of Type: Languages |
Age | Label: Member age Type: Integer |
BirthSequenceNumber | Label: Member birth sequence number Type: Integer |
CitizenshipStatusCode | Label: Member citizenship status code Type: Text |
Communication | Label: Member communication Type: List Of Type: Communication - Phone-Email-Social |
DateOfDeath | Label: Member date of death Type: Date |
Disability | Label: Member disability Type: List Of Type: Disability Information |
Height | Label: Member height Type: Text |
MaritalStatusCode | Label: Member marital status code Type: Text |
MiddleName | Label: Member middle name Type: Text |
NamePrefix | Label: Member name prefix Type: Text |
MemberPolicy | Label: Member policy Type: List Of Type: Policy |
PregnancyIndicator | Label: Member pregnancy indicator Type: TrueFalse |
PreviousNames | Label: Member previous names Type: List Of Type: Embed-PegaHC-Member |
RaceOrEthnicityCode | Label: Member race or ethnicity code Type: Text |
SitusState | Label: Member situs state Type: Text |
SocialSecurityNumber | Label: Member social security number Type: Text |
Weight | Label: Member weight Type: Integer |
pyNameSuffix | Label: Name Suffix Type: Text |
NumberOfChildren | Label: Number Of Children Type: Integer |
pyWorkPartyUri | Label: Party ID Type: Text |
AddressLine1 | Label: Party address line 1 Type: Text |
AddressLine2 | Label: Party address line 2 Type: Text |
BankAccountNumber | Label: Party bank account number Type: Text |
BankIDNumber | Label: Party bank identifier number Type: Text |
Contact | Label: Party contact Type: List Of Type: Contact |
ContactFunctionCode | Label: Party contact function code Type: Text |
EntityIdentifierCode | Label: Party entity identifier code Type: Text |
EntityTypeQualifier | Label: Party entity type qualifier Type: Text |
UCASEFirstName | Label: Party first name - uppercase Type: Text |
FlowType | Label: Party flow type Type: Text |
GroupName | Label: Party group name Type: Text |
HierarchicalIDNumber | Label: Party hierarchical ID number Type: Text |
HierarchicalChildCode | Label: Party hierarchical child code Type: Text |
HierarchicalLevelCode | Label: Party hierarchical level code Type: Text |
IdentificationCode | Label: Party identification code Type: Text |
IdentificationCodeQualifier | Label: Party identification code qualifier Type: Text |
IndividualIdentifier | Label: Party individual identifier Type: Text |
UCASELastName | Label: Party last name - uppercase Type: Text |
NationalProviderIdentifier | Label: Party national provider identifier Type: Text |
NewTaxonomyCode | Label: Party new taxonomy code Type: Text |
PriorityNote | Label: Party priority note Type: Text |
ReceivingDFIIdentifier | Label: Party receiving DFI identifier Type: Text |
SecondaryID | Label: Party secondary identifier Type: List Of Type: Embed-PegaHC-Reference |
PaymentCode | Label: PaymentCode Type: Text |
PrivacyRestricted | Label: PrivacyRestricted Type: TrueFalse |
School | Label: School Type: List Of Type: School Information |
Source | Label: Source Type: Text |
VIP | Label: VIP Type: Text |
PrimaryContact | Label: primary contact Type: List Of Type: Contact Information - Embedded |
pyFirstName | Label: pyFirstName Type: Text |
pyLastName | Label: pyLastName Type: Text |
Member incident
Data class to hold the incidents that are created and filed on behalf of a member.
Pega Internal Name: PegaHC-Data-Incident
Category | Label: Category Type: Text |
Description | Label: Description Type: Text |
EventDate | Label: Event date Type: DateTime |
Followupinstructions | Label: Followup instructions Type: Text |
FollowUpType | Label: Followup type Type: Text |
Hospital | Label: Hospital Type: Object Of Type: Provider |
HospitalAddress | Label: Hospital address Type: List Of Type: Common |
HospitalName | Label: HospitalName Type: Text |
IncidentImpact | Label: Impact of Incident Type: Text |
IncidentDt | Label: Incident date Type: Date |
IncidentHospital | Label: Incident hospital Type: Text |
IncidentHospitalAddress | Label: Incident hospital address Type: List Of Type: Common |
IncidentHospitalOther | Label: Incident hospital other Type: TrueFalse |
IncidentTime | Label: Incident time Type: TimeOfDay |
IncidentTime1 | Label: Incident time Type: Text |
IncidentType | Label: Incident type Type: Text |
IncidentDate | Label: IncidentDate Type: DateTime |
IncidentID | Label: IncidentID Type: Text |
Incidentlocation | Label: Incidentlocation Type: Text |
IsFollowupRequired | Label: Is followup required Type: TrueFalse |
Member | Label: Member Type: Object Of Type: Member |
OtherFacilityOrPhysician | Label: Other facility or physician Type: TrueFalse |
OtherFollowUp | Label: Other followup Type: Text |
OtherIncidentHospital | Label: Other incident hospital Type: Text |
OtherIncidentType | Label: Other incident type Type: Text |
OtherLocation | Label: Other location Type: Text |
OtherPhysician | Label: Other physician Type: Text |
OtherHospital | Label: OtherHospital Type: Text |
PatientOutcome | Label: Patient outcome Type: Text |
PhoneNumber | Label: Phone number Type: Text |
PhysicianName | Label: PhysicianName Type: Text |
Relationship | Label: Relationship Type: Text |
Reportee | Label: Reportee Type: Text |
ReportingLastName | Label: Reporting last name Type: Text |
ReportingFirstName | Label: ReportingFirstName Type: Text |
RequiresHospitalVisit | Label: Requires hospital visit Type: TrueFalse |
RequiresPhysicianVisit | Label: Requires physician visit Type: TrueFalse |
Source | Label: Source Type: Text |
TelephoneNumber | Label: Telephone number Type: Text |
Test | Label: Test Type: Text |
Tooltip | Label: Tooltip Type: Text |
Type | Label: Type Type: Text |
Witness | Label: Witness Type: List Of Type: Member |
WithnessRelationship | Label: Witness relationship Type: Text |
Testtime | Label: testtime Type: TimeOfDay |
Member notes
Data class to hold the notes provided by care giver in member profile
Pega Internal Name: PegaHC-Data-MemberNotes
Note | Label: Note Type: Text |
Source | Label: Source Type: Text |
Data class to hold the value for risk score for the member
Pega Internal Name: PegaHC-Data-RiskScore
PatientRiskScore | Label: Patient Risk Score Type: Text |
Source | Label: Source Type: Text |
Participant type
Data class to hold the participant type (i.e. care team members) who can be part of visit/conference case
Pega Internal Name: PegaHC-Data-ParticipantType
CaseType | Label: CaseType Type: Identifier |
ParticipantType | Label: ParticipantType Type: Identifier |
Source | Label: Source Type: Text |
Patient's Allergy information
The Allergy data class holds data related to Allergy's identified by the patient. Additional information will relate to allergy source, allergy severity , reaction, and date of initial occurrence.
Pega Internal Name: PegaHC-Data-Allergies
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AllergyCategory | Label: Allergy Category Type: Text |
AllergyOccurrence | Label: Allergy Occurrence Type: Text |
AllergySeverity | Label: Allergy Severity Type: Text |
AllergySource | Label: Allergy Source Type: Text |
AllergyTitle | Label: Allergy Title Type: Text |
AllergyType | Label: Allergy Type Type: Text |
AllergyValue | Label: Allergy Value Type: Text |
AllergySymptoms | Label: AllergySymptoms Type: Object Of Type: AllergySymptoms |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
Comments | Label: Comments Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
Description | Label: Description Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
LISTING_SEQ_NO | Label: NDC codes listing sequence number Type: Integer |
NewVersionNote | Label: New version note Type: Text |
NoKnownAllergy | Label: No Known Allergy Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
OtherSymptoms | Label: Other Symptoms Type: Text |
Others | Label: Others Type: Text |
PatientID | Label: Patient ID Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanVersion | Label: PlanVersion Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
ReportedDate | Label: ReportedDate Type: DateTime |
ResolvedDate | Label: ResolvedDate Type: DateTime |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status of the data instance Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
Code | Label: Test code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Patient's appointment information
Class to save Appointment instances. This class holds appointment information such as appointment date, appointment time slot, appointment notes.
