CLAIM_INFO2

Description: |
This table contains claims information from claim information (CLM) records for both 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 | CVR_NUM_TIMES_PREG | INTEGER | No |
Number of pregnancies, for contraceptive vaginal ring (CVR).
3 | CVR_NUM_BIRTHS | INTEGER | No |
Number of births, for contraceptive vaginal ring (CVR).
4 | NUM_LIVING_CHILDREN | INTEGER | No |
Number of living children, for contraceptive vaginal ring (CVR).
5 | CVR_VISIT_TYPE_C_NAME | VARCHAR | No |
Contraceptive vaginal ring (CVR) visit type.
May contain organization-specific values: Yes
Category Entries:
First Annual Exam
Return Annual Exam
Other Medical
Counseling Only
Pregnancy Test Visit
Vasectomy Referral
Supply Only Visit
Infection/Disease/Other Medical
Contraceptive Visit
Off-Site Contraceptive Visit/Other Medical
6 | CVR_PRV_COUN_EDU_C_NAME | VARCHAR | No |
Provider of counseling and educational services for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Resource
Physician
7 | CVR_CONTRA_BEFORE_C_NAME | VARCHAR | No |
Contraceptive method, before visit for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Female Sterilization
Oral Contraceptives
IUD
Diaphragm/Cervical Cap
Foam and Condoms
Male Condom
Spermicide
Fertility Awareness Method
Other Method
None
Hormone Implant
Hormonal Injection - 1 month
Abstinence
Male Sterilization
IUS
Hormonal Injection - 3 month
Hormonal Patch
Vaginal Ring
Female Condom
Withdrawal
Contraceptive Sponge
LAM
8 | CVR_CONTRA_AFTER_C_NAME | VARCHAR | No |
Contraceptive method, after visit for contraceptive vaginal ring (CVR).
The category values for this column were already listed for column: CVR_CONTRA_BEFORE_C_NAME
9 | CVR_REASON_CO_C_NAME | VARCHAR | No |
Reason for using no contraceptive method, for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Planned Pregnancy
High Risk Pregnancy
Seeking Pregnancy
Other Medical Reason
Relying on Partner's Method
Not Sexually Active
Other
Unplanned Pregnancy
10 | CVR_INT_CODE | INTEGER | No |
Internal use code, for contraceptive vaginal ring (CVR).
11 | CVR_STATUS_C_NAME | VARCHAR | No |
Contraceptive vaginal ring (CVR) status.
May contain organization-specific values: Yes
Category Entries:
Not Reported
Reported
Queued for Reporting
Queued for Voiding
Queued for Resubmittal
Voided not Reported
Reported as Voided
Reported as FPEP
12 | TPR_INS_CODE_C_NAME | VARCHAR | No |
The Third Party Resource Insurance Code from Medicare.
May contain organization-specific values: Yes
Category Entries:
Service under deductible
Service not covered by insurance policy
Patient not covered by insurance policy
Insurance coverage cancelled/terminated
Insurance lapsed or not in effect on date of service
Insurance payment went to policy holder
Insurance payment went to patient
Service not authorized or prior authorized by insurance
Service not considered emergency by insurance
Service not provided by primary care provider facility
Maximum benefits used for diagnosis/condition
Requested information not received by insurance from client
Requested information not received by insurance from policy holder
Motor vehicle accident fund maximum benefits exhausted
Insurance mandated under court order not paid within 30 days
Other
Primary Insurance Paid - Secondary Paid
Primary Insurance Paid - Secondary Under Deductible
Primary and Secondary Under Deductible
Primary Insurance Under Deductible-Secondary Paid
Primary Insurance Paid-Secondary Service Not Covered
Primary Insurance Paid-Secondary Patient Not Covered
Primary Insurance Paid-Secondary Canceled/Terminated
Primary Insurance Paid-Secondary Lapsed or Not in effect
Primary Insurance Paid-Secondary Payment went to patient
Primary Insurance Paid-Secondary Payment Went to Policyholder
Primary Insurance Paid-Secondary Denied-Service Not Authorized
Primary Insurance Paid-Secondary Denied-Service Not Considered Emergency
Primary Insurance Paid-Secondary Denied-Svc Not Provided by Primary Care Provider/Fac
Primary Insurance Paid-Secondary Denied-Maximum Benefits Used for Diagnosis/Condition
Primary Insurance Paid-Secondary Denied-Requested Info Not Received from Policyholder
Denied-Requested Information Not Received from Patient
Service Not Covered by Primary or Secondary Insurance
13 | BLOOD_FURNISHED | INTEGER | No |
Pints of blood furnished.
14 | BLOOD_REPLACED | INTEGER | No |
Pints of blood replaced.
15 | BLOOD_NOT_REPLACED | INTEGER | No |
Pints of blood not replaced.
