APPEAL_GRV_REQ_ATTACHMENT

Description: |
This table holds information about documents that are required to be attached to appeals and grievances. Each row corresponds to an individual document requirement and the document that satisfied the requirement.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | APPEAL_GRV_ID | NUMERIC | No |
The unique identifier (.1 item) for the appeal/grievance 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 | TAT_TIME_STANDARD_C_NAME | VARCHAR | No |
The timeliness standard category ID that corresponds to this attachment requirement.
May contain organization-specific values: Yes
Category Entries:
Operational
Medicare Advantage
4 | DOC_INFO_TYPE_C_NAME | VARCHAR | No |
The attachment type category ID for this attachment requirement.
May contain organization-specific values: Yes
Category Entries:
Other
Waveform Strip
Annotation
Advance Directives and Living Will
Power of Attorney
HIPAA Notice of Privacy
National POLST Form
Clinical Unknown
Patient Photo
SmartTextBox Patient Image
Study Attachment for Report
Study Attachment
DICOM Study
DICOM Series
DICOM Image
ECG
Spirometry
Holter
SMART Health Patient-Submitted
Authorization to Release Protected Health Information
HIM Release of Information Output
Kanta Informing
Kanta Consent to Data Sharing
Kanta Denial of Consent to Data Sharing
Kanta PikaXML CHF
Kanta GWN Disclosure Auth
Kanta Secondary Use Prohibition
Kanta Social Care Consent to Data Sharing
Kanta Social Care Denial of Consent to Data Sharing
Generated Form
Organ Donation Will
Living Will
Consent Form
Vaccine Information Statement
ABN Waiver
Discharge Instruction
Release of Information
Behavior Contract
Clinical References Attachment
External Medication Information Consent
After Visit Summary
Summary of Care
CMS IM for Patient Signature
CMS IM Copy of Signed
Detailed Notice of Discharge
Communication Verbal Consent
Referral Implied Consent
Unverified Proxy Video Visit After Visit Summary
Fetal Monitoring Strip
Lab Result Scan
Lab Requisition Scan
Lab Result Document
Lab Managed Result Scan
Lab Managed Requisition Scan
Lab Instrument Image
Lab External Image
Lab Pathology Result
Encounter Dictation
History Dictation
Order Dictation
Clinician Jot
Clinical Note Import
Clinical Progress Note
View Private Medications Consent
FMK Med Card PDF
FMK Dose Dispensing PDF
Research Consent
Research Data Capture
Plan of Care E-Sig Form
Plan of Care Snapshot
CCAPS Profile Report PDF
Safety Plan
Patient Belongings
Patient Belongings Intake
Patient Belongings Discharge
Hospice Election
EOB
Payment / Check
Historic Transaction
Historic Correspondence
Activity Schedule
Billing Correspondence
My Files Document
Employer Contract
Employer Reference
PDF Report
PDF Letter
Prov Comm E-Letter PDF
Prospective Auth
Dental Tooth Chart
Dental Baseline
Dental Perio Chart
Member Attachment
Coverage Attachment
Coverage Ins Card
Coverage Enrollment Application
Coverage COB Information
AP Claim Attachment
AP Claim Image
Vendor Contract Attachment
Vendor Attachment
W-9 Form
Benefit Plan Attachment
CRM Attachment
Appeal or Grievance Attachment
Prescriber Supporting Statement
PB Account Attachment
Referral Attachment
Referral Notification Document
Authorization Notification Document
Payer Notification Document
Payer Approval Document
Payer Notification of Extension Document
Payer Request for Information Document
Payer Denial Document
Payer Cancellation Document
Payer Partial Approval Document
Provider Attachment
Payer No Auth Required Document
Payer Withdrawal Document
Payer Dismissal Document
Payer Closure Document
Employer Group Attachment
Case Management Attachment
Broadcast Message Attachment
Member Appointment of Representative Form
Tapestry Payer Exchange Clinical Attachment
Managed Care Periodic Explanation of Benefits
Managed Care Periodic Summary EOB
Medical Policy
Medical Record Review Document
Biometric Enrollment
PDR Authorization
PDR Disclaimer
MOON
Obsolete Type 1
Community Upload
Account Request Attachment
HH Care Summary
Proof of Assets
Proof of Expenses
Broker Agreement
Patient Entered Attachment
Patient Entered Drawing
MyChart COVID-19 Vaccination Record Document
MyChart Test Results Record Document
Electronic Prior Authorization Attachment
Sent via Secure Chat
MDS CMS PDF
Unused
Self-Pay Consent
Estimate
Visit Auto Pay Consent
Financial Arrangement
Journal Entry Supporting Document
AP Invoice
Endoscopy Image
Endoscopy Anatomical Diagram
Endoscopy Video
Medication Consent
MCSA-5876 ME Certificate
MCSA-5875 ME Report
CG-719K Mariner Medical Certificate
CA-17 Duty Status Report