Pega Internal Name: PegaHC-Data-Appointment
IsActive | Label: Active? Type: TrueFalse |
Address | Label: Address Type: List Of Type: Common |
AdjudicationDate | Label: Adjudication Date Type: DateTime |
AgendaList | Label: AgendaList Type: List Of Type: Embed-PegaHC-Agenda |
AllowDelete | Label: Allow delete Type: Text |
AmountQualifierCode | Label: Amount qualifier code Type: Text |
AppealLevel1Disposition | Label: AppealLevel1Disposition Type: Text |
AppealLevel2Disposition | Label: AppealLevel2Disposition Type: Text |
AppealLevel3Disposition | Label: AppealLevel3Disposition Type: Text |
AppointmentDateTime | Label: AppointmentDateTime Type: DateTime |
AppointmentID | Label: AppointmentID Type: Identifier |
IsApproved | Label: Approved? Type: TrueFalse |
IsAtleastSavedOnce | Label: Atleast saved once? Type: Text |
IsAuthorizationRequired | Label: Authorization required? Type: Text |
ChangeKey | Label: ChangeKey Type: Text |
County | Label: County Type: Text |
CustomID | Label: CustomID Type: Text |
DRGGrouper | Label: DRG grouper Type: Object Of Type: DRG Grouper Information |
DateTimePeriodFormatQualifier | Label: Date time period format qualifier Type: Text |
DateTimeQualifier | Label: Date time qualifier Type: Text |
IsDeceased | Label: Deceased? Type: TrueFalse |
DentalOnlyPlan | Label: DentalOnlyPlan Type: Text |
Description | Label: Description Type: Text |
DiagnosisCodeVersion | Label: Diagnosis code version Type: Text |
DiagnosisType | Label: Diagnosis type version Type: Text |
DisplayEffectiveDate | Label: Display effective date Type: Date |
DisplayEndDate | Label: Display end date Type: Date |
DisplayName | Label: Display name Type: Text |
EffectiveDate | Label: Effective date Type: Date |
EffectiveDate_String | Label: Effective date string Type: Text |
EndDate | Label: End date Type: Date |
EndDate_String | Label: End date string Type: Text |
ErrorCode | Label: ErrorCode Type: Text |
ErrorDescription | Label: ErrorDescription Type: Text |
ExternalID | Label: ExternalID Type: Text |
FollowupActionCode | Label: Follow up action code Type: Text |
Gap2EndDate | Label: Gap end date Type: Date |
GapEndDate | Label: Gap end date Type: Date |
GapStartDate | Label: Gap start date Type: Date |
Gap2StartDate | Label: Gap2 start date Type: Date |
HIOSIssuerID | Label: HIOS Issuer ID Type: Text |
HRef | Label: HRef Type: Text |
InformationReceiver | Label: Information receiver Type: Object Of Type: PegaHC-Data-Party |
InformationSource | Label: Information source Type: Object Of Type: PegaHC-Data-Party |
IsWithinRange | Label: Is Within Range Type: TrueFalse |
Languages | Label: Languages Type: List Of Type: Languages |
Latitude | Label: Latitude Type: Text |
ListofLanguages | Label: List of languages Type: Text |
ListOfSecondaryAdmittingHosp | Label: List of secondary admitting hospital Type: Text |
ListOfSecondaryAdmittingHospital | Label: List of secondary admitting hospital Type: Text |
ListOfSecondarySpecialities | Label: List of secondary specialties Type: Text |
LISTING_PREFIX | Label: Listing prefix Type: Text |
Location | Label: Location Type: Text |
LocationMatched | Label: Location matched Type: Text |
Longitude | Label: Longitude Type: Text |
MarketCoverage | Label: Market Coverage Type: Text |
MasterEffectiveDate | Label: Master effective date Type: Date |
MasterEndDate | Label: Master end date Type: Date |
MedicareEligibilityReasonCode | Label: Medicare eligibility reason code Type: Text |
MedicareNumber | Label: Medicare number Type: Text |
MedicarePlanCode | Label: Medicare plan code Type: Text |
MedicareStatusCode | Label: Medicare status code Type: TrueFalse |
MeetingDuration | Label: MeetingDuration Type: Text |
MeetingType | Label: MeetingType Type: Text |
EmailCommunication | Label: Member email communication Type: List Of Type: Embed-PegaHC-Communication-Email |
PhoneCommunication | Label: Member phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
SocialMediaCommunication | Label: Member social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
LISTING_SEQ_NO | Label: NDC codes listing sequence number Type: Integer |
NewVersionNote | Label: New version note Type: Text |
OldKey | Label: OldKey Type: Text |
OnHold | Label: On hold Type: TrueFalse |
OtherTopic | Label: OtherTopic Type: Text |
Participants | Label: Participants Type: List Of Type: Embed-PegaHC-Participant |
PatientID | Label: Patient identifier Type: Text |
AllowedAmount | Label: Payment allowed amount Type: Decimal |
PlanVersion | Label: PlanVersion Type: Text |
PrepNotes | Label: PrepNotes Type: Text |
Priority | Label: Priority Type: Text |
ProcedureCodeType | Label: ProcedureCodeType Type: Text |
ProductCategory | Label: Product category Type: Text |
ProductKey | Label: Product number Type: Text |
ProductOrServiceIDQualifier | Label: Product or service ID qualifier Type: Text |
ProviderContractPick | Label: Provider contract pick Type: List Of Type: Embed-PegaHC-ProviderContractPick |
ProviderPickMessage | Label: Provider pick message Type: Text |
Providers | Label: Providers Type: List Of Type: @baseclass |
Reason | Label: Reason Type: Text |
ReasonForCancellation | Label: ReasonForCancellation Type: Text |
RejectReasonCode | Label: Reject Reason Code Type: Text |
RelativeEffectiveDate | Label: Relative effective date Type: Date |
RelativeEndDate | Label: Relative end date Type: Date |
Reminder | Label: Reminder Type: Text |
ResourceSettings | Label: ResourceSettings Type: List Of Type: Environment settings for extension |
ResponseClass | Label: ResponseClass Type: Text |
SchedulerNotes | Label: SchedulerNotes Type: Text |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
SlotDuration | Label: SlotDuration Type: Integer |
Source | Label: Source Type: Text |
SpecialtyMatched | Label: Specialty matched Type: Text |
Status | Label: Status of the data instance Type: Text |
TaxIdentificationNumber | Label: TaxIdentificationNumber Type: Text |
TaxonomyCode | Label: Taxonomy code Type: Text |
Code | Label: Test code Type: Text |
TraceTypeCode | Label: Trace type code Type: Text |
TranslatorRequired | Label: TranslatorRequired Type: TrueFalse |
UpdateFlag | Label: Update flag Type: Text |
UCASEName | Label: Upper case name Type: Text |
Value_list | Label: Value list Type: Text |
Versions | Label: Versions Type: List Of Type: PegaHC-Data- |
VIPIndicator | Label: Very important person indicator Type: TrueFalse |
Comment | Label: comment Type: Text |
Endtime | Label: endtime Type: DateTime |
MinutesDuration | Label: minutesDuration Type: Integer |
Starttime | Label: starttime Type: DateTime |
Policy
The Membership Policy Data Class holds membership data specifically y related to the policies held by the member. Medical Policy is contract that defines medical benefits available to subscriber as long as premium is being paid.
Pega Internal Name: PegaHC-Data-Policy
BenefitCoverageLevelCode | Label: Policy benefit coverage level code Type: Text |
ContractID | Label: Policy contract ID Type: Text |
EffectiveDate | Label: Policy effective date Type: Date |
PolicyNumber | Label: Policy number Type: Identifier |
PlanNumber | Label: Policy plan number Type: Text |
TermDate | Label: Policy term date Type: Date |
InsuranceTypeCode | Label: Service insurance type code Type: Text |
Source | Label: Source Type: Text |
Practitioner
The Practitioner data class holds provider data as it is utilized within the application. Practitioner is generally an independent provider better known as doctor.