16 | BLOOD_DEDUCTIBLE | INTEGER | No |
The number of pints of blood that are deductible.
17 | PSROUR_APRV_IND_C_NAME | VARCHAR | No |
Professional Standards Review Organization Utilization Review (PSRO/UR) approval indicator.
May contain organization-specific values: No
Category Entries:
Approved As Billed
Automatic Approval As Billed
Partial Approval
Admission Denied
Post-Payment Review Applicable
Admission Preauthorization
18 | PSROUR_APRV_FROM_DT | DATETIME | No |
Professional Standards Review Organization Utilization Review (PSRO/UR) approval date.
19 | PSROUR_APRV_TO_DT | DATETIME | No |
Professional Standards Review Organization Utilization Review (PSRO/UR) approval expiry date.
20 | NUM_OF_GRACE_DAYS | INTEGER | No |
Number of grace days.
21 | TREAT_AUTH_CODE | VARCHAR | No |
Treatment authorization code.
22 | PART_A_EXHAUST_DT | DATETIME | No |
The date a patient's Medicare Part A benefits are exhausted.
23 | PAT_HEIGHT | VARCHAR | No |
Patient height in inches.
24 | PAT_WEIGHT | VARCHAR | No |
Patient weight in ounces.
25 | BIRTH_WEIGHT_WT | NUMERIC | No |
The patient's birth weight.
26 | SYSTOLIC_BP | INTEGER | No |
Blood pressure - systolic.
27 | DIASTOLIC_BP | INTEGER | No |
Blood pressure - diastolic.
28 | PAT_VISIT_TYPE_C_NAME | VARCHAR | No |
The patient's visit type for the State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: Yes
Category Entries:
New Patient
Extended Visit
Routine Visit
Extended Visit/New Patient
29 | PAT_SCREEN_TYPE_C_NAME | VARCHAR | No |
The type of screening performed during the State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: Yes
Category Entries:
Initial Screen
Periodic Visit
30 | WIC_STATUS_C_NAME | VARCHAR | No |
The patient's status in the Women, Infants, and Children (WIC) program.
May contain organization-specific values: No
Category Entries:
Enrolled in WIC
Referred to WIC
Neither
31 | PAT_SCRN_PARTIAL_C_NAME | VARCHAR | No |
Indicates whether the State of California Child Health and Disability Prevention (CDHP) visit was a partial screening, or a recheck for an earlier screening.
May contain organization-specific values: No
Category Entries:
Neither
Partial Screen
Recheck
32 | PAT_PRIOR_SCREEN_DT | DATETIME | No |
Date of prior screening.
33 | HEAD_START_YN | VARCHAR | No |
Indicate whether this patient has been referred by a Head Start or a State Preschool program for this State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: No
Category Entries:
Yes
No
34 | HEAD_START_NUMBER | VARCHAR | No |
The 5 digit Head Start Grantee number, or the 11 digit State Preschool Project number for the program which referred the patient for this State of California Child Health and Disability Prevention (CHDP) visit.
35 | FOSTER_CHILD_YN | VARCHAR | No |
Indicates whether the patient is a foster child in the State of California Child Health and Disability Prevention (CHDP) program.
May contain organization-specific values: No
Category Entries:
Yes
No
36 | TOBACCO_PASSIV_YN | VARCHAR | No |
Indicates whether tobacco exposure has occurred.
The category values for this column were already listed for column: FOSTER_CHILD_YN
37 | TOBACCO_USAGE_YN | VARCHAR | No |
Indicated tobacco usage.
The category values for this column were already listed for column: FOSTER_CHILD_YN
38 | TOBACCO_CNSL_YN | VARCHAR | No |
Indicates whether tobacco counseling was given.
The category values for this column were already listed for column: FOSTER_CHILD_YN
39 | PAT_NEXT_VISIT_DT | DATETIME | No |
Next visit date.
40 | DENTAL_REFERRAL_YN | VARCHAR | No |
Dental referral.
The category values for this column were already listed for column: HEAD_START_YN
41 | BLOOD_LEAD_REF_YN | VARCHAR | No |
Blood lead referrals.
The category values for this column were already listed for column: HEAD_START_YN
42 | CONTRACEPTIVE_C_NAME | VARCHAR | No |
Contraceptive method the patient is using.
