Article

Pega Care Management 8.2 Data Model Overview

This article provides a data dictionary for the Pega Care Management application, which describes the structure of primary classes.

In Dev Studio, use the Data Visualizer tool to display a visual depiction of the relationships between a selected data type and its properties, and between the data type and other data types.

The following tables are described in this article:

Account Role

Provides application access to account role data such as role type, role name, and roleId used by the Customer Service application.

Pega Internal Name: PegaCA-Interface-Roles

 

Active

Label: Active

Type: Text

AddressLine1

Label: Address line one

Type: Text

City

Label: City

Type: Text

Country

Label: Country

Type: Text

CountryCode

Label: CountryCode

Type: Text

CustomerValue

Label: Customer Value

Type: Text

Description

Label: Description

Type: Text

Email

Label: Email

Type: Text

Language

Label: Language

Type: Text

PhoneNumber

Label: Phone Number

Type: Text

RoleDescription

Label: Role Description

Type: Text

RoleName

Label: Role name

Type: Text

RoleId

Label: RoleId

Type: Text

RoleType

Label: RoleType

Type: Text

SocialSecurityNumber

Label: Social security number

Type: Text

StateCode

Label: State Code

Type: Text

ZipCode

Label: Zip code

Type: Text

Accumulators - Family (Benefits)

PegaHC-Data-FamilyAccumulators data type is used to manage benefit accumulator data for a family. Benefits such as annual Out of pocket maximum, deductible have certain limits defined at family level. All these limits are tracked in accumulators. This data type help managing all such family accumulators.

Pega Internal Name: PegaHC-Data-FamilyAccumulators

 

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FamilyINOOPocketUsed

Label: Family IN OOP used

Type: Double

FamilyOONOOPocketLimit

Label: Family OON OOP limit

Type: Double

FamilyOOPocketLimitTotal

Label: Family OON OOP limit total

Type: Double

FamilyOONOOPocketRemain

Label: Family OON OOP remaining

Type: Double

FamilyOOPocketRemainTotal

Label: Family OON OOP remaining total

Type: Double

FamilyOOPocketUsedTotal

Label: Family OON OOP used total

Type: Double

PolicyID

Label: Family accumulator policy identifier

Type: Text

FamilyINDedLimit

Label: Family accumulator-accumulator family IN ded limit

Type: Double

FamilyINDedRemain

Label: Family accumulator-accumulator family IN ded remain

Type: Double

FamilyINDedUsed

Label: Family accumulator-accumulator family IN ded used

Type: Double

FamilyOONOOPocketUsed

Label: Family accumulator-accumulator family OON OO pocket used

Type: Double

FamilyOONDedLimit

Label: Family accumulator-accumulator family OON ded limit

Type: Double

FamilyOONDedRemain

Label: Family accumulator-accumulator family OON ded remain

Type: Double

FamilyOONDedUsed

Label: Family accumulator-accumulator family OON ded used

Type: Double

FamilyDedLimitTotal

Label: Family accumulator-accumulator family ded limit total

Type: Double

FamilyDedRemainTotal

Label: Family accumulator-accumulator family ded remain total

Type: Double

FamilyDedUsedTotal

Label: Family accumulator-accumulator family ded used total

Type: Double

AccPeriodBegin

Label: Family accumulator-accumulator period begin

Type: Date

AccPeriodEnd

Label: Family accumulator-accumulator period end

Type: Date

FamilyINOOPocketLimit

Label: Family in OOP limit

Type: Double

FamilyINOOPocketRemain

Label: Family in OOP remaining

Type: Double

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

PatientID

Label: Patient identifier

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanID

Label: PlanID

Type: Identifier

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Accumulators - Individual (Benefits)

Accumulators- Individual(Benefits) data type is used to manage benefit accumulator data for an individual. Benefits such as annual Out of pocket maximum, deductible , annual physical exams have certain limits defined at individual level. All these limits are tracked in accumulators. This data type help managing all such individual accumulators.

Pega Internal Name: PegaHC-Data-IndividualAccumulators

 

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

IndividualOONOOPocketRemain

Label: Ind OON OOP remaining

Type: Double

IndividualOOPocketLimitTotal

Label: Ind OON OOP total

Type: Double

IndividualOOPocketRemainTotal

Label: Ind OOP remaining total

Type: Double

IndividualOOPocketUsedTotal

Label: Ind OOP used total

Type: Double

PolicyID

Label: Individual accumulator policy identifier

Type: Text

IndividualINOOPocketLimit

Label: Individual accumulators IN OOP limit

Type: Double

IndividualINOOPocketRemain

Label: Individual accumulators IN OOP remain

Type: Double

IndividualINOOPocketUsed

Label: Individual accumulators IN OOP used

Type: Double

IndividualINDedLimit

Label: Individual accumulators IN ded limit

Type: Double

IndividualINDedRemain

Label: Individual accumulators IN ded remain

Type: Double

IndividualINDedUsed

Label: Individual accumulators IN ded used

Type: Double

IndividualOONOOPocketLimit

Label: Individual accumulators OON OOP limit

Type: Double

IndividualOONOOPocketUsed

Label: Individual accumulators OON OOP used

Type: Double

IndividualOONDedLimit

Label: Individual accumulators OON ded limit

Type: Double

IndividualOONDedRemain

Label: Individual accumulators OON ded remain

Type: Double

IndividualOONDedUsed

Label: Individual accumulators OON ded used

Type: Double

IndividualDedLimitTotal

Label: Individual accumulators ded limit total

Type: Double

IndividualDedRemainTotal

Label: Individual accumulators ded remain total

Type: Double

IndividualDedUsedTotal

Label: Individual accumulators ded used total

Type: Double

MemberID

Label: Individual accumulators member identifier

Type: Text

AccPeriodBegin

Label: Individual accumulators period begin

Type: Date

AccPeriodEnd

Label: Individual accumulators period end

Type: Date

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

PatientID

Label: Patient identifier

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanID

Label: PlanID

Type: Identifier

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Authorization details

The Authorization Data Class holds authorization data as it is created from the Authorization flows. These could be inpatient, Outpatient, Referral or Pharmacy authorizations

Pega Internal Name: PegaHC-Data-Authorization

 

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

ActionCode

Label: Action Code

Type: Text

AuthType

Label: Action type

Type: Text

AdmissionTypeCode

Label: Admission Type Code

Type: Text

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

ApprovedLOS

Label: ApprovedLOS

Type: Integer

Attachments

Label: Attachments

Type: List

Of Type: Attachments

AuthHistory

Label: Auth history

Type: List

Of Type: Embed-PegaHC-CMF-AuthHistory

AuthList

Label: Auth list

Type: List

Of Type: Authorization details

AuthorizationDecision

Label: Authorization decision

Type: Text

DrugCodeList

Label: Authorization drug code list

Type: List

Of Type: Drug Information

FacilityName

Label: Authorization facility name

Type: Text

PrescriptionEndDate

Label: Authorization prescription end date

Type: Date

Procedure

Label: Authorization procedure

Type: List

Of Type: Service (Healthcare)

RequesterEmployer

Label: Authorization requester employer

Type: Object

Of Type: Company

RequesterPayer

Label: Authorization requester payer

Type: Object

Of Type: Payer

RequesterTPA

Label: Authorization requester third-party administrator

Type: Object

Of Type: Contact

ServiceProvider

Label: Authorization service provider

Type: Object

Of Type: Provider

ServiceTraceNumber

Label: Authorization service trace number

Type: Text

Submitter

Label: Authorization submitter

Type: Object

Of Type: PegaHC-Data-Party

Subscriber

Label: Authorization subscriber

Type: Object

Of Type: Member

TraceAssigningEntityIdentifier

Label: Authorization trace assigning entity identifier

Type: Text

TraceAssigningEntityAdditionalIdentifier

Label: Authorization trace assigning entity primary identifier

Type: Text

UMGuidelineDescription

Label: Authorization um guideline description

Type: Text

UnitsUnused

Label: Authorization units unused

Type: Integer

UMO

Label: Authorization utilization management organization

Type: Object

Of Type: PegaHC-Data-Party

AuthorizedAmount

Label: Authorized Amount

Type: Double

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

CertificationEffectiveDate

Label: Certification Effective Date

Type: Date

CertificationExpirationDate

Label: Certification Expiration Date

Type: Date

CertificationIssueDate

Label: Certification Issue Date

Type: Date

CertificationNumber

Label: Certification Number

Type: Text

CertificationTypeCode

Label: Certification Type Code

Type: Text

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

CodeCategory

Label: Code Category

Type: Text

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

ContactChannel

Label: ContactChannel

Type: Text

CreateAuthorization

Label: Create Authorization

Type: Text

DecisionNote

Label: Decision Note

Type: List

Of Type: Embed-PegaHC-Notes

DelayReasonCode

Label: Delay Reason Code

Type: Text

AuthDeniedDate

Label: Denied Date

Type: Date

Diagnosis

Label: Diagnosis

Type: List

Of Type: ***Deprecated***

DiagnosisCodeList

Label: DiagnosisCodeList

Type: List

Of Type: Diagnosis Information - Embedded

DischargeLocation

Label: Discharge Location Code

Type: Text

EPSDTIndicator

Label: EPSDT indicator

Type: Text

EquipmentReasonDescription

Label: Equipment Reason Description

Type: Text

EstimatedBirthDate

Label: Estimated Birth Date

Type: Date

Facility

Label: Facility

Type: Object

Of Type: Provider - Group / Facility

FacilityCodeQualifier

Label: Facility Code Qualifier

Type: Text

FacilityID

Label: FacilityID

Type: Text

Frequency

Label: Frequency

Type: Text

HomeHealthCertificationPeriod

Label: Home Health Certification Period

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

LastAdmissionPeriod

Label: Last Admission Period

Type: Date

LastMenstrualPeriodDate

Label: Last Menstrual Period Date

Type: Date

LastVisitDate

Label: Last Visit Date

Type: Date

LengthOfStay

Label: LengthOfStay

Type: Integer

LevelOfServiceCode

Label: Level Of Service Code

Type: Text

MedicareCoverageIndicator

Label: Medicare Coverage Indicator

Type: Text

Member

Label: Member

Type: Object

Of Type: Member

MemberFirstName

Label: MemberFirstName

Type: Text

MemberID

Label: MemberID

Type: Text

MemberLastName

Label: MemberLastName

Type: Text

MemberValid

Label: MemberValid

Type: Text

ModifiedProcedureCodeList

Label: Modify Procedure CodeList

Type: List

Of Type: Embed-PegaHC-Procedure

NegotiatedRateFrequency

Label: Negotiated Rate Frequency

Type: Text

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

NegotiatedRate

Label: NegotiatedRate

Type: Decimal

NumberofVisits

Label: Number of Visits

Type: Integer

NursingHomeResidentialStatusCode

Label: Nursing Home Residential Status Code

Type: Text

OnsetDate

Label: Onset Date

Type: Date

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

OxygenDeliverySystemCode

Label: Oxygen Delivery System Code

Type: Text

OxygenEquipmentTypeCode

Label: Oxygen Equipment Type Code

Type: Text

OxygenUsePeriodHourCount

Label: Oxygen Use Period Hour Count

Type: Integer

PeriodCount

Label: Period Count

Type: Integer

PhysicianContactDate

Label: Physician Contact Date

Type: Date

PhysicianOrderDate

Label: Physician Order Date

Type: Date

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

PolicyNumber

Label: PolicyNumber

Type: Text

PortableOxygenSystemFlowRate

Label: Portable Oxygen System Flow Rate

Type: Text

PreviousCertificationIdentifier

Label: Previous Certification Identifier

Type: Text

PriceFrequency

Label: PriceFrequency

Type: Text

PrimaryDiagnosis

Label: Primary Diagnosis

Type: Text

ProcedureCodeList

Label: ProcedureCodeList

Type: List

Of Type: Embed-PegaHC-Procedure

PrognosisCode

Label: Prognosis Code

Type: Text

ProposedOrActualAdmissionDate

Label: Proposed Or Actual Admission Date

Type: Date

ProposedOrActualDischargeDate

Label: Proposed Or Actual Discharge Date

Type: Date

ProposedOrActualServiceDate

Label: Proposed Or Actual Service Date

Type: Date

ProposedOrActualSurgeryDate

Label: Proposed Or Actual Surgery Date

Type: Date

ProviderValid

Label: ProviderValid

Type: Text

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

ReferringProvider

Label: Referring Provider

Type: Object

Of Type: Provider

ReferringProviderID

Label: ReferringProviderID

Type: Text

ReleaseofInformationCode

Label: Release of Information Code

Type: Text

RequestCategoryCode

Label: Request Category Code

Type: Text

RequestDate

Label: RequestDate

Type: Date

RequestedAmount

Label: Requested Amount

Type: Decimal

LOB

Label: Requested LOB

Type: Text

Requester

Label: Requester

Type: Object

Of Type: Provider

RespiratoryTherapistOrderText

Label: Respiratory Therapist Order Text

Type: Text

SecondSurgicalOpinionIndicator

Label: Second Surgical Opinion Indicator

Type: Text

ServiceDate

Label: Service Date

Type: Date

AccidentDate

Label: Service accident date

Type: Date

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

DaysofSupply

Label: Service days of supply

Type: Integer

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceFromDate

Label: Service from date

Type: Date

ServiceIdentificationCode

Label: Service identification code

Type: Text

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

IssueDate

Label: Service issue date

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PrescriptionDate

Label: Service prescription date

Type: Date

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrescriptionNumber

Label: Service prescription number

Type: Text

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

PriorIncorrectInsured

Label: Service prior incorrect insured

Type: Object

Of Type: Member

ProcedureCode

Label: Service procedure code

Type: Text

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifier

Label: Service procedure modifier

Type: Text

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

ReferringProviderList

Label: Service referring provider list

Type: List

Of Type: Provider

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

SurgeryDate

Label: Service surgery date

Type: Date

SurgicalProcedureCode

Label: Service surgical procedure code

Type: Text

ServiceToDate

Label: Service to date

Type: Date

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceTypeCode

Label: Service type code

Type: Text

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServiceProviderID

Label: ServiceProviderID

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

ShowDiagErrMess

Label: Show Diagnosis Error Message

Type: Text

SkilledNursingFacilityIndicator

Label: Skilled Nursing Facility Indicator

Type: Text

Source

Label: Source

Type: Text

SourceFileID

Label: Source File ID

Type: Text

StateCode

Label: State Code

Type: Text

TimePeriodQualifier

Label: Time Period Qualifier

Type: Text

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidRequestIndicator

Label: Valid Request Indicator

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

ValidMember

Label: ValidMember

Type: TrueFalse

ValidRequestor

Label: ValidRequestor

Type: TrueFalse

ValidServiceProvider

Label: ValidServiceProvider

Type: TrueFalse

ValidSubscriber

Label: ValidSubscriber

Type: TrueFalse

Business entity

Data Class to hold Business Entity attributes such as NPI , billing address

Pega Internal Name: PegaHC-Data-Party-BusinessEntity

 

BankAccountInformation

Label: BankAccountInformation

Type: Object

Of Type: Bank Account

isAffiliationActive

Label: Business entity active affiliation?

