Hi everyone,
Tomorrow we have a CDM workgroup meeting at 1pm eastern where we will be discussing the PAYER_PLAN_PERIOD table. The Skype meeting link can be found on our homepage and the straw-man description of the PAYER_PLAN_PERIOD table is below. Please review and come ready to discuss.
Clair
Table Description
The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table.
| CDM Field Name | User Guidance | ETL Conventions |
|---|---|---|
| payer_plan_period_id | A unique identifier for each period of time a person is covered by a specific health benefit Plan. | |
| person_id | The Person covered by the Plan. | A single Person can have multiple, overlapping, Payer Plan Periods |
| payer_plan_period_start_date | Start date of Plan coverage. | |
| payer_plan_period_end_date | End date of Plan coverage. | |
| payer_concept_id | This field represents the payer who administers transactions on behalf of the Person. Concepts | |
| payer_source_value | This is the Payer as it appears in the source data. | |
| payer_source_concept_id | ||
| plan_concept_id | This field represents the specific health benefit Plan the Person is enrolled in. Concepts. | |
| plan_source_value | This is the health benefit Plan of the Person as it appears in the source data. | |
| plan_source_concept_id | ||
| sponsor_concept_id | This field represents the sponsor of the Plan who finances the transaction. This includes self-insured, small group health plan and large group health plan. Concepts | |
| sponsor_source_value | The Plan sponsor as it appears in the source data. | |
| sponsor_source_concept_id | ||
| family_source_value | If the source data has an identifier for members on the same plan, that identifier should go here. | |
| stop_reason_concept_id | This field represents the reason the Person left the Plan. Concepts | |
| stop_reason_source_value | The Plan stop reason as it appears in the source data. | |
| stop_reason_source_concept_id |
