PMPM Chart
The Health Chain PMPM Chart data mart is a specialized, centralized repository of data designed to drive member-level financial insights, including but not limited to; claims, allowed amounts vs. paid amounts, month over month costs, plan type, type of encounters, itemized costs, encounter volume, and more!
| Table | Column | Datatype | Description |
|---|---|---|---|
| hc_explanationOfbenefit | eob_id | varchar | FHIR record UUID |
| hc_explanationOfbenefit | status | varchar | ExplanationOfBenefitsStatus active | cancelled | draft | entered-in-error |
| hc_explanationOfbenefit | outcome | varchar | Claim Processing Codes queued | complete | error | partial |
| hc_explanationOfbenefit | billable_period_start | datetime | Relevant start time for the claim |
| hc_explanationOfbenefit | billable_period_end | datetime | Relevant end time for the claim |
| hc_adjudication | adjudication_value | decimal | Monetary amount, An amount of economic utility in some recognized currency. |
| hc_codeableconcept | codeableconcept_code | varchar | Type of adjudication information. Filtered on the category of adjudication. |
| hc_explanation_of_benefit_item | unitprice_value | decimal | Fee, charge or cost per item |
| hc_explanation_of_benefit_item | quantity_value | decimal | Count of products or services |
| hc_explanation_of_benefit_item | net_value | decimal | Total item cost |
| hc_explanation_of_benefit_item | serviced_date | datetime | Date or dates of service or product delivery |
| hc_patient | patient_id | varchar | FHIR record UUID |
| hc_humanname | given, family | varchar | A name associated with the patient. Usually a combination of Given names (not always 'first') and Family name (often called 'Surname'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name |
| hc_patient | patient_id | varchar | Unique identifier for each member |
| hc_humanname | given | varchar | Member's first name |
| hc_humanname | family | varchar | Member's last name |
| hc_patient | birth_date | date | Member's date of birth |
| hc_patient | gender | varchar | Member's gender |
| hc_address | address | varchar | Member's address |
| hc_address | city | varchar | City of member's address |
| hc_address | state | varchar | State of member's address |
| hc_address | postal_code | varchar | Postal code of member's address |
| hc_coverage | plan_id | varchar | Unique identifier for the associated plan |
| hc_coverage_class | class_name | varchar | Name of the insurance plan |
| hc_codeableconcept | codeableconcept_type | varchar | Type of the plan (e.g., HMO, PPO) |
| hc_coverage | period_start | date | Coverage start date |
| hc_coverage | period_end | date | Coverage end date |
| hc_encounter | encounter_id | varchar | Unique identifier for each encounter |
| hc_encounter | period_start | date | Date when the encounter occurred |
| hc_codeableconcept | codeableconcept_type | varchar | Type of the encounter (e.g., inpatient, outpatient) |
| hc_encounter | encounter_amount | decimal | Amount associated with the encounter |
| hc_claim | claim_id | varchar | Unique identifier for the claim. |
| hc_claim_item | net | float | The total paid amount across all claims. |
| hc_claim_item | total_allowed_amount | float | The total allowed amount across all claims. |
| hc_claim_item | total_charge_amount | float | The total charge amount across all claims. |
| N/A | month_year | date | Month and year for which the calculation is done |
| N/A | total_amount | decimal | Total amount of encounters in the month |
| N/A | pmpm_value | decimal | PMPM value calculated as total_amount / number of members |