Print

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