CLAIM_REFERENCE_DATA

Description: |
Table of Claim Reference Data collections, where each collection represents a single piece of received claim-related data.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
REF_DATA_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | REF_DATA_ID | NUMERIC | No |
The unique identifier for the Claim Reference Data record.
2 | RECORD_STATUS_C_NAME | VARCHAR | No |
Stores the record status (hidden, soft-deleted, and others).
May contain organization-specific values: No
Category Entries:
Soft Deleted
Hidden
Hidden and Soft Deleted
3 | ORGANIZATION_ID | NUMERIC | No |
The ID of the organization that sent the invoice.
4 | ORGANIZATION_ID_EXTERNAL_NAME | VARCHAR | No |
Organization's external name used as the display name on forms and user interfaces.
5 | PAT_ID | VARCHAR | No |
The Patient ID of the member in the Payer system for whom the invoice was sent.
6 | MEMBER_IDENT | VARCHAR | No |
The Member ID of the associated member for whom the invoice was sent.
7 | CRF_RECORD_TYPE_C_NAME | VARCHAR | No |
The type of Claim Reference Data record. This is determined by the claims-related record the Claim Reference Data record will link to (Claim, Referal, or other).
May contain organization-specific values: No
Category Entries:
Claim
8 | LINKED_CLAIM_ID | NUMERIC | No |
The ID of the Claim record linked to the Claim Reference Data record.
9 | BILLING_PROV_NPI | VARCHAR | No |
The NPI of the Billing Provider / Vendor that sent the invoice.
10 | BILLING_PROV_TAX_IDENT | VARCHAR | No |
The Tax ID of the Billing Provider / Vendor that sent the invoice.
11 | BILLING_SYS_C_NAME | VARCHAR | No |
The type of the Billing System that sent the invoice.
May contain organization-specific values: No
Category Entries:
Professional Billing
Hospital Billing
Tapestry
Healthy Planet
Payer Platform
Data Aggregation
12 | HOSPITAL_ACCT_IDENT | VARCHAR | No |
The external identifier of the Hospital Account associated with the invoice. This identifier should not be used to join to internal Hospital Account tables.
13 | CLAIM_INT_CONTROL_NUMBER | VARCHAR | No |
The Internal Control Number (ICN) for the claim. Each ICN points to a unique Claim record in the Payer system.
14 | INVOICE_NUMBER | VARCHAR | No |
The number of the invoice in the claim reference data set.
15 | CLAIM_FROM_DATE | DATETIME | No |
The minimum service date on the claim.
16 | CLAIM_TO_DATE | DATETIME | No |
The maximum service date on the claim.
17 | BILLED_AMOUNT | NUMERIC | No |
The total of the charges on the claim.
18 | ORIGINAL_INVOICE_NUMBER | VARCHAR | No |
The number of the original or previous invoice in a series of invoices where the previous invoice was canceled, replaced, resubmitted, or otherwise nullified.
19 | CANCEL_FLAG_C_NAME | VARCHAR | No |
Flag raised if the associated invoice is a Cancellation.
May contain organization-specific values: No
Category Entries:
Yes
20 | REPLACE_FLAG_C_NAME | VARCHAR | No |
Flag raised if the associated invoice is a Replacement.
The category values for this column were already listed for column: CANCEL_FLAG_C_NAME
21 | RESUBMIT_FLAG_C_NAME | VARCHAR | No |
Flag raised if the associated invoice is a Resubmission.
The category values for this column were already listed for column: CANCEL_FLAG_C_NAME
22 | RECORD_NAME | VARCHAR | No |
The name of the Claim Reference Data record.
23 | PRIMARY_LINK_UTC_DTTM | DATETIME (UTC) | No |
The instant a Primary record was linked to the Claim Reference Data record.
24 | CANCELLED_BY_PROV_FLAG_C_NAME | VARCHAR | No |
Indicates whether the associated invoice has been cancelled by the submitter.
The category values for this column were already listed for column: CANCEL_FLAG_C_NAME
25 | PAT_MRN | VARCHAR | No |
The patient's medical record number.
26 | FILING_ORDER_C_NAME | VARCHAR | No |
Stores the providers claim filing order.
May contain organization-specific values: No
Category Entries:
Primary
Secondary
Tertiary
Post-Tertiary
Unknown
27 | REF_DATA_CLAIM_PRINT_ID | NUMERIC | No |
The claim print record for which the CRF record is generated from. This item is only populated on a shared instance implementation of CRF.
28 | ASSOCIATED_CLAIM_FORM_TYPE_C_NAME | VARCHAR | No |
The claim type associated with this Claim Reference Data record.
May contain organization-specific values: Yes
Category Entries:
CMS Claim
UB Claim
State Visit Data
State Visit Provider Data
Vektis Claim
Pharmacy Claim
Medical Claim
29 | ASSOCIATED_COVERAGE_ID | NUMERIC | No |
The coverage associated with this Claim Reference Data record.
30 | PROV_CLM_RECON | VARCHAR | No |
The Claim Reconciliation (CRD) record id in the provider system's Epic instance. This is not a networked item and does not link to a Claim Reconciliation record.
31 | SUBSCRIBER_IDENT | VARCHAR | No |
The Subscriber ID of the member in the Payer system associated with the claim reference data set.
32 | MEM_REL_TO_SUB_C_NAME | VARCHAR | No |
The relationship of the patient to the subscriber for the member in the Payer system associated with the claim reference data set.
May contain organization-specific values: Yes
Category Entries:
Self
Spouse
Child
Employee
Unknown