Procella HelpdeskPoint-in-Time Architecture Examples
Point in Time Architecture (PTA) is the process of identifying the correct record to use based on the date of service. There are many dates associated with the records in the system. This is critical when establishing dates on Criteria and other elements within the Procella System. The general process for Point in Time Architecture (PTA) is to find all active records. Then within those Active records, select all records where the Date of Service is between the respective record Effective Start Date and record Effective End date. Find the most effective records based on the record effective START date. Then find the most recently created record, which is needed when there is more than one record with the same record Effective Start Date.
For point-in-time architecture, we focus on 5 primary dates.
Date of Service: The Date of Service (aka Date Filled) is a key date. This is the date that the system will find the appropriate records to process the claim.
Effective Start Date: The Effective Start Date is the first date the record can be used. Throughout this example, we will use CRITERIA as the record. So, the Effective Start Date is the first date to use this Criteria.
Effective End Date: The Effective End Date is the last date the record will be used. This date is a through date. Therefore, if the effective end date is 12/31/2021, the Criteria record will be used for all of December 31, 2021.
Activated At: The Activated At date is when the record was first activated in the system. While this date is not seen by the user, it is stored in the database. This date/time field is system generated.
Deactived At: The Deactivated At date is the date the record was deactivated. The default Deactivated At date is 12/31/9999, also referred to as the end of time date. This date/time field is system generated.
NOTE: Do not confuse the Effective End Date with the Deactivated Date, nor the Effective Start Date and the Activated At dates. While these may be the same, it is not necessarily so. Refer to the following examples.
Below are examples of PTA, where new records and record changes take place.
Example 1 – Simple Example History
All examples will be based upon the claim being adjudicated on 6/15/2020.
Below are examples of point in time. In the example, we are looking for the right copay based on the date of service.
All examples use the adjudication date of 6/15/2020, the date the pharmacy submitted the POS claim to Procella’s platform.
Scenario 1: One Record
The setup has a record created at 12/24/2019 that has a Start Date on 01/01/2020 for a copay of $100.00.
Date of Service: 1/10/2020
ROW 1: On 1/1/2020 through 2/28/2020, the copay is $ 100.00.
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 12/24/2019 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 02/28/2020 | $100.00 |
The copay selected when the date of service is 1/10/2020 will be $100.00. Why?
| The row that satisfies the following result in the use of ROW 1 | |
| The Deactivated At date is End of Time (EOT) and therefore active (in other words, not deactivated at the time of adjudication). | Row 1 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 1 |
| COPAY | $100.00 |
Scenario 2: Two Records – new record added on 1/15/2020 with an effective start of 3/1/2020.
Date of Service: 3/10/2020
ROW 1: On 1/1/2020 through 2/28/2020, the copay is $ 100.00.
ROW 2: On 3/1/2020 through 12/31/2020, the copay is $ 150.00.
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 12/24/2019 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 02/28/2020 | $100.00 |
| 2 | 1/15/2020 02:04:07 AM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/2020 | $150.00 |
| The row that satisfies the following result in the use of ROW 2 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 2 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 2 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 2 |
| COPAY | $150.00 |
Scenario 3: Three Records – new record added on 1/25/2020 with an effective start of 2/1/2020.
Date of Service: 2/14/2020
ROW 1: On 1/1/2020 through 2/28/2020, the copay is $ 100.00.
ROW 2: On 3/1/2020 through 12/31/2020, the copay is $ 150.00.
ROW 3: On 2/1/2020 through 12/31/2020, the copay is $ 75.00.
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 12/24/2019 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 02/28/2020 | $100.00 |
| 2 | 1/15/2020 02:04:07 AM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/2020 | $150.00 |
| 3 | 1/25/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 02/01/2020 | 12/31/2020 | $75.00 |
The copay selected when the date of service was 2/14/2020 was $75.00. Why?
| The row that satisfies the following result in the use of ROW 3 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Rows 1 and 3 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 3 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 3 |
| COPAY | $75.00 |
Scenario 4: Three Records – the row 3 record deactivated on 2/1/2020.
