| Business Rule |
| Each Authorization may Authorized Procedure one or more Authorized Procedure |
| may Authorized Visit one or more Authorized Visit |
| may Claim Detail one or more Claim Detail |
| may Member Authorization History one or more Member Authorization History |
| must Authorize one and only one Provider Person |
| must Authorized By one and only one Employee |
| must Be Catagorized In one and only one Authorization Type |
| must Group Master one and only one Group Master |
| must Have Been Refered By one and only one Provider Person |
| must Member one and only one Member |
| must Place Of Service one and only one Place Of Service |
| must Provider Person one and only one Provider Person |
| Each Authorization Status Type may Authorized Visit one or more Authorized Visit |
| Each Authorization Type may Define The Type Of one or more Authorization |
| Each Authorized Diagnosis must Authorized Visit one and only one Authorized Visit |
| must Diagnosis Code one and only one Diagnosis Code |
| Each Authorized Procedure must Authorization one and only one Authorization |
| must Specific Procedure Code one and only one Specific Procedure Code |
| Each Authorized Visit may Authorized Diagnosis one or more Authorized Diagnosis |
| must Authorization one and only one Authorization |
| must Authorization Status Type one and only one Authorization Status Type |
| must Facility Authorization one or more Facility Authorization |
| must Service Reason one and only one Service Reason |
| Each Code Category may Procedure Code one or more Procedure Code |
| Each Diagnosis Code may Authorized Diagnosis one or more Authorized Diagnosis |
| may Claim Diagnosis Code one or more Claim Diagnosis Code |
| may Diagnosis Type Diag Code one or more Diagnosis Type Diag Code |
| must Have Its Gender Specific Type In one and only one Gender Code |
| Each Employee may Authorize one or more Authorization |
| may Bank one or more Bank |
| may Be A Team Member In one or more Team Member |
| may be given one or more Employee Bonus |
| may be terminated for one or more Termination Reason |
| may be the responsible recruiter for one or more Employment Application |
| may Be The Team Leader Of one or more Team |
| may charged one and only one Life Insurance Rate |
| may Employee Benefit one or more Employee Benefit |
| may Employee Internal Contact one or more Employee Internal Contact |
| may Employee Phone one or more Employee Phone |
| may Employee Skill one or more Employee Skill |
| may have one or more Dependant Care Transaction |
| may have - over time one or more Employee Pay Rate |
| may have access through one or more Person Facility Access |
| may have records in one or more Payroll Ledger |
| may have their veteran status in one and only one Veteran Status |
| may have worked one or more Employee Labor Hours |
| may Package Employee Approval one or more Package Employee Approval |
| may Package Internal Contact one or more Package Internal Contact |
| may Package Print Function History one or more Package Print Function History |
| may select one or more Employee Selected Deduction |
| may verify one or more Provider Degree Education |
| must be one and only one Utilization Nurse or... |
| Case Manager or... |
| Account Coordinator or... |
| Account Executive |
| must be assigned one and only one Job Code |
| must be employeed by one and only one Internal Organization |
| must have been assigned one and only one Exempt Code |
| must MMI Demographic one and only one Organization & Person Demographic |
| Each Facility Authorization may Authorized Visit one and only one Authorized Visit |
| must be an authorization for one and only one Facility |
| Each Group Master may Account Insurance Information one or more Account Insurance
Information |
| may Authorization one or more Authorization |
| may Contracted Group one and only one Contracted Group |
| may Contracted Group Phy one or more Contracted Group Phy |
| may Group Address one or more Group Address |
| may Group Adjudication Rule one or more Group Adjudication Rule |
| may Group Benefit Package one or more Group Benefit Package |
| may Group Billing History one or more Group Billing History |
| may Group Broker one or more Group Broker |
| may Group Carrier History one or more Group Carrier History |
| may Group COBRA Employee one or more Group COBRA Employee |
| may Group Employee Summary one or more Group Employee Summary |
| may Group External Contact one or more Group External Contact |
| may Group Health Risk Evaluation one or more Group Health Risk Evaluation |