Pega Internal Name: PegaHC-Data-Party-Provider-Practitioner
ALSCertification | Label: ALSCertification Type: TrueFalse |
ALSExpirationDate | Label: ALSExpirationDate Type: Date |
ALSNeonatalCertification | Label: ALSNeonatalCertification Type: TrueFalse |
ALSNeonatalExpirationDate | Label: ALSNeonatalExpirationDate Type: Date |
ALSOBCertification | Label: ALSOBCertification Type: TrueFalse |
ALSOBExpirationDate | Label: ALSOBExpirationDate Type: Date |
ALSPediatricCertification | Label: ALSPediatricCertification Type: TrueFalse |
ALSPediatricExpirationDate | Label: ALSPediatricExpirationDate Type: Date |
ALSTraumaCertification | Label: ALSTraumaCertification Type: TrueFalse |
ALSTraumaExpirationDate | Label: ALSTraumaExpirationDate Type: Date |
BLSCertification | Label: BLSCertification Type: TrueFalse |
BLSExpirationDate | Label: BLSExpirationDate Type: Date |
BoardCertifications | Label: Board Certifications Type: List Of Type: Provider Credentialing - Certifications |
PrimaryContact | Label: Business entity primary contact Type: List Of Type: Contact Information - Embedded |
CDSExpirationDate | Label: CDSExpirationDate Type: Date |
CDSIssueDate | Label: CDSIssueDate Type: Date |
CDSNumber | Label: CDSNumber Type: Text |
CDSState | Label: CDSState Type: Text |
CPRCertification | Label: CPRCertification Type: TrueFalse |
CPRExpiration | Label: CPRExpiration Type: Date |
DEAList | Label: DEAList Type: List Of Type: Embed-PegaHC-Stringlist |
ECFMGIssueDate | Label: ECFMGIssueDate Type: Date |
ECFMGNumber | Label: ECFMGNumber Type: Text |
ExclusiveInpatientPractice | Label: ExclusiveInpatientPractice Type: TrueFalse |
FNINCountryCode | Label: FNINCountryCode Type: Text |
FNIN | Label: FOREIGN NATIONAL IDENTIFICATION NUMBER Type: Text |
pyFirstName | Label: First Name Type: Text |
GraduateType | Label: GraduateType Type: Text |
HierarchicalParentIDNumber | Label: Hierarchical parent identifier number Type: Text |
Languages | Label: Languages Type: List Of Type: Languages |
pyLastName | Label: Last Name Type: Text |
MilitaryDuty | Label: MilitaryDuty Type: TrueFalse |
pyNameSuffix | Label: Name Suffix Type: Text |
NetworkID | Label: Network ID Type: Text |
OtherCertifications | Label: Other Certifications Type: List Of Type: Provider Credentialing - Certifications |
OtherInformation | Label: OtherInformation Type: List Of Type: Other Information Class |
Othername | Label: Othername Type: TrueFalse |
AccountNumber | Label: Party account number Type: Text |
AdditionalName | Label: Party additional name Type: Text |
AddressLine1 | Label: Party address line 1 Type: Text |
AddressLine2 | Label: Party address line 2 Type: Text |
Age | Label: Party age Type: Text |
BankAccountNumber | Label: Party bank account number Type: Text |
BankIDNumber | Label: Party bank identifier number Type: Text |
Contact | Label: Party contact Type: List Of Type: Contact |
ContactFunctionCode | Label: Party contact function code Type: Text |
DateOfDeath | Label: Party date of death Type: Date |
EntityIdentifierCode | Label: Party entity identifier code Type: Text |
EntityTypeQualifier | Label: Party entity type qualifier Type: Text |
UCASEFirstName | Label: Party first name - uppercase Type: Text |
FlowType | Label: Party flow type Type: Text |
GroupName | Label: Party group name Type: Text |
GroupNumber | Label: Party group number Type: Text |
HierarchicalIDNumber | Label: Party hierarchical ID number Type: Text |
HierarchicalChildCode | Label: Party hierarchical child code Type: Text |
HierarchicalLevelCode | Label: Party hierarchical level code Type: Text |
IdentificationCode | Label: Party identification code Type: Text |
IdentificationCodeQualifier | Label: Party identification code qualifier Type: Text |
IndividualIdentifier | Label: Party individual identifier Type: Text |
UCASELastName | Label: Party last name - uppercase Type: Text |
MiddleName | Label: Party middle name Type: Text |
NewTaxonomyCode | Label: Party new taxonomy code Type: Text |
PriorityNote | Label: Party priority note Type: Text |
ReceivingDFIIdentifier | Label: Party receiving DFI identifier Type: Text |
SecondaryID | Label: Party secondary identifier Type: List Of Type: Embed-PegaHC-Reference |
pyWorkPartyUri | Label: Payer identifier Type: Text |
PolicyID | Label: PolicyID Type: Text |
EmailCommunication | Label: Practitioner Type: List Of Type: Embed-PegaHC-Communication-Email |
HospitalAdmittingPrivileges | Label: Practitioner Type: List Of Type: Embed-PegaHC-Stringlist |
Gender | Label: Practitioner Type: Text |
IsPCP | Label: Practitioner is PCP Type: Text |
IsEligibleForPCP | Label: Practitioner is eligible for PCP Type: TrueFalse |
PhoneCommunication | Label: Practitioner phone communication Type: List Of Type: Embed-PegaHC-Communication-Phone |
PrimarySpecialty | Label: Practitioner primary specialty Type: Text |
SocialMediaCommunication | Label: Practitioner social media communication Type: List Of Type: Embed-PegaHC-Communication-SocialMedia |
PractitionerSuffix | Label: Practitioner suffix Type: Text |
TerminationReason | Label: Practitioner termination reason Type: Text |
Title | Label: Practitioner title Type: Text |
ProviderAffiliations | Label: Provider affiliations Type: List Of Type: Embed-PegaHC-ProviderAffiliation |
CredentialedSpecialities | Label: Provider credentialed specialties Type: List Of Type: Embed-PegaHC-Stringlist |
DateOfBirth | Label: Provider date of birth Type: Date |
EffectiveDate | Label: Provider effective date Type: Date |
EndDate | Label: Provider end date Type: Date |
FederalTaxID | Label: Provider federal tax ID Type: Text |
LicenseandState | Label: Provider license and state Type: List Of Type: Embed-PegaHC-Stringlist |
MaintenanceReasonCode | Label: Provider maintenance reason code Type: Text |
MedicaidNumberandState | Label: Provider medicaid number and state Type: List Of Type: Embed-PegaHC-Stringlist |
MedicareNumber | Label: Provider medicare number Type: Text |
MedicareNumberEffectiveDate | Label: Provider medicare number effective date Type: Date |
MedicareNumberEndDate | Label: Provider medicare number end date Type: Date |
NationalProviderIdentifier | Label: Provider national provider identifier Type: Text |
NPIType | Label: Provider national provider identifier type Type: Text |
PaymentCode | Label: Provider payment code Type: Text |
SocialSecurityNumber | Label: Provider social security number Type: Text |
Type | Label: Provider type Type: Text |
Source | Label: Source Type: Text |
Status | Label: Status of the data instance Type: Text |
MemberID | Label: Subscriber member ID Type: Text |
USMLENumber | Label: USMLENumber Type: Text |
WorkersCompNumber | Label: WorkersCompNumber Type: Text |
Prescription - Clinical
The Prescription data class holds data related to prescription data . Prescription data includes actual medication , dosages, duration, quantity information .
