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Auth Referral Query

The SQL query retrieves distinct records related to member authorization details, including member ID, authorization type, and status. It joins multiple tables to gather comprehensive data on member history, authorization facts, and referral information while applying various filters to ensure the data is current. The query specifically focuses on active members with certain authorization types within a specified date range.
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0% found this document useful (0 votes)
4 views3 pages

Auth Referral Query

The SQL query retrieves distinct records related to member authorization details, including member ID, authorization type, and status. It joins multiple tables to gather comprehensive data on member history, authorization facts, and referral information while applying various filters to ensure the data is current. The query specifically focuses on active members with certain authorization types within a specified date range.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd
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SELECT

DISTINCT
--ASSF.AUTH_BENEFIT_COUNT_APPROVED NUMBEROFVISITSAPPROVED,
--ASSF.AUTH_BENEFIT_COUNT_USED NUMBEROFVISITSUSED,
--AUTH_BENEFIT_COUNT_REMAINING NUMBEROFVISITSREMAINING,
--AFTD.DIAGNOSIS_CODE PRIMARYDIAGNOSISCODE,
--D.DIAGNOSIS_LONG_DESC PRIMARYDIAGCODEDESC,
----CF.PRINCIPAL_PROCEDURE_CODE PRIMARYPROCEDURECODE,
----CF.REMARKS DECISIONREASONDESCRIPTION,
--ARS.SERVICE_CODE PRIMARYPROCEDURECODE,
--ASRC.AUTH_STATUS_REASON_DESC DECISIONREASONDESCRIPTION,
--S.SERVICE_SHORT_DESC PRIMARYPROCCODEDESC,
--AFSTART.DATE_VALUE EFFECTIVEFROM,
--AFEND.DATE_VALUE EFFECTIVETO,
--CASE WHEN ASCD.AUTH_STATUS_DESC = 'NOT APPROVED' THEN DD3.DATE_VALUE ELSE NULL
END AS DATEOFDENIAL,
--AHF.ACCOUNT_NAME,
--AHF.ACCOUNT_HCC_ID,
MHF.MEMBER_HCC_ID MEMBER_ID,
ATC.AUTH_TYPE_NAME,
--MHF.MEMBER_FULL_NAME,
--MHFBIRTH.DATE_VALUE BIRTH_DATE,
ASCD.AUTH_STATUS_DESC,
AF.AUTH_ADMIT_STATUS_CODE ADMIT_STATUS,
--MHF.MEMBER_GENDER_CODE GENDER,
--RTS.RLTP_TO_SUBSCRIBER_NAME RELATIONSHIP_TO_SUBSCRIBER,
--ART.REFERRED_TO_HCC_ID PROVIDER_ID,
--ART.REFERRED_TO_NAME PROVIDER_NAME,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER' THEN TSA.ADDRESS_LINE ELSE
TPA.ADDRESS_LINE END ADDRESS_LINE1,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER' THEN TSA.ADDRESS_LINE_2 ELSE
TPA.ADDRESS_LINE_2 END ADDRESS_LINE2,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER' THEN TSA.ADDRESS_LINE_3 ELSE
TPA.ADDRESS_LINE_3 END ADDRESS_LINE3,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER' THEN TSA.CITY_NAME ELSE
TPA.CITY_NAME END CITY_NAME,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER' THEN TSA.STATE_CODE ELSE
