General informations
Fields (122)
| Name | Label | Type | Description |
|---|---|---|---|
| Id | Care Request ID | ID | |
| IsDeleted | Deleted | CHECKBOX | |
| Name | Name | TEXT(255) | |
| RecordTypeId | Record Type ID | LOOKUP | |
| CreatedDate | Created Date | DATETIME | |
| CreatedById | Created By ID | LOOKUP | |
| LastModifiedDate | Last Modified Date | DATETIME | |
| LastModifiedById | Last Modified By ID | LOOKUP | |
| SystemModstamp | System Modstamp | DATETIME | |
| LastViewedDate | Last Viewed Date | DATETIME | |
| LastReferencedDate | Last Referenced Date | DATETIME | |
| CareRequestCaseId | Case ID | MASTER-DETAIL | |
| GeneralPractitionerId | Contact ID | LOOKUP | |
| GeneralPractitionerVerbalNotifiedDate | General Practitioner Verbal Notification Date | DATETIME | |
| GeneralPractitionerWrittenNotifiedDate | General Practitioner Written Notification Date | DATETIME | |
| AppointedRepresentativeId | Account ID | LOOKUP | |
| AorRequestedDate | AOR Requested Date | DATETIME | |
| AorReceivedDate | AOR Received Date | DATETIME | |
| AppointedRepVerbalContactDate | Appointed Rep Verbal Contact Date | DATETIME | |
| AppointedRepWrittenContactDate | Appointed Rep Written Contact Date | DATETIME | |
| MemberId | Account ID | LOOKUP | |
| FacilityRecordNumber | Facility Record Number | TEXT(32) | |
| FacilityRoomNumber | Facility Room Number | TEXT(32) | |
| RequestingPractitionerId | Contact ID | LOOKUP | |
| ServicingPractitionerId | Contact ID | LOOKUP | |
| ServicingFacilityId | Account ID | LOOKUP | |
| AdmissionNotes | Admission Notes | TEXT AREA (LONG)(32000) | |
| RequestedLengthOfStay | Requested Length of Stay | AUTO NUMBER | |
| ModifiedLengthOfStay | Modified Length of Stay | AUTO NUMBER | |
| ApprovedLengthOfStay | Approved Length of Stay | AUTO NUMBER | |
| DeniedLengthOfStay | Denied Length of Stay | AUTO NUMBER | |
| CumulativeLengthOfStay | Cumulative Length of Stay | AUTO NUMBER | |
| ScheduledAdmissionDate | Scheduled Admission Date | DATETIME | |
| ActualAdmissionDate | Actual Admission Date | DATETIME | |
| ScheduledDischargeDate | Scheduled Discharge Date | DATETIME | |
| ActualDischargeDate | Actual Discharge Date | DATETIME | |
| MemberVerbalNotificationDate | Member Verbal Notification Date | DATETIME | |
| MemberWrittenNotificationDate | Member Written Notification Date | DATETIME | |
| RequestPractitionerVerbalNotifiedDate | Requesting Practitioner Verbal Notification Date | DATETIME | |
| RequestPractitionerWrittenNotifiedDate | Requesting Practitioner Written Notification Date | DATETIME | |
| ReceivedDate | Received Date | DATETIME | |
| RequestedDate | Requested Date | DATETIME | |
| DecisionReasonDescription | Decision Reason Description | TEXT AREA (LONG)(32000) | |
| DecisionNotes | Decision Notes | TEXT AREA (LONG)(32000) | |
| DecisionDate | Decision Date | DATETIME | |
| EffectiveFrom | Effective From | DATETIME | |
| EffectiveTo | Effective To | DATETIME | |
| ExpirationDate | Expiration Date | DATETIME | |
| DueDate | Due Date | DATETIME | |
| ReviewDate | Review Date | DATETIME | |
| NextReviewDate | Next Review Date | DATETIME | |
| ReopenedDate | Reopened Date | DATETIME | |
| ReopenReasonDescription | Reopen Reason Description | TEXT AREA (LONG)(32000) | |
| ModificationDate | Modification Date | DATETIME | |
| IsExtendedRequest | Extended Request | CHECKBOX | |
| ExtensionRequestReceivedDate | Extension Request Received Date | DATETIME | |
| SourceSystemIdentifier | Source System Identifier | TEXT(255) | |
| SourceSystem | Source System | TEXT(255) | |
| SourceSystemModified | Source System Modified | DATETIME | |
| DecisionLetter | Decision Letter | TEXT AREA (LONG)(32000) | |
| InfoRequestedDate | Info Requested Date | DATETIME | |
| InfoReceivedDate | Info Received Date | DATETIME | |
| FirstReviewerId | User ID | LOOKUP | |
