COVERAGE_2

Description: |
The COVERAGE_2 table contains high-level information on both managed care and indemnity coverage records in your system.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
CVG_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CVG_ID | NUMERIC | No |
The unique identifier for the coverage record.
2 | STATUS_C_NAME | VARCHAR | No |
The category number of the status for this coverage record.
May contain organization-specific values: No
Category Entries:
Active
Inactive
Deleted
Inactive and Deleted
Hidden
Inactive and Hidden
Deleted and Hidden
Inactive Deleted and Hidden
3 | IS_DEDUCT_MET_C_NAME | VARCHAR | No |
Indicates whether the deductible has been met for this coverage. The deductible can be established on the guarantor account or patient level.
May contain organization-specific values: No
Category Entries:
Deductible Met
Not Met
4 | IS_ASGN_CVG_C_NAME | VARCHAR | No |
Indicated whether the provider's assignment status is set to Coverage Assignment for this coverage's payor.
May contain organization-specific values: No
Category Entries:
Accept Assignment
Do Not Accept Assignment
5 | SIG_ON_FILE_DATE | DATETIME | No |
The date when the signature was filed.
6 | SIG_ON_FILE_LOC | VARCHAR | No |
The location at which the signature was filed.
7 | MEDIGAP_AUTH_YN | VARCHAR | No |
Indicates whether the payor for this coverage has Medigap authorization.
May contain organization-specific values: No
Category Entries:
Yes
No
8 | TPL_RESOURCE_CODE | VARCHAR | No |
This column lists the Third Party Liability resource code for a specific plan. This code is either returned in the real-time eligibility response or found on the patient's insurance card.
9 | THIRD_PARTY_LIAB_YN | VARCHAR | No |
Indicates if there is third-party liability for this coverage.
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
10 | BENEFIT_CODE | VARCHAR | No |
The benefit code for this coverage. This can contain any facility-specific benefit code.
11 | EMPLOYEE_ID_NUM | VARCHAR | No |
The coverage subscriber's employee ID number.
12 | SCHEDULED_DISCON_DT | DATETIME | No |
The date when the coverage is scheduled to be discontinued.
13 | SCHEDULED_ACTV_DT | DATETIME | No |
The date when the coverage is scheduled to be activated.
14 | YR_ALLOW_DOL_TOT | VARCHAR | No |
The yearly dollar limit for payments against this coverage's payor.
15 | YR_ALLOW_DOL_USE | VARCHAR | No |
The year-to-date payments made against the coverage's payor.
16 | ORG_FOR_CLM_SUBMIT | VARCHAR | No |
The title or name of the organization to which submitted claims under this coverage will be sent.
17 | FINANCIAL_CLASS_C_NAME | VARCHAR | No |
The financial class for this coverage. This is only used for CMS claims forms and may not be reliably populated for reporting. Reporting should done using the financial class of the payor specified in this coverage.
May contain organization-specific values: Yes
Category Entries:
Commercial
Medicare
Medicaid
Self-Pay
Worker's Comp
Tricare
Champva
Group Health Plan
FECA Black Lung
Blue Shield
Medigap
Other
DK Regional
Client
Received Self-Pay
Sent to Consolidated Self-Pay
Patient Assistance Program
18 | COVERAGE_FAX | VARCHAR | No |
The fax number for this coverage.
19 | FREE_TXT_PLAN_NAME | VARCHAR | No |
The free-text plan name for this coverage.
20 | FREE_TXT_PAYOR_NAME | VARCHAR | No |
The free-text payor name for this coverage.
21 | PLAN_FREE_TEXT | VARCHAR | No |
The format of the coverage's free-text plan.
22 | TEFRA_PAT_YN | VARCHAR | No |
Indicates whether the patient is TEFRA. A patient is TEFRA if an eligible Medicare beneficiary is covered by a group health plan.
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
23 | ADMISSION_SRC_C_NAME | VARCHAR | No |
The category number of the admission source.
