CLAIM_INFO

Description: |
This table contains information from claim info records for Hospital and Professional Billing.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_ID | NUMERIC | No |
The unique ID for the claim information record.
2 | CLAIM_NAME | VARCHAR | No |
The description of the claim record.
3 | ACCOUNT_ID | NUMERIC | No |
The billing system accounts receivable account ID associated with this claim.
4 | CLAIM_TYPE_C_NAME | VARCHAR | No |
The claim type category of the claim. Identifies whether the claim was filed as a workers' compensation or commercial claim.
May contain organization-specific values: Yes
Category Entries:
Commercial
Workers' Compensation
5 | USER_ID | VARCHAR | No |
The ID of the staff member who entered the claim into the system.
6 | USER_ID_NAME | VARCHAR | No |
The name of the user record. This name may be hidden.
7 | ENTRY_DATE | DATETIME | No |
The date on which this claim was entered into the system.
8 | COVERAGE_ID | NUMERIC | No |
The coverage ID of the coverage used for this claim. This column can be used to report on coverages that are associated with a hospital account.
9 | ADMIT_DATETIME | DATETIME (Local) | No |
The admission date and time for the patient encounter associated with the claim.
10 | CLM_PAT_STATUS_C_NAME | VARCHAR | No |
The patient status category ID for the patient for whom this claim was filed.
May contain organization-specific values: Yes
11 | 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.
12 | ADMISSION_SOURCE_C_NAME | VARCHAR | No |
The admission source (e.g., physician referral, clinic referral, Health Maintenance Organization (HMO) referral, transfer from a hospital, transfer from a skilled nursing facility, emergency room, court/law enforcement, information not available) for the encounter associated with this claim.
May contain organization-specific values: Yes
13 | ADMISSION_TYPE_C_NAME | VARCHAR | No |
The admission type for the patient encounter associated with this claim (e.g., emergency, urgent, elective, newborn, trauma center, information not available).
May contain organization-specific values: Yes
14 | ADMIT_DX_ID_DX_NAME | VARCHAR | No |
The name of the diagnosis.
15 | ILL_INJ_LMP_C_NAME | VARCHAR | No |
The category type identifying the claim as resulting from illness, injury or pregnancy (e.g., illness, accident (injury), pregnancy (last menstrual period, or LMP)).
May contain organization-specific values: No
Category Entries:
Illness
Accident (Injury)
Pregnancy (LMP)
16 | REL_CONDITION_C_NAME | VARCHAR | No |
The related condition for the claim (e.g. Auto, Other Party Liability, Other Accident Related Injury, Patient Employment, Crime Victim).
May contain organization-specific values: Yes
Category Entries:
Auto
Other Party Liability
Other Accident Related Injury
Patient Employment
Crime Victim
17 | DOC_CTRL_NUM | VARCHAR | No |
The document control number (DCN) for the claim record.
18 | INJURY_DATETIME | DATETIME (Local) | No |
The date and time on which the injury resulting in the claim occurred.
19 | ACCIDENT_TYPE_C_NAME | VARCHAR | No |
The accident type for the injury resulting in the claim (e.g., Workers' Compensation, Automobile).
May contain organization-specific values: Yes
20 | IS_EPSDT_YN | VARCHAR | No |
This is a yes/no flag indicating whether or not the patient is being seen for an Early Periodic Screening Diagnosis and Treatment (EPSDT) program.
May contain organization-specific values: No
Category Entries:
No
Yes
21 | EPSDT_CODE_C_NAME | VARCHAR | No |
Early Periodic Screening and Diagnosis Treatment (EPSDT) program value.
May contain organization-specific values: Yes
22 | WC_CLAIM_NUM | VARCHAR | No |
Workers' Comp Claim Number for the claim record.
23 | WC_EMPLOYER_ID | VARCHAR | No |
The ID of the employer associated with a Workers' Comp claim.
24 | WC_EMPLOYER_ID_EMPLOYER_NAME | VARCHAR | No |
The name of the employer.
25 | TRAN_CODE_C_NAME | VARCHAR | No |
Ambulance transport code.
May contain organization-specific values: Yes
Category Entries:
Initial Trip
Return Trip
Transfer Trip
Round Trip
26 | TRAN_REASON_C_NAME | VARCHAR | No |
Ambulance transport reason code.
May contain organization-specific values: Yes
Category Entries:
Nearest Facility for Care of Symptoms, Complaints, or Both
For the Benefit of a Preferred Physician
For the Nearness of Family Members
For the Care of a Specialist or for Availability of Specialized Equipment
Rehabilitation Facility
27 | TRAN_DIST | NUMERIC | No |
Ambulance transport distance.
28 | CLM_LOGIN_SA_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
29 | ILL_INJ_LMP_DT | DATETIME | No |
The date of the onset of illness, the occurrence of the injury, or the patient's last menstrual period (related to pregnancy).
30 | AUTO_ACDNT_STATE_C_NAME | VARCHAR | No |
Auto accident State.
May contain organization-specific values: Yes
31 | EMPY_RELATED_YN | VARCHAR | No |
Indicates whether patient's condition is related to employment.
The category values for this column were already listed for column: IS_EPSDT_YN
32 | FIRST_CONSULT_DT | DATETIME | No |
First consult date.
33 | PAT_CHIEF_COMPLAINT | VARCHAR | No |
Patients chief complaint.
34 | EMERG_YN | VARCHAR | No |
Indicates whether the procedure is related to an emergency.
The category values for this column were already listed for column: IS_EPSDT_YN
35 | LAST_WORKED_DT | DATETIME | No |
Date last worked.
36 | RETURN_TO_WORK_DT | DATETIME | No |
Return to work date.
37 | DISCHARGE_DT | DATETIME | No |
Discharge date.
38 | OUTSIDE_LAB_NAME_C_NAME | VARCHAR | No |
Outside lab name.
May contain organization-specific values: Yes
Category Entries:
Other
39 | HLTH_APPR_SCRN_YN | VARCHAR | No |
Routine health appraisal/screening procedure.
May contain organization-specific values: No
Category Entries:
Yes
No
40 | SIG_ON_FILE_YN | VARCHAR | No |
Signature on file?
The category values for this column were already listed for column: IS_EPSDT_YN
41 | WK_COMP_CLAIM_NUM | VARCHAR | No |
Workers' Comp claim number.
42 | WK_COMP_INJ_DESC | VARCHAR | No |
Workers' Comp injury description.
43 | WK_COMP_APRV_CODE | VARCHAR | No |
Workers' Comp approval code.
44 | WK_COMP_MED_RLS_DT | DATETIME | No |
Workers' Comp medical release date.
45 | DF_DELAY_RSN_CODE_C_NAME | VARCHAR | No |
Default delay reason code.
May contain organization-specific values: Yes
Category Entries:
Proof of Eligibility Unknown or Unavailable
Litigation
Authorization Delays
Delay in Certifying Provider
Delay in Supplying Billing Forms
Delay in Delivery of Custom-made Appliances
Third-Party Processing Delay
Delay in Eligibility Determination
Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation
Administration Delay in the Prior Approval Process
Other
Natural Disaster
46 | FIRST_NEXT_VISIT_C_NAME | VARCHAR | No |
First/subsequent visit indicator.
May contain organization-specific values: No
Category Entries:
First Visit
Subsequent Visit
47 | MED_HX_SOC_WORKER | VARCHAR | No |
Social worker associated with this visit.
48 | MED_HX_PSYCHOLOGIST | VARCHAR | No |
Psychologist associated with this visit.
49 | MED_HX_SUP_PROV | VARCHAR | No |
Supervising medical doctor for this visit.
50 | MED_HX_COUNSELOR | VARCHAR | No |
Counselor associated with this visit.
51 | HDH_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the health and developmental history assessment.
May contain organization-specific values: No
Category Entries:
Physician
Dental
Hearing
Speech
Visual-Visual Problem
Visual-Specific Medical Problem
Other
Behavioral
52 | PHY_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the physical assessment.
May contain organization-specific values: No
Category Entries:
Completed/Normal
ABN/Treated Abnormal by Screening Provider
ABN/Referred Abnormal
Not Required
Not Performed
53 | PHY_EXAM_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the physical assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
54 | VISION_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the vision assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
55 | VISION_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the vision assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
56 | HEARING_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the hearing assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
57 | HEARING_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the hearing assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
58 | DEV_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the developmental assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
59 | DEV_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the developmental assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
60 | NUTRI_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the nutritional assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
61 | NUTRI_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the nutritional assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
62 | OTHER_TREATMNT_DT | DATETIME | No |
Stores date of other treatment.
63 | HOSPITAL_NAME | VARCHAR | No |
Name of the hospital where the patient was admitted.
64 | HOSPITAL_ADDRESS | VARCHAR | No |
The street address of the hospital where the patient was admitted.
65 | HOSPITAL_CITY | VARCHAR | No |
The city where the hospital to which the patient was admitted is located.
66 | HOSPITAL_STATE_C_NAME | VARCHAR | No |
The state where the hospital to which the patient was admitted is located.
The category values for this column were already listed for column: AUTO_ACDNT_STATE_C_NAME
67 | HOSPITAL_ZIP | VARCHAR | No |
The ZIP of the hospital to which the patient was admitted.
68 | HOSP_REQ_YN | VARCHAR | No |
Flag indicating whether or not hospitalization is required.
May contain organization-specific values: No
Category Entries:
No
Yes
69 | ADV_RET_WORK_YN | VARCHAR | No |
Flag to indicate whether a patient was advised to return to work.
The category values for this column were already listed for column: HOSP_REQ_YN
70 | ADV_RET_WORK_DT | DATETIME | No |
The date that patient was advised to return to work.
71 | REF_PHYS_NAME | VARCHAR | No |
Stores the referring physician's name.
72 | REF_PHYS_ADDR | VARCHAR | No |
Stores the referring physician's address.
73 | REF_PHYS_CITY | VARCHAR | No |
Stores the referring physician's city.
74 | REF_PHYS_STATE_C_NAME | VARCHAR | No |
Stores the referring physician's state.
The category values for this column were already listed for column: AUTO_ACDNT_STATE_C_NAME
75 | REF_PHYS_ZIP | VARCHAR | No |
Stores the referring physician's ZIP code.
76 | REF_PHYS_SPEC_C_NAME | VARCHAR | No |
Stores referring physician's specialty.
May contain organization-specific values: Yes
77 | REF_PHYS_REASON_C_NAME | VARCHAR | No |
Stores the referring physician's reason for the referral.
May contain organization-specific values: Yes
Category Entries:
Consultation
Treatment
78 | FIRST_TREAT_HOUR_TM | DATETIME (Local) | No |
First treatment hour. Some extensions add a value code to your claim if this item has a value.
79 | PAT_PREV_TREATED_YN | VARCHAR | No |
Is patient previously treated?
May contain organization-specific values: No
Category Entries:
Yes
No
80 | IDE_NUM | VARCHAR | No |
Investigational Device Exemption Number.
81 | EST_DOB_DT | DATETIME | No |
The estimated date of delivery for the pregnancy.
82 | RESPONSIBLE_IND_YN | VARCHAR | No |
Indicate if the patient's condition is due to an accident or illness caused by another party.
The category values for this column were already listed for column: IS_EPSDT_YN
83 | REFERRAL_SOURCE_ID | VARCHAR | No |
The referral source for the visit.
84 | REFERRAL_SOURCE_ID_REFERRING_PROV_NAM | VARCHAR | No |
The name of the referral source.
85 | EMERGENCY_CODE_C_NAME | VARCHAR | No |
The Emergency Service Code for emergency room services. This field is required for Illinois Department of Public Aid claims for emergency related services. It will populate record EA0-05.0 in the Illinois Department of Public Aid NSF 2.00 electronic claim file and box 10b-other on the IDPA 2360 paper claim form.
May contain organization-specific values: No
Category Entries:
Obstetrical crises and/or labor
Acute trauma
Reparative surgery necessitated by antecedent trauma
Hemorrhage or threat of hemorrhage
Serious infection
Severe pain
Shock or impending shock
Decompensated vital functions or threat to vital functions
Congenital defects in a newborn infant
Any condition requiring prompt diagnostic procedures
Any other condition causing serious pain or possible death
Child/adult abuse
Sexual assault
Not an emergency
86 | DISABILITY_LEVEL_C_NAME | VARCHAR | No |
The extent of the disability caused by the incident.
May contain organization-specific values: Yes
Category Entries:
Short Term Disability
Long Term Disability
Permanent/Total Disability
No Disability
87 | DISABILITY_FROM_DT | DATETIME | No |
The date the disability started.
88 | DISABILITY_TO_DT | DATETIME | No |
The date the disability ended.
89 | OUTSIDE_LAB_YN | VARCHAR | No |
Indicate if lab services outside the provider's office are involved.
The category values for this column were already listed for column: IS_EPSDT_YN
90 | OUTSIDE_LAB_CHARGE | NUMERIC | No |
The cost of services performed at the outside lab.
91 | FAM_PLANNING_YN | VARCHAR | No |
Indicate whether the patient is being seen for family planning care.
The category values for this column were already listed for column: IS_EPSDT_YN
92 | SPECIAL_PROGRAM_C_NAME | VARCHAR | No |
The special program under which the services rendered to the patient were performed.
May contain organization-specific values: No
Category Entries:
Special Federal Funding
Disability
PPV/Medicare 100% Payment
Induced Abortion - Danger to Woman's Life
Induced Abortion - Victim of Rape/Incest
Second Opinion/Surgery
TRICARE Program for the Disabled
Physically Handicapped Children's Program
Medicare Demonstration Project for Lung Volume Reduction Surgery
93 | PGM_FOR_HANDICAP_C_NAME | VARCHAR | No |
Indicates the patient's relationship to the sponsor for the program that benefits people with handicaps.
May contain organization-specific values: No
Category Entries:
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child, PFTH Number Unknown
Sponsor
Spouse
Widow/Widower
94 | EMPLOYER_LOB | VARCHAR | No |
A free text nature/line of business for the employer.
95 | OTH_INFO | VARCHAR | No |
Any additional free text information that should be recorded in conjunction with the claim.
96 | AUTH_DT | DATETIME | No |
Authorization date.
97 | CHIR_FIRST_TREAT_DT | DATETIME | No |
The initiation date of the course of treatment for chiropractic services.
98 | CHIR_X_RAY_DT | DATETIME | No |
The X-ray date for chiropractic services.
99 | NAT_OF_COND_C_NAME | VARCHAR | No |
Stores the nature of condition code for Spinal Manipulation.
May contain organization-specific values: Yes
Category Entries:
Acute Condition
Chronic Condition
Non-acute
Non-Life Threatening
Routine
Symptomatic
Acute Manifestation of a Chronic Condition
100 | CHIR_ACUTE_MANI_DT | DATETIME | No |
Stores the acute manifestation date for the spinal manipulation therapy.
101 | HBG_HCT_TEST_INCL_C_NAME | VARCHAR | No |
Indicate whether hemoglobin/hematocrit (HGB/HCT) test is included.