| MedicalDirectorId | User ID | LOOKUP | |
| FirstReviewerNotes | First Reviewer Notes | TEXT AREA (LONG)(32000) | |
| MedicalDirectorNotes | Medical Director Notes | TEXT AREA (LONG)(32000) | |
| ResolutionNotes | Resolution Notes | TEXT AREA (LONG)(32000) | |
| AcknowledgementLetterSentDate | Acknowledgement Letter Sent Date | DATETIME | |
| ResolutionLetterSentDate | Resolution Letter Sent Date | DATETIME | |
| MemberContactDateTime | Member Contact Date | DATETIME | |
| PractitionerContactDateTime | Practitioner Contact Date | DATETIME | |
| OriginalDenialMedicalDirectorId | User ID | LOOKUP | |
| RootCauseNotes | Root Cause Notes | TEXT AREA (LONG)(32000) | |
| DispositionNotes | Disposition Notes | TEXT AREA (LONG)(32000) | |
| ExternalComplaintIdentifier | External Complaint ID | TEXT(255) | |
| ResolutionDate | Resolution Date | DATETIME | |
| ReferenceCaseNumber | Reference Case Number | TEXT(32) | |
| ServiceDate | Service Date | DATE | |
| IsServiceOrMedicationReceived | Service or Medication Received | CHECKBOX | |
| ClaimNumber | Claim Number | TEXT(32) | |
| InitialDenialNotificationDate | Initial Denial Notification Date | DATE | |
| ReconsiderationDenialNotificationDate | Reconsideration Denial Notification Date | DATE | |
| FacilityRoomBedType | Facility Room Bed Type | PICKLIST | |
| RequestedLevelOfCare | Requested Level of Care | PICKLIST | |
| ModifiedLevelOfCare | Modified Level of Care | PICKLIST | |
| ApprovedLevelOfCare | Approved Level of Care | PICKLIST | |
| DeniedLevelOfCare | Denied Level of Care | PICKLIST | |
| CurrentLevelOfCare | Current Level of Care | PICKLIST | |
| FinalLevelOfCare | Final Level of Care | PICKLIST | |
| ClinicalCaseType | Clinical Case Type | PICKLIST | |
| PlaceOfService | Place of Service | PICKLIST | |
| CriteriaMet | Criteria Met | PICKLIST | |
| ParProvider | Par Provider | PICKLIST | |
| RequestingPractitionerLicense | Requesting Practitioner License | PICKLIST | |
| RequestingPractitionerSpecialty | Requesting Practitioner Specialty | PICKLIST | |
| ServicingPractitionerLicense | Servicing Practitioner License | PICKLIST | |
| ServicingPractitionerSpecialty | Servicing Practitioner Specialty | PICKLIST | |
| AdmissionType | Admission Type | PICKLIST | |
| AdmissionSource | Admission Source | PICKLIST | |
| DecisionReason | Decision Reason | PICKLIST | |
| ReopenReason | Reopen Reason | PICKLIST | |
| RequesterType | Requester Type | PICKLIST | |
| MemberFirstName | Member First Name | TEXT(40) | |
| MemberLastName | Member Last Name | TEXT(80) | |
| MemberDateOfBirth | Member Date of Birth | DATE | |
| MemberIdentificationNumber | Member ID | TEXT(64) | |
| MemberGroupNumber | Member Group Number | TEXT(64) | |
| DecisionDaysRemaining | Decision Days Remaining | ROLL-UP SUMMARY | |
| MemberGender | Member Gender | PICKLIST | |
| QuantityType | Quantity Type | PICKLIST | |
| MemberStatus | Member Status | TEXT AREA(255) | |
| MemberCondition | Member Condition | TEXT AREA(255) | |
| MemberPrognosis | Member Prognosis | PICKLIST | |
| MemberPrimaryPlanId | Member Plan ID | LOOKUP | |
| MemberSecondaryPlanId | Member Plan ID | LOOKUP | |
| IsReadmission | Readmission | CHECKBOX | |
| ReferenceCareRequestCaseId | Case ID | LOOKUP | |
| AppealRequestReasonType | Appeal Request Reason Type | PICKLIST | |
| GrievanceType | Grievance Type | PICKLIST | |
| InitialDenialNotificationTime | Initial Denial Notification Time | TIME | |
| ReconsiderationDenialNotificationTime | Reconsideration Denial Notification Time | TIME | |
| HealthcareProvider_Id_1 | HealthcareProvider_Healthcare Provider ID_1 | LOOKUP |
Fields Details (122)
| Name | Id |
| Label | Care Request ID |
| Type | ID |
| Required | Yes |
| Name | IsDeleted |
| Label | Deleted |
| Type | CHECKBOX |
| Required | Yes |
| Default value | false |
| Name | Name |
| Label | Name |
| Type | TEXT(255) |
| Required | Yes |
