CLM_VALUES_5

Description: |
All values associated with a claim are stored in the Claim External Value record. The CLM_VALUES_5 table holds claim-level values set by the system during claims processing or by user edits.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
RECORD_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | RECORD_ID | NUMERIC | No |
The unique identifier for the claim value record
2 | FHIR_GROUP_IDENTIFIER | VARCHAR | No |
The bulk FHIR group ID for which the claim was received.
3 | DEPT_ALT_CODE | VARCHAR | No |
This item stores the alternate code for the department. The alternate code comes from MPI. For Norway, this item stores the IK44 code.
4 | PAYER_ENTERPRISE_IDENTIFIER | VARCHAR | No |
Patient's enterprise ID assigned by the payer.
5 | ATT_PROV_SPECIALTY | VARCHAR | No |
The specialty of the attending provider.
6 | NON_PAYMENT_RSN_DESC | VARCHAR | No |
Claim level denial reason code description.
7 | CARRIER_PAYMENT_DNL_CD | VARCHAR | No |
Carrier claim payment denial code.
8 | NON_PAYMENT_RSN_CD | VARCHAR | No |
Claim level denial reason code.
9 | CARRIER_PAYMENT_DNL_DESC | VARCHAR | No |
Carrier claim payment denial code description.
10 | BCDA_GROUP_IDENT | VARCHAR | No |
Claim Group Identifier provided by Beneficiary Claims Data API
11 | PRIMARY_PAYER_CD | VARCHAR | No |
Code used to determine if Medicare was the primary payer of this claim.
12 | BIL_PROV_SPEC_CODE_SET | VARCHAR | No |
Stores the code set for the Billing Provider Specialty Code.
13 | OPER_PROV_TAXONOMY | VARCHAR | No |
Holds the Operating Provider Taxonomy Code for a claim.
14 | PREDETERMIN_IDENT | VARCHAR | No |
This is the predetermination of benefits identifier for the claim.
15 | ADJ_TO_CLAIM_ID | VARCHAR | No |
Holds the adjustment to claim ID for the claim received from raw data
16 | REV_TO_CLAIM_ID | VARCHAR | No |
Holds the reversal to claim ID for the claim received from raw data
17 | ADJ_SEQUENCE | VARCHAR | No |
Holds the adjustment sequence for the claim received from raw data
18 | PLAN_NAME | VARCHAR | No |
The plan name from raw claims data.
19 | CORPORATION_NAME | VARCHAR | No |
Corporation name from raw claims data.
20 | NETWORK_LEVEL | VARCHAR | No |
Specifies the network level of the claim.
21 | REGION_NAME | VARCHAR | No |
The name of the region associated with the claim.
22 | LINE_OF_BUSINESS_NAME | VARCHAR | No |
The name of the line of business associated with the claim.
23 | SVC_PROV_IN_NETWORK | VARCHAR | No |
This value indicates if the service provider / pharmacy is in-network.
24 | MEDICARE_DRUG_CVG_CODE | VARCHAR | No |
Identifies if a claim was processed under the Medicare Part B benefit or Part D benefit.
25 | SVC_FAC_CCN | VARCHAR | No |
Centers for Medicare and Medicaid Services Certification Number (CCN) for the service facility location.
26 | PCP_REF_PROV_NAM_LAST | VARCHAR | No |
This item holds the PCP referring provider's last name (NM1*P3).
27 | PCP_REF_PROV_NAM_FIRST | VARCHAR | No |
This item holds the PCP referring provider's first name (NM1*P3).
28 | PCP_REF_PROV_NAM_MID | VARCHAR | No |
This item holds the PCP referring provider's middle name (NM1*P3).
29 | PCP_REF_PROV_NAM_SUF | VARCHAR | No |
This item holds the PCP referring provider's suffix (NM1*P3).
30 | PCP_REF_PROV_NPI | VARCHAR | No |
This item holds the PCP referring provider's NPI (NM1*P3).
31 | PCP_REF_PROV_TAXONOMY | VARCHAR | No |
This item holds the referring provider's taxonomy code.
32 | REF_PROV_FROM_LINE_YN | VARCHAR | No |
Identifies whether the referring provider was received at the header level, or rolled up from the line level.
May contain organization-specific values: No
Category Entries:
No
Yes
33 | REN_PROV_FROM_LINE_YN | VARCHAR | No |
Identifies whether the rendering provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
34 | OPER_PROV_FROM_LINE_YN | VARCHAR | No |
Identifies whether the operating provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
35 | OTHOP_PROV_FROM_LINE_YN | VARCHAR | No |
Identifies whether the other operating provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
36 | PAT_RESIDENCE_CODE | VARCHAR | No |
The code identifying the patient's place of residence. This data is only populated for Pharmacy claims.
37 | SVC_FAC_CMS_PARTD_FLAG | VARCHAR | No |
Indicates whether the patient resides in a facility that qualifies for the CMS Part D benefit. This data is only populated for Pharmacy claims.
38 | BANK_IDENT_NUM | VARCHAR | No |
The card issuer ID or bank ID number used for network routing. This data is only populated for Pharmacy claims.
39 | PROCESSOR_CTL_NUM | VARCHAR | No |
The number assigned by the processor. This data is only populated for Pharmacy claims.
40 | RX_PRIOR_AUTH_TYPE | VARCHAR | No |
The code clarifying the prior authorization number submitted or benefit/plan exemption.
41 | PRESCRIBER_LAST_NAME | VARCHAR | No |
The last name of the prescribing provider. This data is only populated for Pharmacy claims.
42 | SNAPSHOT_CEV_YN | VARCHAR | No |
Contains a flag for whether or not the CEV respresents a snapshot of the data sent on an outgoing 837. Snapshot CEV records are created for rejected Tapestry claims that are added to Claim Export workqueues.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
43 | SNAPSHOT_CEV_RECORD_ID | NUMERIC | No |
Contains the ID, if one exists, of the CEV containing the data sent on an outgoing 837 for an editable CEV record.
44 | PICK_UP_CNTY | VARCHAR | No |
Stores the Ambulance Pick-Up Location County
45 | DROP_OFF_CNTY | VARCHAR | No |
Stores the Ambulance Drop-Off Location County
46 | LAST_SRP_DATE | DATETIME | No |
The Last Scaling and Root Planing Procedure Date for the claim.
47 | NCH_CLAIM_TYPE | VARCHAR | No |
The CMS National Claims History (NCH) code indicating the type of claim submitted.
48 | CMS_ADJSTMT_DLTN_CD | VARCHAR | No |
The CMS Adjustment Deletion Code for the claim. This value distinguishes an adjusted or deleted PDE claim from an original.
49 | CLAIM_TYPE_OUT_IN | VARCHAR | No |
Claim type for use on Canadian claims
50 | COVERAGE_EXPIRY_DATE | DATETIME | No |
Expiry date of the plan registration number, for use with Canadian Claims
51 | DECEASED_INDICATOR | VARCHAR | No |
Deceased indicator, for use with Canadian Claims
52 | CLAIM_NET_AMOUNT | NUMERIC | No |
The net amount of the claim expected to be paid by the payer to the provider.
53 | VALUE_ADDED_TAX | NUMERIC | No |
The total Value Added Tax (VAT) charged on a claim.
54 | ENC_TYPE | VARCHAR | No |
The encounter type for a claim. Also known as Admitting Category.
55 | ENC_TRANSFER_SOURCE | VARCHAR | No |
The transfer source location for the encounter on the claim. Also known as Point of Origin.
56 | ENC_TRANSFER_DEST | VARCHAR | No |
The transfer destination for the encounter on the claim. Also known as Discharge Destination.