AP_CLAIM_IF_INFO_3

Description: |
Additional information sent to prospective payment systems (PPS) groupers/pricers.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_ID | NUMERIC | No |
The unique identifier for the claim info 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 | CLINICAL_TRIAL_REGISTRY_NUM | VARCHAR | No |
Identifies the clinical trial registry number.
4 | DISCHARGE_DATE | VARCHAR | No |
For inpatient, the date the patient was discharged from the facility. For outpatient, the end date of the period covered on the claim.
5 | NONCOVERED_CHARGES | VARCHAR | No |
The portion of the claim's total charges that is not recognized for payment.
6 | ADMIT_DX_USED | VARCHAR | No |
The admit diagnosis code that was used during processing.
7 | ANALYSIS_PAYMENT | VARCHAR | No |
The standard payment for the claim including applicable add-ons or adjustments, but excluding transfers and outliers.
8 | CAPITAL_COST_OUTLIER_PAYMENT | VARCHAR | No |
Additional payment for high cost cases, allowing for reimbursement for capital expenses.
9 | CAPITAL_COST_OUTLIER_THRESHOLD | VARCHAR | No |
Capital portion of the cost threshold.
10 | CAPITAL_COSTS | VARCHAR | No |
Charges reduced to capital portion of costs.
11 | CAPITAL_DSH_FACTOR | VARCHAR | No |
Calculated amount that is multiplied by the capital federal specific portion (FSP) payment to derive the capital disproportionate share hospital (DSH) payment.
12 | CAPITAL_EXCEPTION_PAYMENT | VARCHAR | No |
A set amount per claim to reimburse for capital expenses.
13 | CAPITAL_FSP_PAYMENT | VARCHAR | No |
Federal specific portion payment for capital, the standard prospective payment to reimburse for capital expenses.
14 | CAPITAL_HSP_PAYMENT | VARCHAR | No |
The hospital specific portion payment for capital.
15 | CAPITAL_IME_FACTOR | VARCHAR | No |
Calculated amount that is multiplied by the capital federal specific portion (FSP) payment to derive the capital indirect medical education (IME) payment.
16 | CAPITAL_OLD_HOLD_HARMLESS_PMT | VARCHAR | No |
Cost payment for old capital.
17 | CAPITAL_PAYMENT | VARCHAR | No |
The total capital payment for the claim.
18 | CLINICAL_TRIAL_ADDON_PAYMENT | VARCHAR | No |
The add-on payment for agency approved procedure codes determined to be a part of clinical trials.
19 | DEVICE_AMOUNT | VARCHAR | No |
The vendor credit amount for a replacement device as reported with value code FD.
20 | DEVICE_CREDIT_FLAG | VARCHAR | No |
Indicates whether the diagnosis related group is subject to a device credit.
21 | DISCHARGE_STATUS_USED | VARCHAR | No |
Indicates the discharge status used in grouping.
22 | DSH_PAYMENT | VARCHAR | No |
The disproportionate share hospital payment.
23 | HAC_CAT_SATISFIED_COUNT | VARCHAR | No |
Number of unique hospital-acquired condition categories satisfied on the claim.
24 | HAC_REDUCTION_PROGRAM_ADJ | VARCHAR | No |
Amount the total claim payment was reduced due to the Hospital-Acquired Condition reduction program.
25 | HAC_STATUS | VARCHAR | No |
Indicates overall results of hospital-acquired condition processing at the claim level.
26 | HEMOPHILIA_ADDON_PAYMENT | VARCHAR | No |
Add-on payment for blood clotting factor administered to hemophilia inpatients.
27 | HOSP_READMIT_REDUCT_PROG_ADJ | VARCHAR | No |
Adjustment to the claim payment in accordance with the hospital readmissions reduction program.
28 | ICD_VERSION_QUALIFIER_USED | VARCHAR | No |
Indicates whether the code set used for processing was ICD-9 or ICD-10.
29 | INDIRECT_MEDICAL_EDU_PAYMENT | VARCHAR | No |
Reimbursement for indirect medical education.
30 | INIT_DX_RELATED_GROUP | VARCHAR | No |
The diagnosis related group (DRG) calculated before CMS Hospital-Acquired Conditions are considered.
31 | INIT_MAJOR_DX_CAT | VARCHAR | No |
The major diagnostic category (MDC) assigned before CMS hospital-acquired conditions are considered.
