AP_CLAIM_IF_INFO

Description: |
The table contains information sent to or returned from a prospective payment systems (PPS) pricer.

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 | COMM_STAT_C_NAME | VARCHAR | No |
The Interface communication status.
May contain organization-specific values: No
Category Entries:
Successful
Communication timed out
Communication failed
License for interface not found
Required data missing
No service lines were sent out
Invalid diagnosis or procedure type
4 | GROUPER_RETURN_CODE | VARCHAR | No |
The Grouper Return Code field from APC Grouper output fields.
5 | GROUPER_TYPE | VARCHAR | No |
The Grouper Type field from APC Grouper output fields.
6 | GROUPER_VERSION | VARCHAR | No |
The Grouper Version field from APC Grouper output fields.
7 | PAT_VISIT_TYPE | VARCHAR | No |
The Patient or Visit Type field from APC Grouper output fields.
8 | APC_STATUS_CODE | VARCHAR | No |
The ambulatory payment classification (APC) status code field from APC grouper output fields.
9 | PRICER_RETURN_CODE | VARCHAR | No |
The Pricer Return Code field from APC Pricer output fields.
10 | PRICER_TYPE | VARCHAR | No |
The Pricer Type field from APC Pricer output fields.
11 | BASE_APC_REIMB | VARCHAR | No |
The Base APC Reimbursement field from APC Pricer output fields.
12 | PAT_COPAY | VARCHAR | No |
The Patient Co-payment field from APC Pricer output fields.
13 | OUTLIER_PMT | VARCHAR | No |
The Outlier Payment field from APC Pricer output fields.
14 | PPS_CHRGS | VARCHAR | No |
The PPS Charges field from APC Pricer output fields.
15 | PPS_PMT | VARCHAR | No |
The PPS Payment field from APC Pricer output fields.
16 | TRANS_COR_HOLD_HARM | VARCHAR | No |
The Transitional Corridor/Hold Harmless Add-on field from APC Pricer output fields.
17 | CLM_DEDUCT | VARCHAR | No |
The Claim Deductible field from APC Pricer output fields.
18 | TOTAL_APC_REIMB | VARCHAR | No |
The Total APC Reimbursement field from APC Pricer output fields.
19 | OUTLIER_FLAG | VARCHAR | No |
The Outlier Flag field from APC Pricer output fields.
20 | BASE_RATE_FLAG | VARCHAR | No |
The Base Rate Flag field from APC Pricer output fields.
21 | COST_REDUCT_FACTOR | VARCHAR | No |
The Cost Reduction Factor field from APC Pricer output fields.
22 | RURAL | VARCHAR | No |
The Rural field from APC Pricer output fields.
23 | OUTPAT_RCC | VARCHAR | No |
The outpatient ratio of cost to charge (RCC) field from APC pricer output fields.
24 | MARKUP_DISCNT_FACT | VARCHAR | No |
The Mark-up/Discount Factor field from APC Pricer output fields.
25 | PRICER_METHOD | VARCHAR | No |
The Method field from APC Pricer output fields.
26 | ACE_RETURN_CODE | VARCHAR | No |
The editor return code field from Ambulatory Code Editor (ACE), Medicare Code Editor (MCE), or Medicaid Outpatient Editor (MOE) output fields.
27 | ACE_VERSION | VARCHAR | No |
The editor version field from Ambulatory Code Editor (ACE), Medicare Code Editor (MCE), or Medicaid Outpatient Editor (MOE) output fields.
28 | ACE_RLS_VERSION | VARCHAR | No |
The ACE Release Version field from ACE output fields.
29 | NUM_CLM_ERRORS | VARCHAR | No |
The Number of Claim Errors field from ACE output fields.
30 | NUM_DX_ERRORS | VARCHAR | No |
The Number of Diagnosis Errors field from ACE output fields.
31 | NUM_PX_ERRORS | VARCHAR | No |
The Number of Procedure Errors field from ACE output fields.
32 | NUM_CCI_ERRORS | VARCHAR | No |
The Number of CCI Errors field from ACE output fields.
33 | NUM_ADMIT_DX_ERRORS | VARCHAR | No |
The Number of Admit Diagnosis Errors field from ACE output fields.
34 | TOT_NUM_ERRORS | VARCHAR | No |
The Total Number of Errors field from ACE output fields.
35 | ADMIT_DX_DISP | VARCHAR | No |
The Admit Diagnosis Disposition field from ACE output fields.
36 | OVERALL_CLM_DISP | VARCHAR | No |
The Overall Claim Disposition field from ACE output fields.
37 | OCE_ERROR_DISP | VARCHAR | No |
The OCE Error Disposition field from ACE output fields.
38 | CLM_ERROR_DETAIL | VARCHAR | No |
The Claim Error Detail field from ACE output fields.
39 | RSN_VIS_DX_ERRORS | VARCHAR | No |
The Reason for Visit Diagnosis Errors field from ACE output fields.
40 | ADJUD_TIME_DTTM | DATETIME (Local) | No |
The timestamp for each communication.
41 | OPTIMIZER_RET_VAL | VARCHAR | No |
The Optimizer return value.
42 | MOST_RECENT_ADJU_YN | VARCHAR | No |
Indicate if the adjudication is the most recent adjudication that we get APC values.
May contain organization-specific values: No
Category Entries:
No
Yes
43 | OUT_FROM_DATE | VARCHAR | No |
The admission from date of the claim.
44 | OUT_THRU_DATE | VARCHAR | No |
The admission through date of the claim.
45 | OUT_BIRTH_DATE | VARCHAR | No |
The patient birth date.
