Tables | METL

📄️ address_canonical

Canonical address information retrieved from smarty.com API. See address_seen for field details. (https://www.smarty.com/products/us-address-verification)

📄️ address_seen

Stores every address we've ever encountered from any source in the database.

📄️ api_metrics

Stores metrics for Application Programming Interface (API) calls.

📄️ claim

Information about a healthcare or prescription drug claim

📄️ claim_adjustment_reason_code_lookup

The anesthesia related surgical procedure (Loop 2300 HI). This could be the principal (HI01-01='BP') or secondary (HI01-01='BO') Healthcare Common Procedure Coding System (HCPCS) code. See the 837i x12 spec for more information.

📄️ claim_coordination_of_benefits

Information about other subscribers that may be responsible for payment during coordination of benefits. Some repricers also use the SBR/CAS segments to indicate the price for a primary payer, even if that is not technically spec compliant

📄️ claim_coordination_of_benefits_adjustment

Lists the adjustments that have been performed on a claim during the process of adjudication. Only used for Coordination of Benefits according to the EDI spec, but may be used for repricing with the primary payer (from 2320 loop). (https://www.ehealthinsurance.com/resources/individual-and-family/coordination-of-benefits)

📄️ claim_coverage

Provides information about member coverage for a specific plan during service dates

📄️ claim_diagnosis

Provides information about the ICD diagnosis codes associated with a claim. https://www.cms.gov/medicare/coding-billing/icd-10-codes

📄️ claim_drg

Provides information about the Diagnosis-Related Group (DRG) code associated with an inpatient claim. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software

📄️ claim_member

Member information for a claim. Includes subscriber and patient (when provided) information

📄️ claim_member_match_hash

Text hash used for finding matches between claims (claim_member) and eligibility (member_seen)

📄️ claim_member_to_member_seen_match

Describes matches between claims (claim_member) and eligibility (member_seen).

📄️ claim_note

Notes for a claim

📄️ claim_occurrence

Provides information about the NUBC occurrence codes associated with a claim

📄️ claim_occurrence_span

Provides information about the NUBC occurrence span codes associated with a claim

📄️ claim_paperwork

Describes a paper attachment following the claim (https://www.cgsmedicare.com/jb/claims/pwk_segment.html)

📄️ claim_pay_to_plan

Information about the subrogation demand payer

📄️ claim_procedure

Provides information about the ICD procedure codes associated with a claim. (https://www.cms.gov/medicare/coding-billing/icd-10-codes)

📄️ claim_provider

Connects a claim to one or more providers

📄️ claim_repricing

Results of a pricing request

📄️ claim_repricing_code_lookup

Claim-level repricing codes

📄️ claim_status

Results of a pricing request

📄️ claim_status_lookup

Available statuses for a claim

📄️ claim_tooth_status

Provides information about the status of individual teeth

📄️ claim_value

Provides information about the NUBC value codes associated with a claim. (https://med.noridianmedicare.com/web/jea/topics/claim-submission/value-codes)

📄️ coordination_of_benefits_subscriber

Contains unique subscriber details for coordination of benefits

📄️ coverage

A unique set of data associated with a member coverage.

📄️ coverage_coordination_of_benefits

Coordination of Benefits information for a member

📄️ coverage_group_or_plan

Pulls together all the information available to map a set of members into one or more groups and one or more plans

📄️ cpt_concept_description

CPT concept descriptions. A CPT concept is the term used by the American Medical Association (AMA) to describe all the concepts surrounding CPT codes (e.g. documentation, hierarchy, codes, etc.). In our case, we're interested in the Descriptor or text definition of each CPT concept.

📄️ cpt_hcup_group

Links CPT code to the appropriate HCUP CCS Group. See https://hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp for more information.

📄️ cpt_hierarchy

Hierarchy for CPT codes.

📄️ cpt_hierarchy_crosswalk

Crosswalk between cpt and cpt hierarchy..

📄️ cpt_hierarchy_lookup

Lookup for CPT code hierarchy.

📄️ eligibility

A unique set of data associated with a member eligibility. (https://www.stedi.com/edi/x12/transaction-set/834)

📄️ eligibility_person_or_org

Contains unique people or organizations that are in some way connected to a member

📄️ email

A unique list of every email address we've seen in claims and eligibility

📄️ fax

A unique list of fax numbers we've seen in claims and eligibility

📄️ group

Information about a group of employees for a plan sponsor of a health plan (e.g. Intel California). For a small employer, this will usually match the company name. Note that this is our group definition, and may not match with the group definition of a TPA or other trading partner.

