Abstract:
A web-based system for collecting and managing administrative details of a member in a managed care organization. The system collects and makes available over the Internet to all concerned parties digital information that can be selectively retrieved, viewed and managed by all authorized participants. This information, for example, includes the personal demographic details concerning the member and their eligible dependents, their plan elections and preferences, and their benefits usage history. The aggregated information is stored in a central database, using a “member account” paradigm. The member supplies the base information for the member account at initial enrollment in a health plan, either directly through the Internet or through an interface to their employer&#39;s human resources data system. Such information is then available to be shared via the Internet with a health provider, new employer or health insurance plan, or for the member themselves. Historical information about expenditures, usage, payments, and the like, can then be added to the record as experienced, allowing a greater ability to derive value from the contained information.

Description:
BACKGROUND OF THE INVENTION 
   1. Technical Field 
   The present invention relates generally to a system for providing web-based data collection and management in a managed care organization. 
   2. Description of the Related Art 
   The business processes currently in place in almost all managed care organizations (MCO) are needlessly complex and inefficient, requiring a great deal of manual labor and resultant expense.  FIG. 1  shows a simple example illustrating such inefficiencies. This drawing illustrates how the key constituents (members  100 , employers  102  and providers  104 ) now carry out the simple task of making an inquiry to the MCO. As illustrated, the MCO typically provides or uses a member services call center  106 , an account service call center  108 , and a provider service call center  110 . Data queries generated from the member services call center  106  are processed by a member services database  107 , while data queries generated from account services and provider services are processed by the account service database  109  and provider service database  111 . When a member  100 , an employer  102  or a provider  104  desires to make an inquiry, he or she typically accesses the MCO via a telephone  115 , and requested information  117  is usually returned by mail  118 . Another example of the inefficiencies inherent in the current system is shown in  FIG. 2 , which illustrates how an employee  200  enrolls in his or her employer&#39;s managed care program. In this example, the employee  200  fills out enrollment forms  202 , which are then forwarded on to the employer&#39;s HR department  204 . The HR department  204  enters such data into the employer&#39;s information system  206  and then forwards the information via regular mail to the managed care organization  208 . The MCO then has to enter the data in its information system  210 . Such processes are time consuming and inefficient. 
   In addition to the structural and administrative problems inherent in the existing MCO industry, several major trends are now emerging in the health care industry as a whole. Employers are taking a less active role in the payment of and administration of health care benefits. The use of global, interconnected computer systems, such as the Internet, have become commonplace and inexpensive. Moreover, new standards, systems and processes for the health care industry infrastructure have begun to be proposed and implemented. Finally, there has been significantly increased demand by consumers for health-related information. Indeed, consumers are becoming more educated and participatory in clinical decision making and are demanding more from physicians. 
   The Internet has been a major catalyst for change. It is estimated that there are now over 65 million U.S. adults with access to the Internet, which represents over 25% of the population. The Internet is rapidly becoming the most important communications channel for health plans, and many companies have begun to provide health care-related services online. Healtheon Corporation provides software and services that enable healthcare information, both medical and administrative, to be exchanged over the Internet. The company provides a system to automate such tasks as HMO enrollment, referrals, data retrieval, and claims processing for use by insurers, doctors, pharmacies, and consumers. Healtheon, through WebMD, also provides Internet-based technology that connects physicians, hospitals, payors, and consumers to an array of interactive tools and services. Other companies are deploying solutions as application services. Alteer, for example, is an application service provider (ASP) that provides a web-based workflow solution to address administrative and communication needs of healthcare professionals and consumers. Alteer establishes healthcare professionals&#39; practices as online healthcare portals. As a result, patients can visit the respective physician web sites and search for information specific to their physician&#39;s expertise and their personal needs. Other companies now provide online solutions for managing patient information access, contract compliance and billing, and clinical performance analysis. Still others provide online solutions that allow physicians to manage their clinical information and secure access to the same information by patients so that patients can actively participate in their personal family health management. 
   Currently, every constituent of the health care system collects a set of data that is likely to be somewhat different from one party to another. This is manifested in a health care record that is collectively strewn across the health care landscape in various multiple enterprises. The present effort of collecting each element of the data requires that the data set be as small as possible, containing only essential information. The ability to share information, such as submitting a claim to a managed care organization or authorizing a visit to a specialist, is difficult because no party can ensure that they are matching records on the same individual. 
   It would be desirable to be able to leverage the Internet to allow loosely-related parties to share a common set of data, with one common identification number, allowing what was previously disparate data to become meaningful, actionable information. 
   BRIEF SUMMARY OF THE INVENTION 
   The present invention is a web-based system for collecting and managing administrative details of a member in a managed care organization. The system collects and makes available over the Internet to all concerned parties digital information that can be selectively retrieved, viewed and managed by all authorized participants. This information, for example, includes the personal demographic details concerning the member and their eligible dependents, their plan elections and preferences, and their benefits usage history. The aggregated information is stored in a central database, using a “member account” paradigm. The member supplies the base information for the member account at initial enrollment in a health plan, either directly through the Internet or through an interface to their employer&#39;s human resources data system. Such information is then available to be shared via the Internet with a health provider, new employer or health insurance plan, or for the member themselves. Historical information about expenditures, usage, payments, and the like, can then be added to the record as experienced, allowing a greater ability to derive value from the contained information. 
   The data set which results from the present invention substantially reduces the amount of manual record-keeping that is required for each participant, while increasing data accuracy. The invention dramatically lowers administrative costs for every user of the system. In addition, data captured in the system is richer than that which is currently owned by any one party, enabling new forms of value through reporting and data extraction. The invention allows the user (whether member/patient/employee) to access their personal healthcare administrative record and use that information to increase their control over their healthcare experience. The account is portable, meaning that it will support a member&#39;s move to other employers or other health plans. 
   The foregoing has outlined some of the more pertinent objects and features of the present invention. These objects and features should be construed to be merely illustrative of some of the more prominent features and applications of the invention. Many other beneficial results can be attained by applying the disclosed invention in a different manner or modifying the invention as will be described. Accordingly, other objects and a fuller understanding of the invention may be had by referring to the following Detailed Description of the Preferred Embodiment. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     For a more complete understanding of the present invention and the advantages thereof, reference should be made to the following Detailed Description taken in connection with the accompanying drawings in which: 
       FIG. 1  illustrates how members, employers and providers obtain inquiries from existing MCO online systems; 
       FIG. 2  illustrates a conventional MCO enrollment process; 
       FIG. 3  illustrates a web-based managed care system having a common administrative account according to the present invention; 
       FIGS. 4A-4B  illustrate representative screen displays and process flow for a member enrollment function in the web-based managed care system of the invention; 
       FIG. 5  illustrative representative screen displays and process flow for an employer enrollment function in the inventive system; 
       FIG. 6  illustrates representative screen displays and process flow for a Primary Care Physician (PCP) selection function according to the invention; 
       FIG. 7  illustrates representative screen displays and process flow for a benefits inquiry according to the invention; 
       FIG. 8  illustrates representative screen displays and process flow for downloading static pages in the system; 
       FIG. 9  illustrates representative screen displays and process flow for a member re-enrollment function; 
       FIG. 10  illustrates representative screen displays and process flow for a PCP change function; 
       FIG. 11  illustrates representative screen displays and process flow for a Provider Directory inquiry function; 
       FIG. 12  illustrates representative screen displays and process flow for Member Information Change function; and 
       FIGS. 13A-13C  show a data entity diagram illustrating the tables that comprise the member administrative account according to the present invention. 
   

   DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
   Familiarity with the MCO business model is presumed in the following discussion. As is well-known, a member is a subscriber or a subscriber&#39;s dependent if the MCO accepts risk. A subscriber is an employee who is eligible and elects coverage. An employer identifies the employer entity, typically a corporation that has a contract with a health organization to provide services to its employees. The MCO is the managed care organization entity. This is the healthcare organization that is contracting with an employer entity to provide service to the employer&#39;s employees. 
   In an illustrated embodiment, a web-based transaction server is operated at a web site accessible over the Internet. In addition, the managed care organization (MCO) may operate a web-based transaction server (sometimes referred to herein as the MCO server or site). Typically, a user (either a member, employer, or provider) will navigate first to the MCO server and then be redirected to the transaction server, although this is not required. This configuration, of course, is merely exemplary and should not be taken to limit the present invention. 
   Generalizing, the invention may be practiced in any convenient server or set of servers accessible over a computer network from a client machine having a web browser or other graphics viewer. Preferably, an available resource (a document, page, object or the like) is identified by a Uniform Resource Locator (URL) that can be accessed by an authenticated user. The computer network may be the Internet, an intranet, a virtual private network, or the like. Generalizing, a server used in the present invention may be a Web Application Server (WAS), a server application, a servlet process or the like. Through the standard Hypertext Transfer Protocol (HTTP), a client browser accesses the HTTP-enabled server to obtain access to the resource. As is well-known, most browsers provide security through the Transport Layer Security (TLS) protocol. This protocol allows both the browser and the WAS to authenticate each other (i.e. to prove their identity to each other), and it also provides data protection (data integrity and data confidentiality) for data in transit between them. The strongest form of authentication provided by the TLS/SSL protocol is client- and server-side certificate authentication. Such authentication requires the client (the browser) and the server (the WAS) to each have a private/public cryptographic key pair, and associated certificates. Public key authentication maintains a binding between a user&#39;s identity and a public key that can only be unlocked by the associated private key. In an illustrative embodiment of the present invention, a client browser and a WAS implement these protocols to provide mutual authentication. Thus, the invention provides secure web-based access to protected member data which, as described below, is maintained within a novel administrative account structure. 
     FIG. 3  illustrates the web-based managed care system  300  having a common administrative account according to the present invention. Users of the system include members, employers, and others. The system  300  comprises a web server  302  to which users connect over a computer network  304  in a conventional manner using a client machine  306  having a web browser  308 . As noted above, the network  304  is the public Internet, a corporate intranet, a private virtual network, a web content delivery service, or the like. The web server is identified by a publicly-available second level domain name. The system  300  includes a web-based subsystem  310  comprising multiplexer  312 , and a set of functional modules including enrollment  314 , billing  316 , messaging  318 , and inquiry  320 . Each module interfaces to a transaction processor  322  and a database  324 . The transaction subsystem interfaces to the managed care organization (MCO) subsystem  330  through a set of common XML-based interfaces  326  and  328 . The MCO subsystem  330  is accessible through an MCO server  332  and includes a transaction processor  334  and a backend database  336 . 
   Each of the functional modules is accessible via a web browser. Collectively, these modules comprise an administrative toolset that leverages off-the-shelf technology to fundamentally change how these administrative processes are carried out in a managed care organization. In an illustrative embodiment, the enrollment module  314  enables members, employers and providers to enroll, re-enroll, and to view enrollment information. More specifically, the enrollment module provides the following major functions: group account setup, eligible employee roster upload, member enrollment and changes, employer validation, notification, reporting, online help, and temporary ID card provisioning. 
   The billing module  316  enables online billing and payment, and facilitates claims matching. By leveraging the information about who is enrolled through the use of a roster which is shared between the employer and the plan, a great deal of manual work can be eliminated. Currently, each party must reconcile their rosters to the other&#39;s manually. The billing module allows the importation of a roster file from either party, and execution of a “compare roster” function within the module reports on any differences between the two. The shared roster leads to more accurate bills. In particular, the bill is presented via the secure messaging module  318 , eliminating time and postal waste. The bill, which is preferably presented via XML, includes “drill down” capability for detail inquiries, and an Electronic Funds Transfer component to facilitate immediate payment. 
   The messaging module  318  provides secure messaging among the various parties to enable referrals, authorizations, reporting and the like. The use of electronic communication by non-secure means such as standard e-mail is rising, and Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines will require a more robust solution. The messaging module allows users to communicate with other selected parties in their personal healthcare network, such as a patient to their Primary Care Physician, a PCP referring to a specialist, or from any constituent to the MCO. The recipient is notified that a secure communication is waiting to be read on the host server, and only after a secure sign-on process (where the user is identified) can he or she read that information. The message preferably is never exposed to non-secured channels. 
   The inquiry module  320  provides a mechanism for provider database lookup, viewing of enrollment information, and the like. This module provides a solution to one of the biggest sources of constituent frustration in the healthcare industry—the ability to easily get answers to questions. The inquiry module provides a self-service solution for the user to find the answers they need to the most common types of questions: Claims Status, Eligibility and Benefits Inquiry, Provider Network information, and access to FAQ documents that are custom tailored by the application for that particular user. In a preferred implementation, each module uses Common Gateway Interface (CGI) fill-in forms or active server pages (.asp) to obtain data that is managed by the system, as will be seen. 
     FIGS. 4A-4B  illustrate the representative screen displays and process flow for a typical member enrollment. This functionality is provided by the administrative toolset and, in particular, by the enrollment module  314 . The process begins when the user navigates to the MCO home page  400  hosted on web server  332 . When the user selects the Enroll Now link, the user is redirected to the enrollment page  402  hosted on web server  302 . To enroll, the user selects the login link, which opens the browser to an enrollment overview page  404  describing an overview of the enrollment process and the information that the user will need to provide to complete the enrollment process. Upon selection of the Next link, the browser opens up an Employer ID# page  406 . This page requires entry of an Employer ID and Division ID provided to the user by the employer. Upon entry of this information, the user selects the Next link, which opens a Choose Coverage Type page  408 . This page identifies the possible coverage types (e.g., individual, 2 person, family, or the like) that are available from the MCO. Each coverage type is a hypertext link. Selection of one of the links (in the case, the Individual link) opens the browser to Coverage Information page  410 , which describes the relevant coverage. When the user selects the Next button, the browser returns to the Choose Coverage Type page  408 . 
   If the user selects the Next button from the Choose Coverage page  408 , the browser opens a Subscriber Information page  412 , which includes a fill-in form requesting personal details about the subscriber including, for example, name, title, address, telephone, fax, email, etc. The form also requests the user to identify whether he or she is covered under another health plan. If so, the plan benefits will need to be coordinated if they are not already. Thus, once the form is filled-in and the user selects the Next button, a test  414  is executed to determine whether the user is covered by another plan but the system has not coordinated benefits. If the outcome of the test at step  414  is positive, the browser opens up a Coordination of Benefits page  416 , which requests the user to identify his or her other plan by name and plan subscriber. The user then selects the Next button, which executes a test at step  418  to determine whether the plan subscriber is a subscriber to the MCO plan or, alternatively, a family member. If the outcome of the test at step  418  indicates that the plan subscriber is the subscriber, the browser navigates back to the Subscriber Information page  412 . If, however, the test at step  418  indicates that the plan subscriber is a family member, the browser is directed to a Family Member Information page  422  as will be described below. 
   If the outcome of the test at step  414  is negative, however, the user is navigated to a Family Summary page  420 . This page lists each member of the MCO subscriber&#39;s family. By selecting a Details button next to each name, the user can navigate to a Member Details page  424  and then return back to the Family Summary page  420 . By selecting a Change Button in page  420 , the user is navigated back to the Subscriber Information page  412 . By selecting a Remove Button in page  420 , the browser opens up a pop-up window  426  requesting confirmation. A test  428  is then run to determine whether a person is to be removed. If so, the browser returns to the Family Summary page  420  with the selected person removed. If, however, the outcome of the test at step  428  is negative, the browser returns to the Family Summary page  420  without change. 
   The user may select the Add Another Family Member button in page  420 , which opens the browser to the Family Member Information page  422 . This page requests relevant information such as name, title, address, telephone, fax, email, DOB, SSN, relationship, primary language, and the like. As noted above, this page is also reached from the test at step  418 . The Family Member Information page also questions whether the member is covered under another plan and if the member is a full-time student over 18. When the user selects the Next button on page  422 , a test is run at step  430  to determine whether the coordination of benefits box was checked and not filled in. If so, the browser returns the Coordination of Benefits page  416 , which has been previously described. If, however, the outcome of the test at step  430  is negative, a test is executed at step  432  to determine if the student button was selected and not filled in. If not, the browser returns to the Family Summary page  420 . If, however, the outcome of the test at step  432  is positive, the browser navigates to the Enter Student Info page  434  so that data (e.g. school name, city, etc.) can be collected. From Enter Student Info page  434 , selection of the Next button returns the browser to the Family Summary page  420 . 
   When the user selects the Complete button on the Family Summary page  420 , the browser returns a Choose a Plan page  436 . This page identifies specific plan types (e.g., HMO, PPO, or the like), each of which is identified by a hypertext link. When the user selects a plan link, the browser opens up the appropriate description page, in this case the HMO Plan Information page  438 . If the user selects the Next button from the Choose a Plan page  436 , a test is performed at step  440  to determine whether the selected plan requires a Primary Care Physician (PCP) selection. If so, the browser navigates to PCP Selection page  442 . This page enables each family member to select a given PCP or, using a Select All button, to force each family member&#39;s PCP to be the same as the subscribers. If the Select PCP button is selected, the browser navigates to a PCP search page  444 , which is described in more detail below. When the user selects the Next button from the PCP Selection page  442 , or upon a negative outcome of the test at step  440 , the browser opens a Disclaimer page  446  setting forth the legal terms and conditions for enrollment. If the user selects the “I Agree” button, the browser navigates to a Thank You page  448 . If the user selects the “I Disagree” button, the browser navigates to an Are you sure page  450  requesting whether the user desires to cancel enrollment. From the Thank you page  448 , the user can print an Enrollment Confirmation page  452  or return to the MCO home page. This completes the enrollment process. 
     FIG. 5  illustrates a representative employer enrollment process. In this case, the user navigates to the MCO home page  500  and selects the Enroll Now button. This navigates the user&#39;s browser to the system employer login page  502 . By selecting the Login button, the user navigates to the Employer Main Menu page  504 . Selection of the View Roster button returns a View Current Roster page  506 , which identifies the current employees of the company. By selecting a Details button next to each name, the browser navigates to an Enrollee Details page  508 , which identifies the employee and his or her family member data. By selecting a Click to Download button on page  506 , the browser returns a Download Current Roster page  510 , which includes appropriate roster links as shown. From the Verify New Enrollee button in page  504 , the browser navigates to an Approve or Deny New Enrollee page  512 . From that page, the user can verify that an identified enrollee is eligible for the plan by highlighting an entry and selecting the Submit button. After all entries are checked, as determined by a positive outcome of the test at step  514 , control routines the browser to the Employer Main Menu page  504 . The user can then logoff or perform other tasks. 
     FIG. 6  illustrates a representative PCP Selection process, which can occur from enrollment, re-enrollment or PCP Change processes. From the PCP Selection page  600 , the user navigates to the Search for a Physician page  602 . The user can fill in parameters such as name, address, gender, language, hospital affiliation, medical group affiliation, type of plan, specialty, and the like. After selecting the Submit button, the search engine returns a Search Results page  604 , which identifies one or more matching selections based on the search criteria. A test is then performed at step  606  to determine whether the PCP&#39;s Panel is open for additional patients. If not, a Search Results page  608  is returned to the user indicating that the physician cannot accept additional patients and requesting selection of another physician. If the outcome of the test at step  606  is positive, however, the Search Results page  610  is returned identifying the particular physician. 
     FIG. 7  illustrates a representative operation of the benefits inquiry module. The routine begins when the user navigates to the MCO home page  700 . A user can select the Members button, the Employers button or the Providers button. Depending on the button selected, the user is navigated to the appropriate login page  702  of the system. Upon selection of the Login button, an Account page  704  is returned to the browser. Selection of a Benefits Coverage Inquiry button returns a Patient Search page  706 . Following entry of the requested information and selection of the Submit button, a Search Results page  708  is returned if the member is found. This page identifies the member, the provider, co-pay information and other coverage details. If the member cannot be found, another Patient Search page  710  is returned. If the member cannot be located after a given number of attempts, a Patient Search page  712  is returned indicating that the patient could not be located given the search criteria entered. This completes the benefits inquiry process. A similar functionality is provided to inquire about a given provider. 
     FIG. 8  illustrates the process flow and display screens for downloading static pages. This function may also be provided by the inquiry module. The routine begins with the user navigating to the MCO home page  800  and then to the system login page  802 . Upon login, the Account page  804  is returned. Upon selection of the Printed Materials button, the routine tests to identify what document has been selected from the access database  806 . An appropriate Document Listing Page  808  is then returned to the browser. Once the user selects the document to be printed, the browser retrieves the appropriate HTML form  810 . A read-only version  812 , e.g., in .pdf format, may be retrieved by selecting a button in the HTML page. 
     FIG. 9  illustrates screen displays and illustrative process flow for a member re-enrollment function. The routine begins with the user navigating to the MCO home page  900  and then to the system login page  902 . Upon login, the Account page  904  is returned. Upon selection of the Re-enroll button, the Subscriber Information page  912  is returned. From this point forward, the enrollment functionality is similar described above with respect to the screens that are common to  FIGS. 4A-4B . 
     FIG. 10  illustrates screen displays and illustrative process flow for a PCP change function. The routine begins with the user navigating to the MCO home page  1000 , to the system login page  1002 , and then to the Account page  1004 . From this screen, the user selects a Change a PCP button. As a result, the PCP Selection page  1006  is returned. This function was described previously in  FIGS. 4A-4B . 
     FIG. 11  illustrates screen displays and illustrative process flow for a Provider Directory inquiry. The routine begins with the user navigating to the MCO home page  1100 , to the system login page  1102 , and then to the Account page  1104 . Upon selection of a Search Provider Directory button, the browser navigates to a Search For A Physician page  1106 . This functionality was described above in  FIG. 6 . 
     FIG. 12  illustrates screen displays and illustrative process flow for a Member Information Change function. The routine begins with the user navigating to the MCO home page  1200 , to the system login page  1202 , and then to the Account page  1204 . Upon selection of an Update My Information button, the browser navigates to a Family Summary page  1206 . This page was previously described in  FIGS. 4A-4B . If the Add Another Family Member button is selected, a test is run at step  1208  to determine if the change happens during an open enrollment period. If so, the browser returns the Member Information page  1210  as previously described in  FIGS. 4A-4B . If, however, the outcome of the test at step  1208  is negative, the browser returns a Qualifying Event page  1212 , which indicates that the user has requested a change outside of his or her open enrollment period. In such case, the user selects the appropriate Qualifying Condition button, and the browser returns an Affidavit page  1214  to allow the change to be processed. 
   According to a feature of the present invention, a novel account structure is used to manage administrative transactions (e.g., enrollment, changes, inquiries, claims, benefits, etc.) across multiple plans. The account comprises a linked set of data tables that are organized into a logical entity in a database stored in memory or permanent storage. The database is then accessible to the web-based managed care transaction system. As a user moves from one job to another, or as a given plan is changed or replaced, the user&#39;s past history remains persistent and accessible from the account. Thus, the account provides a complete member history that is persistent across plan changes, employment changes, family history changes, and the like. The account allows members the opportunity to review and manage the many aspects of their personal care through a web browser. As will be seen, the account includes a record of the member&#39;s healthcare benefits throughout their life. 
   The account, called ACCOUNT in an illustrative embodiment, is shown in the data entity relationship diagram of  FIGS. 13A-13C . Each block in this diagram is a table that includes a number of attributes. A particular table may have a 1:1 or a 1:many relationship to another table. Thus, for example, the master account (ACCOUNT table  1300 ) has a 1:1 relationship to the MEMBER table  1302  because each account has only one member associated therewith. The MEMBER table  1302  has a 1:many relationship with MEMBER HISTORY table  1304  as a given member may have a history of involvement with more than one health plan. 
   Each of the tables is described generally below: 
   ADDRESS USER  1306 —is the generic address participation matrix identifying a user type (members, PCPs, employers) to possible purposes (home, work, mailing, billing, etc.); 
   ASSIGNED PCP  1308 —is the selected Primary Care Physician for a member enrollment period; 
   CLAIMS INFO  1310 —includes all claims-related information; 
   COORD BENEFIT  1312 —identifies the coordination benefits for the member; 
   DIGITAL ADDRESS  1314 —identifies the electronic and/or digital contacts for an individual; 
   EMPLOYER  1316 —identifies the employer entity, typically a corporation that has a contract with a health organization to provide services to its employees; 
   EMPLOYER PLAN  1318 —identifies the various plans that the Employer group has contracted with an MCO. The data includes Group Number, Division Number, Employer Plan ID, and a selected MCO Product/Plan is part of the designated health plan offering to the employee; 
   EMPLOYER STAFF  1320 —identifies what users of the Employer group are allowed access to the system via an account setup process; 
   ACCOUNT  1300 —is the account setup information that contains userID/password and helpful things to login and use the secured site; 
   LOOKUP  1322 —is a lookup table for allowable values for a table/column_lookup_key combination in the schema; 
   HOSPITAL AFFILIATION  1324 —is a table that identifies all hospital affiliations associated for this particular provider; 
   MCO  1326 —is the managed care organization entity. This is the healthcare organization that is contracting with an Employer Entity, thus providing service to the Employer&#39;s employees; 
   MCO PRODUCT  1328 —is a table listing plans or products that are provided by a health care organization; 
   MCO STAFF  1330 —is a table that identifies what users of the managed healthcare group are allowed access to the system via the account setup process; 
   MEMBER  1302 —is a table that identifies personal data for each member; 
   MEMBER HISTORY  1304 —is a table that describes the participation history of a member. This table identifies the relationship and history of what healthcare plan the member has enrolled in all companies for which he or she worked; 
   MEMBER STUDENT  1332 —is a table identifying information about the school and location if the member is a fulltime student; 
   ORG INFO  1334 —is a table that is relevant if the provider in the PROVIDER INFO table is identified as an organization provider; 
   PHYSICAL ADDRESS  1336 —is a table identifying actual physical addresses that can be associated to anyone or any corporation; 
   PROVIDER AFFILIATION  1338 —is a table that provides the intersection information of a provider practicing what allowable specialties at a practice site; 
   PROVIDER INFO  1340 —is a table describing the provider selected by the member; 
   PROVIDER LANG  1342 —identifies all languages in which this provider can communicate with his or her patient; 
   PROVIDER SPECIALTY  1344 —identifies all specialties practiced by this provider; 
   PROVIDER STAFF  1346 —identifies all staff members to a particular provider who require access to the system via the account setup process; 
   SITE SPECIALTY  1348 —is an intersection table to show a provider&#39;s specialties that are practiced at a particular site; 
   STAGING AREA  1350 —is a table that tracks the process of a member through the system for various transaction events, e.g., enrollment, profile change, or the like; 
   STAGING AUDIT  1352 —is an audit log for a specific record; 
   STAGING DIGITAL ADDR  1354 —is a table that contains other digital addresses that are related to this particular Staging Area record; and 
   STAGING PHYSICAL ADDR  1356 —is a table that contains other physical addresses that are related to this particular Staging Area record. 
   The following is a detailed Data Dictionary for each of the above tables, with each attribute identified by name and description. 
   
     
       
             
             
             
             
             
             
             
           
             
             
             
             
             
             
           
             
             
             
             
             
             
           
             
             
             
             
             
           
             
             
             
             
             
             
             
           
         
             
                 
             
             
                 
                 
               Attribute 
                 
                 
                 
                 
             
             
               Entity Name 
               Entity Description 
               Name 
               Attribute Description 
               PK 
               Req 
               FK 
             
             
                 
             
           
           
             
               ADDRESS USER 
               This is the generic 
               Purpose Cd 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
               Address participation 
                 
               purpose of this 
             
             
                 
               matrix identifying a 
                 
               address; such as: 
             
             
                 
               user type (members, 
                 
               “1. PR = Practice 
             
             
                 
               pcp&#39;s, employers) to 
                 
               Address” “2. HM = 
             
             
                 
               possible purposes 
                 
               Home Address” “3. BL = 
             
             
                 
               (home, work, mailing, 
                 
               Billing Address” 
             
             
                 
               billing, etc.). 
                 
               “4. ML = Mailing 
             
             
                 
                 
                 
               Address” “5. WK = 
             
             
                 
                 
                 
               Work Address” 
             
             
                 
                 
               User Cd 
               The identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               user types of this 
             
             
                 
                 
                 
               address matrix. 
             
             
                 
                 
                 
               Supported types may 
             
             
                 
                 
                 
               include: “1. MEM = 
             
             
                 
                 
                 
               Member” “2. MCO = 
             
             
                 
                 
                 
               MCO” “3. EMP = 
             
             
                 
                 
                 
               Employer Group” “4. 
             
             
                 
                 
                 
               PPS = Provider 
             
             
                 
                 
                 
               Practice Site” 
             
             
                 
                 
               Digital 
               Unique type 
               No 
               No 
               Yes 
             
             
                 
                 
               Address Key 
               identifier of digital 
             
             
                 
                 
                 
               address. 
             
             
                 
                 
               Employer Key 
               Unique lookup key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               that identifies this 
             
             
                 
                 
                 
               employer coverage 
             
             
                 
                 
                 
               based on a contract 
             
             
                 
                 
                 
               number with a MCO. 
             
             
                 
                 
               MCO Key 
               Unique managed care 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               identifier key. 
             
             
                 
                 
               Member Key 
               This identifies a 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               unique Member; 
             
             
                 
                 
                 
               currently based on 
             
             
                 
                 
                 
               Social Security 
             
             
                 
                 
                 
               Number and Date-Of- 
             
             
                 
                 
                 
               Birth. 
             
             
                 
                 
               Physical 
               Unique record 
               No 
               No 
               Yes 
             
             
                 
                 
               Address Key 
               identifier of this 
             
             
                 
                 
                 
               address. 
             
             
                 
                 
               Practice Site 
               This key uniquely 
               No 
               No 
               Yes 
             
             
                 
                 
               Key 
               identifies a practice 
             
             
                 
                 
                 
               site for a provider. 
             
             
                 
                 
                 
               This practice details 
             
             
                 
                 
                 
               the MCO product that 
             
             
                 
                 
                 
               is provided by this 
             
             
                 
                 
                 
               doctor. 
             
             
                 
                 
               AMI Addr Who 
               This is a placeholder 
               No 
               No 
               No 
             
             
                 
                 
                 
               attribute used by the 
             
             
                 
                 
                 
               AMISYS source load 
             
             
                 
                 
                 
               group.  
             