Pega Internal Name: PegaHC-Data-Prescription
DiagnosisCodePointer | Label: ***DEPRECATED*** Type: Text |
AdjustRepricedClaimNumberRefIDQualifier | Label: AdjustRepricedClaimNumberRefIDQualifier Type: Text |
AdmissionTypeCode | Label: Admission Type Code Type: Text |
AllowedBasis | Label: Allowed Basis Type: Decimal |
APCDetails | Label: Ambulatory payment classification details Type: Object Of Type: APC Information |
AppliPlacementDateTimePeriodFormatQualifier | Label: AppliPlacementDate time period format qualifier Type: Text |
AppliancePlacementDateTimeQualifier | Label: Appliance PlacementDate time qualifier Type: Text |
ApprovedPlaceOfService | Label: Approved Place Of Service Type: Text |
AuthParameters | Label: Auth parameters Type: Object Of Type: Parameters for Auth processing |
AuthTypeRequired | Label: Auth type required Type: Text |
AuthorizationDecision | Label: Authorization decision Type: Text |
BenefitList | Label: BenefitList Type: List Of Type: Benefit |
BundledOrUnbundledLineNumber | Label: BundledOrUnbundledLineNumber Type: Text |
CE_DetailStatus | Label: CE_DetailStatus for API Type: Text |
CalculatedAllowedAmount | Label: CalculatedAllowedAmount for API Type: Decimal |
CapitationFlag | Label: Capitation Flag for API Type: Text |
PricingDetails | Label: Capture pricing details from external pricing system Type: List Of Type: Response artifacts obtained from external pricing systems |
PricingResponse | Label: Capture pricing response from external pricing system Type: Object Of Type: Response artifacts obtained from external pricing systems |
RepricedApprovedAPGGroupCode | Label: Claim line - repriced approved ambulatory patient group code Type: Text |
MeasurementReferenceIdentificationCode | Label: Claim line - measurement reference identification code Type: Text |
AssistantSurgeon | Label: Claim line Assistant Surgeon Type: Object Of Type: Provider |
DMEDuration | Label: Claim line DME duration Type: Integer |
DMEPurchasePrice | Label: Claim line DME purchase price Type: Decimal |
DMERentalPrice | Label: Claim line DME rental price Type: Decimal |
DRGCode | Label: Claim line DRG code Type: Text |
DentalProcedureCodeDescription | Label: Claim line Dental procedure code description Type: Text |
AdjRepricedLineRefNumber | Label: Claim line adj repriced line reference number Type: Text |
AdjudOrPaymentDate | Label: Claim line adjudication or payment date Type: Text |
AdjustmentQuantitiy | Label: Claim line adjustment quantity Type: Decimal |
AdjustmentReasonCode | Label: Claim line adjustment reason code Type: Text |
AmbulancePatientCount | Label: Claim line ambulance patient count Type: Decimal |
AmbulatoryPatientGroupNumber | Label: Claim line ambulatory patient group number Type: Text |
AnesthesiaModifyingUnits | Label: Claim line anesthesia modifying units Type: Integer |
AnesthesiaUnitCount | Label: Claim line anesthesia unit count Type: Integer |
ApprovedAmount | Label: Claim line approved amount Type: Decimal |
AssignedNumber | Label: Claim line assigned number Type: Text |
Attachments | Label: Claim line attachments Type: List Of Type: Attachments |
AttendingPhysician | Label: Claim line attending physician Type: Object Of Type: Provider |
CertificationRevisionDate | Label: Claim line certification revision date Type: Date |
ChargeAmount | Label: Claim line charge amount Type: Decimal |
ClaimAdjustmentGroupCode | Label: Claim line claim adjustment group code Type: Text |
ClaimFilingIndicatorCode | Label: Claim line claim filing indicator code Type: Text |
ClaimStatusCategoryCode | Label: Claim line claim status category code Type: Text |
ClaimStatusCode | Label: Claim line claim status code Type: Text |
CodeCategory | Label: Claim line code category Type: Text |
CompositeMedicalProcedure | Label: Claim line composite medical procedure Type: Object Of Type: Embed-PegaHC-AdjudicatedLine |
CompositeMedicalProcedureCode | Label: Claim line composite medical procedure code Type: Text |
CompositeUnitOfMeasurementUnit | Label: Claim line composite unit of measurement unit Type: Text |
ConditionCodeAmbulanceList | Label: Claim line condition code ambulance list Type: List Of Type: Embed-PegaHC-Condition |
ConditionIndicator | Label: Claim line condition indicator Type: Text |
ConditionIndicators | Label: Claim line condition indicators Type: Text |
ContractCode | Label: Claim line contract code Type: Text |
ContractPercentage | Label: Claim line contract percentage Type: Decimal |
ContractType | Label: Claim line contract type Type: Text |
ContractVersion | Label: Claim line contract version Type: Text |
CoPayStatusCode | Label: Claim line copay status code Type: Text |
CCIStatus | Label: Claim line correct coding initiative status Type: Text |
DatePrescriptionDate | Label: Claim line date prescription date Type: Date |
DateTreatmentCompletionDate | Label: Claim line date treatment Completion date Type: Date |
DateTreatmentStartDate | Label: Claim line date treatment start date Type: Date |
EmergencyIndicator | Label: Claim line emergency indicator Type: Text |
ExceptionCode | Label: Claim line exception code Type: Text |
FacilityTaxAmount | Label: Claim line facility tax amount Type: Decimal |
FamilyPlanningIndicator | Label: Claim line family planning indicator Type: Text |
FillNumber | Label: Claim line fill number Type: Text |
FixedFormatInformation | Label: Claim line fixed format information Type: Text |
FormIdentificationListList | Label: Claim line form identification list Type: List Of Type: PegaHC-Data-FormIdentification |
FormIdentifier | Label: Claim line form identifier Type: Text |
HospiceEmployedProviderIndicator | Label: Claim line hospice employed provider indicator Type: TrueFalse |
LaboratoryOrFacility | Label: Claim line laboratory or facility Type: Object Of Type: Provider |
LastCertificationDate | Label: Claim line last certification date Type: Date |
LastSeenDate | Label: Claim line last seen date Type: Date |
LastXRayDate | Label: Claim line last x-ray date Type: Date |
LengthOfMedicalNecessity | Label: Claim line length of medical necessity Type: Decimal |
LineAdjudicationList | Label: Claim line line adjudication list Type: List Of Type: Embed-PegaHC-AdjudicatedLine |
LineItemControlNumber | Label: Claim line line item control number Type: Text |
MammographyCertificationNumber | Label: Claim line mammography certification number Type: Text |
MatchedAuthReference | Label: Claim line matched authorization reference Type: List Of Type: Authorization details |
Measurement | Label: Claim line measurement Type: List Of Type: Embed-PegaHC-Measurement |
MeasurementQualifier | Label: Claim line measurement qualifier Type: Text |
MedicalProcedureCodeDescription | Label: Claim line medical procedure code description Type: Text |
MedicalProductOrServiceIDQualifier | Label: Claim line medical product or service id qualifier Type: Text |
MUEStatus | Label: Claim line medically unlikely edits status Type: Text |
MEEStatus | Label: Claim line mutually exclusive edits status Type: Text |
NationalDrugUnitCount | Label: Claim line national drug unit count Type: Decimal |
NonCoveredChargeAmount | Label: Claim line non covered charges amount Type: Decimal |
NonCoveredReason | Label: Claim line non covered reason Type: Text |
NoteReferenceCode | Label: Claim line note reference code Type: Text |
LineNoteText | Label: Claim line note text Type: Text |
LineNumber | Label: Claim line number Type: Identifier |
ObstetricAdditionalUnits | Label: Claim line obstetric additional units Type: Decimal |
OnsetDate | Label: Claim line onset date Type: Date |
OperatingPhysician | Label: Claim line operating physician Type: Object Of Type: Provider |
OrderingProvider | Label: Claim line ordering provider Type: Object Of Type: Provider |
OrthodonticBandingDate | Label: Claim line orthodontic banding date Type: Date |
OtherProvider | Label: Claim line other provider Type: Object Of Type: Provider |
PatientDateOfBirth | Label: Claim line patient date of birth Type: Date |
Payment | Label: Claim line payment Type: Object Of Type: Payment Information |
PolicyComplianceCode | Label: Claim line policy compliance code Type: Text |
PredeterminationOfBenefitsIdentifier | Label: Claim line predetermination of benefits identifier Type: Text |
PricingMethodology | Label: Claim line pricing methodology Type: Text |
PriorAuthorizationOrReferralNumber | Label: Claim line prior auth or referral number Type: Text |
PriAuthReference | Label: Claim line prior authorization reference Type: List Of Type: Authorization details |
PriorPlacementDate | Label: Claim line prior placement date Type: Date |
ProcedureCode | Label: Claim line procedure code Type: Text |
ProcedureCount | Label: Claim line procedure count Type: Integer |
ProcedureIdentifiers | Label: Claim line procedure identifiers Type: Text |
