RECONCILE_CLM_OT

Description: |
This table contains over time single information for claim reconciliation records.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
CLAIM_REC_ID | 1 |
CONTACT_DATE_REAL | 2 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_REC_ID | VARCHAR | No |
The unique ID of the claim reconciliation record.
2 | CONTACT_DATE | DATETIME | No |
The contact date of the claim, in external format.
3 | CONTACT_DATE_REAL | NUMERIC | No |
The contact date of the claim, in internal format.
4 | CLM_STATUS_CODE_C_NAME | VARCHAR | No |
The status code of the claim being tracked over time.
May contain organization-specific values: Yes
Category Entries:
Unmapped code received
5 | PAYR_CLM_AMT_SUBMT | NUMERIC | No |
The amount submitted by the payer on this claim.
6 | PAYOR_CLM_AMT_PAID | NUMERIC | No |
The amount paid by the payer on this claim.
7 | PAYOR_REF_NUM | VARCHAR | No |
The claim's payer reference number.
8 | PAYOR_NAME | VARCHAR | No |
The payer name of the payer on the claim.
9 | CH_REF_NUM | VARCHAR | No |
This is the claim's clearinghouse reference number.
10 | CH_NAME | VARCHAR | No |
This is the claim's clearinghouse name.
11 | CLAIM_STATUS_MSG | VARCHAR | No |
The claim's textual status message.
12 | STATUS_DATE | DATETIME | No |
The status date of the claim.
13 | FILE_NAME | VARCHAR | No |
This is the filename associated with this claim.
14 | CM_CT_OWNER_ID | VARCHAR | No |
ID of the deployment owner for this contact.
15 | CLM_CLOSED_REASON_C_NAME | VARCHAR | No |
The category value for the reason the claim was closed. This value can be used to link to the ZC_CLM_CLSD_REASON table to get more information on the category values.
May contain organization-specific values: No
Category Entries:
Payment
Posting Action
External Status Change
Bucket Closed
Bucket Rejected
Bucket Replaced
Bucket Reopened
Invoice Split During Refresh
16 | CLAIM_ST_CAT_CODE_C_NAME | VARCHAR | No |
The status category code of the claim being tracked over time.
May contain organization-specific values: Yes
Category Entries:
Unmapped code received
17 | TRANSMIT_MEDIUM_C_NAME | VARCHAR | No |
If claim has been transmitted, this item stores the medium.
May contain organization-specific values: Yes
Category Entries:
Paper
Electronic
18 | ERR_FIELD | VARCHAR | No |
The field a claim error is reported in.
19 | ERR_ITEM | VARCHAR | No |
The item for which the claim error was reported.
20 | ERR_VAL | VARCHAR | No |
The claim value that caused the error.
21 | ERR_MSG | VARCHAR | No |
The error message received for a claim.
22 | CH_SENT_DATE | DATETIME | No |
Stores the date that the claim was sent out of the clearinghouse.
23 | PAYOR_RECV_DATE | DATETIME | No |
Stores the date that the payer received the claim.
24 | CLAIM_SEL_ACT_C_NAME | VARCHAR | No |
Stores the action that was selected to be performed on the invoice.
May contain organization-specific values: No
Category Entries:
No Action
Accept Claim
Send to WQ
25 | CLAIM_ACT_INFO_C_NAME | VARCHAR | No |
Can store additional information on why a given action was selected.
May contain organization-specific values: No
Category Entries:
File payor does not match CLP payor
Billing system mismatch
Claim not on claim run
Claim run not in status of processed
Unable to lock CLP
No codes mapped to Send to WQ
26 | TRANSMIT_STATUS_C_NAME | VARCHAR | No |
Stores the system transmission status for the claim.
May contain organization-specific values: No
Category Entries:
Not Transmitted
Transmit Success
Transmit Failed
Retransmit Success
Retransmit Failed
Queued
27 | EXTERNAL_REJECT_YN | VARCHAR | No |
Yes/No flag indicating that the claim has been rejected by the payor or clearinghouse.
May contain organization-specific values: No
Category Entries:
No
Yes
28 | PERFORM_ACT_C_NAME | VARCHAR | No |
Will store the action that was performed on the invoice.