             
               ASSIGNED PCP 
               This is the selected 
               History Key 
               This is a unique 
               No 
               Yes 
               Yes 
             
             
                 
               Primary Care 
                 
               reference key to a 
             
             
                 
               Physician for a 
                 
               specific member 
             
             
                 
               member enrollment 
                 
               working for a 
             
             
                 
               period. 
                 
               specific employer 
             
             
                 
                 
                 
               enrolled in a 
             
             
                 
                 
                 
               specific plan for a 
             
             
                 
                 
                 
               specific enrollment 
             
             
                 
                 
                 
               period. Basically, 
             
             
                 
                 
                 
               add Start Date, 
             
             
                 
                 
                 
               Coverage Type, 
             
             
                 
                 
                 
               Group/Division Id, 
             
             
                 
                 
                 
               and Employer Plan Id 
             
             
                 
                 
                 
               to the specified list 
             
             
                 
                 
                 
               of foreign keys. 
             
             
                 
                 
               Practice Site 
               This key uniquely 
               No 
               Yes 
               Yes 
             
             
                 
                 
               Key 
               identifies a practice 
             
             
                 
                 
                 
               site for a provider. 
             
             
                 
                 
                 
               This practice details 
             
             
                 
                 
                 
               the MCO product that 
             
             
                 
                 
                 
               is provided by this 
             
             
                 
                 
                 
               doctor. 
             
             
                 
                 
               First Name 
               Provider&#39;s first name 
               No 
               Yes 
               No 
             
             
                 
                 
               Last Name 
               Provider&#39;s last name. 
               No 
               Yes 
               No 
             
             
                 
                 
               Start Date 
               Start date of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               PCP for this member&#39;s 
             
             
                 
                 
                 
               span. 
             
             
                 
                 
               Provider Num 
               A provider number 
               No 
               No 
               No 
             
             
                 
                 
                 
               recognized by a 
             
             
                 
                 
                 
               particular MCO. For 
             
             
                 
                 
                 
               example, this relates 
             
             
                 
                 
                 
               to the PROV# field in 
             
             
                 
                 
                 
               ANISYS. 
             
             
                 
                 
               Site Cd 
               A term identifying 
               No 
               No 
               No 
             
             
                 
                 
                 
               the Site Code of the 
             
             
                 
                 
                 
               group practice that 
             
             
                 
                 
                 
               the physician belongs 
             
             
                 
                 
                 
               to. 
             
           
        
         
             
               CLAIMS INFO 
               FUTURE . . . A generic 
               Claims Reference Key 
               Yes 
               Yes 
               No 
             
             
                 
               cut at all relevant 
             
             
                 
               claims related 
             
             
                 
               information. 
             
           
        
         
             
                 
               Site 
               A unique identifier 
               No 
               Yes 
               Yes 
             
             
                 
               Specialty Key 
               based on all of a 
             
             
                 
                 
               provider&#39;s 
             
             
                 
                 
               specialties at this 
             
             
                 
                 
               site. 
             
             
                 
               Member Key 
                 
               No 
               Yes 
               No 
             
           
        
         
             
                 
               Affiliation Fund Amt 
               No 
               No 
               No 
             
             
                 
               Attending Local Risk Unit 
               No 
               No 
               No 
             
             
                 
               Attending Provider Key 
               No 
               No 
               No 
             
             
                 
               Attending Sub Risk Unit 
               No 
               No 
               No 
             
             
                 
               Authorization Num 
               No 
               No 
               No 
             
             
                 
               Billed Amt 
               No 
               No 
               No 
             
             
                 
               Claim Adjustment Amt 
               No 
               No 
               No 
             
             
                 
               Claim Payment Date 
               No 
               No 
               No 
             
             
                 
               Claim Status 
               No 
               No 
               No 
             
             
                 
               Claim Type Cd 
               No 
               No 
               No 
             
             
                 
               Coinsurance 
               No 
               No 
               No 
             
             
                 
               Amt 
             
             
                 
               Copay Amt 
               No 
               No 
               No 
             
             
                 
               Deductible  
               No 
               No 
               No 
             
             
                 
               Amt 
             
             
                 
               Diagnosis 1 Service Line 
               No 
               No 
               No 
             
             
                 
               Diagnosis 2 Service Line 
               No 
               No 
               No 
             
             
                 
               Discharge 
               No 
               No 
               No 
             
             
                 
               Status 
             
             
                 
               Fee For Service Amt 
               No 
               No 
               No 
             
             
                 
               Financial Service Type 
               No 
               No 
               No 
             
             
                 
               ICD 9 Num 
               No 
               No 
               No 
             
             
                 
               Medicare Payment Amt 
               No 
               No 
               No 
             
             
                 
               Paid Amt 
               No 
               No 
               No 
             
             
                 
               PCP Local Risk Unit 
               No 
               No 
               No 
             
             
                 
               PCP Provider 
               No 
               No 
               No 
             
             
                 
               Key 
             
             
                 
               PCP Sub Risk Unit 
               No 
               No 
               No 
             
             
                 
               Pool Name 
               No 
               No 
               No 
             
             
                 
               Primary Insurance Cd 
               No 
               No 
               No 
             
             
                 
               Procedure 
               No 
               No 
               No 
             
             
                 
               Desc 
             
             
                 
               Referring Local Risk Unit 
               No 
               No 
               No 
             
             
                 
               Referring Provider Key 
               No 
               No 
               No 
             
             
                 
               Referring Sub Risk Unit 
               No 
               No 
               No 
             
             
                 
               Risk Withheld Amt 
               No 
               No 
               No 
             
             
                 
               Service End 
               No 
               No 
               No 
             
             
                 
               Date 
             
             
                 
               Service Start 
               No 
               No 
               No 
             
             
                 
               Date 
             
             
                 
               Servicing Local Risk Unit 
               No 
               No 
               No 
             
             
                 
               Servicing Provider Key 
               No 
               No 
               No 
             
             
                 
               Servicing Sub Risk Unit 
               No 
               No 
               No 
             
             
                 
               TPP Amt 
               No 
               No 
               No 
             
           
        
         
             
               COORD BENEFIT 
               This is the 
               History Key 
               This is a unique 
               No 
               Yes 
               Yes 
             
             
                 
               coordination of 
                 
               reference key to a 
             
             
                 
               benefits for the 
                 
               specific member 
             
             
                 
               member. Shared cost 
                 
               working for a 
             
             
                 
               to another insurance 
                 
               specific employer 
             
             
                 
               group 
                 
               enrolled in a 
             
             
                 
                 
                 
               specific plan for a 
             
             
                 
                 
                 
               specific enrollment 
             
             
                 
                 
                 
               period. Basically, 
             
             
                 
                 
                 
               add Start Date, 
             
             
                 
                 
                 
               Coverage Type, 
             
             
                 
                 
                 
               Group/Division Id, 
             
             
                 
                 
                 
               and Employer Plan Id 
             
             
                 
                 
                 
               to the specified list 
             
             
                 
                 
                 
               of foreign keys. 
             
             
                 
                 
               Start Date 
               Start date of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               COB coverage. 
             
             
                 
                 
               Birthdate 
               Birthday of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               associated subscriber 
             
             
                 
                 
                 
               providing this 
             
             
                 
                 
                 
               additional coverage 
             
             
                 
                 
                 
               term. 
             
             
                 
                 
               Carrier Name 
               Name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               additional insurance 
             
             
                 
                 
                 
               coverage provider. 
             
             
                 
                 
               Coverage Type 
               The coverage type of 
               No 
               No 
               No 
             
             
                 
                 
                 
               this policy; i.e. 
             
             
                 
                 
                 
               Self, Spouse, 
             
             
                 
                 
                 
               Dependents, Medicare, 
             
             
                 
                 
                 
               Medical, Dental, etc. 
             
             
                 
                 
               Effective 
               The effective date of 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               this secondary 
             
             
                 
                 
                 
               policy. 
             
             
                 
                 
               First Name 
               First name of 
               No 
               No 
               No 
             
             
                 
                 
                 
               subscriber to this 
             
             
                 
                 
                 
               secondary 
             
             
                 
                 
                 
               policy/plan. 
             
             
                 
                 
               Last Name 
               Last name of 
               No 
               No 
               No 
             
             
                 
                 
                 
               associated subscriber 
             
             
                 
                 
                 
               to this additional 
             
             
                 
                 
                 
               plan. 
             
             
                 
                 
               Policy Num 
               Insurance policy 
               No 
               No 
               No 
             
             
                 
                 
                 
               number for this 
             
             
                 
                 
                 
               coordinate benefit. 
             
             
               DIGITAL 
               This is the 
               Digital 
               Unique type 
               Yes 
               Yes 
               No 
             
             
               ADDRESS 
               electronic and/or 
               Address Key 
               identifier of digital 
             
             
                 
               digital contacts for 
                 
               address. 
             
             
                 
               an individual. 
             
             
                 
                 
               Type Cd 
               This code defined the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               various types: “1. 
             
             
                 
                 
                 
               VC = Voice/Land 
             
             
                 
                 
                 
               phone” “2. CL = Cell 
             
             
                 
                 
                 
               phone” “3. PG = 
             
             
                 
                 
                 
               Pager” “4. EM = 
             
             
                 
                 
                 
               Email” “5. WB = Web 
             
             
                 
                 
                 
               HomePage” 
             
             
                 
                 
               Value1 
               Contains initial 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               value associated with 
             
             
                 
                 
                 
               a type of digital 
             
             
                 
                 
                 
               address. For example 
             
             
                 
                 
                 
               - voice mail 
             
             
                 
                 
                 
               includes: 
             
             
                 
                 
                 
               800.555.1212 or 
             
             
                 
                 
                 
               abc@foobar.com for 
             
             
                 
                 
                 
               Email type. 
             
             
                 
                 
               Value2 
               This may be a second 
               No 
               No 
               No 
             
             
                 
                 
                 
               value set to a 
             
             
                 
                 
                 
               specific type of 
             
             
                 
                 
                 
               digital address. For 
             
             
                 
                 
                 
               example - voice mail 
             
             
                 
                 
                 
               may include an 
             
             
                 
                 
                 
               extension part to the 
             
             
                 
                 
                 
               original phone 
             
             
                 
                 
                 
               number. 
             
             
                 
                 
               Value3 
               This third value 
               No 
               No 
               No 
             
             
                 
                 
                 
               association is for 
             
             
                 
                 
                 
               obscure elements like 
             
             
                 
                 
                 
               answer back string to 
             
             
                 
                 
                 
               a modem connect 
             
             
                 
                 
                 
               and/or future 
             
             
                 
                 
                 
               electronic 
             
             
                 
                 
                 
               requirements. 
             
             
               EMPLOYER 
               This is an employer 
               Employer Key 
               Unique lookup key 
               Yes 
               Yes 
               No 
             
             
                 
               entity; it identifies 
                 
               that identifies this 
             
             
                 
               an corporation (i.e. 
                 
               employer coverage 
             
             
                 
               General Electric) 
                 
               based on a contract 
             
             
                 
               that has a contract 
                 
               number with a MCO. 
             
             
                 
               with a health 
             
             
                 
               organization to 
             
             
                 
               provide services to 
             
             
                 
               its employees. 
             
             
                 
                 
               Company Name 
               Name of an Employer 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               contracting with a 
             
             
                 
                 
                 
               MCO for services for 
             
             
                 
                 
                 
               its employees. For 
             
             
                 
                 
                 
               example, General 
             
             
                 
                 
                 
               Electric. 
             
             
                 
                 
               Logo1 URL 
               Location of primary 
               No 
               No 
               No 
             
             
                 
                 
                 
               employer graphical 
             
             
                 
                 
                 
               logo. 
             
             
                 
                 
               Logo2 URL 
               Location of secondary 
               No 
               No 
               No 
             
             
                 
                 
                 
               employer graphical 
             
             
                 
                 
                 
               logo. 
             
             
               EMPLOYER PLAN 
               This identifies the 
               Employer Plan 
               This uniquely 
               Yes 
               Yes 
               No 
             
             
                 
               various plans that 
               Key 
               identifies a 
             
             
                 
               the Employer group 
                 
               particular plan that 
             
             
                 
               have contracted with 
                 
               an Employer Group is 
             
             
                 
               a MCO. Group number, 
                 
               providing for its 
             
             
                 
               Division number, 
                 
               employees. 
             
             
                 
               Employer Plan id, and 
             
             
                 
               a selected MCO 
             
             
                 
               Product/Plan is part 
             
             
                 
               of the designated 
             
             
                 
               health plan offering 
             
             
                 
               to the employee. 
             
             
                 
                 
               Employer Key 
               Unique lookup key 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               that identifies this 
             
             
                 
                 
                 
               employer coverage 
             
             
                 
                 
                 
               based on a contract 
             
             
                 
                 
                 
               number with a MCO. 
             
             
                 
                 
               Participation 
               This identifies a 
               No 
               Yes 
               Yes 
             
             
                 
                 
               Key 
               specific product that 
             
             
                 
                 
                 
               a health care 
             
             
                 
                 
                 
               organization will 
             
             
                 
                 
                 
               provide for service 
             
             
                 
                 
                 
               to any employer 
             
             
                 
                 
                 
               groups. 
             
             
                 
                 
               Employer Plan 
               This is the employer 
               No 
               Yes 
               No 
             
             
                 
                 
               Id 
               plan id; it should 
             
             
                 
                 
                 
               uniquely identify the 
             
             
                 
                 
                 
               Employer to a 
             
             
                 
                 
                 
               Contract Id for a 
             
             
                 
                 
                 
               certain 
             
             
                 
                 
                 
               SubGroup (Group/Division) 
             
             
                 
                 
                 
               that it expect 
             
             
                 
                 
                 
               healthcare coverage 
             
             
                 
                 
                 
               from a MCO. This 
             
             
                 
                 
                 
               identifier will be a 
             
             
                 
                 
                 
               generated value; 
             
             
                 
                 
                 
               format = TBD. 
             
             
                 
                 
               Sub GroupId 
               This is the Employer 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               group number that is 
             
             
                 
                 
                 
               known to the health 
             
             
                 
                 
                 
               care provider. For 
             
             
                 
                 
                 
               example, Union and 
             
             
                 
                 
                 
               Non-Union are two 
             
             
                 
                 
                 
               different subgroups 
             
             
                 
                 
                 
               under a single 
             
             
                 
                 
                 
               employer plan with a 
             
             
                 
                 
                 
               MCO. 
             
             
                 
                 
               Tier Type 
               Tier Type that is 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               associated with this 
             
             
                 
                 
                 
               Employer/MCO 
             
             
                 
                 
                 
               contract/plan. This 
             
             
                 
                 
                 
               value is derived from 
             
             
                 
                 
                 
               the same source that 
             
             
                 
                 
                 
               provides for the Sub 
             
             
                 
                 
                 
               Group Id. For HHPC, 
             
             
                 
                 
                 
               the various Tier 
             
             
                 
                 
                 
               Types (Value field in 
             
             
                 
                 
                 
               LOOKUP) are: 1. “02” 
             
             
                 
                 
                 
               2. “03” 3. “04” 4. 
             