Date of Service: 2/14/2020
ROW 1: On 1/1/2020 through 2/28/2020, the copay is $ 100.00.
ROW 2: On 3/1/2020 through 12/31/2020, the copay is $ 150.00.
ROW 3: On 2/1/2020, Row 3 was DEACTIVATED on 2/1/2020, the copay is $ 75.00.
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 12/24/2019 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 02/28/2020 | $100.00 |
| 2 | 1/15/2020 02:04:07 AM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/2020 | $150.00 |
| 3 | 1/25/2020 01:15:10 AM | 2/1/2020 02:14:31 AM | 02/01/2020 | 12/31/2020 | $75.00 |
The copay selected when the date of service was 2/14/2020 was $ 100.00. Why?
| The row that satisfies the following result in the use of ROW 1 | |
| The Deactivated At date is End of Time (EOT) and therefore active | Row 1 and 2 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 1 |
| COPAY | $100.00 |
Since Row 3 is not active (deactivated 2/1/2020) when the claim was processed, row 3 is not considered during processing.
Example 2 – Different Activated At Dates
All examples will be based upon the claim being adjudicated on 6/15/2020.
Date of Service: 1/10/2020
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 1 | |
| The Deactivated At date is End of Time (EOT) and therefore active | Row 1 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 1 |
| COPAY | $100.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:45:10 PM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $150.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 2 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | All Rows |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 2 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 2 |
| COPAY | $150.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:45:10 PM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $150.00 |
| 3 | 5/25/2020 15:33:10 PM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $75.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 2 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | All Rows |
| Select Most Effective Record Start Date (closest to Date of Service) | All Rows |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 3 |
| COPAY | $75.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:45:10 PM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $150.00 |
| 3 | 5/25/2020 15:33:10 PM | 2/1/2020 02:14:31 AM | 01/01/2020 | 12/31/9999 | $75.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 2 | |
| The Deactivated At date is End of Time (EOT) and therefore active | Row 1 and 2 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 and 2 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 and 2 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 2 |
| COPAY | $150.00 |
Example 3 – Different Activated At Dates
All examples will be based upon the claim being adjudicated on 6/15/2020.
Date of Service: 1/10/2020
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 1 | |
| The Deactivated At date is End of Time (EOT) and therefore active | Row 1 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 1 |
| COPAY | $100.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:15:10 PM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/9999 | $150.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 2 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | All Rows |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 2 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 2 |
| COPAY | $150.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:15:10 PM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/9999 | $150.00 |
| 3 | 5/25/2020 15:33:10 PM | 12/31/9999 12:00:00 AM | 02/01/2020 | 12/31/9999 | $75.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 3 | |
| The Deactivated At date is End of Time (EOT) and therefore active | All Rows |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 and 3 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 3 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 3 |
| COPAY | $75.00 |
| CRITERIA START / END DATES | |||||
| Row | Activated At | Deactivated At | Effective Start Date | Effective End Date | Copay |
| 1 | 5/24/2020 01:15:10 AM | 12/31/9999 12:00:00 AM | 01/01/2020 | 12/31/9999 | $100.00 |
| 2 | 5/24/2020 15:15:10 PM | 12/31/9999 12:00:00 AM | 03/01/2020 | 12/31/9999 | $150.00 |
| 3 | 5/25/2020 15:33:10 PM | 2/1/2020 02:14:31 AM | 02/01/2020 | 12/31/9999 | $75.00 |
| REASON | RESULTS |
| The row that satisfies the following result in the use of ROW 1 | |
| The Deactivated At date is End of Time (EOT) and therefore active | Row 1 and 2 |
| The Date of Service of the claim is between the Eff Start/Eff End Date | Row 1 |
| Select Most Effective Record Start Date (closest to Date of Service) | Row 1 |
| Find most recently created record (ActivatedAt). Used when process is down to 2 or more matching records | Row 1 |
| COPAY | $100.00 |