ID

35634

Description

OMOP Common Data Model (CDM) Payer Plan Period The PAYER_PLAN_PERIOD table captures details of the period of time that a Person is continuously enrolled under a specific health Plan benefit structure from a given Payer. Each Person receiving healthcare is typically covered by a health benefit plan, which pays for (fully or partially), or directly provides, the care. These benefit plans are provided by payers, such as health insurances or state or government agencies. In each plan the details of the health benefits are defined for the Person or her family, and the health benefit Plan might change over time typically with increasing utilization (reaching certain cost thresholds such as deductibles), plan availability and purchasing choices of the Person. The unique combinations of Payer organizations, health benefit Plans and time periods in which they are valid for a Person are recorded in this table. OMOP Common Data Model Version 6.0 Specifications 11October2018. The Observational Medical Outcomes Partnership (OMOP) was a public-private partnership established to inform the appropriate use of observational healthcare databases for studying the effects of medical products. © 2014 Observational Health Data Sciences and Informatics. This work is based on work by the Observational Medical Outcomes Partnership (OMOP) and used under license from the FNIH at http://omop.fnih.org/publiclicense. Version updated on 12.03.2019, from https://github.com/OHDSI/CommonDataModel/wiki/PAYER_PLAN_PERIOD Different Payers have different designs for their health benefit Plans. The PAYER_PLAN_PERIOD table does not capture all details of the plan design or the relationship between Plans or the cost of healthcare triggering a change from one Plan to another. However, it allows identifying the unique combination of Payer (insurer), Plan (determining healthcare benefits and limits) and Person. Typically, depending on healthcare utilization, a Person may have one or many subsequent Plans during coverage by a single Payer. Typically, family members are covered under the same Plan as the Person. In those cases, the payer_source_value, plan_source_value and family_source_value are identical. The fields contract_source_value and contract_concept_id justify the contract relationship. It is represented as the relationship from the person_id to contract_person_id. A patient can have multiple overlapping payer plan periods. For more information, pleas see https://github.com/OHDSI/CommonDataModel/wiki/PAYER_PLAN_PERIOD

Link

http://omop.fnih.org/publiclicense

Keywords

Versions (2)
  1. 1/4/17 1/4/17 -
  2. 3/13/19 3/13/19 -
Copyright Holder

Observational Medical Outcomes Partnership (OMOP)

Uploaded on

March 13, 2019

DOI

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License

Creative Commons BY-NC 3.0
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OMOP Common Data Model (CDM)

English

Payer Plan Period

1 forms  
  1. StudyEvent: ODM
    1. Payer Plan Period
Payer Plan Period
Description

Payer Plan Period

Alias
UMLS CUI-1
C2348942
UMLS CUI-2
C0018684
UMLS CUI-3
C0814225
UMLS CUI-4
C1301732
UMLS CUI-5
C1948053
Payer plan period ID
Description

An identifier for each unique combination of payer, plan, family code and time span.

Data type

integer

Alias
UMLS CUI [1,1]
C2348942
UMLS CUI [1,2]
C1301732
UMLS CUI [1,3]
C1948053
UMLS CUI [1,4]
C1300638
Person ID
Description

A foreign key identifier to the person covered by the payer. The demographic details of that person are stored in the person table.

Data type

integer

Alias
UMLS CUI [1]
C2348585
Contract person ID
Description

A foreign key identifier to the person_id in person table, for the person who is the primary subscriber/contract owner for the record in the payer_plan_period table. Maybe the same person or different person, depending on who is the primary subscriber/contract owner. The contract_person_id is meant to refer to the owner of the plan, for instance, a parent who owns the plan under which the child is covered. Contract_person_id many times will be equal to person_id.

Data type

integer

Alias
UMLS CUI [1,1]
C0332522
UMLS CUI [1,2]
C0027361
UMLS CUI [1,3]
C1300638
Payer Plan Period start date
Description

The start date of the payer plan period.

Data type

date

Alias
UMLS CUI [1,1]
C0680264
UMLS CUI [1,2]
C1301732
UMLS CUI [1,3]
C1948053
UMLS CUI [1,4]
C0808070
Payer Plan Period end date
Description

The end date of the payer plan period.