             
                 
                 
                 
               “05” 5. “06” 6. “7” 
             
             
                 
                 
                 
               7. “3S” 8. “ME” 9. 
             
             
                 
                 
                 
               “MR” 10. “SP” Note 
             
             
                 
                 
                 
               that tier types drive 
             
             
                 
                 
                 
               what 
             
             
                 
                 
                 
               coverage/contract 
             
             
                 
                 
                 
               types are allowed for 
             
             
                 
                 
                 
               this particular plan 
             
             
                 
                 
                 
               - i.e. Single; 
             
             
                 
                 
                 
               Family; etc. For 
             
             
                 
                 
                 
               example, in the 
             
             
                 
                 
                 
               corresponding LOOKUP 
             
             
                 
                 
                 
               table, “I” will 
             
             
                 
                 
                 
               populate the 
             
             
                 
                 
                 
               Short_Desc field; and 
             
             
                 
                 
                 
               “Individual” will 
             
             
                 
                 
                 
               populate the 
             
             
                 
                 
                 
               Long Desc field. 
             
             
                 
                 
               Open Enroll 
               Identifies the end 
               No 
               No 
               No 
             
             
                 
                 
               End Date 
               date for open 
             
             
                 
                 
                 
               enrollment for this 
             
             
                 
                 
                 
               particular plan/sub 
             
             
                 
                 
                 
               group. 
             
             
                 
                 
               Open Enroll 
               Identifies the start 
               No 
               No 
               No 
             
             
                 
                 
               Start Date 
               date for open 
             
             
                 
                 
                 
               enrollment for this 
             
             
                 
                 
                 
               particular plan/sub 
             
             
                 
                 
                 
               group. 
             
             
                 
                 
               Sub Group 
               Identifies the 
               No 
               No 
               No 
             
             
                 
                 
               Effective 
               effective date for 
             
             
                 
                 
               Date 
               enrollment allowed by 
             
             
                 
                 
                 
               this particular 
             
             
                 
                 
                 
               plan/sub group. 
             
             
                 
                 
               Sub Group 
               This field will 
               No 
               No 
               No 
             
             
                 
                 
               Text 
               enable a textual 
             
             
                 
                 
                 
               description of the 
             
             
                 
                 
                 
               associated 
             
             
                 
                 
                 
               SubGroupid; if 
             
             
                 
                 
                 
               SubGroupid is a pure 
             
             
                 
                 
                 
               numeric value. For 
             
             
                 
                 
                 
               example, uses 
             
             
                 
                 
                 
               SubGroupId values 
             
             
                 
                 
                 
               like: 066131000; this 
             
             
                 
                 
                 
               represents the 
             
             
                 
                 
                 
               Group/Division 
             
             
                 
                 
                 
               number. 
             
             
                 
                 
               Waiting 
               Identifies the 
               No 
               No 
               No 
             
             
                 
                 
               Period Days 
               waiting period that 
             
             
                 
                 
                 
               is required by this 
             
             
                 
                 
                 
               plan/sub group for 
             
             
                 
                 
                 
               the member applicant. 
             
             
               EMPLOYER 
               This table identifies 
               Employer Key 
               Unique lookup key 
               No 
               Yes 
               Yes 
             
             
               STAFF 
               what users of the 
                 
               that identifies this 
             
             
                 
               Employer group are 
                 
               employer coverage 
             
             
                 
               allowed access to Web 
                 
               based on a contract 
             
             
                 
               Server via the 
                 
               number with a MCO. 
             
             
                 
               account setup 
             
             
                 
               process. 
             
             
                 
                 
               Admin Role 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               particular role that 
             
             
                 
                 
                 
               the system allows the 
             
             
                 
                 
                 
               Employer group to 
             
             
                 
                 
                 
               control what security 
             
             
                 
                 
                 
               levels to access what 
             
             
                 
                 
                 
               part of the database. 
             
             
                 
                 
               Acct Key 
               This is unique Key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               based on Username. 
             
             
                 
                 
               First Name 
               First Name of 
               No 
               No 
               No 
             
             
                 
                 
                 
               Employer group user. 
             
             
                 
                 
               Last Name 
               Last name of Employer 
               No 
               No 
               No 
             
             
                 
                 
                 
               group user. 
             
             
                 
                 
               SSN 
               Social security 
               No 
               No 
               No 
             
             
                 
                 
                 
               number to uniquely 
             
             
                 
                 
                 
               identify the user. 
             
             
               ACCOUNT 
               This is account setup 
               Acct Key 
               This is unique Key 
               Yes 
               Yes 
               No 
             
             
                 
               information. It will 
                 
               based on Username. 
             
             
                 
               contain 
             
             
                 
               username/password and 
             
             
                 
               “helpful” hints to 
             
             
                 
               login and use 
             
             
                 
               secured site. 
             
             
                 
                 
               Effective 
               The effective start 
               No 
               Yes 
               No 
             
             
                 
                 
               Date 
               date that this 
             
             
                 
                 
                 
               account will be 
             
             
                 
                 
                 
               active. 
             
             
                 
                 
               Password 
               Account user&#39;s chosen 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               PASSWORD 
             
             
                 
                 
               Username 
               Account member&#39;s 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               chosen USERNAME. 
             
             
                 
                 
               End Date 
               The effective end 
               No 
               No 
               No 
             
             
                 
                 
                 
               date of this HBK 
             
             
                 
                 
                 
               account. 
             
             
                 
                 
               Hint Answer 
               This is the user&#39;s 
               No 
               No 
               No 
             
             
                 
                 
                 
               specific answer to 
             
             
                 
                 
                 
               the above Hint 
             
             
                 
                 
                 
               Question; it should 
             
             
                 
                 
                 
               correspond to the 
             
             
                 
                 
                 
               user defined 
             
             
                 
                 
                 
               question. If the 
             
             
                 
                 
                 
               user types in the 
             
             
                 
                 
                 
               correct answer, the 
             
             
                 
                 
                 
               assigned Password to 
             
             
                 
                 
                 
               the Username is 
             
             
                 
                 
                 
               displayed, and the 
             
             
                 
                 
                 
               user can try login on 
             
             
                 
                 
                 
               again. 
             
             
                 
                 
               Hint Question 
               This is user defined 
               No 
               No 
               No 
             
             
                 
                 
                 
               question that the 
             
             
                 
                 
                 
               user can designate as 
             
             
                 
                 
                 
               an alternate way of 
             
             
                 
                 
                 
               logging into the 
             
             
                 
                 
                 
               system. For example: 
             
             
                 
                 
                 
               “What&#39;s my favorite 
             
             
                 
                 
                 
               color?” 
             
             
                 
                 
               Login Attempt 
               This is a counter 
               No 
               No 
               No 
             
             
                 
                 
               Cnt 
               that reflects the 
             
             
                 
                 
                 
               number of times the 
             
             
                 
                 
                 
               user is trying to log 
             
             
                 
                 
                 
               into the system. 
             
             
                 
                 
               Modified By 
               Audit purpose to 
               No 
               No 
               No 
             
             
                 
                 
                 
               capture who last 
             
             
                 
                 
                 
               modified this record. 
             
             
                 
                 
               Modified Date 
               Audit purpose to 
               No 
               No 
               No 
             
             
                 
                 
                 
               capture the last 
             
             
                 
                 
                 
               modified date of this 
             
             
                 
                 
                 
               record. 
             
             
                 
                 
               Role Type Cd 
               This is a place 
               No 
               No 
               No 
             
             
                 
                 
                 
               holder attribute for 
             
             
                 
                 
                 
               future releases of 
             
             
                 
                 
                 
               the system. Role 
             
             
                 
                 
                 
               Type can further 
             
             
                 
                 
                 
               define a Username 
             
             
                 
                 
                 
               within the system 
             
             
                 
                 
                 
               into either a Member 
             
             
                 
                 
                 
               or Provider role 
             
             
                 
                 
                 
               type. For example, a 
             
             
                 
                 
                 
               Member who is also a 
             
             
                 
                 
                 
               Provider can have the 
             
             
                 
                 
                 
               same login Username; 
             
             
                 
                 
                 
               role type can 
             
             
                 
                 
                 
               differentiate what 
             
             
                 
                 
                 
               classification the 
             
             
                 
                 
                 
               user wants to be. 
             
             
                 
                 
               Status 
               The status of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               user login session. 
             
             
               LOOKUP 
               This is a lookup 
               Lookup Key 
               This uniquely 
               Yes 
               Yes 
               No 
             
             
                 
               table for allowable 
                 
               identifies a 
             
             
                 
               values for a 
                 
               table/column/value 
             
             
                 
               table/column_lookup_key 
                 
               combination. 
             
             
                 
               combination in the 
             
             
                 
               schema. Note that 
             
             
                 
               the foreign key - 
             
             
                 
               MCO_Key - is optional 
             
             
                 
               in this table; if the 
             
             
                 
               set of lookup values 
             
             
                 
               is generic across all 
             
             
                 
               MCO&#39;s, then this 
             
             
                 
               field is NULL; 
             
             
                 
               otherwise a specific 
             
             
                 
               MCO set of lookup 
             
             
                 
               values will have 
             
             
                 
               field pointing to the 
             
             
                 
               specific MCO. 
             
             
                 
                 
               Column Key 
               The column key name 
               No 
               Yes 
               No 
             
             
                 
                 
               Name 
               for the specified 
             
             
                 
                 
                 
               table. For example, 
             
             
                 
                 
                 
               the table - 
             
             
                 
                 
                 
               MCO_PRODUCT - has a 
             
             
                 
                 
                 
               column called 
             
             
                 
                 
                 
               Plan_Cd_Lookup_Key. 
             
             
                 
                 
                 
               So the 
             
             
                 
                 
                 
               Column_Key_Name in 
             
             
                 
                 
                 
               this LOOKUP table 
             
             
                 
                 
                 
               will be “Plan Cd”. 
             
             
                 
                 
               Table Name 
               The table name in 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               schema. 
             
             
                 
                 
               Value 
               Actual value returned 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               for the table/column 
             
             
                 
                 
                 
               combination. For 
             
             
                 
                 
                 
               example, in 
             
             
                 
                 
                 
               MCO_PRODUCT table - 
             
             
                 
                 
                 
               for column Plan_Cd - 
             
             
                 
                 
                 
               a possible value can 
             
             
                 
                 
                 
               be ‘IH’; which stands 
             
             
                 
                 
                 
               for Integrated HMO 
             
             
                 
                 
                 
               Product. 
             
             
                 
                 
               MCO Key 
               Unique managed care 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               identifier key. 
             
             
                 
                 
               Long Desc 
                 
               No 
               No 
               No 
             
             
                 
                 
               Seq Num 
               Allows for ordering 
               No 
               No 
               No 
             
             
                 
                 
                 
               of values. 
             
             
                 
                 
               Short Desc 
                 
               No 
               No 
               No 
             
             
               HOSPITAL 
               This table identifies 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
               AFFILIATION 
               all hospital 
                 
               provider identifier. 
             
             
                 
               affiliations 
             
             
                 
               associated for this 
             
             
                 
               particular provider. 
             
             
                 
                 
               Hospital 
               This is internal 
               No 
               Yes 
               No 
             
             
                 
                 
               Provider Key 
               unique provider key 
             
             
                 
                 
                 
               that identifies the 
             
             
                 
                 
                 
               hospital as the 
             
             
                 
                 
                 
               Organization 
             
             
                 
                 
                 
               provider. Look at 
             
             
                 
                 
                 
               ORG_INFO table for 
             
             
                 
                 
                 
               organization type of 
             
             
                 
                 
                 
               a hospital facility. 
             
             
                 
                 
               Primary 
               Future . . . A ‘Y’es or 
               No 
               No 
               No 
             
             
                 
                 
               Affiliation 
               ‘N’o indicator; it 
             
             
                 
                 
               Flg 
               identifies whether 
             
             
                 
                 
                 
               this hospital is the 
             
             
                 
                 
                 
               primary facility for 
             
             
                 
                 
                 
               this provider to 
             
             
                 
                 
                 
               treat patients. 
             
             
               MCO 
               Managed Care 
               MCO Key 
               Unique managed care 
               Yes 
               Yes 
               No 
             
             
                 
               Organization Entity. 
                 
               identifier key. 
             
             
                 
               This is a healthcare 
             
             
                 
               organization that is 
             
             
                 
               contracting with an 
             
             
                 
               Employer Entity; thus 
             
             
                 
               providing service to 
             
             
                 
               the Employer&#39;s 
             
             
                 
               employees. 
             
             
                 
                 
               Organization 
               Name of managed care 
               No 
               Yes 
               No 
             
             
                 
                 
               Name 
               organization. 
             
             
                 
                 
               Logo1 URL 
               Location of primary 
               No 
               No 
               No 
             
             
                 
                 
                 
               MCO graphical logo. 
             
             
                 
                 
               Logo2 URL 
               Location of secondary 
               No 
               No 
               No 
             
             
                 
                 
                 
               MCO graphical logo. 
             
             
               MCO PRODUCT 
               This is the list of 
               Participation 
               This identifies a 
               Yes 
               Yes 
               No 
             
             
                 
               plans that is 
               Key 
               specific product that 
             
             
                 
               provided by a health 
                 
               a health care 
             
             
                 
               care organization. 
                 
               organization will 
             
             
                 
               Plans and products 
                 
               provide for service 
             
             
                 
               are synonymous in 
                 
               to any employer 
             
             
                 
               meaning. 
                 
               groups. 
             
             
                 
                 
               MCO Key 
               Unique managed care 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               identifier key. 
             
             
                 
                 
               Plan Cd 
               Contains the 
               No 
               Yes 
               No 
             
             
                 
                 
               Lookup Key 
               appropriate Lookup 
             
             
                 
                 
                 
               Key in LOOKUP table 
             
             
                 
                 
                 
               for Plan Cd. See 
             
             
                 
                 
                 
               definition of Plan Cd 
             
             
                 
                 
                 
               field. This is the 
             
             
                 
                 
                 
               plan code or name 
             
             
                 
                 
                 
               that is offered by 
             
             
                 
                 
                 
               the MCO. 
             
             
                 
                 
               PCP Select 
               This identifies 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               whether a product 
             
             
                 
                 
                 
               requires a PCP 
             
             
                 
                 
                 
               selection. Allowable 
             
             
                 
                 
                 
               values will be ‘Y’ or 
             
             
                 
                 
                 
               ‘N’. 
             
             
                 
                 
               Plan Detail 
               This points to a web 
               No 
               No 
               No 
             
             
                 
                 
               URL 
               page for the 
             
             
                 
                 
                 
               description to this 
             
             
                 
                 
                 
               product/plan code. 
             
             
               MCO STAFF 
               This table identifies 
               MCO Key 
               Unique managed care 
               No 
               Yes 
               Yes 
             
             
                 
               what users of the 
                 
               identifier key. 
             
             
                 
               Managed Healthcare 
             
             
                 
               group are allowed 
             
             
                 
               access to the system 
             
             
                 
               via the account setup 
             
             
                 
               process. 
             