| Name | RecordTypeId |
| Label | Record Type ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | CreatedDate |
| Label | Created Date |
| Type | DATETIME |
| Required | Yes |
| Name | CreatedById |
| Label | Created By ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Required | Yes |
| Name | LastModifiedDate |
| Label | Last Modified Date |
| Type | DATETIME |
| Required | Yes |
| Name | LastModifiedById |
| Label | Last Modified By ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Required | Yes |
| Name | SystemModstamp |
| Label | System Modstamp |
| Type | DATETIME |
| Required | Yes |
| Name | LastViewedDate |
| Label | Last Viewed Date |
| Type | DATETIME |
| Name | LastReferencedDate |
| Label | Last Referenced Date |
| Type | DATETIME |
| Name | CareRequestCaseId |
| Label | Case ID |
| Type | MASTER-DETAIL |
| Foreign key | Yes |
| Required | Yes |
| Name | GeneralPractitionerId |
| Label | Contact ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | GeneralPractitionerVerbalNotifiedDate |
| Label | General Practitioner Verbal Notification Date |
| Type | DATETIME |
| Name | GeneralPractitionerWrittenNotifiedDate |
| Label | General Practitioner Written Notification Date |
| Type | DATETIME |
| Name | AppointedRepresentativeId |
| Label | Account ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | AorRequestedDate |
| Label | AOR Requested Date |
| Type | DATETIME |
| Name | AorReceivedDate |
| Label | AOR Received Date |
| Type | DATETIME |
| Name | AppointedRepVerbalContactDate |
| Label | Appointed Rep Verbal Contact Date |
| Type | DATETIME |
| Name | AppointedRepWrittenContactDate |
| Label | Appointed Rep Written Contact Date |
| Type | DATETIME |
| Name | MemberId |
| Label | Account ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | FacilityRecordNumber |
| Label | Facility Record Number |
| Type | TEXT(32) |
| Name | FacilityRoomNumber |
| Label | Facility Room Number |
| Type | TEXT(32) |
| Name | RequestingPractitionerId |
| Label | Contact ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | ServicingPractitionerId |
| Label | Contact ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | ServicingFacilityId |
| Label | Account ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | AdmissionNotes |
| Label | Admission Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | RequestedLengthOfStay |
| Label | Requested Length of Stay |
| Type | AUTO NUMBER |
| Name | ModifiedLengthOfStay |
| Label | Modified Length of Stay |
| Type | AUTO NUMBER |
| Name | ApprovedLengthOfStay |
| Label | Approved Length of Stay |
| Type | AUTO NUMBER |
| Name | DeniedLengthOfStay |
| Label | Denied Length of Stay |
| Type | AUTO NUMBER |
| Name | CumulativeLengthOfStay |
| Label | Cumulative Length of Stay |
| Type | AUTO NUMBER |
| Name | ScheduledAdmissionDate |
| Label | Scheduled Admission Date |
| Type | DATETIME |
| Name | ActualAdmissionDate |
| Label | Actual Admission Date |
| Type | DATETIME |
| Name | ScheduledDischargeDate |
| Label | Scheduled Discharge Date |
| Type | DATETIME |
| Name | ActualDischargeDate |
| Label | Actual Discharge Date |
| Type | DATETIME |
| Name | MemberVerbalNotificationDate |
| Label | Member Verbal Notification Date |
| Type | DATETIME |
| Name | MemberWrittenNotificationDate |
| Label | Member Written Notification Date |
| Type | DATETIME |
| Name | RequestPractitionerVerbalNotifiedDate |
| Label | Requesting Practitioner Verbal Notification Date |
| Type | DATETIME |
| Name | RequestPractitionerWrittenNotifiedDate |
| Label | Requesting Practitioner Written Notification Date |
| Type | DATETIME |
| Name | ReceivedDate |
| Label | Received Date |
| Type | DATETIME |
| Name | RequestedDate |
| Label | Requested Date |
| Type | DATETIME |
| Name | DecisionReasonDescription |
| Label | Decision Reason Description |
