Payer Plan Period

Epic equivalent: Registration / ADT insurance data / Eligibility feeds

The payer_plan_period table captures spans of insurance coverage under specific plans and payers. In Epic, this comes from registration and insurance eligibility feeds. Each row is a continuous period of enrollment or coverage.

Essential for eligibility criteria, payer stratification, and continuous enrollment filters. Sparse in EHR-derived OMOP including Emory's.

Epic-to-OMOP Field Mapping

Field reference (click to expand)

OMOP Field	Epic Equivalent	What It Captures
payer_plan_period_id	Coverage segment ID	Unique identifier
person_id	Patient ID / MRN	Links to the patient
payer_plan_period_start_date	Coverage start	First day of active coverage
payer_plan_period_end_date	Coverage end	Last day of coverage
payer_concept_id	Payer organization	"Medicare", "Private payer", etc.
payer_source_value	Raw payer name/code	Original payer ID from source
plan_concept_id	Plan type	HMO, PPO, etc.
plan_source_value	Local plan name	Original plan name (e.g., "BlueCross HMO Plan 2023")
sponsor_concept_id	Employer/group	Sponsoring organization (rarely populated)
family_source_value	Family group code	Household policy ID (for dependent analyses)

What to Watch For

Common pitfalls

Often absent in EHR-derived OMOP

This table is primarily populated from claims or linked eligibility data. Emory's is limited. See Known Issues for updates.

Coverage, not claims

This table represents insurance enrollment, not service-level claim detail.

Validate continuity

Gaps between coverage periods are possible. Don't assume continuous enrollment without checking.

Research Patterns

Question	Tables Involved
Continuous Medicaid coverage during pregnancy	payer_plan_period + condition_occurrence (pregnancy)
Cancer screening rates by insurance type	payer_concept_id + procedure_occurrence or measurement
Average commercial plan enrollment duration	payer_plan_period end − start date
12-month continuous eligibility filter	payer_plan_period duration filtering
Access to high-cost therapies by payer type	drug_exposure + payer_concept_id