Type: TrueFalse

IsContractActive

Label: Business entity active contract?

Type: Text

isProviderActive

Label: Business entity active provider?

Type: TrueFalse

IsBusinessEntityActive

Label: Business entity active?

Type: TrueFalse

BusinessType

Label: Business entity business type

Type: Text

Contract

Label: Business entity contract

Type: Object

Of Type: Provider contract

BEHoldingContractTIN

Label: Business entity contract TIN

Type: Text

IsContractEntity

Label: Business entity contract entity?

Type: TrueFalse

ContractID

Label: Business entity contract identifier

Type: Text

ContractName

Label: Business entity contract name

Type: Text

CurrencyCode

Label: Business entity currency code

Type: Text

Description

Label: Business entity description

Type: Text

EffectiveDate

Label: Business entity effective date

Type: Date

EndDate

Label: Business entity end date

Type: Date

FederalTaxID

Label: Business entity federal tax identifier

Type: Text

BEHoldingContract

Label: Business entity holding contract

Type: Text

BEHoldingContractID

Label: Business entity holding contract ID

Type: Text

LOBs

Label: Business entity line of business

Type: List

Of Type: Embed-HC-BusinessEntity-LOB

Locations

Label: Business entity locations

Type: List

Of Type: Embed-PegaHC-BEAddress

Name

Label: Business entity name

Type: Text

NationalProviderIdentifier

Label: Business entity national provider identifier

Type: Text

IsOnlyContractEntity

Label: Business entity only contract entity?

Type: TrueFalse

PracticeAddress

Label: Business entity practice address

Type: List

Of Type: Common

PrimaryContact

Label: Business entity primary contact

Type: List

Of Type: Contact Information - Embedded

ProviderCode

Label: Business entity provider code

Type: Text

TaxIdentificationNumber

Label: Business entity tax identification number

Type: Text

TaxIdentifierQualifer

Label: Business entity tax identifier qualifier

Type: Text

Versions

Label: Business entity versions

Type: List

Of Type: Business entity

CountContracts

Label: CountContracts

Type: Text

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

AccountNumber

Label: Party account number

Type: Text

AdditionalName

Label: Party additional name

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

Age

Label: Party age

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

DateOfBirth

Label: Party date of birth

Type: Date

DateOfDeath

Label: Party date of death

Type: Date

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

GroupNumber

Label: Party group number

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

MiddleName

Label: Party middle name

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

PaymentCode

Label: PaymentCode

Type: Text

ProviderContracts

Label: ProviderContracts

Type: List

Of Type: Provider contract

Source

Label: Source

Type: Text

MemberID

Label: Subscriber member ID

Type: Text

CareTeam contact

Data class to hold the member contacts information (Contact name, Care team type, Address, Flag for Is Primary)

Pega Internal Name: PegaHCCMF-Data-Party-Contact

 

Active

Label: Active

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AddressLine3

Label: AddressLine3

Type: Text

AddressLine4

Label: AddressLine4

Type: Text

AddressLine5

Label: AddressLine5

Type: Text

CareTeamPrimaryEmail

Label: CareTeamPrimaryEmail

Type: Text

CareTeamPrimaryFax

Label: CareTeamPrimaryFax

Type: Text

CareTeamPrimaryPhoneNumber

Label: CareTeamPrimaryPhoneNumber

Type: Text

CareTeamPrimaryPhoneNumberExtension

Label: CareTeamPrimaryPhoneNumberExtension

Type: Text

CareTeamPrimaryRoleDescription

Label: CareTeamPrimaryRoleDescription

Type: Text

CareTeamType

Label: CareTeamType

Type: Text

CaseSpecific

Label: CaseSpecific

Type: TrueFalse

Category

Label: Category

Type: Text

Class

Label: Class

Type: Text

CommunicationId

Label: CommunicationId

Type: Text

ConsentDate

Label: Consent date

Type: DateTime

ConsentShare

Label: Consent share

Type: Text

ContactString

Label: ContactString

Type: Text

Country

Label: Country

Type: Text

CountryCode

Label: CountryCode

Type: Text

CurrentDate

Label: CurrentDate

Type: Date

Description

Label: Description

Type: Text

InActiveDateRange

Label: InActiveDateRange

Type: List

Of Type: Unavailable period

IsActiveBeforeInactiveDateRange

Label: IsActiveBeforeInactiveDateRange

Type: TrueFalse

IsEligibleForPCM

Label: IsEligibleForPCM

Type: TrueFalse

IsInterestedParty

Label: IsInterestedParty

Type: TrueFalse

IsPrimary

Label: IsPrimary

Type: TrueFalse

IsRemove

Label: IsRemove

Type: TrueFalse

Key

Label: Key

Type: Text

NPI

Label: NPI

Type: Text

NextDate

Label: NextDate

Type: Date

OperatorCountList

Label: Operator Membercount List

Type: List

Of Type: CareTeam contact

OperatorID

Label: OperatorID

Type: Text

OwnerID

Label: OwnerID

Type: Text

PrimaryAddress

Label: PrimaryAddress

Type: Text

RecentDate

Label: RecentDate

Type: Date

RecentNextDate

Label: RecentNextDate

Type: Date

RecentNextToDate

Label: RecentNextToDate

Type: Date

RecentToDate

Label: RecentToDate

Type: Date

Relationship

Label: Relationship

Type: Text

Relationships

Label: Relationships

Type: Text

ResponsibleParty

Label: ResponsibleParty

Type: Text

Role

Label: Role

Type: List

Of Type: Embed-CMF-Role

SecondarySpeciality

Label: Secondary Speciality

Type: Text

Skills

Label: Skills

Type: List

Of Type: Operator skills

Source

Label: Source

Type: Text

Speciality

Label: Speciality

Type: Text

TopThreeSkills

Label: TopThreeSkills

Type: Text

Type

Label: Type

Type: Text

Value

Label: Value

Type: Text

ZipCode

Label: ZipCode

Type: Text

Claim data

The Claim Data Class holds Claims data as it is utilized within the application. In most cases this will be either medical or pharmacy claims. Claims is detailed invoice containing details of services provided, and is sent by service providers such as hospitals to Payers.

Pega Internal Name: PegaHC-Data-Claim

 