| Type | TEXT AREA (LONG)(32000) |
| Name | DecisionNotes |
| Label | Decision Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | DecisionDate |
| Label | Decision Date |
| Type | DATETIME |
| Name | EffectiveFrom |
| Label | Effective From |
| Type | DATETIME |
| Name | EffectiveTo |
| Label | Effective To |
| Type | DATETIME |
| Name | ExpirationDate |
| Label | Expiration Date |
| Type | DATETIME |
| Name | DueDate |
| Label | Due Date |
| Type | DATETIME |
| Name | ReviewDate |
| Label | Review Date |
| Type | DATETIME |
| Name | NextReviewDate |
| Label | Next Review Date |
| Type | DATETIME |
| Name | ReopenedDate |
| Label | Reopened Date |
| Type | DATETIME |
| Name | ReopenReasonDescription |
| Label | Reopen Reason Description |
| Type | TEXT AREA (LONG)(32000) |
| Name | ModificationDate |
| Label | Modification Date |
| Type | DATETIME |
| Name | IsExtendedRequest |
| Label | Extended Request |
| Type | CHECKBOX |
| Required | Yes |
| Default value | false |
| Name | ExtensionRequestReceivedDate |
| Label | Extension Request Received Date |
| Type | DATETIME |
| Name | SourceSystemIdentifier |
| Label | Source System Identifier |
| Type | TEXT(255) |
| Name | SourceSystem |
| Label | Source System |
| Type | TEXT(255) |
| Name | SourceSystemModified |
| Label | Source System Modified |
| Type | DATETIME |
| Name | DecisionLetter |
| Label | Decision Letter |
| Type | TEXT AREA (LONG)(32000) |
| Name | InfoRequestedDate |
| Label | Info Requested Date |
| Type | DATETIME |
| Name | InfoReceivedDate |
| Label | Info Received Date |
| Type | DATETIME |
| Name | FirstReviewerId |
| Label | User ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | MedicalDirectorId |
| Label | User ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | FirstReviewerNotes |
| Label | First Reviewer Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | MedicalDirectorNotes |
| Label | Medical Director Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | ResolutionNotes |
| Label | Resolution Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | AcknowledgementLetterSentDate |
| Label | Acknowledgement Letter Sent Date |
| Type | DATETIME |
| Name | ResolutionLetterSentDate |
| Label | Resolution Letter Sent Date |
| Type | DATETIME |
| Name | MemberContactDateTime |
| Label | Member Contact Date |
| Type | DATETIME |
| Name | PractitionerContactDateTime |
| Label | Practitioner Contact Date |
| Type | DATETIME |
| Name | OriginalDenialMedicalDirectorId |
| Label | User ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | RootCauseNotes |
| Label | Root Cause Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | DispositionNotes |
| Label | Disposition Notes |
| Type | TEXT AREA (LONG)(32000) |
| Name | ExternalComplaintIdentifier |
| Label | External Complaint ID |
| Type | TEXT(255) |
| Name | ResolutionDate |
| Label | Resolution Date |
| Type | DATETIME |
| Name | ReferenceCaseNumber |
| Label | Reference Case Number |
| Type | TEXT(32) |
| Name | ServiceDate |
| Label | Service Date |
| Type | DATE |
| Name | IsServiceOrMedicationReceived |
| Label | Service or Medication Received |
| Type | CHECKBOX |
| Required | Yes |
| Default value | false |
| Name | ClaimNumber |
| Label | Claim Number |
| Type | TEXT(32) |
| Name | InitialDenialNotificationDate |
| Label | Initial Denial Notification Date |
| Type | DATE |
| Name | ReconsiderationDenialNotificationDate |
| Label | Reconsideration Denial Notification Date |
| Type | DATE |
| Name | FacilityRoomBedType |
| Label | Facility Room Bed Type |
| Type | PICKLIST |
| Picklist values | Acute Intermediate Telemetry ICU |
| Name | RequestedLevelOfCare |
| Label | Requested Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | ModifiedLevelOfCare |
| Label | Modified Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | ApprovedLevelOfCare |