ProcedureModifier | Label: Claim line procedure modifier Type: Text |
ProcessingStatus | Label: Claim line processing status Type: Text |
ProfessionalServiceUnitCode | Label: Claim line professional service unit code Type: Text |
ProsthesisCrownOrInlayCode | Label: Claim line prosthesis crown or inlay code Type: Text |
PurchasedServiceChargeAmount | Label: Claim line purchased service charge amount Type: Decimal |
PurchasedServiceProvider | Label: Claim line purchased service provider Type: Object Of Type: Provider |
PurchasedServiceProviderIdentifier | Label: Claim line purchased service provider identifier Type: Text |
QuestionNumberOrLetter | Label: Claim line question number or letter Type: Text |
QuestionResponse | Label: Claim line question response Type: Text |
ReferenceIdentificationQualifier | Label: Claim line reference identification qualifier Type: Text |
ReferralDate | Label: Claim line referral date Type: Date |
ReferralNumber | Label: Claim line referral number Type: Text |
ReferralNumberList | Label: Claim line referral number list Type: List Of Type: Authorization details |
ReferringProvider | Label: Claim line referring provider for claim line Type: Object Of Type: Provider |
RenderingProvider | Label: Claim line rendering provider Type: Object Of Type: Provider |
RentalUnitPriceIndicator | Label: Claim line rental unit price indicator Type: Text |
ReplacementDate | Label: Claim line replacement date Type: Date |
RepricedLineItemReferenceNumber | Label: Claim line repriced line item reference number Type: Text |
RepricingOrganizationIdentifier | Label: Claim line repricing organization identifier Type: Text |
RevenueCodeDescription | Label: Claim line revenue code description Type: Text |
ServiceAdjudicationOrPaymentDate | Label: Claim line service adj or payment date Type: Date |
ServiceFacility | Label: Claim line service facility Type: Object Of Type: Provider |
ServiceTaxAmount | Label: Claim line service tax amount Type: Decimal |
ShippedDate | Label: Claim line shipped date Type: Date |
SimilarIllnessOrSymptomDate | Label: Claim line similar illness or symptom date Type: Date |
StatusDate | Label: Claim line status date Type: Date |
StatusReason | Label: Claim line status reason Type: Text |
SupervisingProvider | Label: Claim line supervising provider Type: Object Of Type: Provider |
TermsDiscountPercentage | Label: Claim line terms discount percentage Type: Decimal |
TestPerformedDate | Label: Claim line test performed date Type: Date |
TestResults | Label: Claim line test results Type: Text |
ThirdPartyOrganizationNotes | Label: Claim line third party organization notes Type: Text |
ToothCode | Label: Claim line tooth code Type: Text |
ToothSurfaceCode | Label: Claim line tooth surface code Type: Text |
TreatmentCompletionDate | Label: Claim line treatment completion date Type: Date |
TreatmentStartDate | Label: Claim line treatment start date Type: Date |
UnitsOfServicePaidCount | Label: Claim line units of service paid count Type: Integer |
UniversalProductNumber | Label: Claim line universal product number Type: Integer |
Visits | Label: Claim line visits Type: Integer |
Weight | Label: Claim line weight Type: Integer |
XRayAvailabilityIndicator | Label: Claim line x-ray availability indicator Type: TrueFalse |
CompositeMedicalProductOrServiceIDQualifier | Label: Composite med product / svc ID qualifier Type: Text |
ConditionCodeEPSDTReferral | Label: Condition code EPSDT referral Type: Text |
DMEAttachmentTransmissionCode | Label: DME attachment transmission code Type: Text |
DMEUnitorBasisforMeasurementCode | Label: DME measurement code Type: Text |
DentalProductOrServiceIDQualifier | Label: DentalProductOrServiceIDQualifier Type: Text |
DiagnosisCodeAndPointer | Label: DiagnosisCodeAndPointer Type: List Of Type: Diagnosis Information - Embedded |
DischargeLocation | Label: Discharge Location Code Type: Text |
EPSDTIndicator | Label: EPSDT indicator Type: Text |
Frequency | Label: Frequency Type: Text |
GMEFactor | Label: GMEFactor Type: Decimal |
GMETaxAmount | Label: GMETaxAmount Type: Decimal |
HCPCSCode | Label: HCPCS code Type: Text |
ImmunizationBatchNumber | Label: ImmunizationBatchNumber Type: Text |
ICDVersion | Label: International classification of diseases version Type: Text |
IsSANPPricingSuppressed | Label: Is SANP Pricing suppressed Type: TrueFalse |
IsParticipatingNetwork | Label: Is participating network (true/false) Type: TrueFalse |
LineDateTimePeriodFormatQualifier | Label: LineDate time period format qualifier Type: Text |
LineDateTimeQualifier | Label: LineDate time qualifier Type: Text |
LineItemCntNumberRefIDQualifier | Label: LineItemCntNumberRefIDQualifier Type: Text |
NDC | Label: NDC Type: Object Of Type: National Drug Codes (NDC) - Package |
NegotiatedPrice | Label: NegotiatedPrice Type: Decimal |
Network | Label: Network for API Type: Text |
OralCavityDesignationCode | Label: OralCavityDesignationCode Type: Text |
Originalline | Label: Originalline Type: Text |
OutOfStateIndicator | Label: Out of State Indicator for API Type: TrueFalse |
PaidServiceUnitCount | Label: PaidServiceUnitCount Type: Decimal |
PatientCalculatedAmount | Label: Patient Calculated Amount for API Type: Text |
PlaceOfProfessionalServiceCode | Label: Place of professional service code Type: Text |
PlaceofServiceCode | Label: PlaceofServiceCode Type: Text |
Active | Label: Prescription active Type: Text |
LISTING_SEQ_NO | Label: Prescription listing sequence number Type: Integer |
PrescriptionNumber | Label: PrescriptionNumber Type: Text |
PriceFrequency | Label: PriceFrequency Type: Text |
PriorPlacementDateTimePeriodFormatQualifier | Label: PriorPlacementDate time period format qualifier Type: Text |
PriorPlacementDateTimeQualifier | Label: PriorPlacementDateTimeQualifier Type: Text |
ProcessedAuthReference | Label: Processed auth reference Type: List Of Type: Authorization details |
Contract | Label: Provider Contract Type: List Of Type: Provider contract |
RARCodes | Label: RAR Codes Type: List Of Type: Claim Remittance/Remark Codes |
RateSheetID | Label: RateSheetID Type: Text |
ReferringCLIANumber | Label: ReferringCLIANumber Type: Text |
ReplacementDateTimePeriodFormatQualifier | Label: ReplacementDate time period format qualifier Type: Text |
ReplacementDateTimeQualifier | Label: ReplacementDate time qualifier Type: Text |
RepricedClaimNumberRefIDQualifier | Label: RepricedClaimNumberRefIDQualifier Type: Text |
LineRepricingProductOrServiceIDQualifier | Label: Repricing product / svc ID qualifier Type: Text |
ResolvedInSANP | Label: ResolvedInSANP Type: TrueFalse |
ServiceDate | Label: Service Date Type: Date |
AccidentDate | Label: Service accident date Type: Date |
ActionCode | Label: Service action code Type: Text |
ActivitiesPermittedCode | Label: Service activities permitted code Type: Text |
ActualAdmissionDate | Label: Service actual admission date Type: Date |
ActualDischargeDate | Label: Service actual discharge date Type: Date |
AcuteManifestationDate | Label: Service acute manifestation date Type: Date |
AdmissionDate | Label: Service admission date Type: Date |
AdmissionDiagnosis | Label: Service admission diagnosis Type: Text |
AdmissionSourceCode | Label: Service admission source code Type: Text |
AmbulanceDropOffCity | Label: Service ambulance drop off city Type: Text |
AmbulanceDropOffPostalCode | Label: Service ambulance drop off postal code Type: Text |
AmbulanceDropOffStateCode | Label: Service ambulance drop off state code Type: Text |
AmbulanceDropOff | Label: Service ambulance drop-off Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulancePickUpCity | Label: Service ambulance pick up city Type: Text |
AmbulancePickUpPostalCode | Label: Service ambulance pick up postal code Type: Text |
AmbulancePickUpStateCode | Label: Service ambulance pick up state code Type: Text |
AmbulancePickup | Label: Service ambulance pickup Type: Object Of Type: PegaHC-Data-AmbulanceServices |
AmbulanceTransportCode | Label: Service ambulance transport code Type: Text |
AmbulanceTransportReasonCode | Label: Service ambulance transport reason code Type: Text |
AmbulanceTripDestinationAddress | Label: Service ambulance trip destination address Type: Text |
AmbulanceTripOriginAddress | Label: Service ambulance trip origin address Type: Text |
AnesthesiaRelatedSurgicalProcedure | Label: Service anesthesia related surgical procedure Type: Text |
ArterialBloodGasQuantity | Label: Service arterial blood gas quantity Type: Decimal |
AssessmentDate | Label: Service assessment date Type: Date |
AssumedRelinqCareDate | Label: Service assumed or relinquished care date Type: Date |
AuthorizationReason | Label: Service authorization reason Type: Text |