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

AdjRepricedClaimRefNumber

Label: Adjusted repriced claim reference number

Type: Text

AdmissionTypeCode

Label: Admission Type Code

Type: Text

AdmissionHour

Label: AdmissionHour

Type: Text

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

AuthorizationDecision

Label: Authorization decision

Type: Text

BillingEntity

Label: Billing entity

Type: Object

Of Type: Business entity

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

CheckStatus

Label: Check Status

Type: Text

COB

Label: Claim COB

Type: List

Of Type: Payer

DRGInformation

Label: Claim DRG information

Type: Object

Of Type: PegaHC-Data-InformationCodes

AdjudOrPaymentDate

Label: Claim adjudication or payment date

Type: Text

ClaimAdjustmentGroupCode

Label: Claim adjustment group code

Type: Text

AdjustmentQuantity

Label: Claim adjustment quantity

Type: Integer

AdjustmentReasonCode

Label: Claim adjustment reason code

Type: Text

AdmissionDateFormatQualifier

Label: Claim admission date format qualifier

Type: Text

AdmissionDateTime

Label: Claim admission date time

Type: DateTime

AdmittingDiagnosis

Label: Claim admitting diagnosis

Type: Object

Of Type: PegaHC-Data-InformationCodes

AmbulanceCertification

Label: Claim ambulance certification

Type: List

Of Type: Embed-PegaHC-Condition

AmbulatoryPatientGroupNumber

Label: Claim ambulatory patient group number

Type: Text

AssumedOrRelinquishedCareDate

Label: Claim assumed or relinquished care date

Type: Date

AssumedOrRelinquishedCareDateQualifier

Label: Claim assumed or relinquished care date qualifier

Type: Text

Attachments

Label: Claim attachments

Type: List

Of Type: Attachments

AttendingPhysician

Label: Claim attending physician

Type: Object

Of Type: Provider

AutoAccidentStateCode

Label: Claim auto accident state code

Type: Text

BenefitAssignmentCertificationIndicator

Label: Claim benefit assignment certification indicator

Type: Text

BillClassification

Label: Claim bill classification

Type: Text

BillType

Label: Claim bill type

Type: Text

BillingNoteText

Label: Claim billing note text

Type: Text

CarePlanOversightNumber

Label: Claim care plan oversight number

Type: Text

CodeCategory

Label: Claim code category

Type: Text

ConditionInformation

Label: Claim condition information

Type: List

Of Type: PegaHC-Data-InformationCodes

ContractCode

Label: Claim contract code

Type: Text

ContractPercentage

Label: Claim contract percentage

Type: Decimal

ContractType

Label: Claim contract type

Type: Text

ContractVersion

Label: Claim contract version

Type: Text

CostReportDayCount

Label: Claim cost report day count

Type: Integer

ReceivedDate

Label: Claim date claim was received

Type: Date

DelayReasonCode

Label: Claim delay reason code

Type: Text

DemonstrationProjectIdentifier

Label: Claim demonstration project identifier

Type: Text

DeviceExemption

Label: Claim device exemption

Type: List

Of Type: Embed-PegaHC-Reference

DisabilityDateFormatQualifier

Label: Claim disability date format qualifier

Type: Text

DisabilityDateQualifier

Label: Claim disability date qualifier

Type: Text

DisabilityFromDate

Label: Claim disability from date

Type: Date

DisabilityToDate

Label: Claim disability to date

Type: Date

DischargedDate

Label: Claim discharge date

Type: Date

DischargeDateTime

Label: Claim discharge date time

Type: DateTime

ExceptionCode

Label: Claim exception code

Type: Text

ExternalCauseOfInjury

Label: Claim external cause of injury

Type: Object

Of Type: PegaHC-Data-InformationCodes

FacilityCodeQualifier

Label: Claim facility code qualifier

Type: Text

FacilityType

Label: Claim facility type

Type: Text

ClaimFilingIndicatorCode

Label: Claim filing indicator code

Type: Text

FixedFormatInformation

Label: Claim fixed format information

Type: Text

ClaimFormType

Label: Claim form type

Type: Text

ClaimFrequencyCode

Label: Claim frequency code

Type: Text

HierarchicalStructureCode

Label: Claim hierarchical structure code

Type: Text

HomeboundIndicator

Label: Claim homebound indicator

Type: Text

ImageNumber

Label: Claim image number

Type: Text

IndustryCode

Label: Claim industry code

Type: Text

InterChangeControlNumber

Label: Claim interchange control number

Type: Text

ICDType

Label: Claim international classification of diseases type

Type: Text

LastMenstrualPeriodDate

Label: Claim last menstrual period date

Type: Date

LastSeenDate

Label: Claim last seen date

Type: Date

LastWorkedDate

Label: Claim last worked date

Type: Date

LastXRayDate

Label: Claim last x-ray date

Type: Date

LifetimePsychiatricDaysCount

Label: Claim lifetime psychiatric days count

Type: Integer

ClaimLine

Label: Claim line

Type: List

Of Type: Claim Line

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

MammographyCertificationNumber

Label: Claim mammography certification number

Type: Text

ClaimMediaType

Label: Claim media type

Type: Identifier

MedicalRecordNumber

Label: Claim medical record number

Type: Text

MedicareSection4081Indicator

Label: Claim medicare section 4081 indicator

Type: Text

NationalProviderIdentifier

Label: Claim national provider identifier

Type: Text

OccurrenceInformation

Label: Claim occurrence information

Type: List

Of Type: PegaHC-Data-InformationCodes

OccurrenceSpanInformation

Label: Claim occurrence span information

Type: List

Of Type: PegaHC-Data-InformationCodes

OperatingPhysician

Label: Claim operating physician

Type: Object

Of Type: Provider

ClaimOrEncounterIdentifier

Label: Claim or encounter identifier

Type: Text

OriginalReferenceNumber

Label: Claim original reference number

Type: Text

OtherDiagnosisInformation

Label: Claim other diagnosis information

Type: List

Of Type: PegaHC-Data-InformationCodes

OtherProcedureInformation

Label: Claim other procedure information

Type: List

Of Type: PegaHC-Data-InformationCodes

PACDateOfFirstContact

Label: Claim pac date of first contact

Type: Date

Patient

Label: Claim patient

Type: Object

Of Type: Member

PatientDateOfBirth

Label: Claim patient date of birth

Type: Date

PatientLastName

Label: Claim patient last name

Type: Text

PatientPaidAmount

Label: Claim patient paid amount

Type: Decimal

PatientSignatureSourceCode

Label: Claim patient signature source code

Type: Text

PatientVisionCondition

Label: Claim patient vision condition

Type: List

Of Type: Embed-PegaHC-Condition

PayToPlan

Label: Claim pay to plan

Type: Object

Of Type: Payer

PayToProvider

Label: Claim pay to provider

Type: Object

Of Type: Provider

Payer

Label: Claim payer

Type: List

Of Type: Payer

PayerClaimControlNumber

Label: Claim payer claim control number

Type: Text

PayerName

Label: Claim payer name

Type: Text

PayerResponsibilitySequenceNumberCode

Label: Claim payer responsibility sequence number code

Type: Text

Payment

Label: Claim payment

Type: Object

Of Type: Payment Information

PeerReviewAuthorizationNumber

Label: Claim peer review authorization number

Type: Text

PolicyComplianceCode

Label: Claim policy compliance code

Type: Text

PolicyNumber

Label: Claim policy number

Type: Text

PredeterminationOfBenefitsIdentifier

Label: Claim predetermination of benefits identifier

Type: Text

PregnancyIndicator

Label: Claim pregnancy indicator

Type: Text

Prescription

Label: Claim prescription

Type: List

Of Type: Prescription - Clinical

PrescriptionDate

Label: Claim prescription date

Type: Date

PricingMethodology

Label: Claim pricing methodology

Type: Text

PrincipalDiagnosisInfo

Label: Claim principal diagnosis information

Type: Object

Of Type: PegaHC-Data-InformationCodes

PrincipalProcedureInformation

Label: Claim principal procedure information

Type: Object

Of Type: PegaHC-Data-InformationCodes

PriorAuthorizationNumber

Label: Claim prior authorization number

Type: Text

PropertyCasualtyClaimNumber

Label: Claim property casualty claim number

Type: Text

ProviderAcceptAssignmentCode

Label: Claim provider accept assignment code

Type: Text

ProviderOrSupplierSignatureIndicator

Label: Claim provider or supplier signature indicator

Type: Text

PurchasedServiceProvider

Label: Claim purchased service provider

Type: Object

Of Type: Provider

ReasonForVisit

Label: Claim reason for visit

Type: Object

Of Type: PegaHC-Data-InformationCodes

Receiver

Label: Claim receiver

Type: Object

Of Type: PegaHC-Data-Party

ReferralNumber

Label: Claim referral number

Type: Text

ReferringProvider

Label: Claim referring provider

Type: Object

Of Type: Provider

ReferringProviderList

Label: Claim referring provider list

Type: List

Of Type: Provider

ReimbursementRate

Label: Claim reimbursement rate

Type: Text

ReleaseofInformationCode

Label: Claim release of information code

Type: Text

RenderingProvider

Label: Claim rendering provider

Type: Object

Of Type: Provider

RepricedApprovedAPGGroupCode

Label: Claim repriced approved apg code

Type: Text

RepricedApprovedRevenueCode

Label: Claim repriced approved revenue code

Type: Text

RepricedClaimReferenceNumber

Label: Claim repriced claim reference number

Type: Text

RepricerReceivedDate

Label: Claim repricer received date

Type: Date

RepricingOrganizationIdentifier

Label: Claim repricing organization identifier

Type: Text

ServiceAuthorizationExceptionCode

Label: Claim service authorization exception code

Type: Text

ServiceFacility

Label: Claim service facility

Type: Object

Of Type: Provider

ServiceFromDate

Label: Claim service from date

Type: Date

ServiceToDate

Label: Claim service to date

Type: Date

SimilarIllnessOrSymptomDate

Label: Claim similar illness or symptom date

Type: Date

SpecialProgramIndicator

Label: Claim special program indicator

Type: Text

StatementFromDate

Label: Claim statement from date

Type: Date

StatementToDate

Label: Claim statement to date

Type: Date

ClaimStatus

Label: Claim status

Type: Text

ClaimSubmissionType

Label: Claim submission type

Type: Identifier

Submitter

Label: Claim submitter

Type: Object

Of Type: PegaHC-Data-Party

SubmitterNumber

Label: Claim submitter number

Type: Text

Subscriber

Label: Claim subscriber

Type: Object

Of Type: Member

SubscriberDateOfBirth

Label: Claim subscriber date of birth

Type: Date

SubscriberLastName

Label: Claim subscriber last name

Type: Text

SubscriberPrimaryIdentifier

Label: Claim subscriber primary identifier

Type: Text

SupervisingProvider

Label: Claim supervising provider

Type: Object

Of Type: Provider

SurchargeFactor

Label: Claim surcharge factor

Type: Decimal

TermsDiscountPercentage

Label: Claim terms discount percentage

Type: Decimal

TotalClaimAllowedAmount

Label: Claim total allowed amount

Type: Decimal

TotalClaimApprovedAmount

Label: Claim total approved amount

Type: Decimal

TotalClaimCoinsuranceAmount

Label: Claim total coinsurance amount

Type: Decimal

TotalClaimCopayAmount

Label: Claim total copay amount

Type: Decimal

TotalClaimDeductibleAmount

Label: Claim total deductible amount

Type: Decimal

TraceNumber

Label: Claim trace number

Type: Text

TransactionSetCreationDate

Label: Claim transaction set creation date

Type: Date

TransactionSetCreationTime

Label: Claim transaction set creation time

Type: Text

TransactionSetPurposeCode

Label: Claim transaction set purpose code

Type: Text

TransactionType

Label: Claim transaction type

Type: Text

TreatmentCodeInfo

Label: Claim treatment code information

Type: List

Of Type: PegaHC-Data-InformationCodes

TestClaimType

Label: Claim type

Type: Text

Type

Label: Claim type

Type: Text

CE_HeaderStatus

Label: ClaimStatus

Type: Text

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

pyCountry

Label: Country Code

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DischargeHour

Label: Discharge Hour

Type: Text

DischargeLocation

Label: Discharge Location Code

Type: Text

EPSDT

Label: EPSDT

Type: Object

Of Type: EPSDT Referral

EPSDTIndicator

Label: EPSDT indicator

Type: Text

Frequency

Label: Frequency

Type: Text

GracePeriod

Label: GracePeriod

Type: Integer

ImplementationGuideVersionName

Label: ImplementationGuideVersionName

Type: Text

IndividualDeathDate

Label: IndividualDeathDate

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

LatePaymentInterest

Label: LatePaymentInterest

Type: Decimal

LatePaymentInterestPercent

Label: LatePaymentInterestPercent

Type: Decimal

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

OutOfStateIndicator

Label: Out of State Indicator

Type: TrueFalse

PatientCalculatedAmount

Label: PatientCalculatedAmount

Type: Text

PatientStatus

Label: PatientStatus

Type: Text

RepricedAllowedAmount

Label: Payment repriced allowed amount

Type: Decimal

RepricedApprovedAPGAmount

Label: Payment repriced approved ambulatory patient group amount

Type: Decimal

RepricedSavingAmount

Label: Payment repriced saving amount

Type: Decimal

RepricingPerDiemOrFlatRateAmount

Label: Payment repricing per diem or flat rate amount

Type: Decimal

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

PriceFrequency

Label: PriceFrequency

Type: Text

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

RejectReasonCode

Label: Reject Reason Code

Type: Text

ResolvedInSANP

Label: ResolvedInSANP

Type: TrueFalse

AccidentDate

Label: Service accident date

Type: Date

ActionCode

Label: Service action code

Type: Text

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

DaysofSupply

Label: Service days of supply

Type: Integer

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Diagnosis

Label: Service diagnosis

Type: List

Of Type: ***Deprecated***

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceIdentificationCode

Label: Service identification code

Type: Text

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

IssueDate

Label: Service issue date

Type: Date

LastAdmissionPeriod

Label: Service last admission period

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

NumberofVisits

Label: Service number of visits

Type: Integer

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PeriodCount

Label: Service period count

Type: Decimal

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrescriptionNumber

Label: Service prescription number

Type: Text

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

ProcedureCode

Label: Service procedure code

Type: Text

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifier

Label: Service procedure modifier

Type: Text

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

TimePeriodQualifier

Label: Service time period qualifier

Type: Text

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServiceTypeCode

Label: ServiceTypeCode

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

Source

Label: Source

Type: Text

SubmittedDate

Label: SubmittedDate

Type: Date

SubmitterName

Label: SubmitterName

Type: Text

SurchargeAmount

Label: SurchargeAmount

Type: Decimal

TotalPatientCOB

Label: TotalPatientCOB

Type: Decimal

TotalPayerCOB

Label: TotalPayerCOB

Type: Decimal

TransactionSegmentCount

Label: TransactionSegmentCount

Type: Text

TransactionSetControlNumber

Label: TransactionSetControlNumber

Type: Text

TransactionSetIdentifierCode

Label: TransactionSetIdentifierCode

Type: Text

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

ValueAddedNetworkTrace

Label: Value added network trace number

Type: Text

ValueInformation

Label: Value information

Type: List

Of Type: PegaHC-Data-InformationCodes

WorkReturnDate

Label: Work return date

Type: Date

Clinical observation

The Observation data class holds data related to Clinical Observations related to the patient. These observations can come from a variety of sources, IoT, EMR, Patient, Internal User.

Pega Internal Name: PegaHC-Data-Observation

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IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

Code

Label: Code

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

PatientID

Label: PatientID

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Conference type

Data class to hold the conference type value. Case conference can be launched from Admission case, Auth request, Patient 360. On the basis of different launch points from the application, the value conference type varies. This class holds all the different launch points and corresponding conference types.

Pega Internal Name: PegaHC-Data-ConferenceType

 

ConferenceType

Label: ConferenceType

Type: Identifier

LaunchPoint

Label: Launch point

Type: Identifier

Source

Label: Source

Type: Text

Contact

Provides application access to contact data such as the name, phone numbers, email address, account roles, social ID’s, and other key data.

Pega Internal Name: PegaCA-Interface-Contact

 

Active

Label: Active

Type: Text

AddressLine1

Label: Address line one

Type: Text

Addresses

Label: Addresses

Type: List

Of Type: Customer address

AssistantEmail

Label: Assistant email

Type: Text

AssistantName

Label: Assistant name

Type: Text

AssistantPhone

Label: Assistant phone

Type: Text

BestTimeToCall

Label: Best time to call

Type: Text

ChildContacts

Label: Child Contacts

Type: List

Of Type: Contact to contact relationship

City

Label: City

Type: Text

CommPreferenceByEmail

Label: Communication preference by Email

Type: Text

CommPreferenceByFax

Label: Communication preference by Fax

Type: Text

CommPreferenceByMail

Label: Communication preference by Mail

Type: Text

CommPreferenceByPhone

Label: Communication preference by Phone

Type: Text

CompanyName

Label: Company name

Type: Text

ContactId

Label: Contact identifier

Type: Identifier

ContactType

Label: Contact type

Type: Text

ContactFullName

Label: ContactFullName

Type: Text

Country

Label: Country

Type: Text

CountryCode

Label: CountryCode

Type: Text

CustomerValue

Label: Customer Value

Type: Text

DateOfBirth

Label: Date of birth

Type: Date

DepartmentName

Label: Department name

Type: Text

Email

Label: Email

Type: Text

FacebookID

Label: Facebook ID

Type: Text

FacebookURL

Label: Facebook URL

Type: Text

Fax

Label: Fax

Type: Text

FirstName

Label: First Name

Type: Text

Gender

Label: Gender

Type: Text

HomeContactNumber

Label: Home Contact Number

Type: Text

JobTitle

Label: Job title

Type: Text

Language

Label: Language

Type: Text

LanguagePreference

Label: Language preference

Type: Text

LastName

Label: Last Name

Type: Text

LinkedinURL

Label: Linkedin URL

Type: Text

LinkedinId

Label: Linkedin identifier

Type: Text

MaritalStatus

Label: Marital status

Type: Text

MarketingByEmail

Label: Marketing by email

Type: Text

MarketingByMail

Label: Marketing by mail

Type: Text

MarketingByPhone

Label: Marketing by phone

Type: Text

MiddleName

Label: Middle name

Type: Text

MobilePhone

Label: Mobile Phone

Type: Text

NationalId

Label: National identifier

Type: Text

ParentContactId

Label: Parent contact identifier

Type: Text

PhoneNumber

Label: Phone Number

Type: Text

PrimaryEmailType

Label: Primary Email Type

Type: Text

PrimaryPhoneType

Label: Primary Phone Type

Type: Text

PrimaryPhoneNumber

Label: Primary phone number

Type: Text

PrimaryEmail

Label: PrimaryEmail

Type: Text

PriorityNote

Label: Priority note

Type: Text

RoleDescription

Label: Role Description

Type: Text

RoleName

Label: Role name

Type: Text

SecondaryEmailType

Label: Secondary Email Type

Type: Text

SecondaryPhoneType

Label: Secondary Phone Type

Type: Text

SecondaryPhoneNumber

Label: Secondary phone number

Type: Text

SecondaryEmail

Label: SecondaryEmail

Type: Text

SocialSecurityNumber

Label: Social security number

Type: Text

StateCode

Label: State Code

Type: Text

Suffix

Label: Suffix

Type: Text

TerritoryId

Label: Territory ID

Type: Text

TertiaryPhoneNumber

Label: Tertiary Phone Number

Type: Text

TertiaryPhoneType

Label: Tertiary Phone Type

Type: Text

TimeZone

Label: TimeZone

Type: Text

TwitterID

Label: Twitter ID

Type: Text

TwitterURL

Label: Twitter URL

Type: Text

ZipCode

Label: Zip code

Type: Text

Conversation logs

Data class to hold all the type of conversation happened with member. This class stores conversation instances for Program enrolled, Task, and Pulse Communication

Pega Internal Name: PegaHC-Data-ConversationsLog

 

CallDateAndTime

Label: Call date and time

Type: DateTime

CallNotes

Label: Call notes

Type: Text

CallOwner

Label: Call owner

Type: Text

ConversationID

Label: Conversation ID

Type: Identifier

InstanceKey

Label: InstanceKey

Type: Text

Source

Label: Source

Type: Text

Subject

Label: Subject

Type: Text

TaskDetails

Label: TaskDetails

Type: Text

WorkID

Label: WorkID

Type: Text

Customer Address

Provides application access to customer address data such as address details (address lines1-5, city, state, province, country, postal code), and related contact info such as contact ID, first and last name, and other customer address data.