CA-20 Attending Physician's Report
MCSA-5870 Insulin-Treated Diabetes Mellitus Assessment Form
MCSA-5871 Vision Evaluation Report
MCSA-5872 Non-Insulin Treated Diabetes Mellitus Assessment Form
Child Resistant Cap Waiver
Rx Prescription
Rx Prescription Sale E-Signature
Rx Prescription Dispense Customer ID
Rx Dispense Prep Image
Rx CNR Image
ED Patient Billing Extract
Imaging Order
Key Image Object
Screening Form
Annotated Cardiology Image
Archived Procedural Result
IRF-PAI
THL Form Filler
Derm Clinical Image
Pedigree Image
Occ Med Form
Spreadsheet Report Data
Clinical Spreadsheet Report Data
CE Point of Care Auth
CE Prospective Auth
CE Persistent Point of Care Auth
CE Auth Form (Scanned)
System-Retrieved CE Auth Form
Care Everywhere Authorization
PDF CE Auth Form
CE Attachment
MyChart-Signed CE Auth Form
Uploaded CE Auth Form
Document Generation Template
External Administration
External Clinical
External Billing
External Insurance Card
External Insurance-Related Form
External Patient Consent
External ROI / HIM Consent
External Legal Document
External Living Will
External DNR
External Power of Attorney
External Legal Letter
External Photo ID
External Birth Certificate
External Death Certificate
External Misc Administration
External Medication
External Medication Order Report
External Medication Reconciliation
External Prescription List
External Radiology and Imaging
External Cardiology Imaging
External Endoscopy Imaging
External OB/GYN Imaging
External Dental Imaging
External Oncology Imaging
External Lab
External Procedure
External Referral Request / Referral Report
External Other Order
External Note
External Consult Note
External H&P Note
External Progress Note
External Procedure Note
External Operative Note
External Nurse Note
External ED Note
External Cardiology Note
External GI Note
External Oncology Note
External Behavior Health Note
External Referral Note
External Physical Therapy Note
External Occupational Therapy Note
External OB/GYN Note
External Clinical Consent
External Procedure Consent
External Anesthesia Consent
External Surgical Consent
External Abortion Consent
External Sterilization Consent
External Organ Donation Consent
External Research Consent
External Photographic Image
External Wound Care Image
External Dermatology Image
External Plastic Surgery Image
External Flowsheet
External Physician Letter
External Patient Summary
External Discharge Summary
External Transfer Summary
External Immunization Summary
External Labor and Delivery Summary
External Physical Therapy Summary
External Occupational Therapy Summary
External After Visit Summary
External Patient Reported Information
External Questionnaire
External Patient Upload
External Patient History
External Patient Education and Instructions
External Discharge Instructions
External Evaluation and Plan
External Transplant Evaluation
External Risk Assessment
External Physical Therapy Treatment Plan
External Occupational Therapy Treatment Plan
External Oncology Treatment Plan
External Case Management
External Episode Summary
External Surgical Treatment Plan
External Misc Clinical
External Occupational Health Form
Auto-filled Result Image
Waiver of Liability for Claim Appeal
Pharmacy Prior Request
Driver's License
Passport Visa
DD214
Passport
State ID
Credentialing Curriculum Vitae
Research Protocol
Research Contract
Research CDA
Grid Capture
AN Patient Billing Extract
Hospice Non-Covered Documentation
Face Sheet Capture
Patient-Created Image
Patient-Created Audio
Patient-Created Video
Patient-Created Text
Continuing Care Options
Continuing Care Preferences
Dental Soft Tissue
Obsolete Type 2
5 | ATTACHMENT_SUBMIT_UTC_DTTM | DATETIME (UTC) | No |
The date and time the required attachment was submitted. NULL indicates that the attachment is still outstanding. Stored in UTC.
6 | APPEAL_GRV_WKFL_STEP_C_NAME | VARCHAR | No |
The workflow step category ID that this attachment is required for.
May contain organization-specific values: No
Category Entries:
Intake (Tapestry Link)
Intake
Submission
Initial Review
MD Review
External Decision
Finalize
Completed
Void
7 | REQUIRED_FOR_TAT_YN | VARCHAR | No |
Indicates whether the attachment being attached resets the turnaround time clock. 'Y' indicates that attaching this attachment will reset the clock. 'N' or NULL indicates that attaching this attachment will not reset the clock.
May contain organization-specific values: No
Category Entries:
No
Yes
8 | ATTACHMENT_SUBMIT_LOCAL_DTTM | DATETIME (Local) | No |
The date and time the required attachment was submitted. NULL indicates that the attachment is still outstanding.