AuthorizedUnitCount | Label: Service authorized service unit count Type: Integer |
BeginTherapyDate | Label: Service begin therapy date Type: Date |
BenefitAmount | Label: Service benefit amount Type: Decimal |
BenefitBeginDate | Label: Service benefit begin date Type: Date |
BenefitCoverageLevelCode | Label: Service benefit coverage level code Type: Text |
BenefitEndDate | Label: Service benefit end date Type: Date |
BenefitPercent | Label: Service benefit percent Type: Integer |
BenefitQuantity | Label: Service benefit quantity Type: Integer |
CertificationConditionIndicator | Label: Service certification condition indicator Type: Text |
CertificationPeriodProjVisitCount | Label: Service certification period projected visit count Type: Integer |
CertificationTypeCodeValues | Label: Service certification type code values Type: Text |
ClaimServicePeriod | Label: Service claim service period Type: Text |
CLIANumber | Label: Service clinical laboratory improvement amendment number Type: Text |
CodeListQualifierCode | Label: Service code list qualifier code Type: Text |
ComplicationIndicator | Label: Service complication indicator Type: Text |
ConditionAdditionalDescriptionPatient | Label: Service condition additional description patient Type: Text |
ConditionCode | Label: Service condition code Type: Text |
ConditionCodeAbortion | Label: Service condition code - abortion Type: Text |
ConditionCodeAmbulance | Label: Service condition code - ambulance transport Type: Text |
ConditionCodePatient | Label: Service condition code - patient Type: Text |
ConditionCodeVision | Label: Service condition code - vision Type: Text |
ConditionDescriptionPatient | Label: Service condition description - patient Type: Text |
CoveragePeriod | Label: Service coverage period Type: Date |
CoveredDaysorVisitsCount | Label: Service covered days or visits count Type: Integer |
CurrentHealthConditionCode | Label: Service current health condition code Type: Text |
DailyOxygenUseCount | Label: Service daily oxygen use count Type: Integer |
Date | Label: Service date Type: List Of Type: Embed-PegaHC-Date |
DaysofSupply | Label: Service days of supply Type: Integer |
DeliveryFrequencyCode | Label: Service delivery frequency code Type: Text |
DeliveryPatternTimeCode | Label: Service delivery pattern time code Type: Text |
Diagnosis | Label: Service diagnosis Type: List Of Type: ***Deprecated*** |
Dose | Label: Service dose Type: Text |
DurationofVisitsNumberofUnits | Label: Service duration of visits number of units Type: Integer |
DurationofVisitsUnits | Label: Service duration of visits units Type: Integer |
EligibilityDate | Label: Service eligibility date Type: Date |
EligibilityOrBenefitInformation | Label: Service eligibility or benefit information Type: Text |
ServiceFacilityLocationSecondaryIdentifier | Label: Service facility location secondary identifier Type: Text |
ServiceFacilityName | Label: Service facility name Type: Text |
FacilityTypeCode | Label: Service facility type code Type: Text |
FileInformation | Label: Service file information Type: List Of Type: Embed-PegaHC-FileInformation |
FrequencyCount | Label: Service frequency count Type: Integer |
FrequencyPeriod | Label: Service frequency period Type: Text |
ServiceFromDate | Label: Service from date Type: Date |
ServiceIdentificationCode | Label: Service identification code Type: Text |
InPlanNetworkIndicator | Label: Service in plan network indicator Type: Text |
InitialTreatmentDate | Label: Service initial treatment date Type: Date |
IssueDate | Label: Service issue date Type: Date |
LastAdmissionPeriod | Label: Service last admission period Type: Date |
ServiceLineDate | Label: Service line date Type: Date |
ServiceLineRate | Label: Service line rate Type: Text |
ServiceLineRevenueCode | Label: Service line revenue code Type: Text |
MonthlyTreatmentCount | Label: Service monthly treatment count Type: Integer |
Notes | Label: Service notes Type: List Of Type: Embed-PegaHC-Notes |
NumberofVisits | Label: Service number of visits Type: Integer |
OnsetofCurrentIllnessorInjury | Label: Service onset of current illness or injury Type: Date |
OrderDate | Label: Service order date Type: Date |
OriginalUnitsofServiceCount | Label: Service original units of service count Type: Integer |
OtherOperatingPhysician | Label: Service other operating physician Type: Object Of Type: Provider |
OxygenFlowRate | Label: Service oxygen flow rate Type: Text |
OxygenSaturationQuantity | Label: Service oxygen saturation quantity Type: Decimal |
OxygenSaturationTestDate | Label: Service oxygen saturation test date Type: Date |
OxygenTestConditionCode | Label: Service oxygen test condition code Type: Text |
OxygenTestFindingsCode | Label: Service oxygen test findings code Type: Text |
PatientStatusCode | Label: Service patient status code Type: Text |
PendCodes | Label: Service pend codes Type: List Of Type: PegaHC-Data-ClaimPendCodes |
PeriodCount | Label: Service period count Type: Decimal |
PrescriptionDate | Label: Service prescription date Type: Date |
PrescriptionFillNumber | Label: Service prescription fill number Type: Integer |
PrincipalDiagnosis | Label: Service principal diagnosis Type: Text |
PrincipalDiagnosisDate | Label: Service principal diagnosis date Type: Date |
PriorIncorrectInsured | Label: Service prior incorrect insured Type: Object Of Type: Member |
ProcedureCodeDescription | Label: Service procedure code description Type: Text |
ProcedureCodeQualifier | Label: Service procedure code qualifier Type: Text |
ProcedureDate | Label: Service procedure date Type: Date |
ProcedureModifiers | Label: Service procedure modifiers Type: Text |
ProcedureQuantity | Label: Service procedure quantity Type: Integer |
ProductCode | Label: Service product code Type: Text |
ProposedAdmissionDate | Label: Service proposed admission date Type: Date |
ProposedDischargeDate | Label: Service proposed discharge date Type: Date |
QuantityDispensed | Label: Service quantity dispensed Type: Text |
QuantityQualifier | Label: Service quantity qualifier Type: Text |
ReferringProviderList | Label: Service referring provider list Type: List Of Type: Provider |
CausesCode | Label: Service related causes code Type: Text |
RelatedCausesCode | Label: Service related causes code Type: Text |
RepricedApprovedServiceUnitCount | Label: Service repriced approved service unit count Type: Integer |
RoundTripPurposeDescription | Label: Service round trip purpose description Type: Text |
SampleSelectionModulus | Label: Service sample selection modulus Type: Text |
ShipDeliveryorCalendarPatternCode | Label: Service ship delivery or calendar pattern code Type: Text |
StretcherPurposeDescription | Label: Service stretcher purpose description Type: Text |
SubluxationLevelCode | Label: Service subluxation level code Type: Text |
SurgeryDate | Label: Service surgery date Type: Date |
SurgicalProcedureCode | Label: Service surgical procedure code Type: Text |
TimePeriodQualifier | Label: Service time period qualifier Type: Text |
ServiceToDate | Label: Service to date Type: Date |
TransportDistance | Label: Service transport distance Type: Integer |
TreatmentCount | Label: Service treatment count Type: Integer |
TreatmentPeriodCount | Label: Service treatment period count Type: Integer |
TreatmentSeriesNumber | Label: Service treatment series number Type: Integer |
ServiceUnitCount | Label: Service unit count Type: Integer |
UnitorBasisforMeasurementCode | Label: Service unit or basis for measurement code Type: Text |
ServiceValid | Label: Service valid Type: Text |
ServicePredeterminationIdentification | Label: ServicePredeterminationIdentification Type: List Of Type: Authorization details |
ServiceTypeCode | Label: ServiceTypeCode Type: Text |
ServicingState | Label: Servicing State for API Type: Text |
ServicingCounty | Label: ServicingCounty Type: Text |
ServicingZipCode | Label: ServicingZipCode Type: Text |
Source | Label: Source Type: Text |
SplitLines | Label: SplitLines Type: List Of Type: Embed-PegaHC-Stringlist |
SurchargeAmount | Label: SurchargeAmount for API Type: Decimal |
SurchargeFactor | Label: SurchargeFactor for API Type: Decimal |
TestProp | Label: TestProp Type: Text |
ToothInformation | Label: ToothInformation Type: List Of Type: Tooth Information |
TreatmentCompDateTimeQualifier | Label: TreatmentCompDate time qualifier Type: Text |
TreatmentStartDateTimeQualifier | Label: TreatmentStartDate time qualifier Type: Text |
UnitOrBasisForMeasurementCodeForService | Label: Unit or basis for measurement code for service Type: Text |
ValidService | Label: Valid service Type: TrueFalse |
Product - Benefits
The Product data class holds data related to Product. Product for healthcare is plans and benefits. This data class has properties for benefits such as benefit type , benefit id .
