Market Example: Setting Up a Claims Relational Database Management System
A claims RDBMS will have several considerations. For example, one part of the data dictionary will be the header file of all possible fields of the universal billing form for facility services.
The data table will allow for available content from each possible field. The data table will allow “empty” to be recorded as “nothing.”
The entire content of a universal billing form could qualify as one database. Every component on the claim form can be related to the other data elements.
For example, a diagnosis code of septicemia could be related to the revenue code for pharmacy. Septicemia is a systemic blood infection. It is a serious condition and can be life-threatening. A second table of diagnosis and revenue data would be compared to the claim data.
It would be normal to have a diagnosis code of septicemia and have a high dollar amount of pharmaceutical charges due to expected treatment with intravenous antibiotics.
If the dollar amount on the claim did not fit within the parameters of the revenue table, ...
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