TPA.STATE_CODE END STATE_CODE,
--CASE WHEN ART.REFERRED_TO_TYPE_NAME = 'SUPPLIER'
--THEN CASE WHEN TSA.ZIP_4_CODE IS NULL THEN TSA.ZIP_CODE ELSE ISNULL(TSA.ZIP_CODE,
'') + '-' + ISNULL(TSA.ZIP_4_CODE, '') END
--ELSE CASE WHEN TPA.ZIP_4_CODE IS NULL THEN TPA.ZIP_CODE ELSE ISNULL(TPA.ZIP_CODE,
'') + '-' + ISNULL(TPA.ZIP_4_CODE, '') END
--END ZIP_CODE,
--REQDATE.DATE_VALUE REQUEST_DATE,
--AF.RECEIVED_ON_TIME,
--ROIC.RELEASE_OF_INFO_NAME,
AF.AUTH_HCC_ID EXTERNAL_ID
--STC.SOURCE_TYPE_NAME INPUT_SOURCE,
--AF.PATIENT_TRACKING_NUMBER,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FS.SUPPLIER_HCC_ID ELSE
FP.PRACTITIONER_HCC_ID END REFERRED_FROM_ID,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FS.SUPPLIER_NAME ELSE
FP.PRACTITIONER_FULL_NAME END REFERRED_FROM_NAME,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FSA.ADDRESS_LINE ELSE
FPA.ADDRESS_LINE END REFERRED_FROM_ADDRESS_LINE1,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FSA.ADDRESS_LINE_2 ELSE
FPA.ADDRESS_LINE_2 END REFERRED_FROM_ADDRESS_LINE2,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FSA.ADDRESS_LINE_3 ELSE
FPA.ADDRESS_LINE_3 END REFERRED_FROM_ADDRESS_LINE3,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FSA.CITY_NAME ELSE
FPA.CITY_NAME END REFERRED_FROM_CITY_NAME,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER' THEN FSA.STATE_CODE ELSE
FPA.STATE_CODE END REFERRED_FROM_STATE_CODE,
--CASE WHEN ARF.REFERRED_FROM_TYPE_NAME = 'SUPPLIER'
--THEN CASE WHEN FSA.ZIP_4_CODE IS NULL THEN FSA.ZIP_CODE ELSE ISNULL(FSA.ZIP_CODE,
'') + '-' + ISNULL(FSA.ZIP_4_CODE, '') END
--ELSE CASE WHEN FPA.ZIP_4_CODE IS NULL THEN FPA.ZIP_CODE ELSE ISNULL(FPA.ZIP_CODE,
'') + '-' + ISNULL(FPA.ZIP_4_CODE, '') END
--END REFERRED_FROM_ZIP_CODE,
--ASSF.AUTH_BENEFIT_COUNT_APPROVED
FROM MEMBER MHF WITH(NOLOCK)
INNER JOIN DATE_DIMENSION MHFEFF WITH(NOLOCK) ON MHFEFF.DATE_KEY =
MHF.VERSION_EFF_DATE_KEY
INNER JOIN DATE_DIMENSION MHFEXP WITH(NOLOCK) ON MHFEXP.DATE_KEY =
MHF.VERSION_EXP_DATE_KEY
INNER JOIN DATE_DIMENSION MHFBIRTH WITH(NOLOCK) ON MHF.MEMBER_BIRTH_DATE_KEY =
MHFBIRTH.DATE_KEY
INNER JOIN ACCOUNT_HISTORY_FACT AHF WITH(NOLOCK) ON MHF.ACCOUNT_KEY =
AHF.ACCOUNT_KEY
INNER JOIN DATE_DIMENSION AHFEFF WITH(NOLOCK) ON AHFEFF.DATE_KEY =
AHF.VERSION_EFF_DATE_KEY
INNER JOIN DATE_DIMENSION AHFEXP WITH(NOLOCK) ON AHFEXP.DATE_KEY =
AHF.VERSION_EXP_DATE_KEY
INNER JOIN AUTH_FACT AF WITH(NOLOCK) ON MHF.MEMBER_KEY = AF.MEMBER_KEY
INNER JOIN DATE_DIMENSION AFSTART WITH(NOLOCK) ON AF.AUTHORIZED_START_DATE_KEY =
AFSTART.DATE_KEY
INNER JOIN DATE_DIMENSION AFEND WITH(NOLOCK) ON AF.AUTHORIZED_END_DATE_KEY =
AFEND.DATE_KEY
INNER JOIN RLTP_TO_SUBSCRIBER RTS WITH(NOLOCK) ON MHF.RLTP_TO_SUBSCRIBER_KEY =
RTS.RLTP_TO_SUBSCRIBER_KEY
INNER JOIN AUTH_STATUS_CODE ASCD WITH(NOLOCK) ON AF.AUTH_STATUS_CODE =
ASCD.AUTH_STATUS_CODE