46 | OUT_PROV | VARCHAR | No |
The provider of the claim. If your organization uses Tapestry's generic APC interface, this column saves the vendor identity ID of the claim.
47 | OUT_PAYOR | VARCHAR | No |
The payor of the claim.
48 | OUT_AGE | VARCHAR | No |
The patient age.
49 | OUT_SEX | VARCHAR | No |
The patient sex.
50 | OUT_MRN | VARCHAR | No |
The patient medical record number.
51 | OUT_PAT_CONTROL_NUM | VARCHAR | No |
The patient control number.
52 | OUT_TOB | VARCHAR | No |
The type of bill of the claim.
53 | OUT_DISCHRG_STAT | VARCHAR | No |
The patient discharge status of the claim.
54 | OUT_TTL_CHRG | VARCHAR | No |
The total charge of the claim.
55 | OUT_LEN_STAY | VARCHAR | No |
The length of stay of the claim.
56 | OUT_ADMIT_SRC | VARCHAR | No |
The source of admission listed on the claim.
57 | OUT_ADMSN_DX | VARCHAR | No |
The admission diagnosis of the claim.
58 | OUT_ADMSN_TYPE | VARCHAR | No |
The admission type of the claim.
59 | OUT_NPI | VARCHAR | No |
The National Provider Identifier (NPI) of the claim.
60 | OUT_TAXONOMY | VARCHAR | No |
The taxonomy of the claim.
61 | OUT_COND_CODES | VARCHAR | No |
The condition codes of the claim.
62 | OUT_ACE_OVRIDE | VARCHAR | No |
The ACE override ID of the claim.
63 | CCI_EDIT_SUM | VARCHAR | No |
The Correct Coding Initiative (CCI) edit summary returned by the APC interface.
64 | OCE_EDIT_SUM | VARCHAR | No |
The outpatient code editor (OCE) edit summary returned by the APC interface.
65 | TRACE_INFO | VARCHAR | No |
The trace info of the claim.
66 | OUT_PAT_ID_NUM | VARCHAR | No |
The patient identity ID of the claim.
67 | OUT_PROV_ID_NUM | VARCHAR | No |
The provider identity ID of the claim.
68 | OUT_POS_ID_NUM | VARCHAR | No |
The ID of the Place of Service (POS) on the claim.
69 | OUT_CLM_SVC_DATE | VARCHAR | No |
The claim service date.
70 | OUT_AUTHCODE | VARCHAR | No |
Authorization code
71 | OUT_ADMIT_DATE | VARCHAR | No |
Admission date.
72 | OUT_ESRD_ONSET_DATE | VARCHAR | No |
End-stage Renal Disease (ESRD) onset date sent to the Prospective Payment System (PPS) pricer.
73 | ALTERNATE_HHRG | VARCHAR | No |
Alternate home health resource group (HHRG) for home health agency (HHA) pricer.
74 | ALTERNATE_HHRG_FLAG | VARCHAR | No |
Alternate HHRG flag.
75 | HOME_HEALTH_RES_GRP | VARCHAR | No |
HHRG - Home Health Resource Group.
76 | NON_RESRC_SUPPLIES | VARCHAR | No |
Non-resource supplies code.
77 | TREATMNT_AUTH_VALID | VARCHAR | No |
Treatment authorization code validity flag.
78 | MAJOR_DIAG_CATEGORY | VARCHAR | No |
Major Diagnostic Category.
79 | DRG | VARCHAR | No |
Diagnostic Related Group (DRG).
80 | ALTERNATE_DRG | VARCHAR | No |
Alternate diagnosis related group (DRG)
81 | RIC | VARCHAR | No |
Rehabilitation Impairment Category.
82 | CLINICAL_CMG | VARCHAR | No |
Original/Clinical Casemix Group.
83 | HIPPS | VARCHAR | No |
Health Insurance Prospective Payment System (HIPPS) code
84 | COMORBIDITY_CODE | VARCHAR | No |
Comorbidity code used for health insurance prospective payment system (HIPPS) assignment.
85 | ALTERNATE_PMT | VARCHAR | No |
Alternate payment.
86 | ALT_ADDON_PMT | VARCHAR | No |
Alternate add-on payment.
87 | COMORBIDITY_CAT | VARCHAR | No |
Comorbidity category.
88 | QUALITY_FLAG | VARCHAR | No |
Quality flag.
89 | ADJUSTED_BASE_RATE | VARCHAR | No |
Adjusted base rate without patient-case mix adjustment.
90 | ADJUSTED_OUTL_MAP | VARCHAR | No |
Outlier services Medicare anticipated payment used for cost outlier calculation.
91 | AVG_PERTREAT | VARCHAR | No |
Actual amount of formerly separately payable services per dialysis treatment on monthly bill.
92 | AVG_PERTREAT_BLEND | VARCHAR | No |
Predicted amount of separately payable services per dialysis treatment on monthly bill.
93 | DISPENSE_FEE | VARCHAR | No |
Dispensing fee for oral-only drugs with an injectable equivalent.
94 | FIXED_LOSS_AMT | VARCHAR | No |
Fixed dollar loss amount that is added to the predicted Medicare Allowable Payment to determine the cost outlier threshold.
95 | MONTHLY_SERV_AMT | VARCHAR | No |
Total amount of formerly separately payable services utilized for the cost outlier calculation.
96 | AGE_FCTR_SEP_PYBL | VARCHAR | No |
Separately payable portion of bundled age adjustment utilized for cost outlier calculation.
97 | BMI | VARCHAR | No |
The Body Mass Index (BMI) of the patient.