I've created a generic, comprehensive Data Vault 2.0 model and solution overview for a healthcare claims adjudication system.
The Data Vault pattern is particularly powerful for healthcare claims because it maintains complete data lineage while providing the flexibility to integrate new data sources and adapt to changing business rules — exactly what's needed for the complex, regulated claims adjudication environment.
Regulatory compliance and audit trails: Data Vault's auditability ensures organizations can maintain detailed historical records and data lineage. For Master Data Management (MDM), Data Vault serves as a foundational model — providing a structured way to manage and govern core business entities.
Core architecture
- 7 primary hubs — Member, Provider, Plan, Claim, Procedure, Diagnosis, Payment
- 6 key links — connecting all major relationships in the claims process
- 15+ satellites — capturing descriptive data and process states
- Process-specific satellites — for pre-adjudication, adjudication, and post-adjudication tracking
Key benefits
- Complete auditability — every data change tracked with source-system lineage
- Scalable integration — parallel loading and independent schema evolution
- Real-time processing — support for both batch and streaming data integration
- Regulatory compliance — built-in historical tracking and audit capabilities
Solution highlights — data marts & operational store
The model addresses several industry challenges through dedicated marts and an operational data store:
Claims Processing Data Mart — optimized for claims analytics and reporting, sourced from claims data across all processing stages.
Financial Data Mart — financial reporting and payment analytics, sourced from payment, accumulator, and purse management data.
Member Analytics Data Mart — member behavior and utilization analytics, sourced from member interactions, claims history, and service utilization.
Provider Performance Data Mart — network management and provider performance, sourced from provider validation, claims processing, and payment data.
Provider claim submission quality — network utilization, provider payment patterns, and credentialing status tracking.
Fraud & Compliance Data Mart — fraud detection and regulatory compliance, sourced from fraud detection, audit, and validation data.
Operational Data Store (ODS) — near real-time operational reporting and monitoring, sourced from current state data across all hubs and satellites.
This is a reference Data Vault 2.0 model with full definitions and details. Reach out for a copy of the data dictionary.
Healthcare claims Data Vault schema — focused view
The full model is too big to fit in one diagram. Below is a focused view of the Member–Plan slice, demonstrating the hub-satellite-link pattern.