📄️ group_match

Information used to match members received from a TPA, plan sponsor, or other trading partner to our definition of a group (in the group table).

📄️ hcpcs_hcup_group

Links HCPCS code to the appropriate HCUP CCS Group. See https://hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp for more information.

📄️ hcup_diagnosis_chronic_condition_indicator_lookup

Identifies diagnosis codes that indicate a chronic condition.

📄️ hcup_diagnosis_crosswalk

HCUP diagnosis crosswalk. See icd_diagnosis_hcup_group for the linkage between icd_diagnosis_id and hcup_diagnosis_group_id. (https://hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp)

📄️ hcup_diagnosis_group_lookup

Information about the HCUP CCS groups for diagnosis codes. See https://hcup-us.ahrq.gov/toolssoftware/ccs10/ccs10.jsp for more information.

📄️ hcup_hcpcs_crosswalk

HCUP HCPCS crosswalk. See hcpcs_hcup_group for the linkage between line_item_procedure_code_id and hcup_hcpcs_group_id. (https://hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp)

📄️ hcup_hcpcs_group_lookup

Information about the HCUP CCS groups for HCPCS codes. See https://hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp for more information.

📄️ hcup_procedure_crosswalk

HCUP procedure crosswalk. See icd_procedure_hcup_group for the linkage between icd_procedure_id and hcup_procedure_group_id. https://hcup-us.ahrq.gov/toolssoftware/ccsr/prccsr.jsp

📄️ hcup_procedure_group_lookup

Information about the HCUP CCS groups for HCPCS codes. See https://hcup-us.ahrq.gov/toolssoftware/procedureicd10/procedure_icd10.jsp for more information.

📄️ icd_diagnosis_hcup_group

Links ICD Diagnosis code to the appropriate HCUP CCS Group. See https://hcup-us.ahrq.gov/toolssoftware/ccs10/ccs10.jsp for more information.

📄️ icd_diagnosis_hierarchy

ICD diagnosis code hierarchy.

📄️ icd_diagnosis_hierarchy1_lookup

ICD diagnosis code hierarchy level 1 lookup (https://www.cms.gov/medicare/coding-billing/icd-10-codes).

📄️ icd_diagnosis_hierarchy2_lookup

ICD diagnosis code hierarchy level 2 lookup (https://www.cms.gov/medicare/coding-billing/icd-10-codes).

📄️ icd_diagnosis_hierarchy3_lookup

ICD diagnosis code hierarchy level 3 lookup (https://www.cms.gov/medicare/coding-billing/icd-10-codes).

📄️ icd_diagnosis_hierarchy4_lookup

ICD diagnosis code hierarchy level 4 lookup (https://www.cms.gov/medicare/coding-billing/icd-10-codes).

📄️ icd_diagnosis_hierarchy_crosswalk

ICD diagnosis code hierarchy crosswalk.

📄️ icd_diagnosis_horizon_blue_cross_case_management_lookup

Complex case management trigger diagnosis codes (Horizon Blue Cross Blue Shield) See: https://www.horizonblue.com/sites/default/files/ICD_10_charts-FINAL-July.pdf.

📄️ icd_diagnosis_lookup

List of ICD Diagnosis codes from CMS. (https://www.cms.gov/medicare/coding-billing/icd-10-codes)

📄️ icd_diagnosis_stop_loss_trigger

List of ICD Diagnosis stop loss trigger codes

📄️ icd_procedure_hcup_group

Links ICD Procedure code to the appropriate HCUP CCS Group. See https://hcup-us.ahrq.gov/toolssoftware/procedureicd10/procedure_icd10.jsp for more information.

📄️ icd_procedure_hierarchy

Crosswalk between ICD procedure code and the hierarchy lookups.

📄️ icd_procedure_hierarchy1_lookup

ICD procedure code hierarchy level 1 lookup.

📄️ icd_procedure_hierarchy2_lookup

ICD procedure code hierarchy level 2 lookup.

📄️ icd_procedure_hierarchy3_lookup

ICD procedure code hierarchy level 3 lookup.

