REFERRAL_CVG

Description: |
The REFERRAL_CVG table contains coverage information for referrals.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | REFERRAL_ID | NUMERIC | No |
The unique ID of the referral in database.
2 | LINE | INTEGER | No |
A line number that is used to identify a group of coverage-related information. For example, if a referral has 2 valid coverages, line 1 of the coverage items contains the information about the first coverage, line 2 contains the information about the second coverage.
3 | CVG_ID | NUMERIC | No |
The ID of a coverage that is valid for the referral.
4 | CVG_USED_YN | VARCHAR | No |
A yes/no flag that indicates whether or not the coverage should be considered available for the referral use in non-UM (utilization management) workflows. For UM workflows, consider using SUBMITTED_UM_AUTHS_YN. The coverage may be valid on the dates, but still inappropriate to use. Setting the flag to Yes means that the coverage is all right to use.
May contain organization-specific values: No
Category Entries:
Yes
No
5 | AUTH_REQUIRED_YN | VARCHAR | No |
A flag to indicate whether the coverage requires external authorization to be received (as from an insurance carrier) for the services.
6 | CARRIER_AUTH_CMT | VARCHAR | No |
The carrier authorization number or comment, indicating that authorization was received.
7 | EFF_CVG_PRECERT_NUM | VARCHAR | No |
Precertification number associated with a coverage on a referral.
8 | EFF_CVG_AUTH_CMT | VARCHAR | No |
Comments regarding authorization specific to a coverage used on a referral.
9 | CVG_INVALID_FLAG | VARCHAR | No |
Flag for invalid coverage for non-UM (utilization management) workflows.
10 | CHARGE_COUNT_TYPE_C_NAME | VARCHAR | No |
Type of charges that this service level authorization record counts for professional, technical or all charges.
May contain organization-specific values: No
Category Entries:
Only Professional Charges
Only Technical Charges
All Charges
11 | USE_CHARGE_COUNT_YN | VARCHAR | No |
Flag to specify if the referral & coverage are using charge counting.
May contain organization-specific values: No
Category Entries:
No
Yes
12 | CHARGE_COUNT_MTHD_C_NAME | VARCHAR | No |
Charge counting method for this service level authorization.
May contain organization-specific values: No
Category Entries:
Charge Quantity
Each Charge
Once Per Visit
13 | CVG_SVC_TYPE_CODE_C_NAME | VARCHAR | No |
Specifies the service type at the coverage level.
May contain organization-specific values: No
Category Entries:
Medical Care
Surgical
Consultation
Diagnostic X-Ray
Diagnostic Lab
Radiation Therapy
Anesthesia
Surgical Assistance
Other Medical
Blood Charges
Used Durable Medical Equipment
Durable Medical Equipment Purchase
Ambulatory Service Center Facility
Renal Supplies in the Home
Alternate Method Dialysis
Chronic Renal Disease (CRD) Equipment
Pre-Admission Testing
Durable Medical Equipment Rental
Pneumonia Vaccine
Second Surgical Opinion
Third Surgical Opinion
Social Work
Diagnostic Dental
Periodontics
Restorative
Endodontics
Maxillofacial Prosthetics
Adjunctive Dental Services
Health Benefit Plan Coverage
Plan Waiting Period
Chiropractic
Chiropractic Office Visits
Dental Care
Dental Crowns
Dental Accident
Orthodontics
Prosthodontics
Oral Surgery
Routine (Preventive) Dental
Home Health Care
Home Health Prescriptions
Home Health Visits
Hospice
Respite Care
Hospital
Hospital - Inpatient
Hospital - Room and Board
Hospital - Outpatient
Hospital - Emergency Accident
Hospital - Emergency Medical
Hospital - Ambulatory Surgical
Long Term Care
Major Medical
Medically Related Transportation
Air Transportation
Cabulance
Licensed Ambulance
General Benefits
In-vitro Fertilization
MRI/CAT Scan
Donor Procedures
Acupuncture
Newborn Care
Pathology
Smoking Cessation
Well Baby Care
Maternity
Transplants
Audiology Exam
Inhalation Therapy
Diagnostic Medical
Private Duty Nursing
Prosthetic Device
Dialysis
Otological Exam
Chemotherapy
Allergy Testing
Immunizations
Routine Physical
Family Planning
Infertility
Abortion
AIDS
Emergency Services
Cancer
Pharmacy
Free Standing Prescription Drug
Mail Order Prescription Drug
Brand Name Prescription Drug
Generic Prescription Drug
Podiatry
Podiatry - Office Visits
Podiatry - Nursing Home Visits
Professional (Physician)
Anesthesiologist
Professional (Physician) Visit - Office
Professional (Physician) Visit - Inpatient
Professional (Physician) Visit - Outpatient
Professional (Physician) Visit - Nursing Home
Professional (Physician) Visit - Skilled Nursing Facility
Professional (Physician) Visit - Home
Psychiatric
Psychiatric - Room and Board
Psychotherapy
Psychiatric - Inpatient
Psychiatric - Outpatient
Rehabilitation
Rehabilitation - Room and Board
Rehabilitation - Inpatient
Rehabilitation - Outpatient
Occupational Therapy
Physical Medicine
Speech Therapy
Skilled Nursing Care
Skilled Nursing Care - Room and Board
Substance Abuse
Alcoholism
Drug Addiction
Vision (Optometry)
Frames
Routine Exam
Lenses
Nonmedically Necessary Physical
Experimental Drug Therapy
Burn Care
Brand Name Prescription Drug - Formulary
Brand Name Prescription Drug - Non-Formulary
Independent Medical Evaluation
Partial Hospitalization (Psychiatric)
Day Care (Psychiatric)
Cognitive Therapy
Massage Therapy
Pulmonary Rehabilitation
Cardiac Rehabilitation
Pediatric
Nursery
Skin
Orthopedic
Cardiac
Lymphatic
Gastrointestinal
Endocrine
Neurology
Eye
Invasive Procedures
Gynecological
Obstetrical
Obstetrical/Gynecological
Mail Order Prescription Drug: Brand Name
Mail Order Prescription Drug: Generic
Physician Visit - Office: Sick
Physician Visit - Office: Well
Coronary Care
Private Duty Nursing - Inpatient
Private Duty Nursing - Home
Surgical Benefits - Professional (Physician)
Surgical Benefits - Facility
Mental Health Provider - Inpatient
Mental Health Provider - Outpatient
Mental Health Facility - Inpatient
Mental Health Facility - Outpatient
Substance Abuse Facility - Inpatient
Substance Abuse Facility - Outpatient
Screening X-ray
Screening laboratory
Mammogram, High Risk Patient
Mammogram, Low Risk Patient
Flu Vaccination
Eyewear and Eyewear Accessories
Case Management
Dermatology
Durable Medical Equipment
Diabetic Supplies
Generic Prescription Drug - Formulary
Generic Prescription Drug - Non-Formulary
Allergy
Intensive Care
Mental Health
Neonatal Intensive Care
Oncology
Physical Therapy
Pulmonary
Renal
Residential Psychiatric Treatment
Transitional Care
Transitional Nursery Care
Urgent Care
14 | CVG_AUTH_STATUS_C_NAME | VARCHAR | No |
The authorization status category ID for the coverage.
May contain organization-specific values: No
Category Entries:
Authorized
No Auth Required
Pending
Canceled
Denied
Partially Authorized