Pega Internal Name: PegaCA-Interface-Address

 

Active

Label: Active

Type: Text

AddressId

Label: Address Identifier

Type: Text

AddressType

Label: Address Type

Type: Text

Address1

Label: Address line 1

Type: Text

Address2

Label: Address line 2

Type: Text

Address3

Label: Address line 3

Type: Text

Address4

Label: Address line 4

Type: Text

Address5

Label: Address line 5

Type: Text

City

Label: City

Type: Text

pyCity

Label: City

Type: Text

DomainId

Label: Contact Id

Type: Identifier

Country

Label: Country

Type: Text

CustomerValue

Label: Customer Value

Type: Text

DomainType

Label: Domain type

Type: Identifier

Email

Label: Email

Type: Text

FromDate

Label: From date

Type: DateTime

IsPrimary

Label: Is primary

Type: TrueFalse

Language

Label: Language

Type: Text

pyPostalCode

Label: Postal Code

Type: Text

PostalCode

Label: Postal code

Type: Text

ProductName

Label: Product Name

Type: Text

Comments

Label: Property for Comments

Type: Text

RoleDescription

Label: Role Description

Type: Text

RoleName

Label: Role name

Type: Text

RoleType

Label: RoleType

Type: Text

SocialSecurityNumber

Label: Social security number

Type: Text

State

Label: State

Type: Text

pyState

Label: State

Type: Identifier

Status

Label: Status

Type: Text

pyStreet

Label: Street

Type: Text

SubRegion

Label: Sub region

Type: Text

ToDate

Label: To date

Type: DateTime

ZipCode

Label: Zip code

Type: Text

Customer Important Messages

It is used to handle customer important messages

Pega Internal Name: Data-ImportantMessages

 

CustomerID

Label: Customer ID

Type: Text

EndDateTime

Label: End Date Time

Type: DateTime

ImportantMessage

Label: Important Message

Type: Text

ShortMessage

Label: Short Message

Type: Text

SourceID

Label: Source ID

Type: Text

SourceName

Label: Source Name

Type: Text

SourceClass

Label: Source class

Type: Text

StartDateTime

Label: Start Date Time

Type: DateTime

StatusOnWeb

Label: Status On Web

Type: Text

StatusOnMobile

Label: Status on Mobile

Type: Text

EndPointSettings

Pega Internal Name: PegaHC-Data-EndPointSettings

/caption>

EndPointURL

Label: Endpoint URL

Type: Text

ProductionLevel

Label: Production level

Type: Text

ServiceName

Label: Service name

Type: Text

Source

Label: Source

Type: Text

Insurance Contract

The data class holds data related to contract. Contract is written between the employer group/individual and the Payer. Contract defines benefits, premium, covered entities, plans. Effective dates . Contract ID. Covered lives.

Pega Internal Name: PegaHC-Data-Contract

/caption>

ContractedEntity

Label: Contract contracted entity

Type: Object

Of Type: Company

CoveredProducts

Label: Contract covered products

Type: List

Of Type: Product - Benefits

ContractID

Label: Contract identifier

Type: Identifier

Payer

Label: Contract payer

Type: Object

Of Type: Payer

ContractType

Label: Contract type

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EndDate

Label: End date

Type: Date

Source

Label: Source

Type: Text

Status

Label: Status of the data instance

Type: Text

LOINC Codes

Pega Internal Name: PegaHealth-Codes-Data-LOINC

 

ActiveIngredUnit

Label: Active ingred unit

Type: Text

ActiveNumeratorStrength

Label: Active numerator strength

Type: Text

Annotation

Label: Annotation

Type: Text

ApplicationNumber

Label: Application number

Type: Text

ApproximateFlag

Label: Approximate flag

Type: Text

COMPONENT

Label: COMPONENT

Type: Text

Category

Label: Category

Type: Text

Category1

Label: Category 1

Type: Text

Category2

Label: Category 2

Type: Text

Category3

Label: Category 3

Type: Text

Category4

Label: Category 4

Type: Text

Category5

Label: Category 5

Type: Text

ChoiceListsFlag

Label: Choice lists flag

Type: Text

Code

Label: Code

Type: Text

CodeSetType

Label: CodeSetType

Type: Text

CombinationFlag

Label: Combination flag

Type: Text

Deaschedule

Label: Dea schedule

Type: Text

Description

Label: Description

Type: Text

DescriptionFrom

Label: Description from

Type: Text

DescriptionTo

Label: Description to

Type: Text

Disorder

Label: Disorder

Type: Text

DosageFormName

Label: Dosage form name

Type: Text

EffectiveDate

Label: Effective date

Type: DateTime

EffectiveDate_String

Label: Effective date string

Type: Text

EndMarketingDate

Label: End marketing date

Type: Date

ExpirationDate

Label: Expiration date

Type: DateTime

ExpirationDate_String

Label: Expiration date string

Type: Text

Full_Description

Label: Full description

Type: Text

FullDescription

Label: Full description1

Type: Text

InstructionDescription

Label: Instruction description

Type: Text

LOINC_NUM

Label: LOINC_NUM

Type: Text

LabelerName

Label: Labeler name

Type: Text

LastModifiedDate

Label: Last modified date

Type: Date

LastModifiedDate_String

Label: Last modified date string

Type: Text

LISTING_SEQ_NO

Label: Listing sequence number

Type: Identifier

LongDescription

Label: Long description

Type: Text

Long_Description

Label: Long description

Type: Text

MarketingCategoryName

Label: Marketing category name

Type: Text

Name

Label: Name

Type: Text

NDCPackageCode

Label: National drug codes package code

Type: Text

NoMapFlag

Label: No map flag

Type: Text

NonProprietaryName

Label: Non proprietary name

Type: Text

NormalizedNDCPackageCode

Label: Normalized National drug codes package code

Type: Text

Notes

Label: Notes

Type: Text

OrderNumber

Label: OrderNumber

Type: Text

PackageDescription

Label: Package description

Type: Text

PharmClasses

Label: Pharm classes

Type: Text

ProductID

Label: Product id

Type: Identifier

ProductNDC

Label: Product national drug codes

Type: Text

ProductTypeName

Label: Product type name

Type: Text

ProprietaryName

Label: Proprietary name

Type: Text

ProprietaryNameSuffix

Label: Proprietary name suffix

Type: Text

RouteName

Label: Route name

Type: Text

ScenarioFlag

Label: Scenario flag

Type: Text

ShortDescription

Label: Short description

Type: Text

SourceDescription

Label: Source description

Type: Text

StartMarketingDate

Label: Start marketing date

Type: Date

Status

Label: Status

Type: Text

SubstanceName

Label: Substance name

Type: Text

TargetCode

Label: Target code

Type: Text

TargetDescription

Label: Target description

Type: Text

Type

Label: Type

Type: Text

Validity

Label: Validity

Type: Text

LOINC units

Data class to hold the measurement unit for loinc code.

Pega Internal Name: PegaHC-Data-LoincUnits

 

DefaultUnitFlag

Label: Default unit flag

Type: TrueFalse

LOINC_NUM

Label: LOINC_NUM

Type: Identifier

Source

Label: Source

Type: Text

Medical History

Medical History data class holds patient and family historical data related to medical conditions identified by the patient and or Care Team.

Pega Internal Name: PegaHC-Data-MedicalHistory

&

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

Description

Label: Medical history description

Type: Text

LISTING_SEQ_NO

Label: Medical history listing sequence number

Type: Integer

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

PatientID

Label: Patient identifier

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Member

The Member Data Class holds member data as it is utilized within the application. Member data includes Member ID , member name, policy details, PCP information.

Pega Internal Name: PegaHC-Data-Party-Member

 

Address

Label: Address

Type: List

Of Type: Common

DateOfBirth

Label: Date of Birth

Type: Date

Employee

Label: Employee

Type: Text

Employment

Label: Employment

Type: List

Of Type: Employment Information

GenderCode

Label: Gender Code

Type: Text

Guardian

Label: Guardian

Type: Object

Of Type: Guardian Information

GuardianList

Label: Guardian List

Type: List

Of Type: Guardian Information

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

Languages

Label: Languages

Type: List

Of Type: Languages

Age

Label: Member age

Type: Integer

BirthSequenceNumber

Label: Member birth sequence number

Type: Integer

CitizenshipStatusCode

Label: Member citizenship status code

Type: Text

Communication

Label: Member communication

Type: List

Of Type: Communication - Phone-Email-Social

DateOfDeath

Label: Member date of death

Type: Date

Disability

Label: Member disability

Type: List

Of Type: Disability Information

Height

Label: Member height

Type: Text

MaritalStatusCode

Label: Member marital status code

Type: Text

MiddleName

Label: Member middle name

Type: Text

NamePrefix

Label: Member name prefix

Type: Text

MemberPolicy

Label: Member policy

Type: List

Of Type: Policy

PregnancyIndicator

Label: Member pregnancy indicator

Type: TrueFalse

PreviousNames

Label: Member previous names

Type: List

Of Type: Embed-PegaHC-Member

RaceOrEthnicityCode

Label: Member race or ethnicity code

Type: Text

SitusState

Label: Member situs state

Type: Text

SocialSecurityNumber

Label: Member social security number

Type: Text

Weight

Label: Member weight

Type: Integer

pyNameSuffix

Label: Name Suffix

Type: Text

NumberOfChildren

Label: Number Of Children

Type: Integer

pyWorkPartyUri

Label: Party ID

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

NationalProviderIdentifier

Label: Party national provider identifier

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

PaymentCode

Label: PaymentCode

Type: Text

PrivacyRestricted

Label: PrivacyRestricted

Type: TrueFalse

School

Label: School

Type: List

Of Type: School Information

Source

Label: Source

Type: Text

VIP

Label: VIP

Type: Text

PrimaryContact

Label: primary contact

Type: List

Of Type: Contact Information - Embedded

pyFirstName

Label: pyFirstName

Type: Text

pyLastName

Label: pyLastName

Type: Text

Member incident

Data class to hold the incidents that are created and filed on behalf of a member.

Pega Internal Name: PegaHC-Data-Incident

 

Category

Label: Category

Type: Text

Description

Label: Description

Type: Text

EventDate

Label: Event date

Type: DateTime

Followupinstructions

Label: Followup instructions

Type: Text

FollowUpType

Label: Followup type

Type: Text

Hospital

Label: Hospital

Type: Object

Of Type: Provider

HospitalAddress

Label: Hospital address

Type: List

Of Type: Common

HospitalName

Label: HospitalName

Type: Text

IncidentImpact

Label: Impact of Incident

Type: Text

IncidentDt

Label: Incident date

Type: Date

IncidentHospital

Label: Incident hospital

Type: Text

IncidentHospitalAddress

Label: Incident hospital address

Type: List

Of Type: Common

IncidentHospitalOther

Label: Incident hospital other

Type: TrueFalse

IncidentTime

Label: Incident time

Type: TimeOfDay

IncidentTime1

Label: Incident time

Type: Text

IncidentType

Label: Incident type

Type: Text

IncidentDate

Label: IncidentDate

Type: DateTime

IncidentID

Label: IncidentID

Type: Text

Incidentlocation

Label: Incidentlocation

Type: Text

IsFollowupRequired

Label: Is followup required

Type: TrueFalse

Member

Label: Member

Type: Object

Of Type: Member

OtherFacilityOrPhysician

Label: Other facility or physician

Type: TrueFalse

OtherFollowUp

Label: Other followup

Type: Text

OtherIncidentHospital

Label: Other incident hospital

Type: Text

OtherIncidentType

Label: Other incident type

Type: Text

OtherLocation

Label: Other location

Type: Text

OtherPhysician

Label: Other physician

Type: Text

OtherHospital

Label: OtherHospital

Type: Text

PatientOutcome

Label: Patient outcome

Type: Text

PhoneNumber

Label: Phone number

Type: Text

PhysicianName

Label: PhysicianName

Type: Text

Relationship

Label: Relationship

Type: Text

Reportee

Label: Reportee

Type: Text

ReportingLastName

Label: Reporting last name

Type: Text

ReportingFirstName

Label: ReportingFirstName

Type: Text

RequiresHospitalVisit

Label: Requires hospital visit

Type: TrueFalse

RequiresPhysicianVisit

Label: Requires physician visit

Type: TrueFalse

Source

Label: Source

Type: Text

TelephoneNumber

Label: Telephone number

Type: Text

Test

Label: Test

Type: Text

Tooltip

Label: Tooltip

Type: Text

Type

Label: Type

Type: Text

Witness

Label: Witness

Type: List

Of Type: Member

WithnessRelationship

Label: Witness relationship

Type: Text

Testtime

Label: testtime

Type: TimeOfDay

Member notes

Data class to hold the notes provided by care giver in member profile

Pega Internal Name: PegaHC-Data-MemberNotes

&

Note

Label: Note

Type: Text

Source

Label: Source

Type: Text

Member risk score

Data class to hold the value for risk score for the member

Pega Internal Name: PegaHC-Data-RiskScore

 

PatientRiskScore

Label: Patient Risk Score

Type: Text

Source

Label: Source

Type: Text

Participant type

Data class to hold the participant type (i.e. care team members) who can be part of visit/conference case

Pega Internal Name: PegaHC-Data-ParticipantType

 

CaseType

Label: CaseType

Type: Identifier

ParticipantType

Label: ParticipantType

Type: Identifier

Source

Label: Source

Type: Text

Patient's Allergy information

The Allergy data class holds data related to Allergy's identified by the patient. Additional information will relate to allergy source, allergy severity , reaction, and date of initial occurrence.

Pega Internal Name: PegaHC-Data-Allergies

 

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AllergyCategory

Label: Allergy Category

Type: Text

AllergyOccurrence

Label: Allergy Occurrence

Type: Text

AllergySeverity

Label: Allergy Severity

Type: Text

AllergySource

Label: Allergy Source

Type: Text

AllergyTitle

Label: Allergy Title

Type: Text

AllergyType

Label: Allergy Type

Type: Text

AllergyValue

Label: Allergy Value

Type: Text

AllergySymptoms

Label: AllergySymptoms

Type: Object

Of Type: AllergySymptoms

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

Comments

Label: Comments

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

NoKnownAllergy

Label: No Known Allergy

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

OtherSymptoms

Label: Other Symptoms

Type: Text

Others

Label: Others

Type: Text

PatientID

Label: Patient ID

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanVersion

Label: PlanVersion

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

ReportedDate

Label: ReportedDate

Type: DateTime

ResolvedDate

Label: ResolvedDate

Type: DateTime

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Patient's appointment information

Class to save Appointment instances. This class holds appointment information such as appointment date, appointment time slot, appointment notes.

Pega Internal Name: PegaHC-Data-Appointment

 

IsActive

Label: Active?

Type: TrueFalse

Address

Label: Address

Type: List

Of Type: Common

AdjudicationDate

Label: Adjudication Date

Type: DateTime

AgendaList

Label: AgendaList

Type: List

Of Type: Embed-PegaHC-Agenda

AllowDelete

Label: Allow delete

Type: Text

AmountQualifierCode

Label: Amount qualifier code

Type: Text

AppealLevel1Disposition

Label: AppealLevel1Disposition

Type: Text

AppealLevel2Disposition

Label: AppealLevel2Disposition

Type: Text

AppealLevel3Disposition

Label: AppealLevel3Disposition

Type: Text

AppointmentDateTime

Label: AppointmentDateTime

Type: DateTime

AppointmentID

Label: AppointmentID

Type: Identifier

IsApproved

Label: Approved?

