PR_EST_AP_CLAIM_PROC

Description: |
This table stores service line information for managed care estimates.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
ESTIMATE_ID | 1 |
LINE | 2 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | ESTIMATE_ID | NUMERIC | No |
The unique identifier for the patient estimate record.
2 | LINE | INTEGER | No |
The line number for the information associated with this record. Multiple pieces of information can be associated with this record.
3 | CONTEXT_LINE | INTEGER | No |
The LINE in the PR_EST_AP_CLAIM table that stores the claim information that this service line is associated with.
4 | PROC_ID_PROC_NAME | VARCHAR | No |
The name of each procedure.
5 | PROC_MODS | VARCHAR | No |
The modifiers associated with the service line.
6 | PROC_QTY | INTEGER | No |
The procedure quantity associated with the service line.
7 | CHG_AMT | NUMERIC | No |
The billed amount associated with the service line.
8 | SYS_CHG_AMT | NUMERIC | No |
The system-calculated billed amount associated with the service line detail.
9 | ALLOW_AMT | NUMERIC | No |
The allowed amount associated with the service line.
10 | SYS_ALLOW_AMT | NUMERIC | No |
The system-calculated allowed amount associated with the service line detail.
11 | SELF_PAY_AMT | NUMERIC | No |
The self-pay amount associated with the service line.
12 | SYS_SELF_PAY_AMT | NUMERIC | No |
The system-calculated self-pay amount associated with the service line detail.
13 | MC_ADDL_LINE | INTEGER | No |
The LINE in the PR_EST_ADDL_INFO table that stores additional information about the service line.
14 | TX_ID | NUMERIC | No |
The AP Claims transaction (ETR) ID associated with this estimate procedure line.
15 | AUTH_REQUIRED_YN | VARCHAR | No |
Identifies if an authorization is required for the procedure line to be covered.
May contain organization-specific values: No
Category Entries:
No
Yes
16 | DRG_ID | VARCHAR | No |
The Diagnosis Related Group (DRG) associated with the service line detail.
17 | DRG_ID_DRG_NAME | VARCHAR | No |
The name of the Diagnoses Related Group name.
18 | MC_NETWORK_LEVELS_C_NAME | VARCHAR | No |
Indicates if the service is priced to be In or Out of network.
May contain organization-specific values: Yes
Category Entries:
In
Out
Out of Area
N/A
19 | MC_CLICKED_ON_YN | VARCHAR | No |
Signals if the line was clicked on by the member
The category values for this column were already listed for column: AUTH_REQUIRED_YN
20 | MC_IS_ANCHOR_YN | VARCHAR | No |
This indicates whether the associated procedure is what the member searched for in Cost Calc (Aka. Anchor)
The category values for this column were already listed for column: AUTH_REQUIRED_YN
21 | REV_CODE_ID | NUMERIC | No |
The revenue code associated with the service line detail.
22 | REV_CODE_ID_REVENUE_CODE_NAME | VARCHAR | No |
The name of the revenue code.