SQL-022: Retrieve medical condition detail with latest decision¶

This SQL document describes how Criteria uses an inline Oracle query to support claim-domain read behavior.

Classification¶

Field	Value
SQL ID	SQL-022
Operation type	Read
Execution method	Inline
Database	Oracle
Schema	[unqualified]**
Command type	Text
Business object	`Criteria`
Criteria property	`retrievesql`
Lifecycle method	`Criteria read`

Parameters¶

Parameter	Direction	Type	Max length	Description
`:ClaimID`	Input	N/A	N/A	Claim identifier used by the retrieval query.
`:MedicalConditionID`	Input	N/A	N/A	Medical condition identifier within the claim.

Tables¶

Table	Access	Columns used
cl_medical_condition	SELECT	See sample SQL for referenced columns.
cl_cond_compensability_decisn	SELECT	See sample SQL for referenced columns.
condition_type_code	SELECT	See sample SQL for referenced columns.
claim_decision_code	SELECT	See sample SQL for referenced columns.
claim_denial_final_reas_cd	SELECT	See sample SQL for referenced columns.
claim_denial_reason_code	SELECT	See sample SQL for referenced columns.
claim_denial_status_code	SELECT	See sample SQL for referenced columns.

Sample SQL¶

SELECT
    cnd.claim_id as ClaimId,
    cnd.medical_condition_id AS MedicalConditionId,
    cnd.medical_condition_descr AS MedicalConditionDescr,
    cnd.major_contributing_cause_fl_cd AS MajorContributingCauseFlag,
    TYP.CODE_DESCR AS ConditionType,
    medically_stationary_Date AS MedicallyStationaryDate,
    cdc.code_descr AS ClaimDecision,
    DSN.COND_COMP_DECISION_DATE AS DecisionDate,
    FR.CODE_DESCR AS DenialFinalReason,
    dr.code_descr AS DenialReason,
    DS.CODE_DESCR AS DenialStatus,
    DSN.DENIAL_STATUS_EFF_DATE AS DenialStatusEffDate,
    CND.DIAGNOSIS_CODE AS DiagnosisCode
FROM cl_medical_condition cnd JOIN condition_type_code typ ON TYP.CODE = CND.CONDITION_TYPE_CODE JOIN cl_cond_compensability_decisn dsn ON DSN.CLAIM_ID = CND.CLAIM_ID AND DSN.MEDICAL_CONDITION_ID = CND.MEDICAL_CONDITION_ID AND DSN.COND_COMP_DECISION_ID = (SELECT max(COND_COMP_DECISION_ID) FROM cl_cond_compensability_decisn dsn2 WHERE DSN2.CLAIM_ID = DSN.CLAIM_ID AND dsn2.MEDICAL_CONDITION_ID = dsn.MEDICAL_CONDITION_ID) JOIN claim_decision_code cdc ON cdc.code = DSN.COND_COMP_DECISION_CODE LEFT OUTER JOIN claim_denial_final_reas_cd fr ON FR.CODE = DSN.DENIAL_FINAL_REASON_CODE LEFT OUTER JOIN claim_denial_reason_code dr ON DR.CODE = DSN.DENIAL_REASON_CODE LEFT OUTER JOIN claim_denial_status_code ds ON DS.CODE = DSN.DENIAL_STATUS_CODE
WHERE
    cnd.claim_id = :ClaimID AND
    medical_condition_id = :MedicalConditionID

Operations and processes¶

Medical condition retrieval

Business rules¶

BR-004: Medical condition detail uses the latest compensability decision

Sources¶

Business\SAIF.Business.View.Claim\clsMedicalConditionData.vb