Type: TrueFalse

IsAtleastSavedOnce

Label: Atleast saved once?

Type: Text

IsAuthorizationRequired

Label: Authorization required?

Type: Text

ChangeKey

Label: ChangeKey

Type: Text

County

Label: County

Type: Text

CustomID

Label: CustomID

Type: Text

DRGGrouper

Label: DRG grouper

Type: Object

Of Type: DRG Grouper Information

DateTimePeriodFormatQualifier

Label: Date time period format qualifier

Type: Text

DateTimeQualifier

Label: Date time qualifier

Type: Text

IsDeceased

Label: Deceased?

Type: TrueFalse

DentalOnlyPlan

Label: DentalOnlyPlan

Type: Text

Description

Label: Description

Type: Text

DiagnosisCodeVersion

Label: Diagnosis code version

Type: Text

DiagnosisType

Label: Diagnosis type version

Type: Text

DisplayEffectiveDate

Label: Display effective date

Type: Date

DisplayEndDate

Label: Display end date

Type: Date

DisplayName

Label: Display name

Type: Text

EffectiveDate

Label: Effective date

Type: Date

EffectiveDate_String

Label: Effective date string

Type: Text

EndDate

Label: End date

Type: Date

EndDate_String

Label: End date string

Type: Text

ErrorCode

Label: ErrorCode

Type: Text

ErrorDescription

Label: ErrorDescription

Type: Text

ExternalID

Label: ExternalID

Type: Text

FollowupActionCode

Label: Follow up action code

Type: Text

Gap2EndDate

Label: Gap end date

Type: Date

GapEndDate

Label: Gap end date

Type: Date

GapStartDate

Label: Gap start date

Type: Date

Gap2StartDate

Label: Gap2 start date

Type: Date

HIOSIssuerID

Label: HIOS Issuer ID

Type: Text

HRef

Label: HRef

Type: Text

InformationReceiver

Label: Information receiver

Type: Object

Of Type: PegaHC-Data-Party

InformationSource

Label: Information source

Type: Object

Of Type: PegaHC-Data-Party

IsWithinRange

Label: Is Within Range

Type: TrueFalse

Languages

Label: Languages

Type: List

Of Type: Languages

Latitude

Label: Latitude

Type: Text

ListofLanguages

Label: List of languages

Type: Text

ListOfSecondaryAdmittingHosp

Label: List of secondary admitting hospital

Type: Text

ListOfSecondaryAdmittingHospital

Label: List of secondary admitting hospital

Type: Text

ListOfSecondarySpecialities

Label: List of secondary specialties

Type: Text

LISTING_PREFIX

Label: Listing prefix

Type: Text

Location

Label: Location

Type: Text

LocationMatched

Label: Location matched

Type: Text

Longitude

Label: Longitude

Type: Text

MarketCoverage

Label: Market Coverage

Type: Text

MasterEffectiveDate

Label: Master effective date

Type: Date

MasterEndDate

Label: Master end date

Type: Date

MedicareEligibilityReasonCode

Label: Medicare eligibility reason code

Type: Text

MedicareNumber

Label: Medicare number

Type: Text

MedicarePlanCode

Label: Medicare plan code

Type: Text

MedicareStatusCode

Label: Medicare status code

Type: TrueFalse

MeetingDuration

Label: MeetingDuration

Type: Text

MeetingType

Label: MeetingType

Type: Text

EmailCommunication

Label: Member email communication

Type: List

Of Type: Embed-PegaHC-Communication-Email

PhoneCommunication

Label: Member phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

SocialMediaCommunication

Label: Member social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

LISTING_SEQ_NO

Label: NDC codes listing sequence number

Type: Integer

NewVersionNote

Label: New version note

Type: Text

OldKey

Label: OldKey

Type: Text

OnHold

Label: On hold

Type: TrueFalse

OtherTopic

Label: OtherTopic

Type: Text

Participants

Label: Participants

Type: List

Of Type: Embed-PegaHC-Participant

PatientID

Label: Patient identifier

Type: Text

AllowedAmount

Label: Payment allowed amount

Type: Decimal

PlanVersion

Label: PlanVersion

Type: Text

PrepNotes

Label: PrepNotes

Type: Text

Priority

Label: Priority

Type: Text

ProcedureCodeType

Label: ProcedureCodeType

Type: Text

ProductCategory

Label: Product category

Type: Text

ProductKey

Label: Product number

Type: Text

ProductOrServiceIDQualifier

Label: Product or service ID qualifier

Type: Text

ProviderContractPick

Label: Provider contract pick

Type: List

Of Type: Embed-PegaHC-ProviderContractPick

ProviderPickMessage

Label: Provider pick message

Type: Text

Providers

Label: Providers

Type: List

Of Type: @baseclass

Reason

Label: Reason

Type: Text

ReasonForCancellation

Label: ReasonForCancellation

Type: Text

RejectReasonCode

Label: Reject Reason Code

Type: Text

RelativeEffectiveDate

Label: Relative effective date

Type: Date

RelativeEndDate

Label: Relative end date

Type: Date

Reminder

Label: Reminder

Type: Text

ResourceSettings

Label: ResourceSettings

Type: List

Of Type: Environment settings for extension

ResponseClass

Label: ResponseClass

Type: Text

SchedulerNotes

Label: SchedulerNotes

Type: Text

InsuranceTypeCode

Label: Service insurance type code

Type: Text

SlotDuration

Label: SlotDuration

Type: Integer

Source

Label: Source

Type: Text

SpecialtyMatched

Label: Specialty matched

Type: Text

Status

Label: Status of the data instance

Type: Text

TaxIdentificationNumber

Label: TaxIdentificationNumber

Type: Text

TaxonomyCode

Label: Taxonomy code

Type: Text

Code

Label: Test code

Type: Text

TraceTypeCode

Label: Trace type code

Type: Text

TranslatorRequired

Label: TranslatorRequired

Type: TrueFalse

UpdateFlag

Label: Update flag

Type: Text

UCASEName

Label: Upper case name

Type: Text

Value_list

Label: Value list

Type: Text

Versions

Label: Versions

Type: List

Of Type: PegaHC-Data-

VIPIndicator

Label: Very important person indicator

Type: TrueFalse

Comment

Label: comment

Type: Text

Endtime

Label: endtime

Type: DateTime

MinutesDuration

Label: minutesDuration

Type: Integer

Starttime

Label: starttime

Type: DateTime

Policy

The Membership Policy Data Class holds membership data specifically y related to the policies held by the member. Medical Policy is contract that defines medical benefits available to subscriber as long as premium is being paid.

Pega Internal Name: PegaHC-Data-Policy

 

BenefitCoverageLevelCode

Label: Policy benefit coverage level code

Type: Text

ContractID

Label: Policy contract ID

Type: Text

EffectiveDate

Label: Policy effective date

Type: Date

PolicyNumber

Label: Policy number

Type: Identifier

PlanNumber

Label: Policy plan number

Type: Text

TermDate

Label: Policy term date

Type: Date

InsuranceTypeCode

Label: Service insurance type code

Type: Text

Source

Label: Source

Type: Text

Practitioner

The Practitioner data class holds provider data as it is utilized within the application. Practitioner is generally an independent provider better known as doctor.

Pega Internal Name: PegaHC-Data-Party-Provider-Practitioner

 

ALSCertification

Label: ALSCertification

Type: TrueFalse

ALSExpirationDate

Label: ALSExpirationDate

Type: Date

ALSNeonatalCertification

Label: ALSNeonatalCertification

Type: TrueFalse

ALSNeonatalExpirationDate

Label: ALSNeonatalExpirationDate

Type: Date

ALSOBCertification

Label: ALSOBCertification

Type: TrueFalse

ALSOBExpirationDate

Label: ALSOBExpirationDate

Type: Date

ALSPediatricCertification

Label: ALSPediatricCertification

Type: TrueFalse

ALSPediatricExpirationDate

Label: ALSPediatricExpirationDate

Type: Date

ALSTraumaCertification

Label: ALSTraumaCertification

Type: TrueFalse

ALSTraumaExpirationDate

Label: ALSTraumaExpirationDate

Type: Date

BLSCertification

Label: BLSCertification

Type: TrueFalse

BLSExpirationDate

Label: BLSExpirationDate

Type: Date

BoardCertifications

Label: Board Certifications

Type: List

Of Type: Provider Credentialing - Certifications

PrimaryContact

Label: Business entity primary contact

Type: List

Of Type: Contact Information - Embedded

CDSExpirationDate

Label: CDSExpirationDate

Type: Date

CDSIssueDate

Label: CDSIssueDate

Type: Date

CDSNumber

Label: CDSNumber

Type: Text

CDSState

Label: CDSState

Type: Text

CPRCertification

Label: CPRCertification

Type: TrueFalse

CPRExpiration

Label: CPRExpiration

Type: Date

DEAList

Label: DEAList

Type: List

Of Type: Embed-PegaHC-Stringlist

ECFMGIssueDate

Label: ECFMGIssueDate

Type: Date

ECFMGNumber

Label: ECFMGNumber

Type: Text

ExclusiveInpatientPractice

Label: ExclusiveInpatientPractice

Type: TrueFalse

FNINCountryCode

Label: FNINCountryCode

Type: Text

FNIN

Label: FOREIGN NATIONAL IDENTIFICATION NUMBER

Type: Text

pyFirstName

Label: First Name

Type: Text

GraduateType

Label: GraduateType

Type: Text

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

Languages

Label: Languages

Type: List

Of Type: Languages

pyLastName

Label: Last Name

Type: Text

MilitaryDuty

Label: MilitaryDuty

Type: TrueFalse

pyNameSuffix

Label: Name Suffix

Type: Text

NetworkID

Label: Network ID

Type: Text

OtherCertifications

Label: Other Certifications

Type: List

Of Type: Provider Credentialing - Certifications

OtherInformation

Label: OtherInformation

Type: List

Of Type: Other Information Class

Othername

Label: Othername

Type: TrueFalse

AccountNumber

Label: Party account number

Type: Text

AdditionalName

Label: Party additional name

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

Age

Label: Party age

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

DateOfDeath

Label: Party date of death

Type: Date

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

GroupNumber

Label: Party group number

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

MiddleName

Label: Party middle name

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

pyWorkPartyUri

Label: Payer identifier

Type: Text

PolicyID

Label: PolicyID

Type: Text

EmailCommunication

Label: Practitioner

Type: List

Of Type: Embed-PegaHC-Communication-Email

HospitalAdmittingPrivileges

Label: Practitioner

Type: List

Of Type: Embed-PegaHC-Stringlist

Gender

Label: Practitioner

Type: Text

IsPCP

Label: Practitioner is PCP

Type: Text

IsEligibleForPCP

Label: Practitioner is eligible for PCP

Type: TrueFalse

PhoneCommunication

Label: Practitioner phone communication

Type: List

Of Type: Embed-PegaHC-Communication-Phone

PrimarySpecialty

Label: Practitioner primary specialty

Type: Text

SocialMediaCommunication

Label: Practitioner social media communication

Type: List

Of Type: Embed-PegaHC-Communication-SocialMedia

PractitionerSuffix

Label: Practitioner suffix

Type: Text

TerminationReason

Label: Practitioner termination reason

Type: Text

Title

Label: Practitioner title

Type: Text

ProviderAffiliations

Label: Provider affiliations

Type: List

Of Type: Embed-PegaHC-ProviderAffiliation

CredentialedSpecialities

Label: Provider credentialed specialties

Type: List

Of Type: Embed-PegaHC-Stringlist

DateOfBirth

Label: Provider date of birth

Type: Date

EffectiveDate

Label: Provider effective date

Type: Date

EndDate

Label: Provider end date

Type: Date

FederalTaxID

Label: Provider federal tax ID

Type: Text

LicenseandState

Label: Provider license and state

Type: List

Of Type: Embed-PegaHC-Stringlist

MaintenanceReasonCode

Label: Provider maintenance reason code

Type: Text

MedicaidNumberandState

Label: Provider medicaid number and state

Type: List

Of Type: Embed-PegaHC-Stringlist

MedicareNumber

Label: Provider medicare number

Type: Text

MedicareNumberEffectiveDate

Label: Provider medicare number effective date

Type: Date

MedicareNumberEndDate

Label: Provider medicare number end date

Type: Date

NationalProviderIdentifier

Label: Provider national provider identifier

Type: Text

NPIType

Label: Provider national provider identifier type

Type: Text

PaymentCode

Label: Provider payment code

Type: Text

SocialSecurityNumber

Label: Provider social security number

Type: Text

Type

Label: Provider type

Type: Text

Source

Label: Source

Type: Text

Status

Label: Status of the data instance

Type: Text

MemberID

Label: Subscriber member ID

Type: Text

USMLENumber

Label: USMLENumber

Type: Text

WorkersCompNumber

Label: WorkersCompNumber

Type: Text

Prescription - Clinical

The Prescription data class holds data related to prescription data . Prescription data includes actual medication , dosages, duration, quantity information .