32 | INIT_MEDICAL_SURGICAL_DRG_FLAG | VARCHAR | No |
Flag indicating if the initial diagnosis related group (DRG) is medical, surgical, or neither.
33 | INITIAL_RETURN_CODE | VARCHAR | No |
Error return code for the initial diagnosis related group assignment.
34 | LENGTH_OF_STAY | VARCHAR | No |
The number of days the patient was hospitalized.
35 | LOW_VOLUME_ADDON_PAYMENT | VARCHAR | No |
The portion of the total payment that is additional due to the provider qualifying as a Medicare low volume hospital.
36 | LOW_VOLUME_ADJ_PERCENT | VARCHAR | No |
The percentage adjustment used to determine the Low Volume Add-on Payment.
37 | MARGINAL_COST_FACTOR | VARCHAR | No |
The variable is used in the calculation of an outlier payment.
38 | MEDICAL_SURGICAL_DRG_FLAG | VARCHAR | No |
Indicates if the Diagnosis Related Group is medical, surgical, or neither.
39 | NATIONAL_FSP_AMOUNT | VARCHAR | No |
The operating base rate, which is multiplied by the weight to determine the Operating Federal Specific Portion payment.
40 | NEW_TECHNOLOGY_ADDON_PAYMENT | VARCHAR | No |
Add-on payment for certain devices, which CMS approves for an additional payment.
41 | OPERATING_COST_OUTLIER_PAYMENT | VARCHAR | No |
Extra payment for a high cost case to reimburse operating expenses.
42 | OPERATING_COST_OUTLIER_THRESH | VARCHAR | No |
Operating portion of the cost threshold.
43 | OPERATING_COSTS | VARCHAR | No |
Charges reduced to operating portion of costs.
44 | OPERATING_DSH_FACTOR | VARCHAR | No |
Used to determine if the hospital qualifies for a Disproportionate Share Hospital (DSH) adjustment and the size of capital and operating DSH adjustments.
45 | OPERATING_FSP_PAYMENT | VARCHAR | No |
The federal specific portion reimbursed for operating expenses.
46 | OPERATING_HSP_PAYMENT | VARCHAR | No |
The hospital specific portion reimbursed for operating expenses.
47 | OPERATING_IME_FACTOR | VARCHAR | No |
A calculated value based around the provider intern to bed ratio, which is multiplied by the relative weight to calculate the operating indirect medical education (IME) payment.
48 | PAYMENT_STATUS | VARCHAR | No |
Payment status for the claim.
49 | POST_ACUTE_CARE_TRANSFER_DRG | VARCHAR | No |
Indicates whether or not the DRG is subject to the post acute care transfer reimbursement policy.
50 | PX_USED_COUNT | VARCHAR | No |
Number of procedure codes used for grouping.
51 | SECONDARY_DX_USED_COUNT | VARCHAR | No |
Number of secondary diagnosis codes and External Cause of Injury Codes that were used during processing.
52 | SERVICE_LOCATION_ID_IN | VARCHAR | No |
A unique identifier for the facility service location.
53 | SPEC_POST_ACUTE_CARE_TRANS_DRG | VARCHAR | No |
Indicates whether or not the DRG is subject to the special post acute care transfer reimbursement policy.
54 | SUGGESTED_PRINCIPAL_PX | VARCHAR | No |
The suggested principal procedure based on coding practice and policies.
55 | TOTAL_EXCL_PASS_THROUGH_PMT | VARCHAR | No |
The total expected payment without miscellaneous per diem amounts.
56 | TOTAL_OPERATING_PAYMENT | VARCHAR | No |
Claim reimbursement for operating expenses.
57 | TOTAL_PAYMENT | VARCHAR | No |
The total payment for the claim.
58 | TRANSFER_IMPACT | VARCHAR | No |
Amount calculated for transfer claims to show the change in payment caused by the transfer status.
59 | UNCOMPENSATED_CARE_PAYMENT | VARCHAR | No |
Interim uncompensated care payment according to the Affordable Care Act for disproportionate share hospital payments.
60 | VBP_PROGRAM_ADJ | VARCHAR | No |
Adjustment to the total payment in accordance with the Hospital Value-Based Purchasing Program.
61 | PROV_MEDICARE_NUM | VARCHAR | No |
The Medicare number of the provider associated with the claim.
62 | DISCHRG_STAT_RET_CD | VARCHAR | No |
Error code assigned to the discharge status mapping assignment.
63 | BIRTH_WEIGHT | VARCHAR | No |
The birth weight, in grams.