Claims Database Schema
Describes the database tables introduced to support insurance claim management.
Overview
The claims management module introduces several database tables used to store claim data and maintain claim history.
These tables capture claim-level information, provider details, test-level data, and bill-to-claim relationships.
The schema ensures that a complete snapshot of claim information is preserved even if billing data changes later.
Core Tables
The main tables used in the claims module include:
- InsuranceClaim
- ClaimProviderInfo
- ClaimTestRelation
- BillClaimRelation
Each table plays a specific role in storing claim-related data.
InsuranceClaim
The InsuranceClaim table represents the primary claim record.
Each entry corresponds to a single claim submitted for processing.
Stored Information
- Bill reference
- Patient information
- Insurance mapping
- Total claim amount
- Claim status
- Claim creation timestamp
- Audit metadata
This table acts as the central entity in the claims system.
ClaimProviderInfo
The ClaimProviderInfo table stores the insurance provider details associated with a claim.
These values are captured at the time of claim submission.
Stored Information
- Insurance name
- Insurance code
- Subscriber details
- Policy number
- Group number
- Insurance type
Capturing these values ensures claim consistency even if patient insurance details change later.
ClaimTestRelation
The ClaimTestRelation table stores test-level information for claims.
Each record represents a single test included in the claim.
Stored Information
- Test ID
- Test amount
- Copay amount
- Deductible amount
- Insurance covered amount
- Approved amount
- Adjusted amount
This table allows the system to track claim decisions at the individual test level.
BillClaimRelation
The BillClaimRelation table maintains the relationship between bills and claims.
A single bill may have multiple claims when partial submissions occur.
Purpose
- Tracks which claims belong to which bill
- Supports partial claim submission
- Enables claim resubmission workflows
Simplified Schema Relationship
Bill
↓
BillClaimRelation
↓
InsuranceClaim
↓
ClaimTestRelation
Provider details are stored in the ClaimProviderInfo table.
This schema ensures that claims remain consistent and auditable throughout the claim lifecycle.