Pega Internal Name: PegaHC-Data-Product
BeginPrimaryCareCostSharingAfterASetNumberOfVisits | Label: BeginPrimaryCareCost-SharingAfterASetNumberOfVisits Type: Text |
BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays | Label: BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays Type: Text |
ChildOnlyPlanID | Label: Child Only Plan ID Type: Text |
ChildOnlyOffering | Label: Child-Only Offering Type: Text |
CompositeRating | Label: CompositeRating Type: Text |
CreateProduct | Label: CreateProduct Type: Text |
DiseaseManagementProgramsOffered | Label: Disease Management Programs Offered Type: Text |
EHBApportionmentForPediatricDental | Label: EHB Apportionment for Pediatric Dental Type: Text |
EHBTotalPremium | Label: EHBTotalPremium Type: Decimal |
FormularyID | Label: FormularyID Type: Text |
GuaranteedVsEstimatedRate | Label: GuaranteedVsEstimated Rate Type: Text |
HIOSProductID | Label: HIOSProductID Type: Text |
HPID | Label: HPID Type: Text |
HSAEligible | Label: HSA Eligible Type: Text |
HSAHRAEmployerContribution | Label: HSA/HRA Employer Contribution Type: TrueFalse |
HSAHRAEmployerContributionAmount | Label: HSA/HRA Employer Contribution Amount Type: Text |
IsAReferralRequiredForSpecialist | Label: Is a Referral Required for Specialist Type: TrueFalse |
LimitedCostSharingPlanVariationEstAdvancedPayment | Label: Limited Cost Sharing Plan Variation - Est Advanced Payment Type: Text |
MaxNoOfDaysForChargingAnInpatientCopay | Label: MaxNoOfDaysForChargingAnInpatientCopay Type: Text |
MetalLevel | Label: Metal Level Type: Text |
NationalNetwork | Label: National Network Type: TrueFalse |
Networks | Label: Networks Type: List Of Type: Network |
NewOrExistingPlan | Label: NewOrExisting Plan Type: Text |
NoticeForPregnancy | Label: NoticeForPregnancy Type: Text |
OfficeVisitCopayOON | Label: Office visit copay out of network Type: Decimal |
OutOfCountryCoverage | Label: Out of Country Coverage Type: TrueFalse |
OutOfCountryCoverageDescription | Label: Out of Country Coverage Description Type: Text |
OutOfServiceAreaCoverage | Label: Out of Service Area Coverage Type: TrueFalse |
OutOfServiceAreaCoverageDescription | Label: Out of Service Area Coverage Description Type: Text |
PlanBrochure | Label: Plan Brochure Type: Text |
PlanLevelExclusions | Label: Plan Level Exclusions Type: Text |
PlanCostShares | Label: PlanCostShares Type: List Of Type: Embed-PegaHC-PlanCostShare |
Availability | Label: Product availability Type: Text |
Benefit | Label: Product benefit Type: List Of Type: Service (Healthcare) |
BenefitGroup | Label: Product benefit group Type: List Of Type: PegaHC-Data-BenefitGroup |
Category | Label: Product category Type: Text |
CertificationConditionIndicator | Label: Product certification condition indicator Type: Text |
ClaimCostPMPM | Label: Product claim cost per member per month Type: Decimal |
CoInsuranceOON | Label: Product co insurance out of network Type: Decimal |
CoInsurance | Label: Product coinsurance Type: Decimal |
DependentEligibilityAgeMax | Label: Product dependent eligibility age max Type: Integer |
EffectiveDate | Label: Product effective date Type: Date |
EndDate | Label: Product end date Type: Date |
FamilyDeductible | Label: Product family deductible Type: Integer |
FamilyDeductibleMultiplier | Label: Product family deductible multiplier Type: Integer |
FamilyDeductibleMultiplierOON | Label: Product family deductible multiplier out of network Type: Integer |
FamilyDeductibleOON | Label: Product family deductible out of network Type: Integer |
FamilyOOPMax | Label: Product family out-of-pocket maximum Type: Double |
FamilyOOPMaxMultiplier | Label: Product family out-of-pocket maximum multiplier Type: Integer |
FamilyOOPMaxMultiplierOON | Label: Product family out-of-pocket maximum multiplier OON Type: Integer |
FamilyOOPMaxOON | Label: Product family out-of-pocket maximum out of network Type: Double |
GroupSizeHigh | Label: Product group size high Type: Integer |
IndividualDeductible | Label: Product individual deductible Type: Integer |
IndividualDeductibleOON | Label: Product individual deductible out of network Type: Integer |
IndividualOOPMax | Label: Product individual out-of-pocket maximum Type: Integer |
IndividualOOPMaxOON | Label: Product individual out-of-pocket maximum out of network Type: Integer |
InsuranceLineCode | Label: Product insurance line code Type: Text |
LifeTimeMax | Label: Product life time max Type: Integer |
LifeTimeMaxOON | Label: Product life time max out of network Type: Integer |
ProductList | Label: Product list Type: List Of Type: Product - Benefits |
MaximumGroupSize | Label: Product maximum group size Type: Integer |
MedicarePlanCode | Label: Product medicare plan code Type: Text |
MemberOOP | Label: Product member out-of-pocket Type: Text |
ProductName | Label: Product name Type: Text |
NetworkRestriction | Label: Product network restriction Type: Text |
OfficeVisitCopay | Label: Product office visit copay Type: Decimal |
OutOfNetworkIndicator | Label: Product out of network indicator Type: Text |
PerformanceFlag | Label: Product performance flag Type: Text |
PlanCoverageDescription | Label: Product plan coverage description Type: Text |
PlanName | Label: Product plan name Type: Text |
PlanNumber | Label: Product plan number Type: Text |
ProductNumber | Label: Product plan number Type: Text |
PCPRequired | Label: Product primary care physician required Type: Text |
RateEffectiveDate | Label: Product rate effective date Type: Date |
RateTermDate | Label: Product rate term date Type: Date |
ShortDescription | Label: Product short description Type: Text |
StudentEligibilityAgeMax | Label: Product student eligibility age maximum Type: Integer |
ValueStatement | Label: Product value statement Type: Text |
QHPOrNonQHP | Label: QHPOrNonQHP Type: Text |
ServiceAreas | Label: ServiceAreas Type: List Of Type: Service Area |
Source | Label: Source Type: Text |
SpecialistsRequiringAReferral | Label: Specialist(s) Requiring a Referral Type: Text |
TempSubscriberName | Label: TempSubscriberName Type: Object Of Type: PegaHC-X12-Data-N271-Loop2100CSubscriberName |
TobaccoWellnessProgramOffered | Label: Tobacco Wellness Program Offered Type: TrueFalse |
URLForEnrollmentPayment | Label: URL for Enrollment Payment Type: Text |
URLForSummaryOfBenefitsAndCoverage | Label: URL for Summary of BenefitsAndCoverage Type: Text |
UniquePlanDesign | Label: UniquePlanDesign Type: TrueFalse |
Provider - Group / Facility
The Group/Facility Data Class holds Servicing provider data as it is utilized within the application. Facility data include NPi, associated Providers and affiliations.
Pega Internal Name: PegaHC-Data-Party-Provider-ServicingOrg
BoardCertifications | Label: Board Certifications Type: List Of Type: Provider Credentialing - Certifications |
DEAList | Label: DEAList Type: List Of Type: Embed-PegaHC-Stringlist |
pyFirstName | Label: First Name Type: Text |
HierarchicalParentIDNumber | Label: Hierarchical parent identifier number Type: Text |
HospitalAdmittingPrivileges | Label: Hospital Admitting Privileges Type: List Of Type: Embed-PegaHC-Stringlist |
Languages | Label: Languages Type: List Of Type: Languages |
pyLastName | Label: Last Name Type: Text |
MilitaryDuty | Label: Military Duty Type: TrueFalse |
pyNameSuffix | Label: Name Suffix Type: Text |
OtherCertifications | Label: Other Certifications Type: List Of Type: Provider Credentialing - Certifications |
OtherInformation | Label: OtherInformation Type: List Of Type: Other Information Class |
AccountNumber | Label: Party account number Type: Text |
AdditionalName | Label: Party additional name Type: Text |
AddressLine1 | Label: Party address line 1 Type: Text |
AddressLine2 | Label: Party address line 2 Type: Text |
Age | Label: Party age Type: Text |
BankAccountNumber | Label: Party bank account number Type: Text |
BankIDNumber | Label: Party bank identifier number Type: Text |
Contact | Label: Party contact Type: List Of Type: Contact |
ContactFunctionCode | Label: Party contact function code Type: Text |
DateOfDeath | Label: Party date of death Type: Date |
EntityIdentifierCode | Label: Party entity identifier code Type: Text |
EntityTypeQualifier | Label: Party entity type qualifier Type: Text |
UCASEFirstName | Label: Party first name - uppercase Type: Text |
FlowType | Label: Party flow type Type: Text |
GroupName | Label: Party group name Type: Text |
GroupNumber | Label: Party group number Type: Text |
HierarchicalIDNumber | Label: Party hierarchical ID number Type: Text |
HierarchicalChildCode | Label: Party hierarchical child code Type: Text |
HierarchicalLevelCode | Label: Party hierarchical level code Type: Text |
IdentificationCode | Label: Party identification code Type: Text |
IdentificationCodeQualifier | Label: Party identification code qualifier Type: Text |
IndividualIdentifier | Label: Party individual identifier Type: Text |
UCASELastName | Label: Party last name - uppercase Type: Text |
MiddleName | Label: Party middle name Type: Text |
NewTaxonomyCode | Label: Party new taxonomy code Type: Text |
PriorityNote | Label: Party priority note Type: Text |
ReceivingDFIIdentifier | Label: Party receiving DFI identifier Type: Text |
SecondaryID | Label: Party secondary identifier Type: List Of Type: Embed-PegaHC-Reference |
pyWorkPartyUri | Label: Payer identifier Type: Text |
Title | Label: Practitioner title Type: Text |
ProviderAffiliations | Label: Provider affiliations Type: List Of Type: Embed-PegaHC-ProviderAffiliation |
CredentialedSpecialities | Label: Provider credentialed specialties Type: List Of Type: Embed-PegaHC-Stringlist |
DateOfBirth | Label: Provider date of birth Type: Date |
EffectiveDate | Label: Provider effective date Type: Date |
EndDate | Label: Provider end date Type: Date |
FederalTaxID | Label: Provider federal tax ID Type: Text |
Gender | Label: Provider gender Type: Text |
LicenseandState | Label: Provider license and state Type: List Of Type: Embed-PegaHC-Stringlist |
MaintenanceReasonCode | Label: Provider maintenance reason code Type: Text |
MedicaidNumberandState | Label: Provider medicaid number and state Type: List Of Type: Embed-PegaHC-Stringlist |
MedicareNumber | Label: Provider medicare number Type: Text |
MedicareNumberEffectiveDate | Label: Provider medicare number effective date Type: Date |
MedicareNumberEndDate | Label: Provider medicare number end date Type: Date |
NationalProviderIdentifier | Label: Provider national provider identifier Type: Text |
NPIType | Label: Provider national provider identifier type Type: Text |
PaymentCode | Label: Provider payment code Type: Text |
SocialSecurityNumber | Label: Provider social security number Type: Text |
Type | Label: Provider type Type: Text |
IsSubpart | Label: Servicingorg is subpart Type: Text |
ParentNPI | Label: Servicingorg parent national identification number Type: Text |
PrimarySpecialty | Label: Servicingorg primary specialty Type: Text |
ProviderAliases | Label: Servicingorg provider aliases Type: List Of Type: Embed-PegaHC-Stringlist |
TerminationReason | Label: Servicingorg termination reason Type: Text |
Source | Label: Source Type: Text |
Status | Label: Status of the data instance Type: Text |
MemberID | Label: Subscriber member ID Type: Text |
PrimaryContact | Label: primary contact Type: List Of Type: Contact Information - Embedded |
Provider affiliation
ProviderAffiliation class relating a Provider with Business Entity. Affiliation indicates the association of provider with other entities such as group practices, hospitals.
