InsurancePlanCoverag

The table contains high-level information on both managed care and indemnity coverage records in your system.

Column Name	Type	Description
SignatureOnFileDate	DATETIME	The date when the signature was filed.
SubscriberRace	INTEGER	The race of the subscriber.
CoverageCardIssueDate	DATETIME	Stores the card issue date.
MedicareReserveDaysRemaining	NUMERIC	This is the number of Medicare Reserved Days Remaining
CoverageBenefitCode	VARCHAR	The benefit code for this coverage. This can contain any facility-specific benefit code.
CoverageSourceOrganizationIdentifier	NUMERIC	The Organization (DXO) that provided the information for this coverage.
CoverageMailingAddressDistrictCode	INTEGER	The district of the mailing address of the coverage (administrative offices).
CoverageExternalRoutingNumber	VARCHAR	The external routing number for the coverage
AssociatedPatientConfidentialName	VARCHAR	This item contains the confidential name of the associated patient, if it exists. The name is used to determine the confidential nature of the subscriber.
CoverageHasThirdPartyLiabilityIndicator	VARCHAR	Indicates if there is third-party liability for this coverage.
SubscriberChampusTricareMilitaryServiceBranch	VARCHAR	The military service branch for a CHAMPUS/Tricare coverage subscriber.
SubscriberDateOfBirth	DATETIME	The date of birth for the subscriber on the coverage.
SubscriberPatientRecordIdentifier	VARCHAR	If the subscriber is the same person as a patient, this item contains the patient ID.
SubscriberSpouseRetirementDate	DATETIME	The date when the coverage subscriber's spouse retired.
SubscriberCityName	VARCHAR	The city of the mailing address for the subscriber on the coverage.
CobraTerminationDate	DATETIME	The termination date for any COBRA arrangement.
SubscriberBankAccountIdentifier	VARCHAR	Banking details of the subscriber.
SubscriberHomePhoneNumber	VARCHAR	The home phone number for the subscriber on the coverage.
TreatmentAuthorizationRequestSecondSpecialAidCode	VARCHAR	Second special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
CoverageAddressLineTwo	VARCHAR	The second line of the address of the coverage (administrative offices).
CoverageMedicareTypeCategory	INTEGER	The category number for the type of Medicare coverage the patient has.
ComprehensiveCommunityServicesCountyOfficePhoneNumber	VARCHAR	Stores the phone number for the Comprehensive Community Services (CCS) County Office.
CoveragePayorCity	VARCHAR	The coverage payor's city.
ShouldPromptCoverageVerification	VARCHAR	Indicates whether the system should prompt for verification of the coverage.
MedicareCoinsuranceDaysRemaining	NUMERIC	This is the number of Medicare Coinsurance Days Remaining
SubscriberEmployerDistrict	INTEGER	The district of the subscriber's employer's address on a coverage
RecordSourceCommunityIdentifier	VARCHAR	The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect.
ExternalPayerName	VARCHAR	Payer name received for a coverage from an external payer system.
IsMedicareSp	VARCHAR	Indicates whether a Medicare patient's spouse is employed.
SubscriberPostalCode	VARCHAR	The postal code of the mailing address for the subscriber on the coverage.
Copied	NUMERIC	The ID of the coverage from which this coverage was copied.
ExternalPayerLineOfBusinessTypeCode	INTEGER	Line of business type received for a coverage from an external payer system.
IsMedicareDisabilityBenefitRecipient	VARCHAR	Indicates if a Medicare patient is receiving disability benefit.
CoverageLastVerifiedDate	DATETIME	The last date the coverage was verified.
ThirdPartyLiabilityResourceCode	VARCHAR	This column lists the Third Party Liability resource code for a specific plan. This code is either returned in the real-time eligibility response or found on the patient's insurance card.
PayorIdentification	NUMERIC	This column is only populated for indemnity coverages (COVERAGE_TYPE_C equal to 1). This column stores the unique identifier of the payor associated with the coverage record. To look up the payor for managed care coverages (COVERAGE_TYPE_C equal to 2), join COVERAGE.COVERAGE_ID on V_COVERAGE_PAYOR_PLAN.COVERAGE_ID and filter on V_COVERAGE_PAYOR_PLAN.EFF_DATE and V_COVERAGE_PAYOR_PLAN.TERM_DATE to find the relevant PAYOR_ID.
CoverageSubscriberRetirementDate	DATETIME	The date when the coverage subscriber retired.
CoverageEnrollmentReason	INTEGER	This category value stores the enrollment reason of the coverage.