May contain organization-specific values: Yes
Category Entries:
Birth Control Pills
Injections
Implants
IUD
Diaphragm
Cervical Cap
Spermicides
Male Condoms
Female Condoms
Fertility Awareness Methods
Natural Family Planning
Sterilization
Infertility Management
Other: Relying on Partner
None: Seeking Preg;Test w/o Method Use;Deferred Activity
43 | CMN_ATTCH_TRNS_CD_C_NAME | VARCHAR | No |
Attachment transmission code for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Previously submitted to payer
Certification included in this claim
Narrative segment included in this claim
No documentation is required
Not specified
44 | CMN_PUMP_NUM_C_NAME | VARCHAR | No |
Pump type - question 1 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
External infusion pump (non-disposable)
Reserved for other or future use
Implantable infusion pump
Disposable infusion pump
45 | CMN_ADMIN_ROUT_C_NAME | VARCHAR | No |
Administration route - question 4 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Intravenous
Reserved for other or future use
Epidural
Subcutaneous
46 | CMN_ADMIN_METH_C_NAME | VARCHAR | No |
Administration method - question 5 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Continuous
Intermittent
Bolus
47 | CMN_CANCER_PAIN_C_NAME | VARCHAR | No |
Whether the patient's pain cannot be managed by oral/transdermal narcotics - question 7 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Yes
No
Does not apply
48 | ASSUMED_CARE_DT | DATETIME | No |
The assumed care date of the claim.
49 | RELINQ_CARE_DT | DATETIME | No |
The date care was relinquished.
50 | DISCHARGE_HOUR_TM | DATETIME (Local) | No |
The time the patient was discharged from inpatient care.
51 | BILL_CLASS_C_NAME | VARCHAR | No |
The second digit for the UB bill type.
May contain organization-specific values: No
Category Entries:
Inpatient (Including Medicare Part A)
Inpatient (Medicare Part B only)
Outpatient
Laboratory Services Provided to Non-patients
Intermediate Care - Level I
Intermediate Care - Level II
Subacute Inpatient (discontinued 10/1/2005)
Swing Beds
52 | PRINCIPAL_PX_ID_PROC_NAME | VARCHAR | No |
The name of each procedure.
53 | PRINCIPLE_PX_DESC | VARCHAR | No |
Principal International Classification of Diseases (ICD) procedure description.
54 | PRINCIPLE_PX_DT | DATETIME | No |
Principal International Classification of Diseases (ICD) procedure date.
55 | PRINCIPAL_DX_ID_DX_NAME | VARCHAR | No |
The name of the diagnosis.
56 | MEDICAID_CRN | VARCHAR | No |
The Medicaid Claim Rejection Number if this claim was rejected by Medicaid (used by some states).
57 | MEDICAID_RA | VARCHAR | No |
The Medicaid Remittance Advice cycle number in which this claim appeared if it was rejected by Medicaid (used by some states).
58 | MEDICAID_LT_CLM_CD | VARCHAR | No |
The exception code for the claim if the claim is being submitted to Medicaid after the normal filing time limit (used by some states).
59 | HEMATOCRIT_CT | NUMERIC | No |
The patient's hematocrit reading, between 18 and 72.
60 | HEMOGLOBIN_COUNT | NUMERIC | No |
The patient's hemoglobin reading to the nearest 0.1 gram, between 6.0 and 24.0.
61 | BLOOD_PRESSURE | VARCHAR | No |
Blood pressure.
62 | LAST_TREATMENT_DT | DATETIME | No |
The last treatment date.
63 | LMTD_RETURN_DT | DATETIME | No |
The date of limited return for Workers' Comp.
64 | COMP_XRAYS_YN | VARCHAR | No |
Indicate if comparative x-rays were taken for the amputation.
The category values for this column were already listed for column: FOSTER_CHILD_YN
65 | AMPUTATION | VARCHAR | No |
Indicate what amputation was present.
66 | STUMP_CONDITION_C_NAME | VARCHAR | No |
The condition of the amputation stump.
May contain organization-specific values: No
Category Entries:
Hardy
Tender
67 | DISCHRG_CURED_DT | DATETIME | No |
The date the patient was discharged as cured.
68 | STOPPED_TREAT_DT | DATETIME | No |
The date the patient stopped treatment without an order.
69 | REFUSED_TREAT_DT | DATETIME | No |
The date the patient refused treatment.
70 | PROGNOSIS | VARCHAR | No |
The prognosis for the injury.
71 | FURTHER_TREATMENT_C_NAME | VARCHAR | No |
The likelihood of further treatment.
May contain organization-specific values: No
Category Entries:
Necessary
Probable
Unlikely
72 | TREATMENT_DESC | VARCHAR | No |
The description of the further treatment that should be given to the patient.
73 | HEALING_END_YN | VARCHAR | No |
Indicate if the healing period has ended.
The category values for this column were already listed for column: FOSTER_CHILD_YN
74 | DISABLED_BODY_PART | VARCHAR | No |
The part of the body that was affected.
75 | BODY_PART_DISABLD_C_NAME | VARCHAR | No |
The affected body part.
May contain organization-specific values: Yes
76 | MIN_PERM_DISABILITY | VARCHAR | No |
The minimum permanent disability expected if healing has not ended.
