PR_EST_PX_BEN_ADDL_INFO

Description: |
Contains additional benefit related information for each procedure in a price estimate.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | ESTIMATE_ID | NUMERIC | No |
The unique identifier for the patient estimate 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 | ADDL_LINE_NUM | INTEGER | No |
The line number of the additional information charge line group.
4 | FILE_ORD_NUM | INTEGER | No |
The coverage level associated with the corresponding coverage (I PES 168).
5 | SERVICE_TYPE_ID | VARCHAR | No |
The service type associated with the benefits on an estimate line.
6 | SERVICE_TYPE_ID_SERVICE_TYPE_NAME | VARCHAR | No |
The name of this benefit service type.
7 | PAYER_BEN_CAT | VARCHAR | No |
The benefit category identifier supplied by the payer. This is used instead of a service type in estimates adjudicated by the payer. It should only be set on an estimate reference benefits.
8 | DEDUCTIBLE_AMT | NUMERIC | No |
This is the deductible amount of an estimate line.
9 | COPAY_AMT | NUMERIC | No |
This is the copay amount of an estimate line.
10 | COINS_AMT | NUMERIC | No |
This is the coinsurance amount of an estimate line.
11 | SELFPAY_EXCESS_AMT | NUMERIC | No |
This is the additional self-pay amount as a result of insurance limits.
12 | MOOP_AMT | NUMERIC | No |
This is the maximum out-of-pocket amount for an estimate line.
13 | ANNUAL_LIMIT | NUMERIC | No |
This is the annual insurance limit amount of an estimate line.
14 | LIFETIME_LIMIT | NUMERIC | No |
This is the lifetime insurance limit amount of an estimate line.
15 | ROLLOVER_AMT | NUMERIC | No |
This is the rollover period amount of an estimate line.
16 | NET_LEVEL_C_NAME | VARCHAR | No |
This is the network level used to calculate benefits of an estimate line.
May contain organization-specific values: Yes
Category Entries:
In
Out
Out of Area
N/A
17 | VISIT_MOOP_AMT | NUMERIC | No |
This is the visit maximum out-of-pocket amount for an estimate line.
18 | VISIT_LIMIT | NUMERIC | No |
This is the amount of an estimate line applied to a visit insurance limit.
19 | PROV_TOTAL | NUMERIC | No |
The total the Provider is estimated pay for an estimate line.
20 | NONCVRD_AMT | NUMERIC | No |
Amount not covered by a member's benefits for an estimate line.
21 | AMT_EXCEEDED | NUMERIC | No |
The amount that exceeded the benefit amount from the estimate line.
22 | BEN_BKT_ID | NUMERIC | No |
The ID of the bucket that the estimate line contributes to.
23 | BEN_BKT_ID_BUCKET_NAME | VARCHAR | No |
The name of the bucket.
24 | BEN_BKT_LIMIT | NUMERIC | No |
The maximum amount the bucket can hold.
25 | BEN_BKT_ADDL_AMT | NUMERIC | No |
Additional amount added to the bucket from the estimate line.
26 | BEN_BKT_REMAIN | NUMERIC | No |
Amount left in the bucket after adding the additional amount from the estimate line.
27 | LTC_MONTHLY_AMT | NUMERIC | No |
This is the Monthly Patient Pay Amount of an estimate line
28 | COINS_PERCENT | NUMERIC | No |
This is the coinsurance percentage for this procedure line.