IsIllnessCoveredByVeteransAdministration	VARCHAR	Indicates if the illness is covered by a Veterans' Administration program.
DeprecatedSubscriberEmployerAddressLine1	VARCHAR	This column, although not deprecated, should no longer be used. Instead you should use the column SUBSCR_EMPR_ADDR (CVG 236) in table CVG_SUBSCR_EMPR_ADDR. The address can contain an unlimited number of lines. Previously you could only access the first two lines with the columns COVERAGE.SUBSCR_EEP_ADDR_1 and COVERAGE.SUBSCR_EEP_ADDR_2. The table CVG_SUBSCR_EMPR_ADDR allows you to get all lines of the coverage subscriber's employer address. We have chosen not to deprecate COVERAGE.SUBSCR_EEP_ADDR_1 and COVERAGE.SUBSCR_EEP_ADDR_2 because doing so would break any custom reports that use these columns.
IsMedicareRenalDialysisPatient	VARCHAR	Indicates whether the patient is a renal dialysis patient.
SubscriberIsUnitedStatesCitizenIndicator	VARCHAR	Indicates whether the subscriber is a U.S. citizen.
MedicaidCaseheadName	VARCHAR	The Medicaid name on the case head.
SubscriberEmployerCounty	VARCHAR	The county of the subscriber's employer's address on a coverage
CoverageHealthMaintenanceOrganizationSitePhoneNumber	VARCHAR	The phone number for the coverage's HMO.
SubscriberEmploymentStartDate	DATETIME	The date on which the subscriber began working for the employer associated with the employer group.
IsVeteransAdministrationProgramCoverage	VARCHAR	Indicates whether this coverage is for a Veterans' Administration program.
SubscriberEmployerAddressCity	VARCHAR	The City field of the subscriber's employer's address on the coverage.
IsMedicareCoveredByWorkersCompensation	VARCHAR	Indicates if a Medicare visit is covered by Workman's Compensation.
CoverageCopayAmount	VARCHAR	The copay amount for the coverage.
CoverageYearToDatePaymentsUsedAmount	VARCHAR	The year-to-date payments made against the coverage's payor.
IsMedicareSpouseRetired	VARCHAR	Indicates whether a Medicare patient's spouse is retired.
CoverageRecordIdentifier	NUMERIC	The unique ID of the coverage record. This column may be hidden if you have elected to use enterprise reporting’s security utility.
CoverageGroupName	VARCHAR	The name of the coverage group.
MedicareOtherInsuranceCompany	VARCHAR	An additional insurance company providing coverage for a Medicare patient.
ScheduledDiscontinuationDate	DATETIME	The date when the coverage is scheduled to be discontinued.
CoverageNextVerificationDate	DATETIME	The date on which this coverage should next be verified. This is calculated every time the coverage is verified.
CoverageHmoSiteNumber	VARCHAR	The site number for the coverage's HMO.
IsMedicarePatientEmployedIndicator	VARCHAR	Indicates whether the Medicare patient is employed.
SubscriberEmployerZipCode	VARCHAR	The zip code of the subscriber's employer's address on a coverage
IsMedicareGuardianEmployerOver100Employees	VARCHAR	Indicates whether the employer of this patient's parent or guardian employs over 100 people.
SubscriberEmployerOtherComment	VARCHAR	A free text comment that can be entered when the value that is considered to be "Other" is selected as the employer. This option is available only if your organization has chosen to link the subscriber employer to the Employer (EEP) master file in the Facility Profile.
FederalEmploymentProgramEnrollmentCode	VARCHAR	The Federal Employment Program enrollment code.
CoverageMailingAddressZipCode	VARCHAR	The zip code of the mailing address of the coverage (administrative offices).
WebApplicationIdentifier	VARCHAR	The unique ID of the web application if the coverage is created based on a web application.
MedicareSecondaryPayerTypeCode	VARCHAR	Medicare Secondary Insurance Type Code.
FirstSpecialAidCodeForMediCalTreatmentAuthorizationRequest	VARCHAR	First special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
CoverageSubscriberEmployerFaxNumber	VARCHAR	The fax number of the coverage subscriber's employer.
IsVerifiedThroughEligibilityVerificationSystem	VARCHAR	Indicates if verification is done through Eligibility Verification Systems (EVS).
CoveragePayorHasMedigapAuthorizationIndicator	VARCHAR	Indicates whether the payor for this coverage has Medigap authorization.
WorkersCompensationEmployerIdentifier	VARCHAR	Workers' compensation employer at the time of injury.
IsMedicareParentOrGuardianEmployed	VARCHAR	Indicates whether the patient's parents or guardians are employed.
