Authorization Configuration Data Model

Authorization Form

Authorization forms are used to categorize authorizations within the application.

Table 1. Authorization Form

Field	Description
Code	The code of the authorization form
Description	The description for this authorization form
Insurance Type	The insurance type for this authorization form

Basket

Baskets are pre-configured templates that are used to authorize certain medical procedures. A basket has the following attributes:

Table 2. Basket

Field	Description
Code	The unique code for this basket
Description	The description for this basket
Currency	The currency for all amount fields in the basket details

A basket has details representing time valid existences of procedures in a basket. A basket detail has the following attributes:

Table 3. Basket Detail

Field	Description
Procedure	The procedure that is authorized
Renewal Reference	Specifies the as-of date that is used to determine which period applies for the basket detail limit when a claim line is evaluated in Claims. The following as-of dates can be specified: After Start of Calendar Year - in short: Calendar Year. The first period starts at January 1st of the year of the service. After First Claim - in short: First Claim. The first time the period starts at the service date (claim line start date). Because claims need not come in the logical order (oldest first), the periods possibly need to be rearranged as more claims come in. After First Claim (irregular periods) - in short: First Claim Irregular. Same as the First Claim reference, with the difference that the periods are irregular. If no reference is specified, this means that the basket detail limit has no fixed period.
Renewal Period	The length of the renewal period (must be specified in combination with a renewal reference)
Renewal Period Unit of Measure	The unit of measure (Day, Month or Year) for the renewal period length (must be specified in combination with a renewal reference)
Authorized Amount	The authorized amount for the procedure
Authorized Amount Currency	The currency of the authorized amount; it will automatically be set to the currency that is specified on the basket
Authorized Units	The authorized units for the procedure
Authorized Service Days	The authorized service days for the procedure
Start Date	The start date of the basket detail
End Date	The end date of the basket detail

Note that basket details have no unique key. This makes it possible to create multiple basket details for the same basket and procedure that have time overlap, for example when wanting to specify that a certain drug is authorized for 12 units per year, but with a maximum of 1 unit per month.

Insurance Type

An insurance type specifies a type of insurance. An insurance type has the following attributes:

Table 4. Insurance Type

Field	Description
Code	The unique code for this insurance type
Description	The description for this insurance type

Supported Insurable Entity Type

A supported insurable entity type specifies which insurable entity types can be insured as part of an insurance type. A supported insurable entity type has the following attributes:

Table 5. Supported Insurable Entity Type

Field	Description
insurance type	The insurance type
Insurable Entity Type	The insurable entity type

Specialty

The entity specifies the domain of available specialties. Specialties can be attached to authorizations, in order to reflect the specialty under which a service was performed. A specialty has the following attributes:

Table 6. Specialty

Field	Description
Code	The unique code for this specialty
Description	The description for this specialty

Unfinalize Reason

An unfinalize reason has the following attributes:

Table 7. Unfinalize Reason

Field	Description
Code	The unique code for this unfinalize reason
Description	The description for this unfinalize reason