May contain organization-specific values: Yes
Category Entries:
Physician Referral
Clinic Referral
HMO Referral
Transfer from Hospital
Transfer from a SNF
Transfer from other Health Care Facility
Emergency Room
Court/Law Enforcement
24 | ENROLL_CODE_FBC | VARCHAR | No |
The Federal Employment Program enrollment code.
25 | GRP_NUMBER | VARCHAR | No |
The group number for the coverage.
26 | HMO_SITE_NUM | VARCHAR | No |
The site number for the coverage's HMO.
27 | HMO_SITE_PHONE | VARCHAR | No |
The phone number for the coverage's HMO.
28 | COPAY_AMOUNT | VARCHAR | No |
The copay amount for the coverage.
29 | CHAMP_SPON_STATUS_C_NAME | VARCHAR | No |
The CHAMPUS/Tricare sponsor's military status, obtained from the military identification card.
May contain organization-specific values: Yes
Category Entries:
Active Military
Retired Military
Deceased
30 | SERVICE_BRANCH | VARCHAR | No |
The military service branch for a CHAMPUS/Tricare coverage subscriber.
31 | CHAMP_SPON_BRANCH_C_NAME | VARCHAR | No |
A CHAMPUS/Tricare coverage sponsor's military service branch.
May contain organization-specific values: Yes
Category Entries:
Army
Air Force
Marines
Navy
Coast Guard
Public Health Service
NOAA (National Oceanic & Atmospheric Adm.)
32 | CHAMP_SPON_GRADE_C_NAME | VARCHAR | No |
A CHAMPUS/Tricare coverage sponsor's military pay grade.
May contain organization-specific values: Yes
Category Entries:
G1 Commissioned
09 Commissioned
08 Commissioned
07 Commissioned
06 Commissioned
05 Commissioned
04 Commissioned
03 Commissioned
02 Commissioned
01 Commissioned
W4 Warrant
W3 Warrant
W2 Warrant
W1 Warrant
E9 Enlisted
E8 Enlisted
E7 Enlisted
E6 Enlisted
E5 Enlisted
E4 Enlisted
E3 Enlisted
E2 Enlisted
E1 Enlisted
Security
NATO
CHAMPVA
33 | MCARE_OTHER_INS_CO | VARCHAR | No |
An additional insurance company providing coverage for a Medicare patient.
34 | MCARE_REC_DIS_YN | VARCHAR | No |
Indicates if a Medicare patient is receiving disability benefit.
May contain organization-specific values: No
Category Entries:
YES
NO
35 | DIS_CVD_BY_EMP_YN | VARCHAR | No |
Indicates if a Medicare patient is receiving disability coverage from their employer.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
36 | MCARE_100_EMP_YN | VARCHAR | No |
Indicates if a Medicare employer has over 100 employees.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
37 | MCARE_AUTO_YN | VARCHAR | No |
Indicates if the illness or injury for this visit is due to an automobile accident.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
38 | MCARE_LIAB_YN | VARCHAR | No |
Indicates if the illness or injury for this visit is due to a liability accident.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
39 | MCARE_WK_COMP_YN | VARCHAR | No |
Indicates if a Medicare visit is covered by Workman's Compensation.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
40 | MCARE_NON_AUTO_YN | VARCHAR | No |
Indicates if the patient's visit is due to an accident not involving automobiles.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
41 | MCARE_BLACK_LUNG_YN | VARCHAR | No |
Indicates whether the illness is covered by the Black Lung program.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
42 | MCARE_VA_YN | VARCHAR | No |
Indicates if the illness is covered by a Veterans' Administration program.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
43 | MCARE_PARENT_EMP_YN | VARCHAR | No |
Indicates whether the patient's parents or guardians are employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
44 | MCARE_CVD_GD_YN | VARCHAR | No |
For large group health plans, indicates if the patient is covered by their parent or guardian.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
45 | MCARE_GD_EMP_100_YN | VARCHAR | No |
Indicates whether the employer of this patient's parent or guardian employs over 100 people.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
46 | IS_MCARE_VET_ADMN_C_NAME | VARCHAR | No |
Indicates whether this coverage is for a Veterans' Administration program.