| may Group Industry one or more Group Industry |
| may Group Master Comment one or more Group Master Comment |
| may Group Name History one or more Group Name History |
| may Group Plan Type one or more Group Plan Type |
| may Group Senate Bill Impact one or more Group Senate Bill Impact |
| may Group Subgroup one or more Group Subgroup |
| may Group Team Message one or more Group Team Message |
| may owned by one or more Group Master |
| may Person Insurance one or more Person Insurance |
| may Sales Plan Detail one or more Sales Plan Detail |
| must Account Coordinator one and only one Account Coordinator |
| must Billing Cycle one and only one Billing Cycle |
| must Group Association Type one and only one Group Association Type |
| must Group Billing Type one and only one Group Billing Type |
| must Group Master one and only one Group Master |
| must Group Size Type one and only one Group Size Type |
| must Group Type one and only one Group Type |
| must Organization & Person Demographic one and only one Organization & Person
Demographic |
| must Proration Method one and only one Proration Method |
| must Region one and only one Region |
| Each Member may Appeal Member one or more Appeal Member |
| may Authorization one or more Authorization |
| may Member Authorization History one or more Member Authorization History |
| may Member Case Management Incident one or more Member Case Management Incident |
| may Member Claim History one or more Member Claim History |
| may Member Communication History one or more Member Communication History |
| may Member Eligibility History one or more Member Eligibility History |
| may Member Grievance History one or more Member Grievance History |
| may Member Insurance Carrier History one or more Member Insurance Carrier History |
| may Member Note one or more Member Note |
| may Member PCP Provider History one or more Member PCP Provider History |
| may Member PEC one or more Member PEC |
| may Member Plan Type Network one or more Member Plan Type Network |
| may Rider Master one and only one Rider Master |
| may select one or more Member Benefit Package Plan |
| must Age Level Group one and only one Age Level Group |
| must be one and only one Dependent or... |
| Subscriber |
| must Case Manager one and only one Case Manager |
| must Group Subgroup one and only one Group Subgroup |
| must Member Status one and only one Member Status |
| must Member Termination Reason one and only one Member Termination Reason |
| must MMI Demographic one and only one Organization & Person Demographic |
| Each Member Authorization History must Authorization one and only one Authorization |
| must Member one and only one Member |
| Each Place Of Service may Authorization one or more Authorization |
| may Ben Cat Place Of Service one or more Ben Cat Place Of Service |
| may Claim Detail one or more Claim Detail |
| may Provider Plan Contract History one or more Provider Plan Contract History |
| may Provider Plan Type one or more Provider Plan Type |
| Each Procedure Code may Claim Detail one or more Claim Detail |
| must Code Category one and only one Code Category |
| must Specific Procedure Code one and only one Specific Procedure Code |
| Each Provider Person may Account Receivable Ledger one or more Account Receivable
Ledger |
| may Appeal Provider one or more Appeal Provider |
| may Authorization one or more Authorization |
| may Be Referred To By one or more Authorization |
| may Be The Admitting Provider For one or more Claim |
| may be the prescribing doctor for one or more Pharmacy Claim |
| may Capitation Withholding one or more Capitation Withholding |
| may Claim one or more Claim |
| may Covering Provider one or more Covering Provider |
| may Encounter Service Charge one or more Encounter Service Charge |
| may Encounter Surgeon Procedure one or more Encounter Surgeon Procedure |
| may Inpatient Hospital Affiliation one or more Inpatient Hospital Affiliation |
| may Member PCP Provider History one or more Member PCP Provider History |
| may Observation one or more Observation |
| may Outpatient Facility Affiliation one or more Outpatient Facility Affiliation |
| may Patient Account Billing Detail one or more Patient Account Billing Detail |
| may Provide Prof Society Affilation one or more Provide Prof Society Affilation |
| may Provider Address one or more Provider Address |
| may Provider Board Certification one or more Provider Board Certification |
| may Provider Board Eligibility one or more Provider Board Eligibility |
| may Provider Contact one or more Provider Contact |
