AP_CLAIM_IF_INFO_2

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 | BMI_FCTR_SEP_PYBL | VARCHAR | No |
Separately payable portion of bundled BMI factor utilized for cost outlier calculation.
4 | BSA | VARCHAR | No |
Body Surface Area (BSA) of patient.
5 | BSA_FCTR_SEP_PYBL | VARCHAR | No |
Separately payable portion of bundled BSA factor utilized for cost outlier calculation.
6 | AGE_FCTR_BUND_PPS | VARCHAR | No |
Age adjustment utilized for the bundled prospective payment of dialysis services.
7 | BMI_FCTR_BUND_PPS | VARCHAR | No |
BMI factor for the bundled prospective payment of dialysis services.
8 | BSA_FCTR_BUND_PPS | VARCHAR | No |
BSA factor for the bundled prospective payment of dialysis services.
9 | COMORB_FCTR | VARCHAR | No |
Comorbidity adjustment utilized for the prospective payment of dialysis services.
10 | COMORB_FCT_SEP_PBL | VARCHAR | No |
Separately payable portion of comorbidity factor utilized for cost outlier calculation.
11 | LOW_VOL_ADJ | VARCHAR | No |
Low volume adjustment utilized for the bundled prospective payment of dialysis services.
12 | LOW_VOL_ADJ_SEP_PBL | VARCHAR | No |
Separately payable portion of low volume factor utilized for cost outlier calculation.
13 | PASS_THRU_PMT | VARCHAR | No |
Additional payment for pass-through expenses.
14 | MEAN_LOS | VARCHAR | No |
Mean Length of Stay.
15 | ADDL_MEAN_LOS | VARCHAR | No |
Additional Mean Length of Stay
16 | DRG_WEIGHT | VARCHAR | No |
DRG-specific weight utilized for patient pricing.
17 | PER_DIEM | VARCHAR | No |
Per Diem Reimbursement.
18 | TIERED_PER_DIEM | VARCHAR | No |
Tiered Per-Diem Reimbursement.
19 | DRG_PAYTYPE | VARCHAR | No |
DRG Specific Pricing Rule.
20 | INLIER_RATE | VARCHAR | No |
Inlier Rate.
21 | TRANSFER_FLAG | VARCHAR | No |
Transfer Flag.
22 | OPR_IME_PMT | VARCHAR | No |
Operating Indirect Medical Education (IME) Payment.
23 | OPR_DSH_PMT | VARCHAR | No |
Operating Disproportionate Hospital (DSH) Payment.
24 | CAP_IME_PMT | VARCHAR | No |
Capital Indirect Medical Education (IME) Payment.
25 | CAP_DSH_PMT | VARCHAR | No |
Capital Disproportionate Hospital (DSH) Payment.
26 | REIMB_DRG | VARCHAR | No |
Reimbursement DRG.
27 | PAYMENT_CMG | VARCHAR | No |
Contains a payment-related Case Mix Group (CMG).
28 | PAYMENT_HIPPS | VARCHAR | No |
Health Insurance Prospective Payment System (HIPPS) code returned by the pricer.
29 | PPS_PENALTY_AMT | VARCHAR | No |
This field contains the dollar amount of any applicable penalty.
30 | PAYMENT_FLAG_CMG | VARCHAR | No |
Payment flag for Inpatient Rehabilitation Facility (IRF) priced claims.
31 | TRANSFER_FLAG_CMG | VARCHAR | No |
Transfer flag for IRF priced claims.
32 | PENALTY_FLAG | VARCHAR | No |
Penalty flag.
33 | PENALTY_PERCENT | VARCHAR | No |
This field contains the percentage the facility was penalized.
34 | HIPPS_WEIGHT | VARCHAR | No |
Relative weight for payment HIPPS code.
35 | HIPPS_AVG_LOS | VARCHAR | No |
Average length of stay for payment HIPPS code.
36 | OUTLIER_CHRGS | VARCHAR | No |
Charges used to determine applicable cost outlier payments.
37 | OUTLIER_THRESHOLD | VARCHAR | No |
Cost outlier threshold for payment HIPPS code.