             
                 
                 
               Admin Role 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               particular role that 
             
             
                 
                 
                 
               the system allows 
             
             
                 
                 
                 
               the group to control 
             
             
                 
                 
                 
               what security levels 
             
             
                 
                 
                 
               to access what part 
             
             
                 
                 
                 
               of the database. 
             
             
                 
                 
               Acct Key 
               This is unique Key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               based on Username. 
             
             
                 
                 
               First Name 
               First name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               MCO-based user. 
             
             
                 
                 
               Last Name 
               Last name of the MCO- 
               No 
               No 
               No 
             
             
                 
                 
                 
               based user. 
             
             
                 
                 
               SSN 
               Social security 
               No 
               No 
               No 
             
             
                 
                 
                 
               number to uniquely 
             
             
                 
                 
                 
               identify this MCO- 
             
             
                 
                 
                 
               based user. 
             
             
               MEMBER 
               This table identifies 
               Member Key 
               This identifies a 
               Yes 
               Yes 
               No 
             
             
                 
               any member. 
                 
               unique Member; 
             
             
                 
                 
                 
               currently based on 
             
             
                 
                 
                 
               Social Security 
             
             
                 
                 
                 
               Number and Date-Of- 
             
             
                 
                 
                 
               Birth. 
             
             
                 
                 
               Birthdate 
               Date of birth of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               First Name 
               First name of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               HBK Acct Flg 
               This flag condition 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               shows that the member 
             
             
                 
                 
                 
               has a 
             
             
                 
                 
                 
               username/password 
             
             
                 
                 
                 
               account already. It 
             
             
                 
                 
                 
               is a Yes/No 
             
             
                 
                 
                 
               condition. 
             
             
                 
                 
               Last Name 
               Last name of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               Relation Cd 
               This field indicates 
               No 
               No 
               No 
             
             
                 
                 
                 
               the relationship of 
             
             
                 
                 
                 
               member to the primary 
             
             
                 
                 
                 
               subscriber of plan. 
             
             
                 
                 
                 
               Current Relation Code 
             
             
                 
                 
                 
               recognized are: 01 = 
             
             
                 
                 
                 
               Self 02 = Spouse 03 = 
             
             
                 
                 
                 
               Unmarried child 
             
             
                 
                 
                 
               under 19 04 = 
             
             
                 
                 
                 
               Unmarried stepchild 
             
             
                 
                 
                 
               under 19 05 = 
             
             
                 
                 
                 
               Unmarried fulltime 
             
             
                 
                 
                 
               student over 19 06 = 
             
             
                 
                 
                 
               Handicapped 07 = Ex- 
             
             
                 
                 
                 
               Spouse 
             
             
                 
                 
               SSN 
               US-based Social 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               Security Number. 
             
             
                 
                 
               Subscriber 
               This identifies a 
               No 
               Yes 
               No 
             
             
                 
                 
               Member Key 
               plan&#39;s subscriber; 
             
             
                 
                 
                 
               the primary and known 
             
             
                 
                 
                 
               employee to the 
             
             
                 
                 
                 
               employer group. 
             
             
                 
                 
                 
               The idea is that 
             
             
                 
                 
                 
               dependant member will 
             
             
                 
                 
                 
               always point back to 
             
             
                 
                 
                 
               the plan&#39;s primary 
             
             
                 
                 
                 
               subscriber id. If 
             
             
                 
                 
                 
               Member Key = 
             
             
                 
                 
                 
               Subscriber Member 
             
             
                 
                 
                 
               Key, then this record 
             
             
                 
                 
                 
               identifies the 
             
             
                 
                 
                 
               primary plan member. 
             
             
                 
                 
               Acct Key 
               This is unique Key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               based on Username. 
             
             
                 
                 
               COB Flg 
               A Yes/No flag 
               No 
               No 
               No 
             
             
                 
                 
                 
               indicator to identify 
             
             
                 
                 
                 
               if this member have 
             
             
                 
                 
                 
               the additional COB 
             
             
                 
                 
                 
               coverage. 
             
             
                 
                 
               Gender 
               This is a single 
               No 
               No 
               No 
             
             
                 
                 
                 
               character column; 
             
             
                 
                 
                 
               note that this is an 
             
             
                 
                 
                 
               optional field: 1. M = 
             
             
                 
                 
                 
               Male 2. F = Female 
             
             
                 
                 
               Hiredate 
               This is the hiring 
               No 
               No 
               No 
             
             
                 
                 
                 
               anniversary date of 
             
             
                 
                 
                 
               the member to the 
             
             
                 
                 
                 
               employer group that 
             
             
                 
                 
                 
               he/she belongs to. 
             
             
                 
                 
               Language Cd 
               The language code 
               No 
               No 
               No 
             
             
                 
                 
                 
               that is preferred by 
             
             
                 
                 
                 
               this member. For 
             
             
                 
                 
                 
               example, 1. AS - 
             
             
                 
                 
                 
               American Sign 
             
             
                 
                 
                 
               Language 2. CA - 
             
             
                 
                 
                 
               Cantonese 3. EN - 
             
             
                 
                 
                 
               English 4. IT - 
             
             
                 
                 
                 
               Italian 5. SP - 
             
             
                 
                 
                 
               Spanish etc. 
             
             
                 
                 
               Member Num 
               This is a place 
               No 
               No 
               No 
             
             
                 
                 
                 
               holder for a member 
             
             
                 
                 
                 
               id/number that can 
             
             
                 
                 
                 
               uniquely identify 
             
             
                 
                 
                 
               this member to the 
             
             
                 
                 
                 
               system. For example, 
             
             
                 
                 
                 
               assigned Member# will 
             
             
                 
                 
                 
               be used here; i.e. 
             
             
                 
                 
                 
               HP12346700 for the 
             
             
                 
                 
                 
               subscriber member and 
             
             
                 
                 
                 
               HP12346701 for a 
             
             
                 
                 
                 
               spouse to this 
             
             
                 
                 
                 
               subscriber. Note 
             
             
                 
                 
                 
               that this field will 
             
             
                 
                 
                 
               be NULL; if a 
             
             
                 
                 
                 
               complete new member 
             
             
                 
                 
                 
               enrollment. The 
             
             
                 
                 
                 
               expectation is that 
             
             
                 
                 
                 
               the MCO will assign 
             
             
                 
                 
                 
               this member a number 
             
             
                 
                 
                 
               once the request goes 
             
             
                 
                 
                 
               through the normal 
             
             
                 
                 
                 
               business process. 
             
             
                 
                 
               Middle Name 
               Middle name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               Prefix 
               The relates to what 
               No 
               No 
               No 
             
             
                 
                 
                 
               the member wants to 
             
             
                 
                 
                 
               be addressed with; 
             
             
                 
                 
                 
               i.e. Mr, Ms, Mrs, Dr, 
             
             
                 
                 
                 
               etc. 
             
             
                 
                 
               Student 19 
               If member is a 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               student over 19, 
             
             
                 
                 
                 
               require additional 
             
             
                 
                 
                 
               information. A ‘Y’es 
             
             
                 
                 
                 
               or ‘N’o indication is 
             
             
                 
                 
                 
               required. 
             
             
                 
                 
               Suffix 
               This relates to what 
               No 
               No 
               No 
             
             
                 
                 
                 
               the member wants to 
             
             
                 
                 
                 
               be addressed with at 
             
             
                 
                 
                 
               the end of his name; 
             
             
                 
                 
                 
               i.e. Paul Williams 
             
             
                 
                 
                 
               III - John Smith, 
             
             
                 
                 
                 
               ESQ. 
             
             
               MEMBER 
               This entity describes 
               History Key 
               This is a unique 
               Yes 
               Yes 
               No 
             
             
               HISTORY 
               the participation 
                 
               reference key to a 
             
             
                 
               history of a member. 
                 
               specific member 
             
             
                 
               It will show the 
                 
               working for a 
             
             
                 
               relationship and 
                 
               specific employer 
             
             
                 
               history of what 
                 
               enrolled in a 
             
             
                 
               healthcare plan he 
                 
               specific plan for a 
             
             
                 
               has enrolled in all 
                 
               specific enrollment 
             
             
                 
               companies that he had 
                 
               period. Basically, 
             
             
                 
               worked for. 
                 
               add Start Date, 
             
             
                 
                 
                 
               Coverage Type, 
             
             
                 
                 
                 
               Group/Division Id, 
             
             
                 
                 
                 
               and Employer Plan Id 
             
             
                 
                 
                 
               to the specified list 
             
             
                 
                 
                 
               of foreign keys. 
             
             
                 
                 
               Employer Plan 
               This uniquely 
               No 
               Yes 
               Yes 
             
             
                 
                 
               Key 
               identifies a 
             
             
                 
                 
                 
               particular plan that 
             
             
                 
                 
                 
               an Employer Group is 
             
             
                 
                 
                 
               provider for its 
             
             
                 
                 
                 
               employees. 
             
             
                 
                 
               Member Key 
               This identifies a 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               unique Member; 
             
             
                 
                 
                 
               currently based on 
             
             
                 
                 
                 
               Social Security 
             
             
                 
                 
                 
               Number and Date-Of- 
             
             
                 
                 
                 
               Birth. 
             
             
                 
                 
               Coverage Type 
               The parameters to 
               No 
               Yes 
               No 
             
             
                 
                 
               Lookup Key 
               LOOKUP table will be 
             
             
                 
                 
                 
               based on the type of 
             
             
                 
                 
                 
               healthcare coverage 
             
             
                 
                 
                 
               that the member is 
             
             
                 
                 
                 
               subscribing to: 1. 
             
             
                 
                 
                 
               I = Individual, 2. 
             
             
                 
                 
                 
               F = Family, 3. etc. 
             
             
                 
                 
                 
               Note that the various 
             
             
                 
                 
                 
               Coverage Types are 
             
             
                 
                 
                 
               different; depending 
             
             
                 
                 
                 
               on the Tier Type (in 
             
             
                 
                 
                 
               EMPLOYER_PLAN table) 
             
             
                 
                 
                 
               that is associated 
             
             
                 
                 
                 
               with 
             
             
                 
                 
                 
               Plan/Contract/Sub 
             
             
                 
                 
                 
               Group Id. 
             
             
                 
                 
               End Date 
               Effective end date of 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               this member&#39;s 
             
             
                 
                 
                 
               participation in 
             
             
                 
                 
                 
               healthcare coverage. 
             
             
                 
                 
               Start Date 
               Effective start date 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               of this member&#39;s 
             
             
                 
                 
                 
               participation in 
             
             
                 
                 
                 
               healthcare coverage. 
             
             
                 
                 
               Member Num 
               This field is 
               No 
               No 
               No 
             
             
                 
                 
                 
               captured for 
             
             
                 
                 
                 
               historical purposes 
             
             
                 
                 
                 
               only; the data should 
             
             
                 
                 
                 
               be read from the 
             
             
                 
                 
                 
               active Member Num 
             
             
                 
                 
                 
               during this 
             
             
                 
                 
                 
               enrollment span. 
             
             
                 
                 
                 
               This is a place 
             
             
                 
                 
                 
               holder for a member 
             
             
                 
                 
                 
               id/number that can 
             
             
                 
                 
                 
               uniquely identify 
             
             
                 
                 
                 
               this member. For 
             
             
                 
                 
                 
               example, assigned 
             
             
                 
                 
                 
               Member# will be used 
             
             
                 
                 
                 
               here; i.e. H212346700 
             
             
                 
                 
                 
               for the subscriber 
             
             
                 
                 
                 
               member and HP12346701 
             
             
                 
                 
                 
               for a spouse to this 
             
             
                 
                 
                 
               subscriber. Note 
             
             
                 
                 
                 
               that this field will 
             
             
                 
                 
                 
               be NULL; if a 
             
             
                 
                 
                 
               complete new member 
             
             
                 
                 
                 
               enrollment. 
             
             
               MEMBER 
               If a member is a 
               History Key 
               This is a unique 
               No 
               Yes 
               Yes 
             
             
               STUDENT 
               fulltime student over 
                 
               reference key to a 
             
             
                 
               19, require 
                 
               specific member 
             
             
                 
               information of the 
                 
               working for a 
             
             
                 
               school and its city 
                 
               specific employer 
             
             
                 
               and state. 
                 
               enrolled in a 
             
             
                 
                 
                 
               specific plan for a 
             
             
                 
                 
                 
               specific enrollment 
             
             
                 
                 
                 
               period. Basically, 
             
             
                 
                 
                 
               add Start Date, 
             
             
                 
                 
                 
               Coverage Type, 
             
             
                 
                 
                 
               Group/Division Id, 
             
             
                 
                 
                 
               and Employer Plan Id 
             
             
                 
                 
                 
               to the specified list 
             
             
                 
                 
                 
               of foreign keys. 
             
             
                 
                 
               School City 
               The City where the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               school is located. 
             
             
                 
                 
               School Name 
               Name of school where 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               the fulltime student 
             
             
                 
                 
                 
               is enrolled. 
             
             
                 
                 
               Start Date 
               Start date of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               school of Fulltime 
             
             
                 
                 
                 
               Student member. 
             
             
                 
                 
               Graduation 
               The expected 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               graduation date for 
             
             
                 
                 
                 
               member from this 
             
             
                 
                 
                 
               school. 
             
             
                 
                 
               School State 
               The state where the 
               No 
               No 
               No 
             
             
                 
                 
                 
               school is located. 
             
             
                 
                 
               School ZIP 
               Postal zipcode of 
               No 
               No 
               No 
             
             
                 
                 
                 
               school. 
             
             
                 
                 
               School ZIP 
               Long postal zipcode 
               No 
               No 
               No 
             
             
                 
                 
               Plus4 
               of school. 
             
             
                 
                 
               Semester End 
               The end date of 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               member&#39;s school 
             
             
                 
                 
                 
               semester. 
             
             
                 
                 
               Semester 
               The start date of 
               No 
               No 
               No 
             
             
                 
                 
               Start Date 
               member&#39;s school 
             
             
                 
                 
                 
               semester. 
             
             
               ORG INFO 
               This table is only 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
                 
               relevant if the 
                 
               HBK provider 
             
             
                 
               Provider in PROVIDER 
                 
               identifier. 
             
             
                 
               INFO table is 
             
             
                 
               identified as an 
             
             
                 
               organization 
             
             
                 
               provider. Since 
             
             
                 
               Organization Provider 
             
             
                 
               is a non person; a 
             
             
                 
               different set of data 
             
             
                 
               is kept; for example, 
             
             
                 
               legal corporate name; 
             
             
                 
               a tax id; etc. 
             
             
                 
                 
               Legal Name 
               A full legal name of 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               this organization; 
             
             
                 
                 
                 
               i.e. Mass. General 
             
             
                 
                 
                 
               Hospital. 
             
             
                 
                 
               Type Cd 
               Future . . . This type 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               code classifies what 
             
             
                 
                 
                 
               organization type is 
             
             
                 
                 
                 
               this org. provider; 
             
             
                 
                 
                 
               i.e. Facilities - 
             
             
                 
                 
                 
               Hospitals; Group 
             
             
                 
                 
                 
               Practices; etc. 
             
             
                 
                 
               Site Cd 
               The Site Cd to 
               No 
               No 
               No 
             
             
                 
                 
                 
               identify this 
             
             
                 
                 
                 
               organization 
             
             
                 
                 
                 
               provider. 
             
