Calculation Data Model
During capitation calculation processing, a number of entities are maintained. Attributions are created in the first part of the flow, before making any calculations. Then in the second part of the flow, attributions are used to calculate rates and adjustments based on the contract configuration; the results are stored in calculation results and calculation result lines.
All of these entities are next described in detail. In addition, capitation calculation processing maintains financial data; these are described in the Developer Guide for Financial Processing.
Attribution
An attribution shows the time valid connection between a member, a contract calculation period and a provider. Contracts of type 'Provider' lead to attributions where the provider is specified, contracts of type 'No Provider' lead to attributions where the provider is left unspecified. An attribution record stores the following information:
Fields | Description |
---|---|
Person |
The member for which the calculation takes place |
Contract Calculation Period |
The contract calculation period for which the calculation takes place |
Provider |
The provider for which the calculation takes place |
Start Date |
The start date of the attribution |
End Date |
The end date of the attribution |
Calculation Result
A calculation result record stores the following information:
Fields | Description |
---|---|
Person |
The member for which the calculation is done |
Contract Calculation Period |
The contract calculation period for which the calculation is done |
Provider |
The provider for which the calculation is done |
Attribution Start Date |
The start date of the attribution |
Attribution End Date |
The end date of the attribution |
Rate |
The rate amount |
Rate Currency |
The currency of the rate |
Adjustment |
The sum of all adjustment amounts |
Adjustment Currency |
The currency of the sum of all adjustment amounts |
Result |
The result amount (Rate + Adjustment) |
Result Currency |
The currency of the result |
Version |
The version of the capitation calculation (the version number is incremented with each recalculation for the same person, contract calculation period, provider and attribution start date) |
Reversed Indicator |
Set to true when the calculation result is reversed; this can happen when:
|
Calculation Result Line
A calculation result line record stores the following information:
Fields | Description |
---|---|
Calculation Result |
The calculation result to which the calculation result line belongs |
Sequence |
Specifies the order in which the steps have been applied (especially relevant for contract adjustments, for which the order is configurable) |
Schedule |
The rate schedule or adjustment schedule |
Percentage |
The percentage that was retrieved from the adjustment schedule line or contract adjustment override |
Amount Interpretation |
The interpretation setting of the rate schedule or adjustment schedule |
Retrieved Amount |
The amount that was retrieved (or calculated by a dynamic logic function) from the rate schedule line, adjustment schedule line or contract adjustment override; it also stores the amount after applying the percentage if the line is based on a percentage |
Retrieved Amount Currency |
The currency of the retrieved amount |
Input Amount |
The aggregated result of all preceding calculation steps that was the starting point for the calculation represented by this calculation result line |
Input Amount Currency |
The currency of the input amount |
Result Amount |
The delta amount that was the result of the calculation step represented by this calculation result line |
Result Amount Currency |
The currency of the result amount |