| Label | Approved Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | DeniedLevelOfCare |
| Label | Denied Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | CurrentLevelOfCare |
| Label | Current Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | FinalLevelOfCare |
| Label | Final Level of Care |
| Type | PICKLIST |
| Picklist values | Hospital - Observation Hospital - Inpatient Hospital - Intensive Care Hospital - Rehabilitation SNF - Inpatient SNF - Specialized Care SNF - Rehabilitation |
| Name | ClinicalCaseType |
| Label | Clinical Case Type |
| Type | PICKLIST |
| Picklist values | Acute Stress Disorder Adult Asthma Adult Diabetes Chemical Dependency CNS Disorders Congestive Heart Failure Coronary Artery Disease Hepatitis C High Risk Elderly High Risk Fall High Risk Infant High Risk Pregnancy Hip Fracture HIV/AIDS Major Depressive Disorder Morbid Obesity Multiple Trauma Neuromuscular Disease Orthopedic Pain Panic Disorder Pediatric Asthma Smoker Spinal Cord Injury Transplant Traumatic Brain Injury Very Low Birth Weight |
| Name | PlaceOfService |
| Label | Place of Service |
| Type | PICKLIST |
| Picklist values | Inpatient Observation Ambulatory Surgical Center Skilled Nursing Facility Outpatient Home Provider Office |
| Name | CriteriaMet |
| Label | Criteria Met |
| Type | PICKLIST |
| Picklist values | Yes No |
| Name | ParProvider |
| Label | Par Provider |
| Type | PICKLIST |
| Picklist values | Yes No |
| Name | RequestingPractitionerLicense |
| Label | Requesting Practitioner License |
| Type | PICKLIST |
| Picklist values | M.D. D.O. N.P. P.A. |
| Name | RequestingPractitionerSpecialty |
| Label | Requesting Practitioner Specialty |
| Type | PICKLIST |
| Picklist values | Addiction Medicine Advanced Heart Failure and Transplant Cardiology Allergy/ Immunology Anesthesiology Cardiac Surgery Cardiovascular Disease (Cardiology) Clinical Psychology Colorectal Surgery (Proctology) Critical Care (Intensivists) Dermatology Diagnostic Radiology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice General Surgery Geriatric Medicine Geriatric Psychiatry Gynecological Oncology Hand Surgery Hematology Heamtology-Oncology Hospice and Palliative Care Hospitalist Infectious Disease Internal Medicine Interventional Cardiology Interventional Pain Management Interventional Radiology Maxillofacial Surgery Medical Oncology Medical Toxicology Nephrology Neurology Neuropsychiatry Neurosurgery Nuclear Medicine Obstetrics and Gynecology Opthamology Orthopedic Surgery Osteopathic Manipulative Medicine Otolaryngology Pain Management Pathology Pediatric Medicine Peripheral Vascular Disease Physical Medicine and Rehabilitation Plastic and Reconstructive Surgery Podiatry Preventive Medicine Psychiatry Pulmonary Disease Radiation Oncology Rheumatology Sleep Medicine Sports Medicine Surgical Oncology Thoracic Surgery Urology Vascular Surgery Undefined |
| Name | ServicingPractitionerLicense |
| Label | Servicing Practitioner License |
| Type | PICKLIST |
| Picklist values | M.D. D.O. N.P. P.A. |
| Name | ServicingPractitionerSpecialty |
| Label | Servicing Practitioner Specialty |
| Type | PICKLIST |
| Picklist values | Addiction Medicine Advanced Heart Failure and Transplant Cardiology Allergy/ Immunology Anesthesiology Cardiac Surgery Cardiovascular Disease (Cardiology) Clinical Psychology Colorectal Surgery (Proctology) Critical Care (Intensivists) Dermatology Diagnostic Radiology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice General Surgery Geriatric Medicine Geriatric Psychiatry Gynecological Oncology Hand Surgery Hematology Heamtology-Oncology Hospice and Palliative Care Hospitalist Infectious Disease Internal Medicine Interventional Cardiology Interventional Pain Management Interventional Radiology Maxillofacial Surgery Medical Oncology Medical Toxicology Nephrology Neurology Neuropsychiatry Neurosurgery Nuclear Medicine Obstetrics and Gynecology Opthamology Orthopedic Surgery Osteopathic Manipulative Medicine Otolaryngology Pain Management Pathology Pediatric Medicine Peripheral Vascular Disease Physical Medicine and Rehabilitation Plastic and Reconstructive Surgery Podiatry Preventive Medicine Psychiatry Pulmonary Disease Radiation Oncology Rheumatology Sleep Medicine Sports Medicine Surgical Oncology Thoracic Surgery Urology Vascular Surgery Undefined |