             
                 
                 
               Tax Id 
               Future . . . This is the 
               No 
               No 
               No 
             
             
                 
                 
                 
               legal tax identifier 
             
             
                 
                 
                 
               for this org. 
             
             
                 
                 
                 
               provider. 
             
             
               PHYSICAL 
               The actual physical 
               Physical 
               Unique record 
               Yes 
               Yes 
               No 
             
             
               ADDRESS 
               addresses that can be 
               Address Key 
               identifier of this 
             
             
                 
               associated to anyone 
                 
               address. 
             
             
                 
               or corporation; i.e. 
             
             
                 
               Mailing, Home, Work, 
             
             
                 
               etc. 
             
             
                 
                 
               Address Line1 
               Address line 1 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               containing the 
             
             
                 
                 
                 
               typical information 
             
             
                 
                 
                 
               of: 123 Main Street 
             
             
                 
                 
               City 
               City name of physical 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               address, 
             
             
                 
                 
               Country 
               A recognized Postal 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               Country Code. 
             
             
                 
                 
               County 
               County name of 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               physical address. 
             
             
                 
                 
               State 
               State where physical 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               address is based. 
             
             
                 
                 
               ZIP 
               US based postal zip 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               code. 
             
             
                 
                 
               Address Line2 
               Address line 2 
               No 
               No 
               No 
             
             
                 
                 
                 
               containing typical 
             
             
                 
                 
                 
               information 
             
             
                 
                 
                 
               regarding: P.O. Box; 
             
             
                 
                 
                 
               Suite#; Apt#; etc. 
             
             
                 
                 
               ZIP Plus4 
               The longer version of 
               No 
               No 
               No 
             
             
                 
                 
                 
               US-based postal zip 
             
             
                 
                 
                 
               code. 
             
             
               PROVIDER 
               This table provides 
               Practice Site 
               This key uniquely 
               Yes 
               Yes 
               No 
             
             
               AFFILIATION 
               the intersection 
               Key 
               identifies a practice 
             
             
                 
               information of a 
                 
               site for a provider. 
             
             
                 
               provider practicing 
                 
               This practice details 
             
             
                 
               what allowable 
                 
               the MCO product that 
             
             
                 
               specialties at a 
                 
               is provided by this 
             
             
                 
               practice site. 
                 
               doctor. 
             
             
                 
                 
               Participation 
               This identifies a 
               No 
               Yes 
               Yes 
             
             
                 
                 
               Key 
               specific product that 
             
             
                 
                 
                 
               a health care 
             
             
                 
                 
                 
               organization will 
             
             
                 
                 
                 
               provide for service 
             
             
                 
                 
                 
               to any employer 
             
             
                 
                 
                 
               groups.  
             
             
                 
                 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               provider identifier. 
             
             
                 
                 
               Provider Num 
               An provider number 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               recognized by a 
             
             
                 
                 
                 
               particular MCO. 
             
             
                 
                 
               Site Cd 
               A term identifying 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               the Site Code to the 
             
             
                 
                 
                 
               group practice that 
             
             
                 
                 
                 
               the physician belongs 
             
             
                 
                 
                 
               to. 
             
             
                 
                 
               Accept New 
               A conditional flag 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               (Yes/No) to indicate 
             
             
                 
                 
                 
               whether a provider is 
             
             
                 
                 
                 
               accepting new 
             
             
                 
                 
                 
               patients at this 
             
             
                 
                 
                 
               particular practice 
             
             
                 
                 
                 
               site. 
             
             
                 
                 
               AMI PlanCd 
               This is a placeholder 
               No 
               No 
               No 
             
             
                 
                 
                 
               attribute used by the 
             
             
                 
                 
                 
               AMISYS source load 
             
             
                 
                 
                 
               group. 
             
             
                 
                 
               Effective 
               This effective start 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               date for this 
             
             
                 
                 
                 
               relationship between 
             
             
                 
                 
                 
               MCO and Provider. 
             
             
                 
                 
               IRS Tax Id 
               Tags each affiliation 
               No 
               No 
               No 
             
             
                 
                 
                 
               with a Tax Id or SSN. 
             
             
                 
                 
                 
               This is tied to the 
             
             
                 
                 
                 
               how each provider at 
             
             
                 
                 
                 
               each site may have a 
             
             
                 
                 
                 
               different tax id for 
             
             
                 
                 
                 
               claims payment. 
             
             
                 
                 
               Primary 
               Indicates whether 
               No 
               No 
               No 
             
             
                 
                 
               Practice Site 
               this site is a 
             
             
                 
                 
               Flg 
               primary practice site 
             
             
                 
                 
                 
               for this provider. 
             
             
                 
                 
                 
               FUTURE . . . This field 
             
             
                 
                 
                 
               may belong in SITE 
             
             
                 
                 
                 
               SPECIALITY if we need 
             
             
                 
                 
                 
               to track primary 
             
             
                 
                 
                 
               practice site at a 
             
             
                 
                 
                 
               provider&#39;s specialty 
             
             
                 
                 
                 
               level. 
             
             
                 
                 
               Site Review 
               This indicates what 
               No 
               No 
               No 
             
             
                 
                 
               Status 
               the site review 
             
             
                 
                 
                 
               status for the 
             
             
                 
                 
                 
               provider&#39;s specialty 
             
             
                 
                 
                 
               at this practice 
             
             
                 
                 
                 
               site. FUTURE . . . This 
             
             
                 
                 
                 
               field may belong in 
             
             
                 
                 
                 
               the SITE SPECIALTY 
             
             
                 
                 
                 
               table if site review 
             
             
                 
                 
                 
               is tracked on the 
             
             
                 
                 
                 
               specialty level at a 
             
             
                 
                 
                 
               practice site for a 
             
             
                 
                 
                 
               provider. 
             
             
                 
                 
               Term Date 
               The termination date 
               No 
               No 
               No 
             
             
                 
                 
                 
               for this relationship 
             
             
                 
                 
                 
               between MCO and 
             
             
                 
                 
                 
               Provider. 
             
             
               PROVIDER INFO 
               A table describing 
               Provider Key 
               An internal unique 
               Yes 
               Yes 
               No 
             
             
                 
               the Provider; if a 
                 
               provider identifier. 
             
             
                 
               person, then 
             
             
                 
               information like SSN; 
             
             
                 
               Last and First Name; 
             
             
                 
               Gender; etc. This 
             
             
                 
               demographics type 
             
             
                 
               information is useful 
             
             
                 
               to selection by 
             
             
                 
               members. Note: if 
             
             
                 
               provider is a non- 
             
             
                 
               person, then the ORG 
             
             
                 
               INFO table will 
             
             
                 
               contain equivalent 
             
             
                 
               corporate information 
             
             
                 
               like: Legal Name; Tax 
             
             
                 
               Id; etc. 
             
             
                 
                 
               Org Flg 
               A flag to indicate 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               whether this provider 
             
             
                 
                 
                 
               is an individual 
             
             
                 
                 
                 
               Clinician/Provider or 
             
             
                 
                 
                 
               an organization like: 
             
             
                 
                 
                 
               hospital; group 
             
             
                 
                 
                 
               practices, etc. A 
             
             
                 
                 
                 
               &#39;Y&#39;condition will 
             
             
                 
                 
                 
               force a lookup for 
             
             
                 
                 
                 
               name; tax id; site 
             
             
                 
                 
                 
               codes in the ORG INFO 
             
             
                 
                 
                 
               table. 
             
             
                 
                 
               AMI Provider 
               This is a placeholder 
               No 
               No 
               No 
             
             
                 
                 
               Num 
               attribute used by the 
             
             
                 
                 
                 
               AMISYS source load 
             
             
                 
                 
                 
               group. 
             
             
                 
                 
               Birthdate 
               Birthdate of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               Clinician provider. 
             
             
                 
                 
               First Name 
               First name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               Clinician provider. 
             
             
                 
                 
               Gender 
               This is a single 
               No 
               No 
               No 
             
             
                 
                 
                 
               character column; 
             
             
                 
                 
                 
               note that this is an 
             
             
                 
                 
                 
               optional field: 1. M = 
             
             
                 
                 
                 
               Male 2. F = Female 
                 
             
             
                 
                 
               Last Name 
               Last Name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               Clinician provider. 
             
             
                 
                 
               Logo1 URL 
               A primary pointer to 
               No 
               No 
               No 
             
             
                 
                 
                 
               a graphical logo for 
             
             
                 
                 
                 
               this physician 
             
             
                 
                 
                 
               provider. 
             
             
                 
                 
               Logo2 URL 
               A secondary pointer 
               No 
               No 
               No 
             
             
                 
                 
                 
               to a graphical logo 
             
             
                 
                 
                 
               for this physician 
             
             
                 
                 
                 
               provider. 
             
             
                 
                 
               Middle Name 
               Middle name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               Clinician provider. 
             
             
                 
                 
               SSN 
               Social Security of a 
               No 
               No 
               No 
             
             
                 
                 
                 
               Clinician provider. 
             
             
               PROVIDER LANG 
               All languages that 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
                 
               this provider can 
                 
               HBK provider 
             
             
                 
               communicate with his 
                 
               identifier. 
             
             
                 
               patients in. 
             
             
                 
                 
               Language Cd 
               Contains the 
               No 
               Yes 
               No 
             
             
                 
                 
               Lookup Key 
               appropriate Lookup 
             
             
                 
                 
                 
               Key in HBK_LOOKUP 
             
             
                 
                 
                 
               table for Language 
             
             
                 
                 
                 
               Cd. See definition 
             
             
                 
                 
                 
               of Language Cd field. 
             
             
                 
                 
                 
               The language code 
             
             
                 
                 
                 
               that this particular 
             
             
                 
                 
                 
               provider is fluent 
             
             
                 
                 
                 
               in. For example, 1. 
             
             
                 
                 
                 
               AS - American Sign 
             
             
                 
                 
                 
               Language 2. CA - 
             
             
                 
                 
                 
               Cantonese 3. EN - 
             
             
                 
                 
                 
               English 4. IT - 
             
             
                 
                 
                 
               Italian 5. SP - 
             
             
                 
                 
                 
               Spanish etc. 
             
             
               PROVIDER 
               This table identifies 
               Prove Spec 
               Uniquely identifies a 
               Yes 
               Yes 
               No 
             
             
               SPECIALTY 
               all specialties 
               Key 
               specialty code to 
             
             
                 
               practiced by this this 
                 
               provider. 
             
             
                 
               provider. 
             
             
                 
                 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               provider identifier. 
             
             
                 
                 
               Specialty Cd 
               Contains the 
               No 
               Yes 
               No 
             
             
                 
                 
               Lookup Key 
               appropriate Lookup 
             
             
                 
                 
                 
               Key in LOOKUP table 
             
             
                 
                 
                 
               for Specialty Cd. 
             
             
                 
                 
                 
               See definition of 
             
             
                 
                 
                 
               Specialty Cd field. 
             
             
                 
                 
                 
               An industry set of 
             
             
                 
                 
                 
               specialties that can 
             
             
                 
                 
                 
               be practiced by a 
             
             
                 
                 
                 
               provider. 
             
             
                 
                 
               Credential 
               Future . . . A ‘Y’es or 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               ‘N’o flag indicating 
             
             
                 
                 
                 
               that this specialty 
             
             
                 
                 
                 
               requires 
             
             
                 
                 
                 
               Credentialing or not. 
             
             
                 
                 
               PCP Allowed 
               Future . . . A ‘Y’es or 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               ‘N’o indicator 
             
             
                 
                 
                 
               identifying whether 
             
             
                 
                 
                 
               the specialty allows 
             
             
                 
                 
                 
               for PCP designation. 
             
             
               PROVIDER 
               This table contains 
               Provider Key 
               An internal unique 
               No 
               Yes 
               Yes 
             
             
               STAFF 
               all staff members to 
                 
               provider identifier. 
             
             
                 
               a particular provider 
             
             
                 
               who requires access 
             
             
                 
               to the system via the 
             
             
                 
               account setup 
             
             
                 
               process. 
             
             
                 
                 
               Admin Role 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               particular role that 
             
             
                 
                 
                 
               allows a Provider to 
             
             
                 
                 
                 
               control what security 
             
             
                 
                 
                 
               levels to access what 
             
             
                 
                 
                 
               part of the database. 
             
             
                 
                 
               Acct Key 
               This is unique Key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               based on Username. 
             
             
                 
                 
               First Name 
               First name of this 
               No 
               No 
               No 
             
             
                 
                 
                 
               Provider group user. 
             
             
                 
                 
               Last Name 
               Last Name of Provider 
               No 
               No 
               No 
             
             
                 
                 
                 
               group user. 
             
             
                 
                 
               SSN 
               Social security 
               No 
               No 
               No 
             
             
                 
                 
                 
               number to uniquely 
             
             
                 
                 
                 
               identify the user. 
             
             
               SITE 
               An intersection table 
               Site 
               A unique identifier 
               Yes 
               Yes 
               No 
             
             
               SPECIALTY 
               to show a provider&#39;s 
               Specialty Key 
               based on all of a 
             
             
                 
               specialties that is 
                 
               provider&#39;s 
             
             
                 
               practice at a 
                 
               specialties at this 
             
             
                 
               particular site. 
                 
               site. 
             
             
                 
                 
               Practice Site 
               This key uniquely 
               No 
               Yes 
               Yes 
             
             
                 
                 
               Key 
               identifies a practice 
             
             
                 
                 
                 
               site for a provider. 
             
             
                 
                 
                 
               This practice details 
             
             
                 
                 
                 
               the MCO product that 
             
             
                 
                 
                 
               is provided by this 
             
             
                 
                 
                 
               doctor. 
             
             
                 
                 
               Prov Spec Key 
               Uniquely identifies a 
               No 
               Yes 
               Yes 
             
             
                 
                 
                 
               specialty code to 
             
             
                 
                 
                 
               this provider. 
             
             
               STAGING AREA 
               This table tracks the 
               Tran Key 
               This is unique 
               Yes 
               Yes 
               No 
             
             
                 
               process of a member 
                 
               identifier for this 
             
             
                 
               through the system 
                 
               particular Staging 
             
             
                 
               for various 
                 
               Area record. 
             
             
                 
               transaction events; 
             
             
                 
               i.e. Enrollment; 
             
             
                 
               Profile Change; etc. 
             
             
                 
                 
               Birthdate 
               Birthdate of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               effected member. 
             
             
                 
                 
               Tran Id 
               This transaction id 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               groups multiple 
             
             
                 
                 
                 
               transaction records 
             
             
                 
                 
                 
               into a single 
             
             
                 
                 
                 
               processing unit. For 
             
             
                 
                 
                 
               example, in the 
             
             
                 
                 
                 
               enrollment process, 
             
             
                 
                 
                 
               the primary 
             
             
                 
                 
                 
               subscriber may have 3 
             
             
                 
                 
                 
               dependents. 
             
             
                 
                 
                 
               Therefore, the same 
             
             
                 
                 
                 
               Tran Id of the 3 
             
             
                 
                 
                 
               dependents is the 
             
             
                 
                 
                 
               same as the Tran Key 
             
             
                 
                 
                 
               and Tran Id of the 
             
             
                 
                 
                 
               subscriber Staging 
             
             
                 
                 
                 
               Area table. 
             