SubscriberEmploymentStatus	INTEGER	The employment status of the subscriber's employer on a coverage (i.e. full, part, etc.).
ExternalCoverageFastHealthcareInteroperabilityResourcesIdentifier	VARCHAR	The FHIR Id of a coverage record on an external system that was used to create this coverage.
SubscriberMailingAddressCountry	VARCHAR	The country of the mailing address for the subscriber on the coverage.
SubscriberEmployerCountryCategory	VARCHAR	The category number for the country of the subscriber's employer.
CoverageCopaymentNotes	VARCHAR	Notes regarding copay information for this coverage.
ExternalReferenceFinancialClass	INTEGER	Reference financial class received for a coverage from an external payer system.
CaseheadMedicaidIdentificationNumber	VARCHAR	The Medicaid ID number on the case head.
IsDeductibleMet	INTEGER	Indicates whether the deductible has been met for this coverage. The deductible can be established on the guarantor account or patient level.
SignatureOnFileLocation	VARCHAR	The location at which the signature was filed.
EmployerGroupIdentifier	VARCHAR	The ID of the employer group that determines the benefits in a managed care coverage. This item is NULL for indemnity coverages.
MedicareRetirementDate	DATETIME	The date when a Medicare patient retired.
IsMedicareCoveredByParentGuardian	VARCHAR	For large group health plans, indicates if the patient is covered by their parent or guardian.
CoverageFinancialClass	VARCHAR	The financial class for this coverage. This is only used for CMS claims forms and may not be reliably populated for reporting. Reporting should done using the financial class of the payor specified in this coverage.
IsMedicareFamilyMemberEmployed	VARCHAR	Indicates whether a Medicare patient's spouse or another family member is employed.
OwningBusinessSegmentFacilityIdentification	NUMERIC	Owning service area/business segment, for use in business segmentation
MedicarePartAEffectiveDate	DATETIME	The effective date of Medicare Part A.
CoverageGroupNumber	VARCHAR	The group number for the coverage.
ComprehensiveCommunityServicesPatientIdentification	VARCHAR	The patient's Comprehensive Community Services (CCS) ID.
External	VARCHAR	The OID of a coverage record on an external system that was used to create this coverage.
MedicarePartBEffectiveDate	DATETIME	The effective date of Medicare Part B.
CoverageFinancialClassification	INTEGER	The category value that indicates whether a coverage is managed care or indemnity; 1 – Indemnity, 2 – Managed Care.
SubscriberEmployer	VARCHAR	The house number of the subscriber's employer's address on a coverage
IntraConnectOwningInstanceCommunityIdentifier	VARCHAR	The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect.
ExternalPlanLogoFhirIdentifier	VARCHAR	Plan logo binary FHIR ID received for a coverage from an external payer system.
PatientToSubscriberRelationshipCategory	INTEGER	The patient to subscriber relationship category number for this coverage.
SubscriberEmployerIdentifier	VARCHAR	This is the unique ID of the employer of the patient subscribing to the coverage if EAF 6410 is set to 1. This is free text if EAF 6410 is set to 2.
CoverageThirdSpecialAidCode	VARCHAR	Third special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
IsDisabilityCoverageByEmployerMedicare	VARCHAR	Indicates if a Medicare patient is receiving disability coverage from their employer.
SubscriberEmployerAddressState	VARCHAR	The state of the subscriber's employer's address on a coverage.
CoverageVerificationUserIdentification	VARCHAR	The ID of the user who performed the verification.
SubscriberWorkPhoneNumber	VARCHAR	The work phone number for the subscriber on the coverage.
IndemnityBenefitPlanIdentifier	NUMERIC	This column is only populated for indemnity coverages (COVERAGE_TYPE_C equal to 1). This column stores the unique identifier of the benefit plan associated with the coverage record. To look up the benefit plan for managed care coverages (COVERAGE_TYPE_C equal to 2), join COVERAGE.COVERAGE_ID on V_COVERAGE_PAYOR_PLAN.COVERAGE_ID and filter on V_COVERAGE_PAYOR_PLAN.EFF_DATE and V_COVERAGE_PAYOR_PLAN.TERM_DATE to find the relevant BENEFIT_PLAN_ID.
MedicareSpouseRetirementDate	DATETIME	The date when a Medicare patient's spouse retired.
SubscriberRelationshipToGuarantorCategory	INTEGER	The category number for the subscriber's relationship to the guarantor.
PayerGroupNumber	VARCHAR	The identification number assigned to this subscriber's employer/plan group by the payor. This number will appear in box 11 of the HCFA claim form.
