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Medical Claim

The medical_claim table contains information on healthcare services and supplies provided to patients, billed by providers, and paid for by health insurers.
It includes information on the provider who rendered the service, the amount paid for the service by the health insurer, and the underlying reason for the service (i.e. diagnosis).

The medical_claim table in core has been enhanced with concepts like service category and encounter that are useful for analytics.

Primary Keys:

  • claim_id
  • claim_line_number

Foreign Keys:

  • patient_id
  • member_id
  • encounter_id
ColumnData TypeDescriptionTerminology