May contain organization-specific values: No
Category Entries:
No Action
Accept Claim from Run
Send to WQ from Run
Accept from WQ
Resubmit from WQ
Resend to WQ
External Test Response No Action Mapped
29 | PERFORM_ACT_RSN | VARCHAR | No |
Stores the reason for the action that was performed on the invoice.
30 | GROUP_CONTROL_NUM | INTEGER | No |
Stores the group control number (GS-06) value for an American National Standards Institute (ANSI) electronic claim file.
31 | TRANSMIT_TYPE_C_NAME | VARCHAR | No |
Records electronic claim transmission type.
May contain organization-specific values: No
Category Entries:
Automatic Transmission
CORE Transmission
32 | PAYOR_CONTACT_NAME | VARCHAR | No |
Name of contact person or department associated with an information request.
33 | CLAIM_BILL_TYPE | VARCHAR | No |
This is the bill type received in the claim reconciliation file.
34 | MRN | VARCHAR | No |
This is the medical record number (MRN) received in the claim reconciliation file.
35 | INTERMEDIARY_IDENT | VARCHAR | No |
This is the transmission identifier received in the claim reconciliation file.
36 | AGENCY_CLAIM_NUM | VARCHAR | No |
This is the claim number received in the claim reconciliation file.
37 | CASE_REF_IDENT | VARCHAR | No |
This is the case reference identifier received in the claim reconciliation file.
38 | INFO_REQ_NUM | VARCHAR | No |
This is the attachment request tracking number received in the claim reconciliation file.
39 | PRIOR_INFO_REQ_NUM | VARCHAR | No |
This is the prior attachment request tracking number received in the claim reconciliation file.
40 | INFO_REQ_DUE_DATE | DATETIME | No |
Stores the date the requested information is to be returned.
41 | RESP_CONTACT_NAME | VARCHAR | No |
Name used by the payer for routing the requested information within their system.
42 | RESP_CONTACT_CITY | VARCHAR | No |
City of the mailing location for the return of attachment data.
43 | RESP_CONTACT_STATE | VARCHAR | No |
State of the mailing location for the return of attachment data.
44 | RESP_CONTACT_ZIP | VARCHAR | No |
Postal Code of the mailing location for the return of attachment data.
45 | RESP_CONTACT_CNTRY | VARCHAR | No |
Country of the mailing location for the return of attachment data.
46 | RESP_CONTACT_SUBDIV | VARCHAR | No |
Subdivision of the mailing location for the return of attachment data.
47 | SUPPORTED_ACTIONS_C_NAME | VARCHAR | No |
The claim actions supported by the interface profile at the time a claim status update is received from an external entity.
May contain organization-specific values: No
Category Entries:
Accept Claim
Send to Workqueue
All Available Actions
48 | TX_DEST_TYPE_C_NAME | VARCHAR | No |
The destination type when the claim is transmitted.
May contain organization-specific values: No
Category Entries:
Payer
Clearinghouse
Other Entity
49 | PAYER_CHECK_DATE | DATETIME | No |
Holds the payer check date from claim reconciliation.
50 | PAYER_CHECK_NUM | VARCHAR | No |
Holds the payer check number from claim reconciliation.
51 | STATUS_RESP_TYPE_C_NAME | VARCHAR | No |
This type of status response this contact represents.
May contain organization-specific values: No
Category Entries:
Claim Acknowledgment
Claim Status Request Response
Claim Pending Status
Claim Request for Additional Information
Implementation Acknowledgment
Claim Payment/Advice
52 | CLAIM_RECON_CSN_ID | NUMERIC | No |
The contact serial number (CSN) of the contact.
53 | HAS_REJ_SVC_LN_YN | VARCHAR | No |
Yes/No flag indicating that the claim contains service lines that were rejected by the payer or clearinghouse.
The category values for this column were already listed for column: EXTERNAL_REJECT_YN
54 | EXPRESS_IMAGE_ID | VARCHAR | No |
This item is set with the invoice level IMD created from a payer's interface message data when responding to an Express claim.
55 | MA_MAO002_ICN_IDENT | VARCHAR | No |
The ICN received on the MAO-002 for Medicare Advantage encounter reporting.