Auth Referral Query
Auth Referral Query
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