Pega Internal Name: PegaHC-Data-ProviderAffiliation
PanelLimit | Label: PanelLimit Type: Text |
PrimaryHospNPI | Label: PrimaryHospNPI Type: Text |
PrimarySpecialtyStatus | Label: PrimarySpecialtyStatus Type: Text |
AcceptingNewPatients | Label: Provider affiliation accepting new patients Type: Text |
Locations | Label: Provider affiliation addresses Type: List Of Type: Embed-PegaHC-BEAddress |
AgeRestriction | Label: Provider affiliation age restriction Type: Integer |
BusinessEntityID | Label: Provider affiliation business entity ID Type: Identifier |
EffectiveDate | Label: Provider affiliation effective date Type: Date |
EndDate | Label: Provider affiliation end date Type: Date |
MarketInDirectory | Label: Provider affiliation market in directory Type: Text |
PractitionerCapacity | Label: Provider affiliation practitioner capacity Type: Text |
PrimaryHospEffectiveDate | Label: Provider affiliation primary hospital effective date Type: Date |
PrimaryHospEndDate | Label: Provider affiliation primary hospital end date Type: Date |
PrimarySpecialityCode | Label: Provider affiliation primary specialty code Type: Text |
PrimarySpecialtyEffectiveDate | Label: Provider affiliation primary specialty effective date Type: Date |
PrimarySpecialtyEndDate | Label: Provider affiliation primary specialty end date Type: Date |
ProviderID | Label: Provider affiliation provider ID Type: Identifier |
SecondarySpecialities | Label: Provider affiliation secondary specialties Type: List Of Type: Embed-PegaHC-Stringlist |
SecondaryHospitalAdmittingPrevilege | Label: Secondary hosp admitting previlege Type: List Of Type: Embed-PegaHC-Stringlist |
Source | Label: Source Type: Text |
Provider contract
DataClass for Contract
Pega Internal Name: PegaHC-Data-ProviderContract
AssociatedBE | Label: AssociatedBE Type: Object Of Type: Business entity |
ContractState | Label: ContractState Type: Text |
CoveredNetworks | Label: Covered Networks Type: List Of Type: Network |
PlanDefault | Label: PlanDefault Type: Text |
CoveredProductGroups | Label: Provider contract covered product groups Type: List Of Type: PegaHC-Data-ProductGroup |
CoveredProducts | Label: Provider contract covered products Type: List Of Type: Product - Benefits |
EffectiveDate | Label: Provider contract effective date Type: Date |
EndDate | Label: Provider contract end date Type: Date |
ContractID | Label: Provider contract identifier Type: Text |
ContractName | Label: Provider contract name Type: Identifier |
PrimaryPaymentMethod | Label: Provider contract primary payment method Type: Text |
PromptPay | Label: Provider contract prompt pay Type: Text |
ContractStatus | Label: Provider contract status Type: Text |
ContractType | Label: Provider contract type Type: Text |
ContractVersion | Label: Provider contract version Type: Text |
RateSheets | Label: Ratesheets associated to contract Type: List Of Type: Rate Sheet |
Source | Label: Source Type: Text |
Subscriber (Policy Holder)
The subscriber Policy Data Class holds membership data specifically y related to the policies held by the subscriber of the policy. Subscriber is the person who pays premium for insurance . All other members on policy are better known as dependents of that subscriber.
Pega Internal Name: PegaHC-Data-Party-Subscriber
HierarchicalParentIDNumber | Label: Hierarchical parent identifier number Type: Text |
IRCTest | Label: IRCTest Type: Text |
Member | Label: Member Type: Object Of Type: Member |
MemberReasonCode | Label: Member reason code Type: Text |
OldPCP | Label: OldPCP Type: Text |
OldTermDate | Label: OldTermDate Type: Date |
PCP | Label: PCP Type: Text |
PCPEffectiveDate | Label: PCPEffectiveDate Type: Date |
PCPEndDate | Label: PCPEndDate Type: Date |
AccountNumber | Label: Party account number Type: Text |
AdditionalName | Label: Party additional name Type: Text |
AddressLine1 | Label: Party address line 1 Type: Text |
AddressLine2 | Label: Party address line 2 Type: Text |
Age | Label: Party age Type: Text |
BankAccountNumber | Label: Party bank account number Type: Text |
BankIDNumber | Label: Party bank identifier number Type: Text |
Contact | Label: Party contact Type: List Of Type: Contact |
ContactFunctionCode | Label: Party contact function code Type: Text |
DateOfBirth | Label: Party date of birth Type: Date |
DateOfDeath | Label: Party date of death Type: Date |
EntityIdentifierCode | Label: Party entity identifier code Type: Text |
EntityTypeQualifier | Label: Party entity type qualifier Type: Text |
UCASEFirstName | Label: Party first name - uppercase Type: Text |
FlowType | Label: Party flow type Type: Text |
GroupName | Label: Party group name Type: Text |
GroupNumber | Label: Party group number Type: Text |
HierarchicalIDNumber | Label: Party hierarchical ID number Type: Text |
HierarchicalChildCode | Label: Party hierarchical child code Type: Text |
HierarchicalLevelCode | Label: Party hierarchical level code Type: Text |
IdentificationCode | Label: Party identification code Type: Text |
IdentificationCodeQualifier | Label: Party identification code qualifier Type: Text |
IndividualIdentifier | Label: Party individual identifier Type: Text |
UCASELastName | Label: Party last name - uppercase Type: Text |
MiddleName | Label: Party middle name Type: Text |
NationalProviderIdentifier | Label: Party national provider identifier Type: Text |
NewTaxonomyCode | Label: Party new taxonomy code Type: Text |
PriorityNote | Label: Party priority note Type: Text |
ReceivingDFIIdentifier | Label: Party receiving DFI identifier Type: Text |
SecondaryID | Label: Party secondary identifier Type: List Of Type: Embed-PegaHC-Reference |
PaymentCode | Label: PaymentCode Type: Text |
ProviderName | Label: ProviderName Type: Text |
Source | Label: Source Type: Text |
FirstName | Label: Subscriber first name Type: Text |
IndividualRelationshipCode | Label: Subscriber individual relationship code Type: Text |
LastName | Label: Subscriber last name Type: Text |
MemberID | Label: Subscriber member ID Type: Text |
MemberKey | Label: Subscriber member key Type: Text |
MemberNumber | Label: Subscriber member number Type: Identifier |
MemberStatus | Label: Subscriber member status Type: Text |
PlanType | Label: Subscriber plan type Type: Text |
PolicyNumber | Label: Subscriber policy number Type: Text |
TaxonomyCode | Label: TaxonomyCode Type: Text |
PcpReasonCode | Label: pcp reason code Type: Text |
PrimaryContact | Label: primary contact Type: List Of Type: Contact Information - Embedded |
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