Pega Internal Name: PegaHC-Data-Prescription

 

DiagnosisCodePointer

Label: ***DEPRECATED***

Type: Text

AdjustRepricedClaimNumberRefIDQualifier

Label: AdjustRepricedClaimNumberRefIDQualifier

Type: Text

AdmissionTypeCode

Label: Admission Type Code

Type: Text

AllowedBasis

Label: Allowed Basis

Type: Decimal

APCDetails

Label: Ambulatory payment classification details

Type: Object

Of Type: APC Information

AppliPlacementDateTimePeriodFormatQualifier

Label: AppliPlacementDate time period format qualifier

Type: Text

AppliancePlacementDateTimeQualifier

Label: Appliance PlacementDate time qualifier

Type: Text

ApprovedPlaceOfService

Label: Approved Place Of Service

Type: Text

AuthParameters

Label: Auth parameters

Type: Object

Of Type: Parameters for Auth processing

AuthTypeRequired

Label: Auth type required

Type: Text

AuthorizationDecision

Label: Authorization decision

Type: Text

BenefitList

Label: BenefitList

Type: List

Of Type: Benefit

BundledOrUnbundledLineNumber

Label: BundledOrUnbundledLineNumber

Type: Text

CE_DetailStatus

Label: CE_DetailStatus for API

Type: Text

CalculatedAllowedAmount

Label: CalculatedAllowedAmount for API

Type: Decimal

CapitationFlag

Label: Capitation Flag for API

Type: Text

PricingDetails

Label: Capture pricing details from external pricing system

Type: List

Of Type: Response artifacts obtained from external pricing systems

PricingResponse

Label: Capture pricing response from external pricing system

Type: Object

Of Type: Response artifacts obtained from external pricing systems

RepricedApprovedAPGGroupCode

Label: Claim line - repriced approved ambulatory patient group code

Type: Text

MeasurementReferenceIdentificationCode

Label: Claim line - measurement reference identification code

Type: Text

AssistantSurgeon

Label: Claim line Assistant Surgeon

Type: Object

Of Type: Provider

DMEDuration

Label: Claim line DME duration

Type: Integer

DMEPurchasePrice

Label: Claim line DME purchase price

Type: Decimal

DMERentalPrice

Label: Claim line DME rental price

Type: Decimal

DRGCode

Label: Claim line DRG code

Type: Text

DentalProcedureCodeDescription

Label: Claim line Dental procedure code description

Type: Text

AdjRepricedLineRefNumber

Label: Claim line adj repriced line reference number

Type: Text

AdjudOrPaymentDate

Label: Claim line adjudication or payment date

Type: Text

AdjustmentQuantitiy

Label: Claim line adjustment quantity

Type: Decimal

AdjustmentReasonCode

Label: Claim line adjustment reason code

Type: Text

AmbulancePatientCount

Label: Claim line ambulance patient count

Type: Decimal

AmbulatoryPatientGroupNumber

Label: Claim line ambulatory patient group number

Type: Text

AnesthesiaModifyingUnits

Label: Claim line anesthesia modifying units

Type: Integer

AnesthesiaUnitCount

Label: Claim line anesthesia unit count

Type: Integer

ApprovedAmount

Label: Claim line approved amount

Type: Decimal

AssignedNumber

Label: Claim line assigned number

Type: Text

Attachments

Label: Claim line attachments

Type: List

Of Type: Attachments

AttendingPhysician

Label: Claim line attending physician

Type: Object

Of Type: Provider

CertificationRevisionDate

Label: Claim line certification revision date

Type: Date

ChargeAmount

Label: Claim line charge amount

Type: Decimal

ClaimAdjustmentGroupCode

Label: Claim line claim adjustment group code

Type: Text

ClaimFilingIndicatorCode

Label: Claim line claim filing indicator code

Type: Text

ClaimStatusCategoryCode

Label: Claim line claim status category code

Type: Text

ClaimStatusCode

Label: Claim line claim status code

Type: Text

CodeCategory

Label: Claim line code category

Type: Text

CompositeMedicalProcedure

Label: Claim line composite medical procedure

Type: Object

Of Type: Embed-PegaHC-AdjudicatedLine

CompositeMedicalProcedureCode

Label: Claim line composite medical procedure code

Type: Text

CompositeUnitOfMeasurementUnit

Label: Claim line composite unit of measurement unit

Type: Text

ConditionCodeAmbulanceList

Label: Claim line condition code ambulance list

Type: List

Of Type: Embed-PegaHC-Condition

ConditionIndicator

Label: Claim line condition indicator

Type: Text

ConditionIndicators

Label: Claim line condition indicators

Type: Text

ContractCode

Label: Claim line contract code

Type: Text

ContractPercentage

Label: Claim line contract percentage

Type: Decimal

ContractType

Label: Claim line contract type

Type: Text

ContractVersion

Label: Claim line contract version

Type: Text

CoPayStatusCode

Label: Claim line copay status code

Type: Text

CCIStatus

Label: Claim line correct coding initiative status

Type: Text

DatePrescriptionDate

Label: Claim line date prescription date

Type: Date

DateTreatmentCompletionDate

Label: Claim line date treatment Completion date

Type: Date

DateTreatmentStartDate

Label: Claim line date treatment start date

Type: Date

EmergencyIndicator

Label: Claim line emergency indicator

Type: Text

ExceptionCode

Label: Claim line exception code

Type: Text

FacilityTaxAmount

Label: Claim line facility tax amount

Type: Decimal

FamilyPlanningIndicator

Label: Claim line family planning indicator

Type: Text

FillNumber

Label: Claim line fill number

Type: Text

FixedFormatInformation

Label: Claim line fixed format information

Type: Text

FormIdentificationListList

Label: Claim line form identification list

Type: List

Of Type: PegaHC-Data-FormIdentification

FormIdentifier

Label: Claim line form identifier

Type: Text

HospiceEmployedProviderIndicator

Label: Claim line hospice employed provider indicator

Type: TrueFalse

LaboratoryOrFacility

Label: Claim line laboratory or facility

Type: Object

Of Type: Provider

LastCertificationDate

Label: Claim line last certification date

Type: Date

LastSeenDate

Label: Claim line last seen date

Type: Date

LastXRayDate

Label: Claim line last x-ray date

Type: Date

LengthOfMedicalNecessity

Label: Claim line length of medical necessity

Type: Decimal

LineAdjudicationList

Label: Claim line line adjudication list

Type: List

Of Type: Embed-PegaHC-AdjudicatedLine

LineItemControlNumber

Label: Claim line line item control number

Type: Text

MammographyCertificationNumber

Label: Claim line mammography certification number

Type: Text

MatchedAuthReference

Label: Claim line matched authorization reference

Type: List

Of Type: Authorization details

Measurement

Label: Claim line measurement

Type: List

Of Type: Embed-PegaHC-Measurement

MeasurementQualifier

Label: Claim line measurement qualifier

Type: Text

MedicalProcedureCodeDescription

Label: Claim line medical procedure code description

Type: Text

MedicalProductOrServiceIDQualifier

Label: Claim line medical product or service id qualifier

Type: Text

MUEStatus

Label: Claim line medically unlikely edits status

Type: Text

MEEStatus

Label: Claim line mutually exclusive edits status

Type: Text

NationalDrugUnitCount

Label: Claim line national drug unit count

Type: Decimal

NonCoveredChargeAmount

Label: Claim line non covered charges amount

Type: Decimal

NonCoveredReason

Label: Claim line non covered reason

Type: Text

NoteReferenceCode

Label: Claim line note reference code

Type: Text

LineNoteText

Label: Claim line note text

Type: Text

LineNumber

Label: Claim line number

Type: Identifier

ObstetricAdditionalUnits

Label: Claim line obstetric additional units

Type: Decimal

OnsetDate

Label: Claim line onset date

Type: Date

OperatingPhysician

Label: Claim line operating physician

Type: Object

Of Type: Provider

OrderingProvider

Label: Claim line ordering provider

Type: Object

Of Type: Provider

OrthodonticBandingDate

Label: Claim line orthodontic banding date

Type: Date

OtherProvider

Label: Claim line other provider

Type: Object

Of Type: Provider

PatientDateOfBirth

Label: Claim line patient date of birth

Type: Date

Payment

Label: Claim line payment

Type: Object

Of Type: Payment Information

PolicyComplianceCode

Label: Claim line policy compliance code

Type: Text

PredeterminationOfBenefitsIdentifier

Label: Claim line predetermination of benefits identifier

Type: Text

PricingMethodology

Label: Claim line pricing methodology

Type: Text

PriorAuthorizationOrReferralNumber

Label: Claim line prior auth or referral number

Type: Text

PriAuthReference

Label: Claim line prior authorization reference

Type: List

Of Type: Authorization details

PriorPlacementDate

Label: Claim line prior placement date

Type: Date

ProcedureCode

Label: Claim line procedure code

Type: Text

ProcedureCount

Label: Claim line procedure count

Type: Integer

ProcedureIdentifiers

Label: Claim line procedure identifiers

Type: Text

ProcedureModifier

Label: Claim line procedure modifier

Type: Text

ProcessingStatus

Label: Claim line processing status

Type: Text

ProfessionalServiceUnitCode

Label: Claim line professional service unit code

Type: Text

ProsthesisCrownOrInlayCode

Label: Claim line prosthesis crown or inlay code

Type: Text

PurchasedServiceChargeAmount

Label: Claim line purchased service charge amount

Type: Decimal

PurchasedServiceProvider

Label: Claim line purchased service provider

Type: Object

Of Type: Provider

PurchasedServiceProviderIdentifier

Label: Claim line purchased service provider identifier

Type: Text

QuestionNumberOrLetter

Label: Claim line question number or letter

Type: Text

QuestionResponse

Label: Claim line question response

Type: Text

ReferenceIdentificationQualifier

Label: Claim line reference identification qualifier

Type: Text

ReferralDate

Label: Claim line referral date

Type: Date

ReferralNumber

Label: Claim line referral number

Type: Text

ReferralNumberList

Label: Claim line referral number list

Type: List

Of Type: Authorization details

ReferringProvider

Label: Claim line referring provider for claim line

Type: Object

Of Type: Provider

RenderingProvider

Label: Claim line rendering provider

Type: Object

Of Type: Provider

RentalUnitPriceIndicator

Label: Claim line rental unit price indicator

Type: Text

ReplacementDate

Label: Claim line replacement date

Type: Date

RepricedLineItemReferenceNumber

Label: Claim line repriced line item reference number

Type: Text

RepricingOrganizationIdentifier

Label: Claim line repricing organization identifier

Type: Text

RevenueCodeDescription

Label: Claim line revenue code description

Type: Text

ServiceAdjudicationOrPaymentDate

Label: Claim line service adj or payment date

Type: Date

ServiceFacility

Label: Claim line service facility

Type: Object

Of Type: Provider

ServiceTaxAmount

Label: Claim line service tax amount

Type: Decimal

ShippedDate

Label: Claim line shipped date

Type: Date

SimilarIllnessOrSymptomDate

Label: Claim line similar illness or symptom date

Type: Date

StatusDate

Label: Claim line status date

Type: Date

StatusReason

Label: Claim line status reason

Type: Text

SupervisingProvider

Label: Claim line supervising provider

Type: Object

Of Type: Provider

TermsDiscountPercentage

Label: Claim line terms discount percentage

Type: Decimal

TestPerformedDate

Label: Claim line test performed date

Type: Date

TestResults

Label: Claim line test results

Type: Text

ThirdPartyOrganizationNotes

Label: Claim line third party organization notes

Type: Text

ToothCode

Label: Claim line tooth code

Type: Text

ToothSurfaceCode

Label: Claim line tooth surface code

Type: Text

TreatmentCompletionDate

Label: Claim line treatment completion date

Type: Date

TreatmentStartDate

Label: Claim line treatment start date

Type: Date

UnitsOfServicePaidCount

Label: Claim line units of service paid count

Type: Integer

UniversalProductNumber

Label: Claim line universal product number

Type: Integer

Visits

Label: Claim line visits

Type: Integer

Weight

Label: Claim line weight

Type: Integer

XRayAvailabilityIndicator

Label: Claim line x-ray availability indicator

Type: TrueFalse

CompositeMedicalProductOrServiceIDQualifier

Label: Composite med product / svc ID qualifier

Type: Text

ConditionCodeEPSDTReferral

Label: Condition code EPSDT referral

Type: Text

DMEAttachmentTransmissionCode

Label: DME attachment transmission code

Type: Text

DMEUnitorBasisforMeasurementCode

Label: DME measurement code

Type: Text

DentalProductOrServiceIDQualifier

Label: DentalProductOrServiceIDQualifier

Type: Text

DiagnosisCodeAndPointer

Label: DiagnosisCodeAndPointer

Type: List

Of Type: Diagnosis Information - Embedded

DischargeLocation

Label: Discharge Location Code

Type: Text

EPSDTIndicator

Label: EPSDT indicator

Type: Text

Frequency

Label: Frequency

Type: Text

GMEFactor

Label: GMEFactor

Type: Decimal

GMETaxAmount

Label: GMETaxAmount

Type: Decimal

HCPCSCode

Label: HCPCS code

Type: Text

ImmunizationBatchNumber

Label: ImmunizationBatchNumber

Type: Text

ICDVersion

Label: International classification of diseases version

Type: Text

IsSANPPricingSuppressed

Label: Is SANP Pricing suppressed

Type: TrueFalse

IsParticipatingNetwork

Label: Is participating network (true/false)

