Member eligibility dimension / fact

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Member eligibility dimension / fact

Post  venky80 on Tue Sep 21, 2010 3:00 pm

How can I think about Member eligibility as both dimension and fact? In health care member eligibility can be both a fact and dimension.

Like how many members are enrolled in a plan ?

Which member a particular claim came for?

We have a member benefits hierarchy which is per day basis, a member can be eligible for multiple benefits on a particular day, how can a dimension/ fact table be envisioned for such scenario?

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Re: Member eligibility dimension / fact

Post  ngalemmo on Tue Sep 21, 2010 4:05 pm

The member is a dimension. A member's eligibility is a fact (it is a business state).

If there is a claim from a member, you may include eligibility status and coverage at the time of the claim, as a dimension, but this information is derived during load from the member's eligibility state. This would be a dimension separate from the member dimension.
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Re: Member eligibility dimension / fact

Post  venky80 on Tue Sep 21, 2010 4:14 pm

so member dimension is a valid dimension for both claims and member eligibility...and member eligibility at the time of claim submission is a dimension?

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Re: Member eligibility dimension / fact

Post  ngalemmo on Tue Sep 21, 2010 4:38 pm

venky80 wrote:...and member eligibility at the time of claim submission is a dimension?

It's a point in time context for the claim fact. It is separate from the eligibility fact table itself. It could, potentially, just be a degenerate dimension implemented as a boolean. If you have a coverage or plan dimension, I would use that instead as it implies eligibility... i.e. if you do not have coverage, you are not eligible.
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