Denoted below are specific Insurance Policy data items and their associated data types to assist with processing a data snapshot.
Field
Description
Values
SEQNO
Unique identifier for the insurance policy.
Numeric - 8 digits
PATIENT
The ID of the Patient. Foreign key to the PACCTNO column in Patient.
Numeric - 8 digits
INSURED_PARTY
The ID of the party that the policy is for. Foreign key to the SEQNO column in Insured Party.
Numeric - 8 digits
INST_DEFAULT
Whether the policy is the default policy for institutional claims for the given priority.
0:Not default 1:Default
PROF_DEFAULT
Whether the policy is the default policy for professional claims for the given priority.
0:Not default 1:Default
Payer
ID of the payer the policy is for. Foreign key to the SEQNO column in Payer.
Numeric - 8 digits
PRIORITY
Whether the policy is Primary, Secondary, or Tertiary. Note: A patient (or insured party) can have multiple policies for each priority, but each priority will only have one professional default and one institutional default per patient.
1:Primary 2:Secondary 3:Tertiary
POLICY_TYPE
The type of policy. The meaning of the value depends on whether the policy is primary or not.
For Primary, values are:
0: Auto Insurance Policy 1: Group Policy 2: Individual Policy 3: Long Term Policy 4: Litigation 6: Medicare Primary 7: Other 8: Self-Pay (Cash) 9: Supplemental Policy
For Secondary, values are:
* (0-9 Same as Primary) 10: MEDICARE SECONDARY - Working Ages 11: MEDICARE SECONDARY - ESRD beneficiary with group health plan 12: MEDICARE SECONDARY - No fault insurance 13: MEDICARE SECONDARY - Worker's Compensation 14: MEDICARE SECONDARY -PHS or other federal agency 15: MEDICARE SECONDARY - Black lung 16: MEDICARE SECONDARY - VA 17: MEDICARE SECONDARY - Disabled beneficiary under age 65 with LGHP 18: MEDICARE SECONDARY - Any liability insurance