AP_CLAIM_2

Description: |
The AP_CLAIM_2 table contains one record for each claim in Tapestry's Accounts Payable module.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
CLAIM_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_ID | NUMERIC | No |
The unique identifier for the claim record.
2 | E_CODE_POA_C_NAME | VARCHAR | No |
Present on Admission (POA) indicator for the external cause of injury diagnosis code.
May contain organization-specific values: No
Category Entries:
1 - Unreported/Not used
Y - Yes
N - No
U - Unknown
W - Clinically undetermined
3 | READY_FOR_AP_MGR_ID_MEM_GRP_NAME | VARCHAR | No |
The name of the member group
4 | TOT_REFD_RECVD | NUMERIC | No |
The total refund received for the claim.
5 | TOTAL_COB_AMOUNT | NUMERIC | No |
Contains the calculated Coordination of Benefits (COB) amount for all services on the claim.
6 | EPSDT_YN | VARCHAR | No |
Stores if an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) referral was given to the patient on the claim.
May contain organization-specific values: No
Category Entries:
No
Yes
7 | RENDERING_PROV_ID_PROV_NAME | VARCHAR | No |
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
8 | TOTAL_MOB_AMOUNT | NUMERIC | No |
Stores the total Maintenance of Benefits (MOB) amount for all services on the claim.
9 | PMT_INFO_MAP_LN | INTEGER | No |
Stores the line that the Tapestry Profile responsibility map matched on.
10 | PMT_INFO_GRPR_ID | VARCHAR | No |
Stores the grouper rule that the Tapestry Profile responsibility map matched on.
11 | PMT_INFO_GRPR_ID_RULE_NAME | VARCHAR | No |
The name of the rule.
12 | PMT_INFO_RULE_ID | VARCHAR | No |
Stores the rule that the Tapestry Profile responsibility map matched on.
13 | PMT_INFO_RULE_ID_RULE_NAME | VARCHAR | No |
The name of the rule.
14 | PMT_INFO_SPLIT_ID | NUMERIC | No |
Stores the split definition record that was determined by the Tapestry Profile responsibility map.
15 | PMT_INFO_SPLIT_ID_SPLIT_DEF_NAME | VARCHAR | No |
The name of the split definition record.
16 | SPECIALTY_SOURCE_C_NAME | VARCHAR | No |
Source of associated specialty.
May contain organization-specific values: No
Category Entries:
Vendor
Physician
User
Provider Taxonomy Code
Vendor Taxonomy Code
Provider Specialty Table
Profile Specialty Table
17 | CASE_MGMT_CREAT_ID | VARCHAR | No |
ID of the case trigger message associated with the claim.
18 | CVG_FILTER_EPP_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
19 | PMT_INFO_STOP_COND | INTEGER | No |
Stores the procedure line that triggered a stopping condition during pricing.
20 | NO_MEM_GRP_YN | VARCHAR | No |
Identifies that the claim does not have a member group.
May contain organization-specific values: No
Category Entries:
No
Yes
21 | INTEREST_TOTAL | NUMERIC | No |
Stores the total interest for the claim, from the constituent service lines.
22 | PROV_ACPT_ASGN_C_NAME | VARCHAR | No |
Stores the provider accept assignment code.
May contain organization-specific values: No
Category Entries:
A - Assigned
B - Assigned for Clinical Lab Services Only
C - Not Assigned
P - Patient Refused to Assign Benefits
23 | BEN_ASGN_IND_C_NAME | VARCHAR | No |
Stores the benefits assignment indicator.
May contain organization-specific values: No
Category Entries:
N - No
Y - Yes
W - Not Applicable
24 | OVRD_SUB_POLICY_YN | VARCHAR | No |
If this item is set, the submission policy tables at the profile and on the vendor contract are ignored. The Claim filing window (days) setting on the vendor contract is also ignored.
The category values for this column were already listed for column: NO_MEM_GRP_YN
25 | OVRD_SUB_POL_RSN_C_NAME | VARCHAR | No |
This item provides an explanation as to why the override submission policy item is set.
May contain organization-specific values: Yes
No Entries Defined
26 | CLM_TRAIT_1_C_NAME | VARCHAR | No |
The first custom claim trait, used to classify and group claims.
May contain organization-specific values: Yes
27 | CLM_TRAIT_2_C_NAME | VARCHAR | No |
The second custom claim trait, used to classify and group claims.
May contain organization-specific values: Yes
28 | CLM_TRAIT_3_C_NAME | VARCHAR | No |
The third custom claim trait, used to classify and group claims.
May contain organization-specific values: Yes
No Entries Defined
29 | CLM_TRAIT_4_C_NAME | VARCHAR | No |
The fourth custom claim trait, used to classify and group claims.
May contain organization-specific values: Yes
No Entries Defined
30 | CLM_TRAIT_5_C_NAME | VARCHAR | No |
The fifth custom claim trait, used to classify and group claims.
May contain organization-specific values: Yes
No Entries Defined
31 | TP_INFO_837_SEND_ID | NUMERIC | No |
The trading partner (NTP record) that sent the ANSI 837 claim file that was used to submit this claim.
32 | TP_INFO_837_SEND_ID_TRADING_PARTNR_NAME | VARCHAR | No |
The name of the trading partner record.
33 | TP_INFO_837_RCVR_ID | NUMERIC | No |
The trading partner (NTP record) that received the ANSI 837 claim file that was used to submit this claim.
34 | TP_INFO_837_RCVR_ID_TRADING_PARTNR_NAME | VARCHAR | No |
The name of the trading partner record.