| may Provider Credential History one or more Provider Credential History |
| may Provider Credential Note one or more Provider Credential Note |
| may Provider DEA License one or more Provider DEA License |
| may Provider Degree Education one or more Provider Degree Education |
| may Provider Demographic Override one and only one Provider Demographic Override |
| may Provider Encounter Role one or more Provider Encounter Role |
| may Provider Fee Schedule one or more Provider Fee Schedule |
| may Provider Malpractice Insurance one or more Provider Malpractice Insurance |
| may Provider Medical Training one or more Provider Medical Training |
| may Provider Note one or more Provider Note |
| may Provider Phone one or more Provider Phone |
| may Provider Plan Type one or more Provider Plan Type |
| may Provider Specialty one or more Provider Specialty |
| may Provider State License one or more Provider State License |
| may Provider Tax ID one or more Provider Tax ID |
| may Refer one or more Claim |
| may Refer To By one or more Claim |
| may Referring one or more Authorization |
| may Resource one and only one Resource |
| may Speak one or more Language |
| must be one and only one Contract Doctor or... |
| External Facility Provider |
| must Have Its Type In one and only one Provider Role Type |
| must MMI Demographic one and only one Organization & Person Demographic |
| must Provider Person Demo History one or more Provider Person Demo History |
| must Provider Termination Reason one and only one Provider Termination Reason |
| must Provider Type one and only one Provider Type |
| Each Provider Plan Type may Accepting New Patients History one or more Accepting New
Patients History |
| may FFS Payment History one or more FFS Payment History |
| may PCP History one or more PCP History |
| may Pharmacy Dispensing Fee one or more Pharmacy Dispensing Fee |
| may Pricing Category History one or more Pricing Category History |
| may Pricing Exception one or more Pricing Exception |
| may Pricing Group one or more Pricing Group |
| may Provider Capitated Payment one or more Provider Capitated Payment |
| may Provider Contract Payment one or more Provider Contract Payment |
| may Provider DRG Pay History one or more Provider DRG Pay History |
| may Provider FFS Vendor one or more Provider FFS Vendor |
| may Provider IPA one or more Provider IPA |
| may Provider Perc Of Charges History one or more Provider Perc Of Charges History |
| may Provider Plan Contract History one or more Provider Plan Contract History |
| may Provider Plan IPA one or more Provider Plan IPA |
| may Provider Plan Network one or more Provider Plan Network |
| may Provider Plan Participating Stat one or more Provider Plan Participating Stat |
| may Provider Procedure Withhold one or more Provider Procedure Withhold |
| may Provider Settlement History one or more Provider Settlement History |
| may Provider Withholding Amount one or more Provider Withholding Amount |
| may Vendor Plan History one or more Vendor Plan History |
| must Place Of Service one and only one Place Of Service |
| must Plan Type one and only one Plan Type |
| must Provider Attribute Code one or more Provider Attribute Code |
| must Provider Contract Status one and only one Provider Contract Status |
| must Provider Person one and only one Provider Person |
| must Provider Termination Reason one and only one Provider Termination Reason |
| Each Service Reason may Authorized Visit one or more Authorized Visit |
| may Claim Detail one or more Claim Detail |
| Each Service Type may Specific Procedure Code one or more Specific Procedure Code |
| Each Specific Procedure Code may Account Receivable Ledger one or more Account
Receivable Ledger |
| may Authorized Procedure one or more Authorized Procedure |
| may Claim Detail one or more Claim Detail |
| may Have Its Charge Pcts Defined In one or more Procedure Pct Of Charges |
| may Procedure Code one or more Procedure Code |
| may Procedure Followup Exclusions one or more Procedure Followup Exclusions |
| may Procedure Followup Type one or more Procedure Followup Type |
| may Procedure Pricing one or more Procedure Pricing |
| may Provider Procedure Withhold one or more Provider Procedure Withhold |
| may Relative Value one or more Relative Value |
| must be one and only one ADA Procedure Code or... |
| Surgical Procedure Code or... |
| HCPC Code or... |
| CPT Procedure Code |
| must have a type in one and only one Procedure Type |
| must Service Type one and only one Service Type |
| Each Utilization Nurse must be of one and only one Employee |