             
                 
                 
               Tran Stage 
               This identifies a 
               No 
               Yes 
               No 
             
             
                 
                 
               Num 
               stage to the 
             
             
                 
                 
                 
               transaction process 
             
             
                 
                 
                 
               of the member of an 
             
             
                 
                 
                 
               employer group. For 
             
             
                 
                 
                 
               example, the various 
             
             
                 
                 
                 
               states for new 
             
             
                 
                 
                 
               enrollment 
             
             
                 
                 
                 
               transaction type 
             
             
                 
                 
                 
               (ENNW) are: “01 = 
             
             
                 
                 
                 
               new enrollment 
             
             
                 
                 
                 
               submitted by member” 
             
             
                 
                 
                 
               “02 = enrollment 
             
             
                 
                 
                 
               approved by employer” 
             
             
                 
                 
                 
               “03 = enrollment sent 
             
             
                 
                 
                 
               successfully to MCO” 
             
             
                 
                 
                 
               “06 = enrollment 
             
             
                 
                 
                 
               denied by employer” 
             
             
                 
                 
                 
               “07 = enrollment 
             
             
                 
                 
                 
               failed in delivery to 
             
             
                 
                 
                 
               MCO” “08 = enrollment 
             
             
                 
                 
                 
               denial exceeds 30 
             
             
                 
                 
                 
               days from initial 
             
             
                 
                 
                 
               creation date” 
             
             
                 
                 
               Tran Start 
               This is the start 
               No 
               Yes 
               No 
             
             
                 
                 
               Date 
               date/time of 
             
             
                 
                 
                 
               transaction process. 
             
             
                 
                 
               Tran Status 
               The status of this 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               transaction request. 
             
             
                 
                 
               Tran Type 
               This defines what 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               type of transaction 
             
             
                 
                 
                 
               is staged; i.e. 
             
             
                 
                 
                 
               enrollment, address 
             
             
                 
                 
                 
               change, etc. 
             
             
                 
                 
               Employer Key 
               Unique lookup key 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               that identifies this 
             
             
                 
                 
                 
               employer coverage 
             
             
                 
                 
                 
               based on a contract 
             
             
                 
                 
                 
               number with a MCO. 
             
             
                 
                 
               MCO Key 
               Unique managed care 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               identifier key. 
             
             
                 
                 
               Member Key 
               This identifies a 
               No 
               No 
               Yes 
             
             
                 
                 
                 
               unique Member; 
             
             
                 
                 
                 
               currently based on 
             
             
                 
                 
                 
               Social Security 
             
             
                 
                 
                 
               Number and Date-Of- 
             
             
                 
                 
                 
               Birth. 
             
             
                 
                 
               Practice Site 
               This key uniquely 
               No 
               No 
               Yes 
             
             
                 
                 
               Key 
               identifies a practice 
             
             
                 
                 
                 
               site for a provider. 
             
             
                 
                 
                 
               This practice details 
             
             
                 
                 
                 
               the MCO product that 
             
             
                 
                 
                 
               is provided by this 
             
             
                 
                 
                 
               doctor. 
             
             
                 
                 
               Address1 
               Address Line 1 - i.e. 
               No 
               No 
               No 
             
             
                 
                 
                 
               111 Main Street 
             
             
                 
                 
               Address2 
               Address Line 2 - i.e. 
               No 
               No 
               No 
             
             
                 
                 
                 
               P.O. Box; Suite 
             
             
                 
                 
                 
               Number; etc. 
             
             
                 
                 
               AMI Division 
               A Division Number for 
               No 
               No 
               No 
             
             
                 
                 
               Num 
               MCO plan in AMISYS. 
             
             
                 
                 
                 
               This field and/or 
             
             
                 
                 
                 
               AMI Group Number will 
             
             
                 
                 
                 
               point to a generic 
             
             
                 
                 
                 
               Sub Group Id. 
             
             
                 
                 
               AMI DOD 
               Amisys required Date 
               No 
               No 
               No 
             
             
                 
                 
                 
               of Death. 
             
             
                 
                 
               AMI Facility 
               Amisys specific for 
               No 
               No 
               No 
             
             
                 
                 
               Cd 
               HPHC Facility Code. 
             
             
                 
                 
               AMI Group Num 
               A Group Number for 
               No 
               No 
               No 
             
             
                 
                 
                 
               its MCO plan in 
             
             
                 
                 
                 
               AMISYS. This field 
             
             
                 
                 
                 
               and/or AMI Division 
             
             
                 
                 
                 
               Number will point to 
             
             
                 
                 
                 
               a generic Sub Group 
             
             
                 
                 
                 
               Id. 
             
             
                 
                 
               AMI PCP City 
               Amisys requested city 
               No 
               No 
               No 
             
             
                 
                 
                 
               of selected PCP. 
             
             
                 
                 
               AMI PCP Id 
               Amisys specific - 
               No 
               No 
               No 
             
             
                 
                 
                 
               Provider Id. 
             
             
                 
                 
               AMI Termdate 
               Amisys specific 
               No 
               No 
               No 
             
             
                 
                 
                 
               Termination date of 
             
             
                 
                 
                 
               subscriber/member. 
             
             
                 
                 
               AMISYS Reject 
               This field will store 
               No 
               No 
               No 
             
             
                 
                 
               Cd 
               the AMISYS rejection 
             
             
                 
                 
                 
               code; if this 
             
             
                 
                 
                 
               member&#39;s record is 
             
             
                 
                 
                 
               rejected by the 
             
             
                 
                 
                 
               AMISYS system 
             
             
                 
                 
               City 
               The city name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               effected member&#39;s 
             
             
                 
                 
                 
               address. 
             
             
                 
                 
               COB Birthdate 
               The birthday of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               subscriber to this 
             
             
                 
                 
                 
               Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               COB Carrier 
               The carrier insurance 
               No 
               No 
               No 
             
             
                 
                 
               Name 
               company name for this 
             
             
                 
                 
                 
               coordination of 
             
             
                 
                 
                 
               benefits. 
             
             
                 
                 
               COB Coverage 
               The coverage type of 
               No 
               No 
               No 
             
             
                 
                 
               Type 
               this policy number of 
             
             
                 
                 
                 
               the subscriber to 
             
             
                 
                 
                 
               this Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               COB Effective 
               The effective date of 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               this policy number of 
             
             
                 
                 
                 
               the subscriber to 
             
             
                 
                 
                 
               this Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               COB First 
               The first name of the 
               No 
               No 
               No 
             
             
                 
                 
               Name 
               subscriber to this 
             
             
                 
                 
                 
               Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               COB Last Name 
               The last name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               subscriber to this 
             
             
                 
                 
                 
               Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               COB Policy 
               The policy number of 
               No 
               No 
               No 
             
             
                 
                 
               Num 
               the subscriber to 
             
             
                 
                 
                 
               this Coordination of 
             
             
                 
                 
                 
               Benefits policy. 
             
             
                 
                 
               Country 
               US postal country 
               No 
               No 
               No 
             
             
                 
                 
                 
               code of the effected 
             
             
                 
                 
                 
               member&#39;s address. 
             
             
                 
                 
               County 
               The county name of 
               No 
               No 
               No 
             
             
                 
                 
                 
               the effected member&#39;s 
             
             
                 
                 
                 
               address. 
             
             
                 
                 
               Coverage Type 
               This field details 
               No 
               No 
               No 
             
             
                 
                 
                 
               the coverage type 
             
             
                 
                 
                 
               selected by the 
             
             
                 
                 
                 
               subscriber member: 
             
             
                 
                 
                 
               1. individual 2. 
             
             
                 
                 
                 
               Family 3. 2Person 
             
             
                 
                 
                 
               . . . etc. 
             
             
                 
                 
               Coverage Type 
               The parameters to 
               No 
               No 
               No 
             
             
                 
                 
               Lookup Key 
               LOOKUP table will be 
             
             
                 
                 
                 
               based on the type of 
             
             
                 
                 
                 
               healthcare coverage 
             
             
                 
                 
                 
               that the member is 
             
             
                 
                 
                 
               subscribing to: 1. 
             
             
                 
                 
                 
               I = Individual, 2. 
             
             
                 
                 
                 
               F = Family, 3. etc. 
             
             
                 
                 
                 
               Note that the various 
             
             
                 
                 
                 
               Coverage Types are 
             
             
                 
                 
                 
               different; depending 
             
             
                 
                 
                 
               on the Tier Type (in 
             
             
                 
                 
                 
               EMPLOYER_PLAN table) 
             
             
                 
                 
                 
               that is associated 
             
             
                 
                 
                 
               with 
             
             
                 
                 
                 
               Plan/Contract/Sub 
             
             
                 
                 
                 
               Group Id. 
             
             
                 
                 
               Effective 
               The effective start 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               date of this 
             
             
                 
                 
                 
               transaction; i.e. 
             
             
                 
                 
                 
               Enrollment date is 
             
             
                 
                 
                 
               future-dated. 
             
             
                 
                 
                 
               Enrollment process 
             
             
                 
                 
                 
               takes place usually 
             
             
                 
                 
                 
               30-60 days before the 
             
             
                 
                 
                 
               actual start date. 
             
             
                 
                 
               Email Address 
               Email address of 
               No 
               No 
               No 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               Employer Plan 
               This is the employer 
               No 
               No 
               No 
             
             
                 
                 
               Id 
               plan id; it should 
             
             
                 
                 
                 
               uniquely identify the 
             
             
                 
                 
                 
               Employer to a 
             
             
                 
                 
                 
               Contract Id for a 
             
             
                 
                 
                 
               certain 
             
             
                 
                 
                 
               SubGroup (Group/Division) 
             
             
                 
                 
                 
               that it expect 
             
             
                 
                 
                 
               healthcare coverage 
             
             
                 
                 
                 
               from a MCO. 
             
             
                 
                 
               Existing 
               A ‘Y’es or ‘No’o flag 
               No 
               No 
               No 
             
             
                 
                 
               Patient Flg 
               to indicate whether 
             
             
                 
                 
                 
               the member is an 
             
             
                 
                 
                 
               existing patient of 
             
             
                 
                 
                 
               the selected PCP. 
             
             
                 
                 
               First Name 
               First name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               effected member of 
             
             
                 
                 
                 
               this transaction. 
             
             
                 
                 
               Gender 
               This is a single 
               No 
               No 
               No 
             
             
                 
                 
                 
               character column; 
             
             
                 
                 
                 
               note that this is an 
             
             
                 
                 
                 
               optional field: 1. M = 
             
             
                 
                 
                 
               Male 2. F = Female 
             
             
                 
                 
               Graduation 
               Expected graduation 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               date of member from 
             
             
                 
                 
                 
               school. 
             
             
                 
                 
               Hiredate 
               The hiring date of 
               No 
               No 
               No 
             
             
                 
                 
                 
               the subscriber member 
             
             
                 
                 
                 
               to the Employer 
             
             
                 
                 
                 
               group. 
             
             
                 
                 
               Home Phone 
               Long hand 
               No 
               No 
               No 
             
             
                 
                 
               Num 
               representation of 
             
             
                 
                 
                 
               member&#39;s home phone 
             
             
                 
                 
                 
               number. For example, 
             
             
                 
                 
                 
               800.555.1212 
             
             
                 
                 
               Language Cd 
               The language code 
               No 
               No 
               No 
             
             
                 
                 
                 
               that is preferred by 
             
             
                 
                 
                 
               this member. For 
             
             
                 
                 
                 
               example, 1. AS - 
             
             
                 
                 
                 
               American Sign 
             
             
                 
                 
                 
               Language 2. CA - 
             
             
                 
                 
                 
               Cantonese 3. EN - 
             
             
                 
                 
                 
               English 4. IT - 
             
             
                 
                 
                 
               Italian 5. Sp - 
             
             
                 
                 
                 
               Spanish . . . etc. 
             
             
                 
                 
               Language Cd 
               Contains the 
               No 
               No 
               No 
             
             
                 
                 
               Lookup Key 
               appropriate Lookup 
             
             
                 
                 
                 
               Key in LOOKUP table 
             
             
                 
                 
                 
               for Language Cd. See 
             
             
                 
                 
                 
               definition of 
             
             
                 
                 
                 
               Language Cd field. 
             
             
                 
                 
               Last Name 
               Last name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               effected member of 
             
             
                 
                 
                 
               this transaction. 
             
             
                 
                 
               Middle Name 
               Middle name of the 
               No 
               No 
               No 
             
             
                 
                 
                 
               effected member of 
             
             
                 
                 
                 
               this transaction. 
             
             
                 
                 
               Nickname 
               A nickname to the 
               No 
               No 
               No 
             
             
                 
                 
                 
               member&#39;s first name. 
             
             
                 
                 
               Plan Cd 
               This is the plan code 
               No 
               No 
               No 
             
             
                 
                 
                 
               or name that is 
             
             
                 
                 
                 
               offered by the MCO. 
             
             
                 
                 
               Plan 
               Cd Contains the 
               No 
               No 
               No 
             
             
                 
                 
               LookupKey 
               appropriate Lookup 
             
             
                 
                 
                 
               Key in LOOKUP table 
             
             
                 
                 
                 
               for Plan Cd. See 
             
             
                 
                 
                 
               definition of Plan Cd 
             
             
                 
                 
                 
               field. 
             
             
                 
                 
               Prefix 
               A prefix to the 
               No 
               No 
               No 
             
             
                 
                 
                 
               member&#39;s name; i.e. 
             
             
                 
                 
                 
               Dr, Mr, Ms, etc. 
             
             
                 
                 
               Relation Cd 
               This field indicates 
               No 
               No 
               No 
             
             
                 
                 
                 
               the relationship of 
             
             
                 
                 
                 
               member to the primary 
             
             
                 
                 
                 
               subscriber of plan. 
             
             
                 
                 
                 
               Current Relation Code 
             
             
                 
                 
                 
               recognized by HPHC 
             
             
                 
                 
                 
               are: 01 = Self 02 = 
             
             
                 
                 
                 
               Spouse 03 = Unmarried 
             
             
                 
                 
                 
               child under 19 04 = 
             
             
                 
                 
                 
               Unmarried stepchild 
             
             
                 
                 
                 
               under 19 05 = 
             
             
                 
                 
                 
               Unmarried fulltime 
             
             
                 
                 
                 
               student over 19 06 = 
             
             
                 
                 
                 
               Handicapped 07 = Ex- 
             
             
                 
                 
                 
               Spouse 
             
             
                 
                 
               School City 
               City code of school 
               No 
               No 
               No 
             
             
                 
                 
                 
               that this full time 
             
             
                 
                 
                 
               student over 19 is 
             
             
                 
                 
                 
               attending. 
             
             
                 
                 
               School Name 
               Name of school that 
               No 
               No 
               No 
             
             
                 
                 
                 
               this full time 
             
             
                 
                 
                 
               student over 19 is 
             
             
                 
                 
                 
               attending. 
             
