medical_claim

One row per medical claim line: the atomic financial and service-level detail behind institutional and professional claims. Use this table when you need line-level codes, modifiers, service categories or cost components. For visit and admission counts prefer encounter, which already groups these lines into episodes of care.

At a glance

Schema	dax_core
Table	medical_claim
Layer	Core Data Model
Object type	table
Columns	66
Grain	medical_claim_id
Tags	core, encounters

Columns

Column	Type	Key	Terminology	Constraints	Description
medical_claim_id	varchar	PK	—	unique, not null	Dax identifier for the claim line. Unique on its own.
claim_id	varchar		—	not null	Source claim identifier, shared by all lines of the same claim.
claim_line_number	integer		—	not null	Position of this line within its claim.
encounter_id	varchar		—	—	The encounter this line was grouped into, where one was assigned.
encounter_type	varchar		—	—	—
encounter_group	varchar		—	—	—
claim_type	varchar		Claim type	—	Whether the claim is institutional, professional or another type.
person_id	varchar		—	not null	The individual who received the service.
member_id	varchar		—	—	—
payer	varchar		—	—	Payer responsible for adjudicating the claim.
plan	varchar		—	—	Benefit plan under which the claim was adjudicated.
claim_start_date	date		—	—	First date of service on the claim.
claim_end_date	date		—	—	Last date of service on the claim.
claim_line_start_date	date		—	—	—
claim_line_end_date	date		—	—	—
admission_date	date		—	—	—
discharge_date	date		—	—	—
service_category_1	varchar		Service categories	—	Top level of the service-category hierarchy.
service_category_2	varchar		Service categories	—	Second level of the service-category hierarchy.
service_category_3	varchar		—	—	Third level of the service-category hierarchy.
admit_source_code	varchar		Admit source	—	—
admit_source_description	varchar		—	—	—
admit_type_code	varchar		Admit type	—	—
admit_type_description	varchar		—	—	—
discharge_disposition_code	varchar		Discharge disposition	—	—
discharge_disposition_description	varchar		—	—	—
place_of_service_code	varchar		Place of service	—	Coded setting in which the service was delivered.
place_of_service_description	varchar		—	—	—
bill_type_code	varchar		Bill type	—	Bill type, on institutional claims.
bill_type_description	varchar		—	—	—
drg_code_type	varchar		—	—	—
drg_code	varchar		—	—	—
drg_description	varchar		—	—	—
revenue_center_code	varchar		Revenue center	—	Revenue center code, on institutional claims.
revenue_center_description	varchar		—	—	—
service_unit_quantity	number		—	—	—
hcpcs_code	varchar		HCPCS level 2	—	Procedure or service code on the line.
hcpcs_modifier_1	varchar		HCPCS level 2	—	—
hcpcs_modifier_2	varchar		HCPCS level 2	—	—
hcpcs_modifier_3	varchar		HCPCS level 2	—	—
hcpcs_modifier_4	varchar		HCPCS level 2	—	—
hcpcs_modifier_5	varchar		HCPCS level 2	—	—
rendering_npi	varchar		Provider	—	NPI of the provider who delivered the service.
rendering_tin	varchar		—	—	—
rendering_name	varchar		—	—	—
billing_npi	varchar		Provider	—	NPI of the entity that submitted the claim.
billing_tin	varchar		—	—	—
billing_name	varchar		—	—	—
facility_npi	varchar		Provider	—	—
facility_name	varchar		—	—	—
paid_date	date		—	—	—
paid_amount	number		—	—	Amount the payer paid for this line.
allowed_amount	number		—	—	Contractually allowed amount for this line.
charge_amount	number		—	—	Amount billed for this line.
coinsurance_amount	number		—	—	Member coinsurance responsibility.
copayment_amount	number		—	—	Member copayment responsibility.
deductible_amount	number		—	—	Amount applied to the member deductible.
total_cost_amount	number		—	—	—
in_network_flag	integer		—	—	Set when the service was delivered in network.
enrollment_flag	integer		—	—	—
member_month_id	varchar		—	—	Links the line to the member month in which it occurred.
file_date	date		—	—	—
ingest_datetime	timestamp		—	—	—
file_name	varchar		—	—	—
dax_last_run	timestamp		—	—	Timestamp of the warehouse build that produced this row.
data_source	varchar		—	not null	Label for the contributing system.

Querying

select *
from dax_core.medical_claim
limit 100;