Data type

date

Alias
UMLS CUI [1,1]
C0680264
UMLS CUI [1,2]
C1301732
UMLS CUI [1,3]
C1948053
UMLS CUI [1,4]
C0806020
Payer concept ID
Description

A foreign key that refers to a standard Payer concept identifier in the Standarized Vocabularies

Data type

integer

Alias
UMLS CUI [1,1]
C2348942
UMLS CUI [1,2]
C0178566
UMLS CUI [1,3]
C1300638
Payer source value
Description

The source code for the payer as it appears in the source data. (Type varchar(50))

Data type

text

Alias
UMLS CUI [1,1]
C2348942
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0805701
Payer source concept ID
Description

A foreign key to a payer concept that refers to the code used in the source.

Data type

integer

Alias
UMLS CUI [1,1]
C2348942
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0178566
UMLS CUI [1,4]
C1300638
Plan concept ID
Description

A foreign key that refers to a standard plan concept identifier that represents the health benefit plan in the Standardized Vocabularies.

Data type

integer

Alias
UMLS CUI [1,1]
C0018684
UMLS CUI [1,2]
C0814225
UMLS CUI [1,3]
C1301732
UMLS CUI [1,4]
C0178566
UMLS CUI [1,5]
C1300638
Plan source value
Description

The source code for the person's coverage plan as it appears in the source data.

Data type

text

Alias
UMLS CUI [1,1]
C1301732
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0805701
Plan source concept ID
Description

A foreign key to a plan concept that refers to the plan code used in the source data.

Data type

text

Alias
UMLS CUI [1,1]
C0018684
UMLS CUI [1,2]
C0814225
UMLS CUI [1,3]
C1301732
UMLS CUI [1,4]
C0449416
UMLS CUI [1,5]
C0178566
UMLS CUI [1,6]
C1300638
Contract concept ID
Description

A foreign key to a standard concept representing the reason justifying the contract between person_id and contract_person_id.

Data type

integer

Alias
UMLS CUI [1,1]
C0332522
UMLS CUI [1,2]
C0178566
UMLS CUI [1,3]
C1300638
Contract source value
Description

The source code representing the reason justifying the contract. Usually it is family relationship like a spouse, domestic partner, child etc.

Data type

integer

Alias
UMLS CUI [1,1]
C0332522
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0805701
Contract source concept ID
Description

A foreign key to a concept that refers to the code used in the source as the reason justifying the contract.

Data type

integer

Alias
UMLS CUI [1,1]
C0332522
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0178566
UMLS CUI [1,4]
C1300638
Sponsor concept IDSponsor concept ID
Description

A foreign key that refers to a concept identifier that represents the sponsor in the Standardized Vocabularies.

Data type

integer

Alias
UMLS CUI [1,1]
C1711305
UMLS CUI [1,2]
C0178566
UMLS CUI [1,3]
C1300638
Sponsor source value
Description

The source code for the Person's sponsor of the health plan as it appears in the source data. (Type varchar(50))

Data type

text

Alias
UMLS CUI [1,1]
C1711305
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0805701
Sponsor source concept ID
Description

A foreign key to a sponsor concept that refers to the sponsor code used in the source data.

Data type

integer

Alias
UMLS CUI [1,1]
C1711305
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0178566
UMLS CUI [1,4]
C1300638
Family source value
Description

The source code for the person's family as it appears in the source data. (Type varchar(50))

Data type

text

Alias
UMLS CUI [1,1]
C0015576
UMLS CUI [1,2]
C0449416
UMLS CUI [1,3]
C0805701
Stop reason concept ID
Description

A foreign key that refers to a standard termination reason that represents the reason for the termination in the Standardized Vocabularies.

Data type

integer

Alias
UMLS CUI [1,1]
C1283212
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0178566
UMLS CUI [1,4]
C1300638
Stop reason source value
Description

The reason for stop-coverage as it appears in the source data. (Type varchar(50))

Data type

text

Alias
UMLS CUI [1,1]
C1283212
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0449416
UMLS CUI [1,4]
C0805701
Stop reason source concept ID
Description

A foreign key to a stop-coverage concept that refers to the code used in the source.

