claim_provider

Connects a claim to one or more providers

Primary Key:

• claim_id
• provider_index

Foreign Keys:

• claim_id => claim.claim_id
• pay_to_address_id => address_seen.address_id
• provider_seen_id => provider_seen.provider_seen_id

Indexes:

• claim_provider_billing_provider_idx (Unique) - claim_id
• claim_provider_claim_id_provider_type_idx - claim_id, provider_type
• claim_provider_pay_to_address_id_idx - pay_to_address_id
• claim_provider_provider_seen_id_idx - provider_seen_id
• claim_provider_uq (Unique) - claim_id, provider_seen_id, provider_type

Column	Data Type	Nullable	Indexed	Description
claim_id	bigint	No	Yes	Link to the claim record. Generated through expression:
provider_index	smallint	No	Yes	Order of provider ID found in the claim. Indexes are 0-based so the first diagnosis code in the claim will have an index of 0, second will have an index of 1 and so on. Generated through expression:
provider_seen_id	bigint	No	Yes	Link to the provider_seen record. (From UB04 FL01/FL05/FL56/FL57 when provider_type is 'Billing Provider', FL02 when 'Pay-to Provider', FL76 when 'Attending Physician', FL77 when 'Operating Physician', FL78/FL79 when 'Referring Provider', 'Other Operating Physician', or 'Rendering Provider' / HCFA item 17 when 'Referring Provider', 'Ordering Physician', or 'Supervising Physician', item 24j when 'Rendering Provider', items 25 and 33 when 'Billing Provider', item 32 when 'Service Location', item 33 when 'Billing Provider') Generated through expression:
provider_type	entity_identifier_type	No	Yes	Identifies the type of entity for this record (From NM101) Generated through expression:
tpa_tax_id_suffix	text	No	No	TPA-specific suffix added to the end of a tax ID to distinguish between different providers which all use the same tax ID. Generated through expression:
tpa_specialty_code	text	No	No	Provider specialty according to the TPA. This is often used to categorize the benefit that the provider services fall under for the claim (e.g. ENT, OB/GYN, etc.) Generated through expression:
taxonomy	text	No	No	NUCC taxonomy code which describes the provider's area of specialty for this claim. (Loop 2010AA or 2310 PRV03 / HCFA item 24j with qualifier 'ZZ' when provider_type is 'Rendering Provider', item 33b with qualifier 'ZZ' when 'Billing Provider'). Generated through expression:
foreign_currency_identifier	text	No	No	The foreign currency used for billing and reimbursement (when not USD). Generated through expression:
pay_to_address_id	bigint	Yes	Yes	Pay to address (From Loop 2010AB / UB04 FL02) Generated through expression: