Configurable platform. The schema below reflects one engagement configuration. Verdict Consulting Group tailors entities, joins, and reference tables to each matter — payer underpayment, FCA defense, qui tam, or commercial disputes.

Entity Relationships

Configured for current engagement

Primary key Foreign key

Claims

  • claim_id
    varchar
  • patient_id
    uuid
  • provider_id
    uuid
  • payer_id
    uuid
  • service_date
    date
  • billed
    money
  • paid
    money
  • status
    enum

One row per claim (the analysis unit).

Patients

  • patient_id
    uuid
  • last_name
    varchar
  • first_name
    varchar
  • dob
    date
  • member_no
    varchar

Disambiguated patient identities across feeds.

Service Lines

  • line_id
    uuid
  • claim_id
    varchar
  • procedure_code
    varchar
  • revenue_code
    varchar
  • billed
    money
  • allowed
    money
  • paid
    money

Line-level CPT / revenue code records per claim.

Payments

  • payment_id
    uuid
  • claim_id
    varchar
  • paid
    money
  • pat_resp
    money
  • remit_date
    date

Remit and adjudication detail (835).

Disputes

  • dispute_id
    uuid
  • claim_id
    varchar
  • type
    enum
  • filed_at
    timestamp
  • outcome
    enum

Dispute or appeal record per claim.

Providers

  • provider_id
    uuid
  • name
    varchar
  • tin
    varchar
  • specialty
    varchar

Facility / provider master.

Payers

  • payer_id
    uuid
  • name
    varchar
  • ein
    varchar
  • plan_type
    enum

Insurance carrier master.

Reference Tables

Versioned reference data joined into the analysis pipeline

Benchmarks Master 2024
54,802 rows

Population-level expected payment reference

Procedure Code Master
11,240 rows

Procedure and supply code dictionary

Payer Crosswalk
248 rows

Carrier-to-plan mapping

Demo engagement • Configurable per matter

Demo Data