| Name | AdmissionType |
| Label | Admission Type |
| Type | PICKLIST |
| Picklist values | Emergency Urgent Elective Newborn |
| Name | AdmissionSource |
| Label | Admission Source |
| Type | PICKLIST |
| Picklist values | Practitioner Referral Clinic Referral Transfer from Hospital (different facility) Transfer from Skilled Nursing Facility Emergency Room Court or Law Enforcement Ambulatory Surgical Center Hospice |
| Name | DecisionReason |
| Label | Decision Reason |
| Type | PICKLIST |
| Picklist values | Date of Service Not Within Allowable Period Required Data Missing Member Not Found Level of Care Not Appropriate Duplicate Request Not Found to be Medically Necessary Step Therapy Not Attempted Quantity Limit Non-Formulary Off-Label or Unapproved Use |
| Name | ReopenReason |
| Label | Reopen Reason |
| Type | PICKLIST |
| Picklist values | Administrative Error Original Decision Overturned |
| Name | RequesterType |
| Label | Requester Type |
| Type | PICKLIST |
| Picklist values | Member Practitioner Appointed Representative |
| Name | MemberFirstName |
| Label | Member First Name |
| Type | TEXT(40) |
| Name | MemberLastName |
| Label | Member Last Name |
| Type | TEXT(80) |
| Name | MemberDateOfBirth |
| Label | Member Date of Birth |
| Type | DATE |
| Name | MemberIdentificationNumber |
| Label | Member ID |
| Type | TEXT(64) |
| Name | MemberGroupNumber |
| Label | Member Group Number |
| Type | TEXT(64) |
| Name | DecisionDaysRemaining |
| Label | Decision Days Remaining |
| Type | ROLL-UP SUMMARY |
| Name | MemberGender |
| Label | Member Gender |
| Type | PICKLIST |
| Picklist values | Female Male Unknown |
| Name | QuantityType |
| Label | Quantity Type |
| Type | PICKLIST |
| Picklist values | Days Units Visits |
| Name | MemberStatus |
| Label | Member Status |
| Type | TEXT AREA(255) |
| Name | MemberCondition |
| Label | Member Condition |
| Type | TEXT AREA(255) |
| Name | MemberPrognosis |
| Label | Member Prognosis |
| Type | PICKLIST |
| Picklist values | Poor Guarded Fair Good Very Good Excellent Less than 6 Months to Live Terminal |
| Name | MemberPrimaryPlanId |
| Label | Member Plan ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | MemberSecondaryPlanId |
| Label | Member Plan ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | IsReadmission |
| Label | Readmission |
| Type | CHECKBOX |
| Required | Yes |
| Default value | false |
| Name | ReferenceCareRequestCaseId |
| Label | Case ID |
| Type | LOOKUP |
| Foreign key | Yes |
| Name | AppealRequestReasonType |
| Label | Appeal Request Reason Type |
| Type | PICKLIST |
| Picklist values | Service Request Rejected Service Claim Unpaid Rejected - Service Not Required Rejected - No Coverage Benefit Notification Delayed Specialist Referral Rejected |
| Name | GrievanceType |
| Label | Grievance Type |
| Type | PICKLIST |
| Picklist values | Enrollment/Disenrollment Benefit Coverage Customer Service Care Quality Other |
| Name | InitialDenialNotificationTime |
| Label | Initial Denial Notification Time |
| Type | TIME |
| Name | ReconsiderationDenialNotificationTime |
| Label | Reconsideration Denial Notification Time |
| Type | TIME |
| Name | HealthcareProvider_Id_1 |
| Label | HealthcareProvider_Healthcare Provider ID_1 |
| Type | LOOKUP |
| Foreign key | Yes |
Parents relationships(22)
Children relationships(17)
Object User-defined metadata (0)
| Label | Value |
|---|