HSP_CLAIM_DETAIL2

Description: |
This table contains detailed claim print record information for claims associated with the hospital liability bucket.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
CLAIM_PRINT_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_PRINT_ID | NUMERIC | No |
The ID of the claim record associated with a single hospital liability bucket.
2 | SA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
3 | INACTV_CLP_YN | VARCHAR | No |
This column has a value of yes when the claim is inactive.
May contain organization-specific values: No
Category Entries:
No
Yes
4 | CLAIM_ACCEPT_DTTM | DATETIME (Local) | No |
This column holds the instant the claim was accepted.
5 | SG_PAYOR_ID_PAYOR_NAME | VARCHAR | No |
The name of the payor.
6 | SG_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
7 | SG_CVG_ID | NUMERIC | No |
The coverage ID for this claim.
8 | INVOICE_NUM | VARCHAR | No |
The invoice number for this claim.
9 | SG_PAT_ID | VARCHAR | No |
The patient ID for this claim.
10 | SG_GR_ACCT_ID | NUMERIC | No |
The guarantor account ID for this claim.
11 | HOSPITAL_ACCT_ID | NUMERIC | No |
The hospital account ID for this claim.
12 | HLB_ID | NUMERIC | No |
The liability bucket ID for this claim.
13 | SG_PROV_ID_PROV_NAME | VARCHAR | No |
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
14 | SG_REF_SRC_ID | VARCHAR | No |
The referring source ID for this claim.
15 | SG_REF_SRC_ID_REFERRING_PROV_NAM | VARCHAR | No |
The name of the referral source.
16 | SG_LOC_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
17 | SG_DEP_ID_EXTERNAL_NAME | VARCHAR | No |
The external name of the department record. This is often used in patient correspondence such as reminder letters.
18 | SG_POS_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
19 | SG_CLM_ID | NUMERIC | No |
The claim information ID used by this claim.
20 | SG_RQG_ID | NUMERIC | No |
The requisition grouper ID for this claim.
21 | CLAIM_CLASS_C_NAME | VARCHAR | No |
The account class used to evaluate this claim.
May contain organization-specific values: Yes
22 | CLAIM_BASE_CLASS_C_NAME | VARCHAR | No |
The base account class used to evaluate this claim.
May contain organization-specific values: No
Category Entries:
Inpatient
Outpatient
Emergency
23 | MIN_SERVICE_DT | DATETIME | No |
The minimum service date for this claim.
24 | MAX_SERVICE_DT | DATETIME | No |
The maximum service date for this claim.
25 | UB_FROM_DT | DATETIME | No |
The uniform billing claim from date.
26 | UB_THROUGH_DT | DATETIME | No |
The uniform billing claim through date.
27 | CLAIM_TYPE_C_NAME | VARCHAR | No |
The claim type.
May contain organization-specific values: Yes
Category Entries:
CMS Claim
UB Claim
State Visit Data
State Visit Provider Data
Vektis Claim
Pharmacy Claim
28 | CLAIM_FRM_TYPE_C_NAME | VARCHAR | No |
The form type. This is either paper or electronic.
May contain organization-specific values: No
Category Entries:
Electronic Form
Paper Form
Both Paper and Electronic
29 | TTL_CHRGS_AMT | NUMERIC | No |
Total charges amount.
30 | TTL_DUE_AMT | VARCHAR | No |
Total due amount.
31 | TTL_NONCVD_AMT | NUMERIC | No |
Total non-covered amount.
32 | TTL_PMT_AMT | NUMERIC | No |
Total payment amount.
33 | TTL_ADJ_AMT | NUMERIC | No |
Total adjustment amount.
34 | UB_BILL_TYPE | VARCHAR | No |
Type of bill.
35 | HM_HLTH_BILL_TYP_C_NAME | VARCHAR | No |
Home Health bill type.
May contain organization-specific values: No
Category Entries:
Request for Anticipated Payment
Home Health Claim
Claim
Cancel Request for Anticipated Payment
Cancel Home Health Claim
Home Health Claim Adjustment
Hospice Election Claim
Hospice Revocation Claim
Cancel Hospice Election Claim
Hospice Claim
36 | UB_SG_GRP_NUM | VARCHAR | No |
Group number.
37 | CNCL_CLAIM | INTEGER | No |
Indicates whether this is a cancel claim.
38 | REPL_CLAIM | INTEGER | No |
Indicates whether this is a replacement claim.
39 | UB_CVD_DAYS | INTEGER | No |
Covered days.
40 | UB_COINS_DAYS | INTEGER | No |
Coinsurance days.
41 | UB_NON_CVD_DAYS | INTEGER | No |
Non-covered days.
42 | UB_PRINC_DX_ID_DX_NAME | VARCHAR | No |
The name of the diagnosis.
43 | CNCL_CLAIM_CODE | VARCHAR | No |
The value code associated with this claim if it is a cancel claim.
44 | REPL_CLAIM_CODE | VARCHAR | No |
The value code associated with this claim if it is a replacement claim.
45 | SG_ALTPYR_CLM_YN | VARCHAR | No |
Flag used to indicate that claim is for alternate payer.