📄️ icd_procedure_hierarchy4_lookup

ICD procedure code hierarchy level 4 lookup.

📄️ icd_procedure_hierarchy5_lookup

ICD procedure code hierarchy level 5 lookup.

📄️ icd_procedure_hierarchy_crosswalk

ICD procedure code hierarchy crosswalk.

📄️ icd_procedure_hierarchy_title_lookup

Stores the titles used to describe each of the hierarchy levels, which vary depending on the section code (hierarchy level 1). For example in 'Medical and Surgical procedures' the letters of the procedure describe the 'section', 'body system', 'operation', etc. but for 'Physical Rehabilitation and Diagnostic Audiology', the letters of the procedure describe the 'section', 'section qualifier', 'type', etc. This table makes it possible to correctly build a ICD-procedure drill-down UI.

📄️ icd_procedure_lookup

List of ICD Procedure codes from CMS. See: https://www.cms.gov/medicare/coding-billing/icd-10-codes

📄️ insurer_payer

Identifies the insurer / network / carrier or other entity responsible for paying the claim on behalf of the employer

📄️ line_item

Information about a line item for a health, dental, prescription drug, etc. claim

📄️ line_item_coordination_of_benefits

Describes the adjudication performed for a line item on behalf of the payer. According to the EDI specification, this is only used for Coordination of Benefits, but some reprices also use it for claims repricing

📄️ line_item_coordination_of_benefits_adjustment

A log of all adjustments made to a line item by a Coordination of Benefits payer. Sometimes used by repricing organizations to show pricing adjustments

📄️ line_item_form

A form that has been filled out to provide documentation

📄️ line_item_form_response

Responses to a codified questionnaire

📄️ line_item_measurement

Measurement details for a line item

📄️ line_item_note

Notes for a line item

📄️ line_item_paperwork

Describes a paper attachment following the line_item

📄️ line_item_procedure_code_lookup

Unified lookup for procedure codes (CPT, HCPCS, ADA CDT, and user-defined).

📄️ line_item_procedure_code_raw

Raw data for procedure code lookup.

📄️ line_item_provider

Connects a line item to a provider

📄️ line_item_repricing

Results of a pricing request for a single service line

📄️ line_item_tooth

Provides information about the status of individual teeth

📄️ line_repricing_code_lookup

Line-level Medicare repricing code

📄️ login

Information about application logins

📄️ matching_session

An append-only table of sessions

📄️ medicare_source_lookup

Medicare amount sources

📄️ member_canonical

The canonical member table. Other tables have foreign keys to this table.

📄️ member_canonical_archive

An archive of old member_canonical records. Rows in this table are created when a user merges two member_canonical, effectively deleting one.

📄️ member_canonical_lock

A lock corresponding to a human currently matching using a member_canonical record. This does not correspond to any Postgres lock as no continuous connection is held during the duration of the matching but updates are still not allowed.

📄️ member_canonical_reconfiguration

📄️ member_coverage

Keeps track of each load of an enrolled member's coverage

📄️ member_coverage_coordination_of_benefits

Coordination of Benefits information for a specific enrolled member

📄️ member_coverage_provider

Member provider selections for primary care, capitated physicians, pharmacy, etc.

📄️ member_eligibility

Keeps track of member eligibility information

📄️ member_eligibility_person_or_org

Links a member_eligibility to employer, custodial parent, school, etc. person_or_org records

📄️ member_eligibility_race_or_ethnicity

Identifies one or more race or ethnicity categories for a member.

📄️ member_history

📄️ member_seen

Contains unique member information from eligibility files

📄️ member_seen_lock

A lock corresponding to a human currently matching using a member_seen record. This does not correspond to any Postgres lock as no continuous connection is held during the duration of the matching but updates are still not allowed.

📄️ member_seen_match_hash

Text hash used for finding matches between claims (claim_member) and eligibility (member_seen)

📄️ member_seen_to_member_seen_match

Describes matches between rows in member_seen.

📄️ msdrg_lookup

Contains Medicare Severity Diagnosis-Related Group (MS-DRG) information. (See: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software)

📄️ name_given_alias

Provides the canonical, formal version of names where applicable (e.g. Bob, Bobby, Rob -> Robert). From https://www.behindthename.com/api/download.php

📄️ nanpa_area_code_lookup

A table for looking up information about North American Numbering Plan Administration (NANPA) area code.