LEFT JOIN AUTH_SERV_SET_FACT ASSF WITH(NOLOCK) ON AF.AUTH_FACT_KEY =
ASSF.AUTH_FACT_KEY
LEFT JOIN AUTH_STATUS_REASON_CODE ASRC WITH(NOLOCK) ON ASRC.AUTH_STATUS_REASON_KEY
= ASSF.AUTH_STATUS_REASON_KEY
LEFT JOIN AUTH_REFERRAL_SERVICE ARS WITH(NOLOCK) ON ARS.AUTH_REFERRAL_SERVICE_KEY =
ASSF.AUTH_REFERRAL_SERVICE_KEY
LEFT JOIN SERVICE S WITH(NOLOCK) ON S.SERVICE_CODE = ARS.SERVICE_CODE
LEFT JOIN AUTH_TYPE_CODE ATC WITH(NOLOCK) ON ASSF.AUTH_TYPE_KEY = ATC.AUTH_TYPE_KEY
LEFT JOIN AUTH_FACT_TO_DIAGNOSIS AFTD WITH(NOLOCK) ON AF.AUTH_FACT_KEY =
AFTD.AUTH_FACT_KEY
LEFT JOIN DIAGNOSIS D WITH(NOLOCK) ON AFTD.DIAGNOSIS_CODE = D.DIAGNOSIS_CODE
LEFT JOIN DATE_DIMENSION DD1 WITH(NOLOCK) ON D.START_DATE_KEY = DD1.DATE_KEY
LEFT JOIN DATE_DIMENSION DD2 WITH(NOLOCK) ON D.END_DATE_KEY = DD2.DATE_KEY
LEFT JOIN DATE_DIMENSION DD3 WITH(NOLOCK) ON ASSF.AUTHORIZED_ON_DATE_KEY =
DD3.DATE_KEY
LEFT JOIN CLAIM_FACT CF WITH(NOLOCK) ON MHF.MEMBER_KEY = CF.MEMBER_KEY
--LEFT JOIN CLAIM_FACT CF WITH(NOLOCK) ON MHF.MEMBER_KEY = CF.MEMBER_KEY
--LEFT JOIN PROCEDURE_CODE PC WITH(NOLOCK) ON CF.PRINCIPAL_PROCEDURE_CODE =
PC.PROCEDURE_CODE
LEFT JOIN AUTH_REFERRED_TO ART WITH(NOLOCK) ON ASSF.AUTH_REFERRED_TO_KEY =
ART.AUTH_REFERRED_TO_KEY
LEFT JOIN PRACTITIONER TP WITH(NOLOCK) ON ART.REFERRED_TO_HCC_ID =
TP.PRACTITIONER_HCC_ID
LEFT JOIN POSTAL_ADDRESS TPA WITH(NOLOCK) ON TP.PRACTITIONER_CORR_ADDR_KEY =
TPA.POSTAL_ADDRESS_KEY
LEFT JOIN SUPPLIER TS WITH(NOLOCK) ON ART.REFERRED_TO_HCC_ID = TS.SUPPLIER_HCC_ID
LEFT JOIN POSTAL_ADDRESS TSA WITH(NOLOCK)ON TS.SUPPLIER_CORR_ADDRESS_KEY =
TSA.POSTAL_ADDRESS_KEY
LEFT JOIN DATE_DIMENSION REQDATE WITH(NOLOCK) ON AF.REQUESTED_ON_DATE_KEY =
REQDATE.DATE_KEY
LEFT JOIN RELEASE_OF_INFO_CODE ROIC WITH(NOLOCK)ON AF.RELEASE_OF_INFO_KEY =
ROIC.RELEASE_OF_INFO_KEY
LEFT JOIN SOURCE_TYPE_CODE STC WITH(NOLOCK) ON AF.SOURCE_TYPE_CODE =
STC.SOURCE_TYPE_CODE
LEFT JOIN AUTH_REFERRED_FROM ARF WITH(NOLOCK) ON ASSF.AUTH_REFERRED_FROM_KEY =
ARF.AUTH_REFERRED_FROM_KEY
LEFT JOIN PRACTITIONER FP WITH(NOLOCK)ON ARF.REFERRED_FROM_HCC_ID =
FP.PRACTITIONER_HCC_ID
LEFT JOIN SUPPLIER FS WITH(NOLOCK) ON ARF.REFERRED_FROM_HCC_ID = FS.SUPPLIER_HCC_ID
LEFT JOIN POSTAL_ADDRESS FPA WITH(NOLOCK) ON FP.PRACTITIONER_CORR_ADDR_KEY =
FPA.POSTAL_ADDRESS_KEY
LEFT JOIN POSTAL_ADDRESS FSA WITH(NOLOCK) ON FS.SUPPLIER_CORR_ADDRESS_KEY =
FSA.POSTAL_ADDRESS_KEY
WHERE MHFEFF.DATE_VALUE <= GETDATE()
AND MHFEXP.DATE_VALUE > GETDATE()
AND AHFEFF.DATE_VALUE <= GETDATE()
AND AHFEXP.DATE_VALUE > GETDATE()
AND AFSTART.DATE_VALUE >= GETDATE() -365

--AND MHF.MEMBER_HCC_ID = 'A1007006800'


AND MHF.MEMBER_STATUS = 'A'
--AND ATC.AUTH_TYPE_NAME = 'AUTHORIZATION'
--AND ATC.AUTH_TYPE_NAME = 'REFERRAL'
AND ATC.AUTH_TYPE_NAME in ('REFERRAL', 'AUTHORIZATION')

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