Health Insurance Claims Application Data Structure
Below is a Health Care Claims Application data model structure.
- Hospitals
-
- Hospital_ID
- Hospital_Name
- Other_Hospital_Details
- Claims
-
- Claim_ID
- Claim_Status_Code
- Hospital_ID
- Insurance_Company_ID
- Patient_ID
- Updated_Date
- Amount_Claimed
- Amount_Paid
- Other_Claim_Details
- Claim Status
-
- Claim_Status_Code
- Claim_Status_Description(In Dispute, Settled)
- Claim Dispute Management
-
- Dispute_Area_Code
- Dispute_Area_Description(None,Consultation,Medication,Treatment)
- Patients
-
- Patient_ID
- Gender
- Date_Of_Birth
- Patient_Name
- Patient_Address
- Other_Patient_Details
- Insurance Companies
-
- Insurance_Company_ID
- Insurance_Company_Name
- Insurance_Company_Other_Details
- Staff
-
- Staff_ID
- Staff_Category_Code
- Gender
- Staff_Firstname
- Staff_Lastname
- Staff_Qualifications
- Staff_Birth_Date
- Staff_Other_Details
- Claim Processing Module
-
- Claim_ID
- Process_Date
- Dispute_Area_Code
- Processor_Staff_ID
- End_Date
- Step_Descriptions
Reference: http://www.databaseanswers.org/data_models/health_insurance_claims/index.htm