📄️ ndc_wasteful_drugs

Johns Hopkins University wasteful drugs. https://www.pbgh.org/wp-content/uploads/2021/01/PBGH-Wasteful-Drugs-Guidebook-FINAL.pdf

📄️ npi_address

A provider's address.

📄️ npi_affiliate

Information about NPI's that are related to another NPI in some way.

📄️ npi_ccn

Association of National Provider Identifier (NPI) to CMS Certification Number (CCN).

📄️ npi_country_lookup

Global country codes used within NPI data. See https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/Data_Dissemination_File-Code_Values.pdf#page=12 section 1.10 for all Country Codes.

📄️ npi_fax

Fax number(s) associated with a provider

📄️ npi_license

Provider licensing data.

📄️ npi_match_hash

Text hash used for finding possible providers for matching.

📄️ npi_name

Names associated with a provider

📄️ npi_other_identifier

Other identifiers of a provider.

📄️ npi_phone

Phone number(s) associated with a provider

📄️ npi_provider

The details about a provider. There will always be exactly one npi_provider row per provider but there may be many locations etc.

📄️ npi_state_lookup

Information about states and territories of the United States of America.

📄️ npi_tax_id

Tax IDs associated with an NPI in claims or contract data.

📄️ npi_taxonomy

A provider's taxonomy information.

📄️ nppes_authorized_official

Contact information for the authorized official for a provider.

📄️ nppes_endpoint

Stores information to securely transmit authenticated and encrypted medical information using a variety of Endpoint Types.

📄️ nubc_admission_source_lookup

NUBC admission source codes (AKA Point of origin). Used to describe where patient was admitted from. https://med.noridianmedicare.com/web/jea/topics/claim-submission/point-of-origin-codes

📄️ nubc_admission_type_lookup

The type/priority of admission for hospital stays. https://med.noridianmedicare.com/web/jea/topics/claim-submission/type-of-admission-or-visit-codes

📄️ nubc_bill_type_facility_lookup

NUBC bill type digit 1 (AKA type of facility) codes. https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

📄️ nubc_bill_type_frequency_lookup

NUBC bill type digit 3 (AKA frequency) codes https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

📄️ nubc_bill_type_lookup

NUBC bill type codes. This includes digit 1 and 2. https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

📄️ nubc_bill_type_to_place_of_service_crosswalk

Crosswalk was designed by Health Rosetta to map Bill Type (UB-04) to Place of Service (HCFA) codes as well as possible for uniform reporting across form types.

📄️ nubc_condition_lookup

NUBC condition codes used to explain special payment, patient, treatment, etc. conditions. https://med.noridianmedicare.com/web/jea/topics/claim-submission/condition-codes

📄️ nubc_occurrence_lookup

NUBC occurrence codes used to specify extra dates associated with a claim. (https://med.noridianmedicare.com/web/jea/topics/claim-submission/occurrence-codes) (https://med.noridianmedicare.com/web/jfa/topics/claim-submission/occurrence-span-codes)

📄️ nubc_patient_status_lookup

NUBC patient status codes (AKA discharge status) used to describe the patient's status at the end of the claim period. https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

📄️ nubc_revenue_code_group_lookup

NUBC revenue code groups provide a higher-level grouping of revenue codes. Grouping brings together up to 10 similar types of revenue codes by making the final digit of the revenue code into an 'X' (e.g. '0022', '0023', and '0024' become '002X') https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes

📄️ nubc_revenue_code_lookup

NUBC revenue codes describe the department performing a service in a facility. https://med.noridianmedicare.com/web/jea/topics/claim-submission/revenue-codes

📄️ nubc_value_lookup

Additional numeric values related to the claim. See https://med.noridianmedicare.com/web/jea/topics/claim-submission/value-codes

📄️ nucc_taxonomy_lookup

National Uniform Claim Committee (NUCC) Structured taxonomy information from https://nucc.org.

📄️ pecos_associate

Information about PECOS associates. For most enrollment scenarios, the PAC ID maps to a unique SSN for individual providers and an EIN for organizational providers, with a few rare exceptions such as sole proprietors. A provider may enroll multiple times, under different enrollment scenarios. One common example is when a provider enrolls in multiple states to bill to Medicare in multiple states. For each enrollment, an enrollment ID is issued and associated with the PAC ID.