77 | PERCENT_DISABILITY | INTEGER | No |
The percentage of disability.
78 | SURGERY_PERF_YN | VARCHAR | No |
Indicate if surgery was performed as a result of the injury.
The category values for this column were already listed for column: FOSTER_CHILD_YN
79 | SURGERY_TYPE | VARCHAR | No |
The type of surgery performed.
80 | PREVIOUS_DISABILITY | VARCHAR | No |
The previous disability before the injury.
81 | CMN_INIT_CERT_DT | DATETIME | No |
Initial certification date for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
82 | CMN_REV_CERT_DT | DATETIME | No |
Revised certification date for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
83 | CMN_NUM_MONTH | INTEGER | No |
Estimated length of need, in months, for the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
84 | CMN_HCPCS_CODE | VARCHAR | No |
Healthcare Common Procedure Coding System (HCPCS) code - question 2 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
85 | CMN_NON_SPEC_CODE | VARCHAR | No |
Drug name for non-specific drug codes - question 3 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
86 | CMN_DRG_INF_DUR | INTEGER | No |
Total duration of infusion, in hours, per 24-hour period - question 6 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
87 | CMN_ROUTE_0903_C_NAME | VARCHAR | No |
Administration route - question 3 on the 09.03 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: Yes
Category Entries:
Intravenous
Subcutaneous
Epidural
Other
88 | CMN_METHOD_0903_C_NAME | VARCHAR | No |
Administration method - question 4 on the 09.03 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: Yes
Category Entries:
Continuous
Intermittent
89 | PLACE_OF_INJURY_C_NAME | VARCHAR | No |
Place of injury.
May contain organization-specific values: Yes
Category Entries:
Work
Home
90 | CITY | VARCHAR | No |
City in which the accident happened.
91 | ZIP | VARCHAR | No |
Zip code of the place where the accident happened.
92 | INFORMANT | VARCHAR | No |
Informant of the accident.
93 | ACCOMP_PERSON | VARCHAR | No |
The person the patient was accompanied by.
94 | POLICE_NOTIFIER | VARCHAR | No |
The person the police were notified by.
95 | ACC_COUNTY_C_NAME | VARCHAR | No |
Accident county.
May contain organization-specific values: Yes
96 | OUT_CLM_YN | VARCHAR | No |
Used to track charges and claims outside of the system.
The category values for this column were already listed for column: FOSTER_CHILD_YN
97 | TPL_STATUS_C_NAME | VARCHAR | No |
The third party liability status.
May contain organization-specific values: Yes
Category Entries:
Lien
Non-Lien
98 | WCAB_NUM | VARCHAR | No |
The number assigned by the appeals board.
99 | CUMU_TRAUMA_YN | VARCHAR | No |
Indicates whether the claim is a cumulative trauma.
The category values for this column were already listed for column: FOSTER_CHILD_YN
100 | AUTO_ACDNT_NUMBER | VARCHAR | No |
Auto Accident Claim Number.
101 | E_CODE_ID_DX_NAME | VARCHAR | No |
The name of the diagnosis.
102 | OTHER_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.
103 | OPERATING_PHYSIC_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.
104 | ATTEND_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.
105 | AUTH_NUM | VARCHAR | No |
Authorization Number: Used on claims for identifying patient referrals and affected reimbursements.
106 | UB92_TOB_OVERRIDE | VARCHAR | No |
Override for the type of bill, a numeric code that provides encounter information to payers.
107 | AMBULANCE_PICK_CITY | VARCHAR | No |
Stores the city of the ambulance pick-up location.
108 | AMBULANCE_PICK_ST_C_NAME | VARCHAR | No |
Stores the state of the ambulance pick-up location.
May contain organization-specific values: Yes
109 | AMBULANCE_PICK_ZIP | VARCHAR | No |
Stores the ZIP code of the ambulance pick-up location.
110 | AMBULANCE_DROP_CITY | VARCHAR | No |
Stores the city of the ambulance drop-off location.
111 | AMBULANCE_DROP_ST_C_NAME | VARCHAR | No |
Stores the state of the ambulance drop-off location.
The category values for this column were already listed for column: AMBULANCE_PICK_ST_C_NAME
112 | AMBULANCE_DROP_ZIP | VARCHAR | No |
Stores the ZIP code of the ambulance drop-off location.
113 | AMBULANCE_DROP_NM | VARCHAR | No |
Stores the last name or organization name of the ambulance drop-off location.
114 | AMBULANCE_PAT_CNT | NUMERIC | No |
Stores number of patients in the ambulance.
115 | WC_JURSD_STATE_C_NAME | VARCHAR | No |
Workers' Comp insurance's state of jurisdiction.
The category values for this column were already listed for column: AMBULANCE_PICK_ST_C_NAME