May contain organization-specific values: Yes
Category Entries:
Yes
No
UNKNOWN
47 | MCARE_EMPLOYED_YN | VARCHAR | No |
Indicates whether the Medicare patient is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
48 | MCARE_ENRL_HMO_YN | VARCHAR | No |
Indicates if the Medicare patient is enrolled in an HMO.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
49 | MCARE_CVD_EGHP_YN | VARCHAR | No |
Indicates whether the patient is covered by an employer group health plan.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
50 | MCARE_EMP_20_YN | VARCHAR | No |
Indicates whether the Medicare patient is employed by an employer with over 20 employees.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
51 | MCARE_REN_DIAL_YN | VARCHAR | No |
Indicates whether the patient is a renal dialysis patient in the first 12 months of entitlement.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
52 | IS_MCARE_RENAL_DI_C_NAME | VARCHAR | No |
Indicates whether the patient is a renal dialysis patient.
The category values for this column were already listed for column: IS_MCARE_VET_ADMN_C_NAME
53 | MCARE_1ST_18MO_YN | VARCHAR | No |
Indicates whether the patient is in the first 18 months of entitlement for renal dialysis.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
54 | MCARE_HOME_DIAL_YN | VARCHAR | No |
Indicates whether the patient is a home dialysis patient.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
55 | MCARE_SELF_EPO_YN | VARCHAR | No |
Indicates whether this patient self-administers EPO.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
56 | MCARE_DISABLE_YN | VARCHAR | No |
Indicates whether a patient's Medicare coverage is due to disability.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
57 | MCARE_SPSE_RET_YN | VARCHAR | No |
Indicates whether a Medicare patient's spouse is retired.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
58 | MCARE_SPOUSE_RET_DT | DATETIME | No |
The date when a Medicare patient's spouse retired.
59 | MCARE_EMPR_INS_YN | VARCHAR | No |
Indicates whether a Medicare patient is insured by their employer.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
60 | MCARE_RETIRE_YN | VARCHAR | No |
Indicates whether a Medicare patient is retired.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
61 | MCARE_RETIRE_DATE | DATETIME | No |
The date when a Medicare patient retired.
62 | MCARE_FAM_EMPY_YN | VARCHAR | No |
Indicates whether a Medicare patient's spouse or another family member is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
63 | MCARE_OTHR_CVG_YN | VARCHAR | No |
Indicates whether a Medicare patient is covered because of their spouse or other family member.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
64 | MCARE_SPC_EMP_YN | VARCHAR | No |
Indicates whether a Medicare patient's spouse is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
65 | MCARE_CVG_FRM_SP_YN | VARCHAR | No |
Indicates whether a Medicare patient is covered through their spouse's employer group health plan.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
66 | VERIF_EVS_YN | VARCHAR | No |
Indicates if verification is done through Eligibility Verification Systems (EVS).
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
67 | EVS_VERIF_DATE | DATETIME | No |
The date when eligibility was verified with Eligibility Verification Systems (EVS).
68 | PAYOR_NAME | VARCHAR | No |
The coverage payor's name.
69 | PAYOR_CITY | VARCHAR | No |
The coverage payor's city.
70 | EXT_CVG_SRC_ORGANIZATION_ID | NUMERIC | No |
The Organization (DXO) that provided the information for this coverage.
71 | EXT_CVG_SRC_ORGANIZATION_ID_EXTERNAL_NAME | VARCHAR | No |
Organization's external name used as the display name on forms and user interfaces.
72 | EXT_CVG_FHIR_IDENT | VARCHAR | No |
The FHIR Id of a coverage record on an external system that was used to create this coverage.
73 | EXT_CVG_OID | VARCHAR | No |
The OID of a coverage record on an external system that was used to create this coverage.
74 | EXT_PAYER_NAME | VARCHAR | No |
Payer name received for a coverage from an external payer system.
75 | EXT_PLAN_NAME | VARCHAR | No |
Plan name received for a coverage from an external payer system.