35 | APPLIANCE_PLACE_DT | DATETIME | No |
This is the date orthodontic appliances were placed.
36 | DNTL_SVC_FROM_DT | DATETIME | No |
This is the dental service span from date.
37 | DNTL_SVC_TO_DT | DATETIME | No |
This is the dental service span to date.
38 | ORTHO_SVCS_YN | VARCHAR | No |
This is to determine if orthodontic services were performed.
The category values for this column were already listed for column: NO_MEM_GRP_YN
39 | ORTHO_TOT_MONTHS | INTEGER | No |
This is the total months of orthodontic treatment.
40 | ORTHO_MNTHS_REMAIN | INTEGER | No |
This is the months of orthodontic treatment remaining
41 | ASSIST_SURGEON_ID_PROV_NAME | VARCHAR | No |
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
42 | DENTAL_INFO_YN | VARCHAR | No |
This is to determine if the claim has dental information.
The category values for this column were already listed for column: NO_MEM_GRP_YN
43 | LMP_DATE | DATETIME | No |
The date of the patient's last menstrual period.
44 | CHIR_FRST_TRT_DT | DATETIME | No |
First treatment date listed on the patient's claim.
45 | FROM_OCR_YN | VARCHAR | No |
Flags whether the claim was originally paper or scanned into the system through an EDI batch load.
The category values for this column were already listed for column: NO_MEM_GRP_YN
46 | CLM_PRICER_IDENT_C_NAME | VARCHAR | No |
When a matching repricer organization is found, the identification is stored on the claim.
May contain organization-specific values: Yes
47 | TOTAL_HRA_AMOUNT | NUMERIC | No |
Stores the total reimbursement amount for all services on the claim.
48 | ORIG_ACT_ADJ_CLM_ID | NUMERIC | No |
The original claim ID of the actual adjustment claim.
49 | REF_CLM | VARCHAR | No |
Contains the reference claim ID in the ANSI 837 file from Loop 2300, Segment REF02 with identifier F8. This is often used in combination with the claim frequency code. When the claim frequency code indicates the claim needs to be adjusted or voided, the reference claim ID is used to help identify the claim.
50 | MGR_ASSOC_EXT_VAL_C_NAME | VARCHAR | No |
Stores the association extension value returned by the association extension on the member group.
May contain organization-specific values: Yes
51 | AMBU_TRAN_REASON_C_NAME | VARCHAR | No |
Transport Reason code for ANSI claims.
May contain organization-specific values: Yes
Category Entries:
Nearest Facility for Care of Symptoms, Complaints, or Both
For the Benefit of a Preferred Physician
For the Nearness of Family Members
For the Care of a Specialist or for Availability of Specialized Equipment
Rehabilitation Facility
52 | AMBU_TRAN_DIST | NUMERIC | No |
Transport distance for the CRC segment in the 2300 loop on ANSI claims.
53 | AMBU_TXPORT_WT | NUMERIC | No |
Weight of the patient at the time of transport in an ambulance.
54 | AMBU_COND_YN | VARCHAR | No |
Indicates a yes or a no condition response code in the related item.
The category values for this column were already listed for column: NO_MEM_GRP_YN
55 | AMBU_PICK_UP_CITY | VARCHAR | No |
Stores the city of the ambulance pick-up location.
56 | AMBU_PICK_UP_ST_C_NAME | VARCHAR | No |
Stores the state of the ambulance pick-up location.
May contain organization-specific values: Yes
57 | AMBU_PICK_UP_ZIP | VARCHAR | No |
Stores the ZIP code of the ambulance pick-up location.
58 | AMBU_DROP_OFF_CITY | VARCHAR | No |
Stores the city of the ambulance drop-off location.
59 | AMBU_DROP_OFF_ST_C_NAME | VARCHAR | No |
Stores the state of the ambulance drop-off location.
The category values for this column were already listed for column: AMBU_PICK_UP_ST_C_NAME
60 | AMBU_DROP_OFF_ZIP | VARCHAR | No |
Stores the ZIP code of the ambulance drop-off location.
61 | AMBU_DROP_OFF_NM | VARCHAR | No |
Stores the last name or organization name of the ambulance drop-off location.
62 | PAYEE_C_NAME | VARCHAR | No |
Payee of the claim.
May contain organization-specific values: No
Category Entries:
Subscriber
Vendor
Member
Third Party
63 | ESRD_ONSET_DATE | DATETIME | No |
This item stores the onset date of End Stage Renal Disease. This date is sent on CMS 2728 form in Field 24.
64 | PAYOR_SEQ_NUMBER_C_NAME | VARCHAR | No |
Sequence number of the payor of the claim.
May contain organization-specific values: No
Category Entries:
Primary
Secondary
Tertiary
Quaternary
Quinary
Senary
Septenary
Octonary
Nonary
Denary
Undenary
65 | CLM_FREQ_CODE_C_NAME | VARCHAR | No |
Contains the claim frequency type code from the ANSI 837 file. The value comes from Loop 2300, Segment CLM05, Piece 3.
May contain organization-specific values: Yes
66 | DENY_CLM_SRC_C_NAME | VARCHAR | No |
Tracks the source of an attempt to deny a claim that can't be immediately denied, but has not yet reached a status of fully paid to be able to be reversed and adjusted. When claims with this item set are removed from a batch or become fully paid, they can be denied or reversed, adjusted and denied.
May contain organization-specific values: No
Category Entries:
Cancel 837
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