Type: TrueFalse

LineDateTimePeriodFormatQualifier

Label: LineDate time period format qualifier

Type: Text

LineDateTimeQualifier

Label: LineDate time qualifier

Type: Text

LineItemCntNumberRefIDQualifier

Label: LineItemCntNumberRefIDQualifier

Type: Text

NDC

Label: NDC

Type: Object

Of Type: National Drug Codes (NDC) - Package

NegotiatedPrice

Label: NegotiatedPrice

Type: Decimal

Network

Label: Network for API

Type: Text

OralCavityDesignationCode

Label: OralCavityDesignationCode

Type: Text

Originalline

Label: Originalline

Type: Text

OutOfStateIndicator

Label: Out of State Indicator for API

Type: TrueFalse

PaidServiceUnitCount

Label: PaidServiceUnitCount

Type: Decimal

PatientCalculatedAmount

Label: Patient Calculated Amount for API

Type: Text

PlaceOfProfessionalServiceCode

Label: Place of professional service code

Type: Text

PlaceofServiceCode

Label: PlaceofServiceCode

Type: Text

Active

Label: Prescription active

Type: Text

LISTING_SEQ_NO

Label: Prescription listing sequence number

Type: Integer

PrescriptionNumber

Label: PrescriptionNumber

Type: Text

PriceFrequency

Label: PriceFrequency

Type: Text

PriorPlacementDateTimePeriodFormatQualifier

Label: PriorPlacementDate time period format qualifier

Type: Text

PriorPlacementDateTimeQualifier

Label: PriorPlacementDateTimeQualifier

Type: Text

ProcessedAuthReference

Label: Processed auth reference

Type: List

Of Type: Authorization details

Contract

Label: Provider Contract

Type: List

Of Type: Provider contract

RARCodes

Label: RAR Codes

Type: List

Of Type: Claim Remittance/Remark Codes

RateSheetID

Label: RateSheetID

Type: Text

ReferringCLIANumber

Label: ReferringCLIANumber

Type: Text

ReplacementDateTimePeriodFormatQualifier

Label: ReplacementDate time period format qualifier

Type: Text

ReplacementDateTimeQualifier

Label: ReplacementDate time qualifier

Type: Text

RepricedClaimNumberRefIDQualifier

Label: RepricedClaimNumberRefIDQualifier

Type: Text

LineRepricingProductOrServiceIDQualifier

Label: Repricing product / svc ID qualifier

Type: Text

ResolvedInSANP

Label: ResolvedInSANP

Type: TrueFalse

ServiceDate

Label: Service Date

Type: Date

AccidentDate

Label: Service accident date

Type: Date

ActionCode

Label: Service action code

Type: Text

ActivitiesPermittedCode

Label: Service activities permitted code

Type: Text

ActualAdmissionDate

Label: Service actual admission date

Type: Date

ActualDischargeDate

Label: Service actual discharge date

Type: Date

AcuteManifestationDate

Label: Service acute manifestation date

Type: Date

AdmissionDate

Label: Service admission date

Type: Date

AdmissionDiagnosis

Label: Service admission diagnosis

Type: Text

AdmissionSourceCode

Label: Service admission source code

Type: Text

AmbulanceDropOffCity

Label: Service ambulance drop off city

Type: Text

AmbulanceDropOffPostalCode

Label: Service ambulance drop off postal code

Type: Text

AmbulanceDropOffStateCode

Label: Service ambulance drop off state code

Type: Text

AmbulanceDropOff

Label: Service ambulance drop-off

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulancePickUpCity

Label: Service ambulance pick up city

Type: Text

AmbulancePickUpPostalCode

Label: Service ambulance pick up postal code

Type: Text

AmbulancePickUpStateCode

Label: Service ambulance pick up state code

Type: Text

AmbulancePickup

Label: Service ambulance pickup

Type: Object

Of Type: PegaHC-Data-AmbulanceServices

AmbulanceTransportCode

Label: Service ambulance transport code

Type: Text

AmbulanceTransportReasonCode

Label: Service ambulance transport reason code

Type: Text

AmbulanceTripDestinationAddress

Label: Service ambulance trip destination address

Type: Text

AmbulanceTripOriginAddress

Label: Service ambulance trip origin address

Type: Text

AnesthesiaRelatedSurgicalProcedure

Label: Service anesthesia related surgical procedure

Type: Text

ArterialBloodGasQuantity

Label: Service arterial blood gas quantity

Type: Decimal

AssessmentDate

Label: Service assessment date

Type: Date

AssumedRelinqCareDate

Label: Service assumed or relinquished care date

Type: Date

AuthorizationReason

Label: Service authorization reason

Type: Text

AuthorizedUnitCount

Label: Service authorized service unit count

Type: Integer

BeginTherapyDate

Label: Service begin therapy date

Type: Date

BenefitAmount

Label: Service benefit amount

Type: Decimal

BenefitBeginDate

Label: Service benefit begin date

Type: Date

BenefitCoverageLevelCode

Label: Service benefit coverage level code

Type: Text

BenefitEndDate

Label: Service benefit end date

Type: Date

BenefitPercent

Label: Service benefit percent

Type: Integer

BenefitQuantity

Label: Service benefit quantity

Type: Integer

CertificationConditionIndicator

Label: Service certification condition indicator

Type: Text

CertificationPeriodProjVisitCount

Label: Service certification period projected visit count

Type: Integer

CertificationTypeCodeValues

Label: Service certification type code values

Type: Text

ClaimServicePeriod

Label: Service claim service period

Type: Text

CLIANumber

Label: Service clinical laboratory improvement amendment number

Type: Text

CodeListQualifierCode

Label: Service code list qualifier code

Type: Text

ComplicationIndicator

Label: Service complication indicator

Type: Text

ConditionAdditionalDescriptionPatient

Label: Service condition additional description patient

Type: Text

ConditionCode

Label: Service condition code

Type: Text

ConditionCodeAbortion

Label: Service condition code - abortion

Type: Text

ConditionCodeAmbulance

Label: Service condition code - ambulance transport

Type: Text

ConditionCodePatient

Label: Service condition code - patient

Type: Text

ConditionCodeVision

Label: Service condition code - vision

Type: Text

ConditionDescriptionPatient

Label: Service condition description - patient

Type: Text

CoveragePeriod

Label: Service coverage period

Type: Date

CoveredDaysorVisitsCount

Label: Service covered days or visits count

Type: Integer

CurrentHealthConditionCode

Label: Service current health condition code

Type: Text

DailyOxygenUseCount

Label: Service daily oxygen use count

Type: Integer

Date

Label: Service date

Type: List

Of Type: Embed-PegaHC-Date

DaysofSupply

Label: Service days of supply

Type: Integer

DeliveryFrequencyCode

Label: Service delivery frequency code

Type: Text

DeliveryPatternTimeCode

Label: Service delivery pattern time code

Type: Text

Diagnosis

Label: Service diagnosis

Type: List

Of Type: ***Deprecated***

Dose

Label: Service dose

Type: Text

DurationofVisitsNumberofUnits

Label: Service duration of visits number of units

Type: Integer

DurationofVisitsUnits

Label: Service duration of visits units

Type: Integer

EligibilityDate

Label: Service eligibility date

Type: Date

EligibilityOrBenefitInformation

Label: Service eligibility or benefit information

Type: Text

ServiceFacilityLocationSecondaryIdentifier

Label: Service facility location secondary identifier

Type: Text

ServiceFacilityName

Label: Service facility name

Type: Text

FacilityTypeCode

Label: Service facility type code

Type: Text

FileInformation

Label: Service file information

Type: List

Of Type: Embed-PegaHC-FileInformation

FrequencyCount

Label: Service frequency count

Type: Integer

FrequencyPeriod

Label: Service frequency period

Type: Text

ServiceFromDate

Label: Service from date

Type: Date

ServiceIdentificationCode

Label: Service identification code

Type: Text

InPlanNetworkIndicator

Label: Service in plan network indicator

Type: Text

InitialTreatmentDate

Label: Service initial treatment date

Type: Date

IssueDate

Label: Service issue date

Type: Date

LastAdmissionPeriod

Label: Service last admission period

Type: Date

ServiceLineDate

Label: Service line date

Type: Date

ServiceLineRate

Label: Service line rate

Type: Text

ServiceLineRevenueCode

Label: Service line revenue code

Type: Text

MonthlyTreatmentCount

Label: Service monthly treatment count

Type: Integer

Notes

Label: Service notes

Type: List

Of Type: Embed-PegaHC-Notes

NumberofVisits

Label: Service number of visits

Type: Integer

OnsetofCurrentIllnessorInjury

Label: Service onset of current illness or injury

Type: Date

OrderDate

Label: Service order date

Type: Date

OriginalUnitsofServiceCount

Label: Service original units of service count

Type: Integer

OtherOperatingPhysician

Label: Service other operating physician

Type: Object

Of Type: Provider

OxygenFlowRate

Label: Service oxygen flow rate

Type: Text

OxygenSaturationQuantity

Label: Service oxygen saturation quantity

Type: Decimal

OxygenSaturationTestDate

Label: Service oxygen saturation test date

Type: Date

OxygenTestConditionCode

Label: Service oxygen test condition code

Type: Text

OxygenTestFindingsCode

Label: Service oxygen test findings code

Type: Text

PatientStatusCode

Label: Service patient status code

Type: Text

PendCodes

Label: Service pend codes

Type: List

Of Type: PegaHC-Data-ClaimPendCodes

PeriodCount

Label: Service period count

Type: Decimal

PrescriptionDate

Label: Service prescription date

Type: Date

PrescriptionFillNumber

Label: Service prescription fill number

Type: Integer

PrincipalDiagnosis

Label: Service principal diagnosis

Type: Text

PrincipalDiagnosisDate

Label: Service principal diagnosis date

Type: Date

PriorIncorrectInsured

Label: Service prior incorrect insured

Type: Object

Of Type: Member

ProcedureCodeDescription

Label: Service procedure code description

Type: Text

ProcedureCodeQualifier

Label: Service procedure code qualifier

Type: Text

ProcedureDate

Label: Service procedure date

Type: Date

ProcedureModifiers

Label: Service procedure modifiers

Type: Text

ProcedureQuantity

Label: Service procedure quantity

Type: Integer

ProductCode

Label: Service product code

Type: Text

ProposedAdmissionDate

Label: Service proposed admission date

Type: Date

ProposedDischargeDate

Label: Service proposed discharge date

Type: Date

QuantityDispensed

Label: Service quantity dispensed

Type: Text

QuantityQualifier

Label: Service quantity qualifier

Type: Text

ReferringProviderList

Label: Service referring provider list

Type: List

Of Type: Provider

CausesCode

Label: Service related causes code

Type: Text

RelatedCausesCode

Label: Service related causes code

Type: Text

RepricedApprovedServiceUnitCount

Label: Service repriced approved service unit count

Type: Integer

RoundTripPurposeDescription

Label: Service round trip purpose description

Type: Text

SampleSelectionModulus

Label: Service sample selection modulus

Type: Text

ShipDeliveryorCalendarPatternCode

Label: Service ship delivery or calendar pattern code

Type: Text

StretcherPurposeDescription

Label: Service stretcher purpose description

Type: Text

SubluxationLevelCode

Label: Service subluxation level code

Type: Text

SurgeryDate

Label: Service surgery date

Type: Date

SurgicalProcedureCode

Label: Service surgical procedure code

Type: Text

TimePeriodQualifier

Label: Service time period qualifier

Type: Text

ServiceToDate

Label: Service to date

Type: Date

TransportDistance

Label: Service transport distance

Type: Integer

TreatmentCount

Label: Service treatment count

Type: Integer

TreatmentPeriodCount

Label: Service treatment period count

Type: Integer

TreatmentSeriesNumber

Label: Service treatment series number

Type: Integer

ServiceUnitCount

Label: Service unit count

Type: Integer

UnitorBasisforMeasurementCode

Label: Service unit or basis for measurement code

Type: Text

ServiceValid

Label: Service valid

Type: Text

ServicePredeterminationIdentification

Label: ServicePredeterminationIdentification

Type: List

Of Type: Authorization details

ServiceTypeCode

Label: ServiceTypeCode

Type: Text

ServicingState

Label: Servicing State for API

Type: Text

ServicingCounty

Label: ServicingCounty

Type: Text

ServicingZipCode

Label: ServicingZipCode

Type: Text

Source

Label: Source

Type: Text

SplitLines

Label: SplitLines

Type: List

Of Type: Embed-PegaHC-Stringlist

SurchargeAmount

Label: SurchargeAmount for API

Type: Decimal

SurchargeFactor

Label: SurchargeFactor for API

Type: Decimal

TestProp

Label: TestProp

Type: Text

ToothInformation

Label: ToothInformation

Type: List

Of Type: Tooth Information

TreatmentCompDateTimeQualifier

Label: TreatmentCompDate time qualifier

Type: Text

TreatmentStartDateTimeQualifier

Label: TreatmentStartDate time qualifier

Type: Text

UnitOrBasisForMeasurementCodeForService

Label: Unit or basis for measurement code for service

Type: Text

ValidService

Label: Valid service

Type: TrueFalse

Product - Benefits

The Product data class holds data related to Product. Product for healthcare is plans and benefits. This data class has properties for benefits such as benefit type , benefit id .

Pega Internal Name: PegaHC-Data-Product

 

BeginPrimaryCareCostSharingAfterASetNumberOfVisits

Label: BeginPrimaryCareCost-SharingAfterASetNumberOfVisits

Type: Text

BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays

Label: BeginPrimaryCareDeductibleOrCoinsuranceAfterASetNumberOfCopays

Type: Text

ChildOnlyPlanID

Label: Child Only Plan ID

Type: Text

ChildOnlyOffering

Label: Child-Only Offering

Type: Text

CompositeRating

Label: CompositeRating

Type: Text

CreateProduct

Label: CreateProduct

Type: Text

DiseaseManagementProgramsOffered

Label: Disease Management Programs Offered

Type: Text

EHBApportionmentForPediatricDental

Label: EHB Apportionment for Pediatric Dental

Type: Text

EHBTotalPremium

Label: EHBTotalPremium

Type: Decimal

FormularyID

Label: FormularyID

Type: Text

GuaranteedVsEstimatedRate

Label: GuaranteedVsEstimated Rate

Type: Text

HIOSProductID

Label: HIOSProductID

Type: Text

HPID

Label: HPID

Type: Text

HSAEligible

Label: HSA Eligible

Type: Text

HSAHRAEmployerContribution

Label: HSA/HRA Employer Contribution

Type: TrueFalse

HSAHRAEmployerContributionAmount

Label: HSA/HRA Employer Contribution Amount

Type: Text

IsAReferralRequiredForSpecialist

Label: Is a Referral Required for Specialist

Type: TrueFalse

LimitedCostSharingPlanVariationEstAdvancedPayment

Label: Limited Cost Sharing Plan Variation - Est Advanced Payment

Type: Text

MaxNoOfDaysForChargingAnInpatientCopay

Label: MaxNoOfDaysForChargingAnInpatientCopay

Type: Text

MetalLevel

Label: Metal Level

Type: Text

NationalNetwork

Label: National Network

Type: TrueFalse

Networks

Label: Networks

Type: List

Of Type: Network

NewOrExistingPlan

Label: NewOrExisting Plan

Type: Text

NoticeForPregnancy

Label: NoticeForPregnancy

Type: Text

OfficeVisitCopayOON

Label: Office visit copay out of network

Type: Decimal

OutOfCountryCoverage

Label: Out of Country Coverage

Type: TrueFalse

OutOfCountryCoverageDescription

Label: Out of Country Coverage Description

Type: Text

OutOfServiceAreaCoverage

Label: Out of Service Area Coverage

Type: TrueFalse

OutOfServiceAreaCoverageDescription

Label: Out of Service Area Coverage Description

Type: Text

PlanBrochure

Label: Plan Brochure

Type: Text

PlanLevelExclusions

Label: Plan Level Exclusions

Type: Text

PlanCostShares

Label: PlanCostShares

Type: List

Of Type: Embed-PegaHC-PlanCostShare

Availability

Label: Product availability

Type: Text

Benefit

Label: Product benefit

Type: List

Of Type: Service (Healthcare)

