ClaimID

int (PK)

YES

Unique database identifier

InsureeID

int

YES

The Insuree receiving the medical services and items
FK tblInsurees

ClaimCode

nvarchar (max 8 chars)

YES

Unique code given by Health Facility

DateFrom

smalldatetime

YES

Start date of the visit to Health Facility

DateTo

smalldatetime

NO

End date of the visit to Health Facility.
NULL value means the visit is only for 1 day.

ICDID

int

YES

The Main Diagnosis
FK tblICDCodes

ClaimStatus

tinyint

YES

2

The Claim Status changing by the adjudication process.
Values: 1: Rejected | 2: Entered | 4: Checked (reviewed or not) | 8: Processed /Reviewed | 16: Valuated

Adjuster

int

NO

Adjustment

ntext

NO

Claimed

decimal (18, 2)

NO

Total amount claimed by Health Facility: sum of price*quantity for all items and services

Approved

decimal (18, 2)

NO

Reinsured

decimal (18, 2)

NO

Valuated

decimal (18, 2)

NO

DateClaimed

date

YES

Current date

The date when the Claim has been entered into openIMIS.

DateProcessed

smalldatetime

NO

Feedback

bit

YES

0

FeedbackID

int

NO

0

The Feedback form linked to this Claim
FK tblFeedback

Explanation

ntext

NO

Health Facility’s general explanation for the Claim

FeedbackStatus

tinyint

NO

1

ReviewStatus

tinyint

NO

1

The status of the Medical Officer review.
Values: 1: Idle | 2: Not Selected | 4: Selected for Review | 8: Reviewed | 16: ByPassed

ApprovalStatus

tinyint

NO

1

RejectionReason

tinyint

NO

0

ValidityFrom

datetime

YES

Current date

ValidityTo

datetime

NO

LegacyID

int

NO

AuditUserID

int

YES

ValidityFromReview

datetime

NO

ValidityToReview

datetime

NO

AuditUserIDReview

int

NO

RowID

timestamp

NO

HFID

int

YES

FK tblHF

RunID

int

NO

FK tblBatchRun

AuditUserIDSubmit

int

NO

AuditUserIDProcess

int

NO

SubmitStamp

datetime

NO

ProcessStamp

datetime

NO

Remunerated

decimal (18, 2)

NO

GuaranteeId

nvarchar (max 50 chars)

NO

ClaimAdminId

int

NO

FK tblClaimAdmin

ICDID1

int

NO

ICDID2

int

NO

ICDID3

int

NO

ICDID4

int

NO

VisitType

char (1)

NO

Emergency, Referral, Other

ClaimCategory

char (1)

NO

Automatically defined in checking process: Surgery, Delivery, Antenatal, Hospitalisation, Consultation, Visit

ClaimUUID

uniqueidentifier

YES

New UUID