Data type

text

Alias
UMLS CUI [1,1]
C1283212
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0449416
UMLS CUI [1,4]
C0178566
UMLS CUI [1,5]
C1300638
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Similar models

Payer Plan Period

1 forms
  1. StudyEvent: ODM
    1. Payer Plan Period
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Payer Plan Period
C2348942 (UMLS CUI-1)
C0018684 (UMLS CUI-2)
C0814225 (UMLS CUI-3)
C1301732 (UMLS CUI-4)
C1948053 (UMLS CUI-5)
Payer plan period ID
Item
Payer plan period ID
integer
C2348942 (UMLS CUI [1,1])
C1301732 (UMLS CUI [1,2])
C1948053 (UMLS CUI [1,3])
C1300638 (UMLS CUI [1,4])
Person ID
Item
Person ID
integer
C2348585 (UMLS CUI [1])
Contract person ID
Item
Contract person ID
integer
C0332522 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Payer Plan Period start date
Item
Payer Plan Period start date
date
C0680264 (UMLS CUI [1,1])
C1301732 (UMLS CUI [1,2])
C1948053 (UMLS CUI [1,3])
C0808070 (UMLS CUI [1,4])
Payer Plan Period end date
Item
Payer Plan Period end date
date
C0680264 (UMLS CUI [1,1])
C1301732 (UMLS CUI [1,2])
C1948053 (UMLS CUI [1,3])
C0806020 (UMLS CUI [1,4])
Payer concept ID
Item
Payer concept ID
integer
C2348942 (UMLS CUI [1,1])
C0178566 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Payer source value
Item
Payer source value
text
C2348942 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Payer source concept ID
Item
Payer source concept ID
integer
C2348942 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0178566 (UMLS CUI [1,3])
C1300638 (UMLS CUI [1,4])
Plan concept ID
Item
Plan concept ID
integer
C0018684 (UMLS CUI [1,1])
C0814225 (UMLS CUI [1,2])
C1301732 (UMLS CUI [1,3])
C0178566 (UMLS CUI [1,4])
C1300638 (UMLS CUI [1,5])
Plan source value
Item
Plan source value
text
C1301732 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Plan source concept ID
Item
Plan source concept ID
text
C0018684 (UMLS CUI [1,1])
C0814225 (UMLS CUI [1,2])
C1301732 (UMLS CUI [1,3])
C0449416 (UMLS CUI [1,4])
C0178566 (UMLS CUI [1,5])
C1300638 (UMLS CUI [1,6])
Contract concept ID
Item
Contract concept ID
integer
C0332522 (UMLS CUI [1,1])
C0178566 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Contract source value
Item
Contract source value
integer
C0332522 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Contract source concept ID
Item
Contract source concept ID
integer
C0332522 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0178566 (UMLS CUI [1,3])
C1300638 (UMLS CUI [1,4])
Sponsor concept ID
Item
Sponsor concept IDSponsor concept ID
integer
C1711305 (UMLS CUI [1,1])
C0178566 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Sponsor source value
Item
Sponsor source value
text
C1711305 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Sponsor source concept ID
Item
Sponsor source concept ID
integer
C1711305 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0178566 (UMLS CUI [1,3])
C1300638 (UMLS CUI [1,4])
Family source value
Item
Family source value
text
C0015576 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Stop reason concept ID
Item
Stop reason concept ID
integer
C1283212 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0178566 (UMLS CUI [1,3])
C1300638 (UMLS CUI [1,4])
Stop reason source value
Item
Stop reason source value
text
C1283212 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0449416 (UMLS CUI [1,3])
C0805701 (UMLS CUI [1,4])
Stop reason source concept ID
Item
Stop reason source concept ID
text
C1283212 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0449416 (UMLS CUI [1,3])
C0178566 (UMLS CUI [1,4])
C1300638 (UMLS CUI [1,5])
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