BenefitGroup

Label: Product benefit group

Type: List

Of Type: PegaHC-Data-BenefitGroup

Category

Label: Product category

Type: Text

CertificationConditionIndicator

Label: Product certification condition indicator

Type: Text

ClaimCostPMPM

Label: Product claim cost per member per month

Type: Decimal

CoInsuranceOON

Label: Product co insurance out of network

Type: Decimal

CoInsurance

Label: Product coinsurance

Type: Decimal

DependentEligibilityAgeMax

Label: Product dependent eligibility age max

Type: Integer

EffectiveDate

Label: Product effective date

Type: Date

EndDate

Label: Product end date

Type: Date

FamilyDeductible

Label: Product family deductible

Type: Integer

FamilyDeductibleMultiplier

Label: Product family deductible multiplier

Type: Integer

FamilyDeductibleMultiplierOON

Label: Product family deductible multiplier out of network

Type: Integer

FamilyDeductibleOON

Label: Product family deductible out of network

Type: Integer

FamilyOOPMax

Label: Product family out-of-pocket maximum

Type: Double

FamilyOOPMaxMultiplier

Label: Product family out-of-pocket maximum multiplier

Type: Integer

FamilyOOPMaxMultiplierOON

Label: Product family out-of-pocket maximum multiplier OON

Type: Integer

FamilyOOPMaxOON

Label: Product family out-of-pocket maximum out of network

Type: Double

GroupSizeHigh

Label: Product group size high

Type: Integer

IndividualDeductible

Label: Product individual deductible

Type: Integer

IndividualDeductibleOON

Label: Product individual deductible out of network

Type: Integer

IndividualOOPMax

Label: Product individual out-of-pocket maximum

Type: Integer

IndividualOOPMaxOON

Label: Product individual out-of-pocket maximum out of network

Type: Integer

InsuranceLineCode

Label: Product insurance line code

Type: Text

LifeTimeMax

Label: Product life time max

Type: Integer

LifeTimeMaxOON

Label: Product life time max out of network

Type: Integer

ProductList

Label: Product list

Type: List

Of Type: Product - Benefits

MaximumGroupSize

Label: Product maximum group size

Type: Integer

MedicarePlanCode

Label: Product medicare plan code

Type: Text

MemberOOP

Label: Product member out-of-pocket

Type: Text

ProductName

Label: Product name

Type: Text

NetworkRestriction

Label: Product network restriction

Type: Text

OfficeVisitCopay

Label: Product office visit copay

Type: Decimal

OutOfNetworkIndicator

Label: Product out of network indicator

Type: Text

PerformanceFlag

Label: Product performance flag

Type: Text

PlanCoverageDescription

Label: Product plan coverage description

Type: Text

PlanName

Label: Product plan name

Type: Text

PlanNumber

Label: Product plan number

Type: Text

ProductNumber

Label: Product plan number

Type: Text

PCPRequired

Label: Product primary care physician required

Type: Text

RateEffectiveDate

Label: Product rate effective date

Type: Date

RateTermDate

Label: Product rate term date

Type: Date

ShortDescription

Label: Product short description

Type: Text

StudentEligibilityAgeMax

Label: Product student eligibility age maximum

Type: Integer

ValueStatement

Label: Product value statement

Type: Text

QHPOrNonQHP

Label: QHPOrNonQHP

Type: Text

ServiceAreas

Label: ServiceAreas

Type: List

Of Type: Service Area

Source

Label: Source

Type: Text

SpecialistsRequiringAReferral

Label: Specialist(s) Requiring a Referral

Type: Text

TempSubscriberName

Label: TempSubscriberName

Type: Object

Of Type: PegaHC-X12-Data-N271-Loop2100CSubscriberName

TobaccoWellnessProgramOffered

Label: Tobacco Wellness Program Offered

Type: TrueFalse

URLForEnrollmentPayment

Label: URL for Enrollment Payment

Type: Text

URLForSummaryOfBenefitsAndCoverage

Label: URL for Summary of BenefitsAndCoverage

Type: Text

UniquePlanDesign

Label: UniquePlanDesign

Type: TrueFalse

Provider - Group / Facility

The Group/Facility Data Class holds Servicing provider data as it is utilized within the application. Facility data include NPi, associated Providers and affiliations.

Pega Internal Name: PegaHC-Data-Party-Provider-ServicingOrg

 

BoardCertifications

Label: Board Certifications

Type: List

Of Type: Provider Credentialing - Certifications

DEAList

Label: DEAList

Type: List

Of Type: Embed-PegaHC-Stringlist

pyFirstName

Label: First Name

Type: Text

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

HospitalAdmittingPrivileges

Label: Hospital Admitting Privileges

Type: List

Of Type: Embed-PegaHC-Stringlist

Languages

Label: Languages

Type: List

Of Type: Languages

pyLastName

Label: Last Name

Type: Text

MilitaryDuty

Label: Military Duty

Type: TrueFalse

pyNameSuffix

Label: Name Suffix

Type: Text

OtherCertifications

Label: Other Certifications

Type: List

Of Type: Provider Credentialing - Certifications

OtherInformation

Label: OtherInformation

Type: List

Of Type: Other Information Class

AccountNumber

Label: Party account number

Type: Text

AdditionalName

Label: Party additional name

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

Age

Label: Party age

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

DateOfDeath

Label: Party date of death

Type: Date

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

GroupNumber

Label: Party group number

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

MiddleName

Label: Party middle name

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

pyWorkPartyUri

Label: Payer identifier

Type: Text

Title

Label: Practitioner title

Type: Text

ProviderAffiliations

Label: Provider affiliations

Type: List

Of Type: Embed-PegaHC-ProviderAffiliation

CredentialedSpecialities

Label: Provider credentialed specialties

Type: List

Of Type: Embed-PegaHC-Stringlist

DateOfBirth

Label: Provider date of birth

Type: Date

EffectiveDate

Label: Provider effective date

Type: Date

EndDate

Label: Provider end date

Type: Date

FederalTaxID

Label: Provider federal tax ID

Type: Text

Gender

Label: Provider gender

Type: Text

LicenseandState

Label: Provider license and state

Type: List

Of Type: Embed-PegaHC-Stringlist

MaintenanceReasonCode

Label: Provider maintenance reason code

Type: Text

MedicaidNumberandState

Label: Provider medicaid number and state

Type: List

Of Type: Embed-PegaHC-Stringlist

MedicareNumber

Label: Provider medicare number

Type: Text

MedicareNumberEffectiveDate

Label: Provider medicare number effective date

Type: Date

MedicareNumberEndDate

Label: Provider medicare number end date

Type: Date

NationalProviderIdentifier

Label: Provider national provider identifier

Type: Text

NPIType

Label: Provider national provider identifier type

Type: Text

PaymentCode

Label: Provider payment code

Type: Text

SocialSecurityNumber

Label: Provider social security number

Type: Text

Type

Label: Provider type

Type: Text

IsSubpart

Label: Servicingorg is subpart

Type: Text

ParentNPI

Label: Servicingorg parent national identification number

Type: Text

PrimarySpecialty

Label: Servicingorg primary specialty

Type: Text

ProviderAliases

Label: Servicingorg provider aliases

Type: List

Of Type: Embed-PegaHC-Stringlist

TerminationReason

Label: Servicingorg termination reason

Type: Text

Source

Label: Source

Type: Text

Status

Label: Status of the data instance

Type: Text

MemberID

Label: Subscriber member ID

Type: Text

PrimaryContact

Label: primary contact

Type: List

Of Type: Contact Information - Embedded

Provider affiliation

ProviderAffiliation class relating a Provider with Business Entity. Affiliation indicates the association of provider with other entities such as group practices, hospitals.

Pega Internal Name: PegaHC-Data-ProviderAffiliation

 

PanelLimit

Label: PanelLimit

Type: Text

PrimaryHospNPI

Label: PrimaryHospNPI

Type: Text

PrimarySpecialtyStatus

Label: PrimarySpecialtyStatus

Type: Text

AcceptingNewPatients

Label: Provider affiliation accepting new patients

Type: Text

Locations

Label: Provider affiliation addresses

Type: List

Of Type: Embed-PegaHC-BEAddress

AgeRestriction

Label: Provider affiliation age restriction

Type: Integer

BusinessEntityID

Label: Provider affiliation business entity ID

Type: Identifier

EffectiveDate

Label: Provider affiliation effective date

Type: Date

EndDate

Label: Provider affiliation end date

Type: Date

MarketInDirectory

Label: Provider affiliation market in directory

Type: Text

PractitionerCapacity

Label: Provider affiliation practitioner capacity

Type: Text

PrimaryHospEffectiveDate

Label: Provider affiliation primary hospital effective date

Type: Date

PrimaryHospEndDate

Label: Provider affiliation primary hospital end date

Type: Date

PrimarySpecialityCode

Label: Provider affiliation primary specialty code

Type: Text

PrimarySpecialtyEffectiveDate

Label: Provider affiliation primary specialty effective date

Type: Date

PrimarySpecialtyEndDate

Label: Provider affiliation primary specialty end date

Type: Date

ProviderID

Label: Provider affiliation provider ID

Type: Identifier

SecondarySpecialities

Label: Provider affiliation secondary specialties

Type: List

Of Type: Embed-PegaHC-Stringlist

SecondaryHospitalAdmittingPrevilege

Label: Secondary hosp admitting previlege

Type: List

Of Type: Embed-PegaHC-Stringlist

Source

Label: Source

Type: Text

Provider contract

DataClass for Contract

Pega Internal Name: PegaHC-Data-ProviderContract

 

AssociatedBE

Label: AssociatedBE

Type: Object

Of Type: Business entity

ContractState

Label: ContractState

Type: Text

CoveredNetworks

Label: Covered Networks

Type: List

Of Type: Network

PlanDefault

Label: PlanDefault

Type: Text

CoveredProductGroups

Label: Provider contract covered product groups

Type: List

Of Type: PegaHC-Data-ProductGroup

CoveredProducts

Label: Provider contract covered products

Type: List

Of Type: Product - Benefits

EffectiveDate

Label: Provider contract effective date

Type: Date

EndDate

Label: Provider contract end date

Type: Date

ContractID

Label: Provider contract identifier

Type: Text

ContractName

Label: Provider contract name

Type: Identifier

PrimaryPaymentMethod

Label: Provider contract primary payment method

Type: Text

PromptPay

Label: Provider contract prompt pay

Type: Text

ContractStatus

Label: Provider contract status

Type: Text

ContractType

Label: Provider contract type

Type: Text

ContractVersion

Label: Provider contract version

Type: Text

RateSheets

Label: Ratesheets associated to contract

Type: List

Of Type: Rate Sheet

Source

Label: Source

Type: Text

Subscriber (Policy Holder)

The subscriber Policy Data Class holds membership data specifically y related to the policies held by the subscriber of the policy. Subscriber is the person who pays premium for insurance . All other members on policy are better known as dependents of that subscriber.

Pega Internal Name: PegaHC-Data-Party-Subscriber

 

HierarchicalParentIDNumber

Label: Hierarchical parent identifier number

Type: Text

IRCTest

Label: IRCTest

Type: Text

Member

Label: Member

Type: Object

Of Type: Member

MemberReasonCode

Label: Member reason code

Type: Text

OldPCP

Label: OldPCP

Type: Text

OldTermDate

Label: OldTermDate

Type: Date

PCP

Label: PCP

Type: Text

PCPEffectiveDate

Label: PCPEffectiveDate

Type: Date

PCPEndDate

Label: PCPEndDate

Type: Date

AccountNumber

Label: Party account number

Type: Text

AdditionalName

Label: Party additional name

Type: Text

AddressLine1

Label: Party address line 1

Type: Text

AddressLine2

Label: Party address line 2

Type: Text

Age

Label: Party age

Type: Text

BankAccountNumber

Label: Party bank account number

Type: Text

BankIDNumber

Label: Party bank identifier number

Type: Text

Contact

Label: Party contact

Type: List

Of Type: Contact

ContactFunctionCode

Label: Party contact function code

Type: Text

DateOfBirth

Label: Party date of birth

Type: Date

DateOfDeath

Label: Party date of death

Type: Date

EntityIdentifierCode

Label: Party entity identifier code

Type: Text

EntityTypeQualifier

Label: Party entity type qualifier

Type: Text

UCASEFirstName

Label: Party first name - uppercase

Type: Text

FlowType

Label: Party flow type

Type: Text

GroupName

Label: Party group name

Type: Text

GroupNumber

Label: Party group number

Type: Text

HierarchicalIDNumber

Label: Party hierarchical ID number

Type: Text

HierarchicalChildCode

Label: Party hierarchical child code

Type: Text

HierarchicalLevelCode

Label: Party hierarchical level code

Type: Text

IdentificationCode

Label: Party identification code

Type: Text

IdentificationCodeQualifier

Label: Party identification code qualifier

Type: Text

IndividualIdentifier

Label: Party individual identifier

Type: Text

UCASELastName

Label: Party last name - uppercase

Type: Text

MiddleName

Label: Party middle name

Type: Text

NationalProviderIdentifier

Label: Party national provider identifier

Type: Text

NewTaxonomyCode

Label: Party new taxonomy code

Type: Text

PriorityNote

Label: Party priority note

Type: Text

ReceivingDFIIdentifier

Label: Party receiving DFI identifier

Type: Text

SecondaryID

Label: Party secondary identifier

Type: List

Of Type: Embed-PegaHC-Reference

PaymentCode

Label: PaymentCode

Type: Text

ProviderName

Label: ProviderName

Type: Text

Source

Label: Source

Type: Text

FirstName

Label: Subscriber first name

Type: Text

IndividualRelationshipCode

Label: Subscriber individual relationship code

Type: Text

LastName

Label: Subscriber last name

Type: Text

MemberID

Label: Subscriber member ID

Type: Text

MemberKey

Label: Subscriber member key

Type: Text

MemberNumber

Label: Subscriber member number

Type: Identifier

MemberStatus

Label: Subscriber member status

Type: Text

PlanType

Label: Subscriber plan type

Type: Text

PolicyNumber

Label: Subscriber policy number

Type: Text

TaxonomyCode

Label: TaxonomyCode

Type: Text

PcpReasonCode

Label: pcp reason code

Type: Text

PrimaryContact

Label: primary contact

Type: List

Of Type: Contact Information - Embedded

Published March 11, 2019 — Updated March 22, 2019

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