The category values for this column were already listed for column: INACTV_CLP_YN
46 | FILING_ORDER_C_NAME | VARCHAR | No |
This column holds the filing order position of the claim coverage at the time claims were processed.
May contain organization-specific values: No
Category Entries:
Primary
Secondary
Tertiary
Post-Tertiary
Unknown
47 | CLM_EXT_VAL_ID | NUMERIC | No |
The ID of the claim record.
48 | SG_TREAT_PLAN_ID | VARCHAR | No |
The unique ID of the treatment plan that is associated with the claim.
49 | UB_COMB_CLM_TYP_C_NAME | VARCHAR | No |
If this column is set to 1, the claim is a combined claim.
May contain organization-specific values: Yes
Category Entries:
Normal claim (not combined)
Combined claim
50 | REND_PROV_ID_PROV_NAME | VARCHAR | No |
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
51 | RESEARCH_ID_RESEARCH_STUDY_NAME | VARCHAR | No |
The name of the research study record.
52 | SRC_INV_NUM | VARCHAR | No |
In PB, this column holds the original invoice number during refresh and resubmit. In HB, this column holds the invoice number associated with the primary claim in a crossover scenario.
53 | CLAIM_TAX_AMOUNT | NUMERIC | No |
Gross tax amount at a claim level, this is the sum of all the tax amounts sent on a claim.
54 | DRG_XR_AMOUNT | NUMERIC | No |
The Diagnosis Related Group expected reimbursement amount. This will be stored for accounts billed with Diagnosis Related Group that need tax calculated specifically for the Diagnosis Related Group without any outliers or add-ons, as compared to the total expected reimbursement on the claim.
55 | DRG_TAX_AMOUNT | NUMERIC | No |
The Diagnosis Related Group tax amount. This will be stored for accounts billed with Diagnosis Related Group that have tax calculated based on expected reimbursement values.
56 | CLAIM_APEC_OUTLIER | NUMERIC | No |
This item stores the Adjudicated Payment per Episode of Care Outlier amount for a claim.
57 | SNF_CLAIM_TYPE_C_NAME | VARCHAR | No |
This item identifies the type of Skilled Nursing Facility claim produced.
May contain organization-specific values: No
Category Entries:
Non-Managed SNF HAR
Normal SNF HAR
Partial Exhaust Before (Combined)
Partial Exhaust Before (Separate)
Partial Exhaust After (Insurance Bucket)
Partial Exhaust After (Exhaust Bucket)
Full Exhaust (Insurance Bucket)
Full Exhaust (Exhaust Bucket)
No-Payment (Insurance Bucket)
No-Payment (No-Pay Bucket)
58 | DEPT_TYPE_C_NAME | VARCHAR | No |
The type of department. For Norway claims, this identifies the department as a GP Office, Trust, or Municipality.
May contain organization-specific values: Yes
No Entries Defined
59 | CLM_REBILL_REASON_C_NAME | VARCHAR | No |
This column stores the reason why we sent the claim again to payer. It holds onto the rebill reason with the highest precedence from the category list.
May contain organization-specific values: No
Category Entries:
New claim
Primary payer changed
Secondary/Tertiary payer changed
Payer's mailing address changed
Subscriber ID changed
Patient/Subscriber name changed
Patient/Subscriber SSN changed
Patient/Subscriber DOB changed
Patient/Subscriber address changed
Patient/Subscriber sex changed
Encounter event date changed
Account/Patient class changed
Discharge status changed
Combined accounts after billing
Procedure changed
DRG changed
Diagnosis changed
Late charges
Cancel claim
Referral/Auth number changed
Other
60 | CLM_REBILL_USER_ID | VARCHAR | No |
This column stores the user who resubmitted the claim.
61 | CLM_REBILL_USER_ID_NAME | VARCHAR | No |
The name of the user record. This name may be hidden.
62 | FAC_ACTOR_TYPE_C_NAME | VARCHAR | No |
This item stores the type of facility. For Norway claims, this identifies the facility as a GP Office, Trust, or Municipality.
May contain organization-specific values: No
Category Entries:
Trust
Municipality
General Practitioner
63 | BENEFIT_RECORD_ID | NUMERIC | No |
Stores the ID of the benefit (BEN) record used to calculate the patient responsibility.
64 | PREDICTED_PAY_DATE | DATETIME | No |
The predicted payment response date for a claim based on historical trends for the payer.
65 | SUGGESTED_FOL_UP_DATE | DATETIME | No |
The suggested initial follow-up date for a claim based on historical trends for the payer.
66 | CLM_CLOSED_TIMELY_YN | VARCHAR | No |
Denotes if the claim closed prior to its Suggested Initial Follow-up Date, whereby it was no longer outstanding to insurance.
The category values for this column were already listed for column: INACTV_CLP_YN
67 | REIMB_DRG_SOI | VARCHAR | No |
The severity of illness (SOI) used for expected reimbursement calculations. Only set for expected reimbursement calculations through an Epic contract, the contract was set to price by DRG, and the DRG used had a severity attached.