             
                 
                 
               School State 
               State code of school 
               No 
               No 
               No 
             
             
                 
                 
                 
               that this full time 
             
             
                 
                 
                 
               student over 19 is 
             
             
                 
                 
                 
               attending. 
             
             
                 
                 
               School ZIP 
               Postal zipcode of 
               No 
               No 
               No 
             
             
                 
                 
                 
               school. 
             
             
                 
                 
               School ZIP 
               Long postal zipcode 
               No 
               No 
               No 
             
             
                 
                 
               Plus4 
               of school. 
             
             
                 
                 
               Selected PCP 
               Selected PCP for this 
               No 
               No 
               No 
             
             
                 
                 
                 
               member; this can be 
             
             
                 
                 
                 
               as simple as the 
             
             
                 
                 
                 
               provider number. 
             
             
                 
                 
               Semester End 
               End date of school 
               No 
               No 
               No 
             
             
                 
                 
               Date 
               semester of member. 
             
             
                 
                 
               Semester 
               Start date of school 
               No 
               No 
               No 
             
             
                 
                 
               Start Date 
               semester for member. 
             
             
                 
                 
               SSN 
               Social Security 
               No 
               No 
               No 
             
             
                 
                 
                 
               number of this 
             
             
                 
                 
                 
               member. 
             
             
                 
                 
               State 
               US postal state code 
               No 
               No 
               No 
             
             
                 
                 
                 
               of the effected 
             
             
                 
                 
                 
               member&#39;s address. 
             
             
                 
                 
               Student 19 
               This flag condition, 
               No 
               No 
               No 
             
             
                 
                 
               Flg 
               ‘Y’es or ‘N’o, 
             
             
                 
                 
                 
               indicates whether the 
             
             
                 
                 
                 
               member information 
             
             
                 
                 
                 
               reflects that of a 
             
             
                 
                 
                 
               fulltime student over 
             
             
                 
                 
                 
               19 and under the 
             
             
                 
                 
                 
               maximum student age 
             
             
                 
                 
                 
               (according to HPHC 
             
             
                 
                 
                 
               standard). 
             
             
                 
                 
               Sub Group Id 
               This is the Employer 
               No 
               No 
               No 
             
             
                 
                 
                 
               group number that is 
             
             
                 
                 
                 
               known to the MCO. 
             
             
                 
                 
                 
               For example, a 
             
             
                 
                 
                 
               company may have a 
             
             
                 
                 
                 
               union and nonunion 
             
             
                 
                 
                 
               subgroups. 
             
             
                 
                 
               Suffix 
               A suffix to the 
               No 
               No 
               No 
             
             
                 
                 
                 
               member&#39;s name; i.e. 
             
             
                 
                 
                 
               ESQ, II, etc. 
             
             
                 
                 
               Tran End Date 
               This is the start 
               No 
               No 
               No 
             
             
                 
                 
                 
               date/time of 
             
             
                 
                 
                 
               transaction process. 
             
             
                 
                 
               Work Phone 
               User can place a Work 
               No 
               No 
               No 
             
             
                 
                 
               Num 
               phone number in this 
             
             
                 
                 
                 
               field 
             
             
                 
                 
               ZIP 
               US postal zip code of 
               No 
               No 
               No 
             
             
                 
                 
                 
               the effected member&#39;s 
             
             
                 
                 
                 
               address. 
             
             
                 
                 
               ZIP Plus4 
               Longer version of US 
               No 
               No 
               No 
             
             
                 
                 
                 
               postal zip code of 
             
             
                 
                 
                 
               the effected member&#39;s 
             
             
                 
                 
                 
               address. 
             
             
               STAGING AUDIT 
               This is an Audit Log 
               Tran Key 
               This is unique 
               No 
               Yes 
               Yes 
             
             
                 
               for a specific 
                 
               identifier for this 
             
             
                 
               record; it will log 
                 
               particular Staging 
             
             
                 
               the WHO and WHEN and 
                 
               Area record. 
             
             
                 
               WHY a “Tran Stage 
             
             
                 
               Num” is reached 
             
             
                 
               within the Staging 
             
             
                 
               Area record. 
             
             
                 
                 
               Modified By 
               The identity of the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               person updating a 
             
             
                 
                 
                 
               Staging transaction 
             
             
                 
                 
                 
               record to the new 
             
             
                 
                 
                 
               Stage Num; i.e. login 
             
             
                 
                 
                 
               user name. 
             
             
                 
                 
               Modified Date 
               The date/tamestamp to 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               when an update to the 
             
             
                 
                 
                 
               Staging transaction 
             
             
                 
                 
                 
               record to the new 
             
             
                 
                 
                 
               Stage Num. 
             
             
                 
                 
               Tran Stage 
               This identifies a 
               No 
               Yes 
               No 
             
             
                 
                 
               Num 
               stage to the 
             
             
                 
                 
                 
               transaction process 
             
             
                 
                 
                 
               of the member of an 
             
             
                 
                 
                 
               employer group. 
             
             
                 
                 
                 
               Initial release 
             
             
                 
                 
                 
               supports: 1. Waiting 
             
             
                 
                 
                 
               For Employer Approval 
             
             
                 
                 
                 
               2.successful to 
             
             
                 
                 
                 
               Connector Queue. 
             
             
                 
                 
                 
               Later releases should 
             
             
                 
                 
                 
               support the various 
             
             
                 
                 
                 
               stages that 
             
             
                 
                 
                 
               enrollment can be; 
             
             
                 
                 
                 
               i.e. all information 
             
             
                 
                 
                 
               except the PCP is 
             
             
                 
                 
                 
               inputted at one time. 
             
             
                 
                 
               Comment 
               This field can 
               No 
               No 
               No 
             
             
                 
                 
                 
               capture any 
             
             
                 
                 
                 
               description that is 
             
             
                 
                 
                 
               attributed to a 
             
             
                 
                 
                 
               change to the stage 
             
             
                 
                 
                 
               of an enrollment. 
             
             
                 
                 
                 
               For example, the 
             
             
                 
                 
                 
               comments tied to a 
             
             
                 
                 
                 
               rejection of employee 
             
             
                 
                 
                 
               validation its 
             
             
                 
                 
                 
               employer. 
             
             
               STAGING 
               This table will 
               Tran Key 
               This is unique 
               No 
               Yes 
               Yes 
             
             
               DIGITAL ADDR 
               contain other digital 
                 
               identifier for this 
             
             
                 
               addresses that is 
                 
               particular Staging 
             
             
                 
               related to this 
                 
               Area record. 
             
             
                 
               particular Staging 
             
             
                 
               Area record. For 
             
             
                 
               example, the STAGING 
             
             
                 
               AREA record contains 
             
             
                 
               a home, work, and 
             
             
                 
               email address for the 
             
             
                 
               primary HOME physical 
             
             
                 
               address. This table 
             
             
                 
               will allow for 
             
             
                 
               additional ones like: 
             
             
                 
               Cell, Pager, etc.; or 
             
             
                 
               different 
             
             
                 
               combinations like a 
             
             
                 
               Vacation Home phone 
             
             
                 
               number. 
             
             
                 
                 
               Purpose Cd 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               purpose of this 
             
             
                 
                 
                 
               address; such as: 
             
             
                 
                 
                 
               “1. PR = Practice 
             
             
                 
                 
                 
               Address” “2. HM = 
             
             
                 
                 
                 
               Home Address” “3. BL = 
             
             
                 
                 
                 
               Billing Address” 
             
             
                 
                 
                 
               “4. ML = Mailing 
             
             
                 
                 
                 
               Address” “5. WK = 
             
             
                 
                 
                 
               Work Address” 
             
             
                 
                 
               Type Cd 
               This code defined the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               various types: “1. 
             
             
                 
                 
                 
               VC = Voice/Land 
             
             
                 
                 
                 
               phone” “2. CL = Cell 
             
             
                 
                 
                 
               phone” “3. PG = 
             
             
                 
                 
                 
               Pager” “4. EM = 
             
             
                 
                 
                 
               Email” “5. WB = Web 
             
             
                 
                 
                 
               Home Page” 
             
             
                 
                 
               Valuel 
               Contains initial 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               value associated with 
             
             
                 
                 
                 
               a type of digital 
             
             
                 
                 
                 
               address. For example 
             
             
                 
                 
                 
               - voice mail 
             
             
                 
                 
                 
               includes: 
             
             
                 
                 
                 
               800.555.1212 or 
             
             
                 
                 
                 
               abc@foobar.com for 
             
             
                 
                 
                 
               Email type. 
             
             
                 
                 
               Value2 
               This may be a second 
               No 
               No 
               No 
             
             
                 
                 
                 
               value set to a 
             
             
                 
                 
                 
               specific type of 
             
             
                 
                 
                 
               digital address. For 
             
             
                 
                 
                 
               example - voice mail 
             
             
                 
                 
                 
               may include an 
             
             
                 
                 
                 
               extension part to the 
             
             
                 
                 
                 
               original phone 
             
             
                 
                 
                 
               number. 
             
             
                 
                 
               Value3 
               This third value 
               No 
               No 
               No 
             
             
                 
                 
                 
               association is for 
             
             
                 
                 
                 
               obscure elements like 
             
             
                 
                 
                 
               answer back string to 
             
             
                 
                 
                 
               a modem connect 
             
             
                 
                 
                 
               and/or future 
             
             
                 
                 
                 
               electronic 
             
             
                 
                 
                 
               requirements. 
             
             
               STAGING 
               This table will 
               Tran Key 
               This is unique 
               No 
               Yes 
               Yes 
             
             
               PHYSICAL ADDR 
               contain other 
                 
               identifier for this 
             
             
                 
               physical addresses 
                 
               particular Staging 
             
             
                 
               that is related to 
                 
               Area record. 
             
             
                 
               this particular 
             
             
                 
               Staging Area record. 
             
             
                 
               For example, beside 
             
             
                 
               the primary Home 
             
             
                 
               address in the 
             
             
                 
               STAGING AREA record; 
             
             
                 
               this member may want 
             
             
                 
               to designate other 
             
             
                 
               types like: Work, 
             
             
                 
               Vacation, Practice, 
             
             
                 
               etc. 
             
             
                 
                 
               Address1 
               Address line 1 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               containing the 
             
             
                 
                 
                 
               typical information 
             
             
                 
                 
                 
               of: 123 Main Street 
             
             
                 
                 
               City 
               City name of physical 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               address, 
             
             
                 
                 
               Country 
               A recognized Postal 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               Country Code. 
             
             
                 
                 
               County 
               County name of 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               physical address. 
             
             
                 
                 
               Purpose Cd 
               This identifies the 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               purpose of this 
             
             
                 
                 
                 
               address; such as: 
             
             
                 
                 
                 
               “1. PR = Practice 
             
             
                 
                 
                 
               Address” “2. HM = 
             
             
                 
                 
                 
               Home Address” “3. BL = 
             
             
                 
                 
                 
               Billing Address” 
             
             
                 
                 
                 
               “4. ML = Mailing 
             
             
                 
                 
                 
               Address” “5. WK = 
             
             
                 
                 
                 
               Work Address” 
             
             
                 
                 
               State 
               State where physical 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               address is based. 
             
             
                 
                 
               ZIP 
               US based postal zip 
               No 
               Yes 
               No 
             
             
                 
                 
                 
               code. 
             
             
                 
                 
               Address2 
               Address line 2 
               No 
               No 
               No 
             
             
                 
                 
                 
               containing typical 
             
             
                 
                 
                 
               information 
             
             
                 
                 
                 
               regarding: P.O. Box; 
             
             
                 
                 
                 
               Suite#; Apt#; etc. 
             
             
                 
                 
               ZIP Plus4 
               The longer version of 
               No 
               No 
               No 
             
             
                 
                 
                 
               US-based postal zip 
             
             
                 
                 
                 
               code. 
             
             
                 
             
           
        
       
     
   
   One of ordinary skill in the art will appreciate that the account structure described above and illustrated in  FIGS. 13A-13C  enables administrative transactions to be moved across health plans. Thus, as a user moves from one job to another, his or her member history can be taken along. As described above, the account provides a complete member history that is persistent across plan changes, employment changes, family history changes, and the like. 
   The administrative account allows members the opportunity to review and manage the many aspects of their personal care through a web browser. The account includes a record of the member&#39;s healthcare benefits throughout their life. Once enrolled, what was previously disparate data is now meaningful, actionable information. The system allows the user (member/patient/employee) to access their personal healthcare administrative record (e.g., personal profile, out-of-pocket expenses, utilization, etc.) and to use that information to increase their control over their healthcare experience. The account is portable, meaning that it will support a member&#39;s move to other employers or other health plans. 
   The account permits the member to view and update demographic information, insurance elections and medical information. The end user can create an online medical history for themselves and their dependents. The record can then be used to create health history reports for their physicians, schools and other institutions. As described above, the messaging module enables secure Web-based messaging among patients, providers, employers, and the MCO. 
   The present invention provides significant advantages. For the managed care organization, the enrollment data entry function is offloaded to members, which leads to quicker data entry and faster turnaround. The invention provides more accurate data due to online data entry by a member in a single place. Validation on data entry leads to fewer manual interventions, and lower cost per transaction due to reduced FTEs and reduced equipment costs. The invention provides for greater member loyalty due to ease of member enrollment and re-enrollment. For the member, the invention makes it easier and faster to re-enroll because data has been previously entered. The invention provides the member a greater degree of ownership as the data can be updated as often as necessary, and it provides a faster turnaround time due to elimination of paper. For the employer, there is less burden of processing paper-based forms. More accurate data is provided, and such data is always available via audit trails, activity reports and roster reports. Employers have lower costs per transaction as the system processes the transaction, not the employer. The invention provides the employers ease of administration when dealing with multiple MCOs. For the healthcare provider, the invention ensures more accurate and up-to-date data, because the member can view and update the data as necessary. 
   The invention is implemented in a server-side piece of code, as has been described. More generally, the inventive functionality is implemented in software executable in a processor, namely, as a set of instructions (program code) in a code module resident in the random access memory of the computer. Until required by the computer, the set of instructions may be stored in another computer memory, for example, in a hard disk drive, or in a removable memory, or downloaded via the Internet or other computer network. 
   In addition, although the various methods described are conveniently implemented in a general purpose computer selectively activated or reconfigured by software, one of ordinary skill in the art would also recognize that such methods may be carried out in hardware, in firmware, or in more specialized apparatus constructed to perform the required method steps. 
   As noted above, a given workstation and a server may communicate over the public Internet, an intranet, or any other computer network. If desired, given communications may take place over a secure connection. Thus, for example, a client may communicate with the server using a network security protocol, such as Netscape&#39;s Secure Socket Layer (SSL) protocol or the like. 
   A representative client is a personal computer, notebook computer, Internet appliance or pervasive computing device (e.g., a PDA or palm computer) that is Pentium-, PowerPC®- or RISC-based. The client includes an operating system, such as Microsoft Windows, Linux, Unix, Microsoft Windows CE, BeOS, PalmOS, and a login program. A representative server comprises a RISC- or Pentium-based processor, an operating system (e.g., NT, Unix, WebSphere, Linux, Apache, or the like) and, as needed, a trusted third party authentication service. 
   Having thus described our invention, what we claim as new and desire to secure by Letters Patent is set forth in the following claims.