May contain organization-specific values: No
Category Entries:
No
Yes
Completed/Normal
ABN/Treated Abnormal by Screening Provider
ABN/Referred Abnormal
Not Required
Not Performed
ABN/Not Referred Abnormal
102 | URINALYSIS_INCL_C_NAME | VARCHAR | No |
Indicate whether Urinalysis test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
103 | TUBERCULOSIS_INCL_C_NAME | VARCHAR | No |
Indicate whether tuberculosis test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
104 | LEAD_TEST_INCL_C_NAME | VARCHAR | No |
Indicate whether lead test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
105 | SICKLE_CELL_INCL_C_NAME | VARCHAR | No |
Indicate whether sickle-cell test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
106 | IMMNZTN_INCL_C_NAME | VARCHAR | No |
The exam code for the immunizations.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
107 | CARDIO_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the cardiovascular assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
108 | CARDIO_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the cardiovascular assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
109 | URINARY_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the genital/urinary tract assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
110 | URINARY_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the genital/urinary tract assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
111 | DIABETE_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the diabetes assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
112 | DIABETE_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the diabetes assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
113 | DENTAL_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for the dental assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
114 | DENTAL_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the dental assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
115 | IMMNZTN_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for the immunizations.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
116 | EDU_EXAM_CODE_C_NAME | VARCHAR | No |
The exam code for health education.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
117 | EDU_RFL_CODE_C_NAME | VARCHAR | No |
The referral code for health education.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
118 | ONLY_CAUSE_YN | VARCHAR | No |
Flag to distinguish whether or not this injury is the only cause of the patient's condition.
The category values for this column were already listed for column: HOSP_REQ_YN
119 | PAT_BURNED_YN | VARCHAR | No |
Flag to determine whether or not patient has been burned.
The category values for this column were already listed for column: HOSP_REQ_YN
120 | XRAY_BY_WHOM | VARCHAR | No |
The name of the person or entity that performed x-rays.
121 | WC_XRAY_DT | DATETIME | No |
The date comparative x-rays were taken.
122 | POLIO_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Polio.
May contain organization-specific values: No
Category Entries:
Given/Up to date
Given/Not up to date
Not Given/Up to date
Not Given/Refused
Not Given/Omitted
123 | DPT_TD_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Diphtheria, pertussis, and tetanus (DPT)/tetanus and diphtheria (DT).
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
124 | MEASLES_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Measles.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
125 | MUMPS_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Mumps.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
126 | RUBELLA_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Rubella.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
127 | HIB_IMMNZTN_C_NAME | VARCHAR | No |
The immunization status for Haemophilus influenzae type B (HIB).
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
128 | CHAMP_NONAVAIL_YN | VARCHAR | No |
Indicate if the provider has a signed Tricare statement of non-availability on file indicating that the services associated with this claim were not available at a military treatment facility.
The category values for this column were already listed for column: IS_EPSDT_YN
129 | CHAMP_NONAV_STMT_NO | VARCHAR | No |
The number of the Tricare non-availability statement.
130 | CHAMPUS_ORG | VARCHAR | No |
Tricare Organization.
131 | CHAMPUS_STATION | VARCHAR | No |
Tricare Station.
132 | CHAMP_MILIT_ACC_YN | VARCHAR | No |
Indicate if the services performed were treatment as a result of a military accident.
The category values for this column were already listed for column: IS_EPSDT_YN
133 | ALTERNATE_CLM_ID | VARCHAR | No |
Alternate Claim ID.
134 | REF_PROVIDER_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.
135 | MC_CLAIMS_WKFLOW_C_NAME | VARCHAR | No |
Indicates the workflow associated with the claim (shadow claims, Accounts Payable claims, export only claims, etc.)
May contain organization-specific values: Yes
Category Entries:
AP claims
Reprice claims
Export only
Shadow claims
Externally paid claims
Externally paid claims with bucket update
Pre-adjudicated external claims
Estimate claims
Adjudicated external claims
136 | CLM_SENSITIVITY_C_NAME | VARCHAR | No |
Indicates the sensitivity type of the claim.
May contain organization-specific values: Yes
137 | PLACE_OF_SERVICE_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
138 | LOC_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.