CoverageRetroAdjudicationQueueFlag	VARCHAR	The retroadjudication queue flag for the coverage. Indicates if the coverage should be queued for retroadjudication from self-pay to insurance. 1 if the coverage is newly created and the only coverage on its account.
DeploymentPhysicalOwnerIdentifier	VARCHAR	ID of the physical deployment owner for this record. Physical owners will be where the data is hosted, either on the cross-over server or the owner deployment.
SubscriberSocialSecurityNumber	VARCHAR	The SSN number of the subscriber on a coverage
CoverageEligibilityCountyCode	INTEGER	This item will store the county code that is returned from the 271 message.
TransferredFromCoverageIdentifier	NUMERIC	The ID of the coverage from which this coverage is transferred from.
IsMedicareCoveredByEmployerGroupHealthPlan	VARCHAR	Indicates whether the patient is covered by an employer group health plan.
CoverageCarryoverBucketLimitsExceededFlag	VARCHAR	Flag to indicate if bucket limits exceeded during carryover
SubscriberSex	VARCHAR	The sex of the subscriber on the coverage.
IsIllnessOrInjuryFromAutoAccident	VARCHAR	Indicates if the illness or injury for this visit is due to an automobile accident.
IsTefraPatient	VARCHAR	Indicates whether the patient is TEFRA. A patient is TEFRA if an eligible Medicare beneficiary is covered by a group health plan.
CoverageMailingAddressCounty	VARCHAR	The county of the mailing address of the coverage (administrative offices).
CoverageVerificationSource	INTEGER	How the information was verified. This is customer-specific and may contain values such as manual, PassPort, WebMD, etc.
CoverageMailingAddressHouseNumber	VARCHAR	The house number of the mailing address of the coverage (administrative offices).
CoverageApplicationDate	DATETIME	The date on which the subscriber applied for coverage.
IsMedicareRenalDialysisPatientEntitlementIndicator	VARCHAR	Indicates whether the patient is a renal dialysis patient in the first 12 months of entitlement.
ClaimSubmissionOrganizationName	VARCHAR	The title or name of the organization to which submitted claims under this coverage will be sent.
HasSignatureOnFile	VARCHAR	Appears in Box 12 of HCFA claims. This is a Yes/No field that denotes whether authorization has been obtained to send bill or other documentation to payor for services relating to the claim.
CoverageScheduledActivationDate	DATETIME	The date when the coverage is scheduled to be activated.
TricareSubscriberStatus	VARCHAR	The CHAMPUS/Tricare subscriber status.
SubscriberPatientIdentification	VARCHAR	This item contains the subscriber patient Id of a coverage and will be used to associate patients with linked premium billing accounts for EHI.
ExternalPayerPlanName	VARCHAR	Plan name received for a coverage from an external payer system.
IsMedicareEmployerOver100Employees	VARCHAR	Indicates if a Medicare employer has over 100 employees.
CoveragePayorName	VARCHAR	The coverage payor's name.
CoveragePlanFreeTextFormat	VARCHAR	The format of the coverage's free-text plan.
ComprehensiveCommunityServicesCoordinatorPhoneNumber	VARCHAR	Stores the phone number for the Comprehensive Community Services (CCS) Case Coordinator.
CoverageAddressLineOne	VARCHAR	The first line of the address of the coverage (administrative offices).
IsMedicarePatientRetired	VARCHAR	Indicates whether a Medicare patient is retired.
IsPatientSelfAdministeringEpoIndicator	VARCHAR	Indicates whether this patient self-administers EPO.
YearlyAllowedDollarTotal	VARCHAR	The yearly dollar limit for payments against this coverage's payor.
CoverageCoinsuranceOverrideAmount	NUMERIC	Numeric Value for the coverage level coinsurance override.
MedicareHmoEnrollmentStatus	VARCHAR	Indicates if the Medicare patient is enrolled in an HMO.
CoverageSubscriberOccupation	VARCHAR	The coverage subscriber's occupation.
SubscriberMailingAddressCounty	VARCHAR	The county of the mailing address for the subscriber on the coverage.
IsMedicareLiabilityAccidentRelated	VARCHAR	Indicates if the illness or injury for this visit is due to a liability accident.
SubscriberName	VARCHAR	The name of the subscriber for the coverage. This column may be hidden if you have elected to use enterprise reporting’s security utility.
IsLateEnrollmentIndicator	VARCHAR	Y if the subscriber applied for coverage outside of the open enrollment period. N or NULL if not specified as a late enrollment coverage.
MedicareSubscriberIdentification	VARCHAR	The unique ID of the subscriber that will be used for supplemental claims.