38 | ASSESSMNT_TDATE | VARCHAR | No |
Assessment transmission date.
39 | AIDS_ADJ_FACTOR | VARCHAR | No |
AIDS adjustment factor.
40 | TOT_THIRD_PARTY_PMT | VARCHAR | No |
Total third party payment is the total reimbursement for this claim minus patient coinsurance.
41 | OR_PROC_FOR_DRG | VARCHAR | No |
First three operating room procedures that influenced DRG assignment.
42 | NOR_PROC_FOR_DRG | VARCHAR | No |
First and second non-operating room procedures that influenced DRG assignment.
43 | COMRBD_DX_FOR_DRG | VARCHAR | No |
Diagnosis code that satisfied the complication/comorbidity (CC) criteria and influenced DRG assignment.
44 | DX_FOR_DRG | VARCHAR | No |
First three diagnoses (other than principal) that influenced DRG assignment.
45 | NUM_OF_MCCS | VARCHAR | No |
Number of major complications/comorbidities in the claim not excluded by the principle diagnosis.
46 | NUM_OF_CCS | VARCHAR | No |
Number of complications/comorbidities in the claim not excluded by the principle diagnosis.
47 | ADM_MOTOR_SCR_CALC | VARCHAR | No |
Total motor score calculated from IRF-PAI admission motor scores.
48 | ADM_MOTOR_SCR_FLAG | VARCHAR | No |
Admission motor score flag.
49 | ADM_COGN_SCR_CALC | VARCHAR | No |
Sum of fields 39N through 39R on the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).
50 | ADM_COGN_SCR_FLAG | VARCHAR | No |
Admission cognitive score flag.
51 | DEMOG_ERR_CNT | VARCHAR | No |
Count of total demographic errors encountered for the input record.
52 | AGE_EDIT | VARCHAR | No |
Age edit.
53 | SEX_EDIT | VARCHAR | No |
Sex edit.
54 | DISCHRG_DISP_EDIT | VARCHAR | No |
Discharge disposition edit.
55 | BWGT_EDIT | VARCHAR | No |
Birthweight edit.
56 | MCE_DX_ERR_CNT | VARCHAR | No |
Count of total diagnosis errors encountered.
57 | PRINC_DX_ERRS | VARCHAR | No |
Principal diagnosis errors.
58 | PRINC_DX_SURG_EDIT | VARCHAR | No |
Principal Diagnosis/Surgery Edit.
59 | ADMIT_DX_ECODE_ERR | VARCHAR | No |
Admit Diagnosis External Cause of Injury Code/Manifestation Code.
60 | MCE_PX_ERR_CNT | VARCHAR | No |
Count of total procedure errors encountered.
61 | NON_SPEC_PX_EDIT | VARCHAR | No |
Nonspecific Procedure Edit.
62 | BILAT_CODING_EDIT | VARCHAR | No |
Bilateral coding edit.
63 | ADMIT_DX_INVALID | VARCHAR | No |
Admit Diagnosis Invalid.
64 | ADMIT_DX_AGE_SEX | VARCHAR | No |
Admit Diagnosis Age/Sex
65 | ADM_DX_MED_SEC_ALRT | VARCHAR | No |
Admit Diagnosis Medicare as Secondary Payer Alert.
66 | MCE_TOT_ERRS | VARCHAR | No |
Total Date-Sensitive Code Editor/Medicare Code Editor errors for this claim.
67 | PERCENT_CHRGS | VARCHAR | No |
Percent of Charges Value.
68 | GRPR_SEV_ILLNESS | VARCHAR | No |
Identifies severity of illness associated with claim level diagnosis. Data received in GOB1.DRG block on incoming message.
69 | GRPR_RSK_MORTALITY | VARCHAR | No |
Identifies risk of mortality associated with claim level diagnosis. Data received in GOB1.DRG block on incoming message.
70 | AGE_DAYS_OF_ADMISSION | VARCHAR | No |
Age in days as the number of days between birth date and the date of admission. Required for neonates. Data sent in PCB2.ICD block on the outgoing message.
71 | AGE_DAYS_OF_DISCHARGE | VARCHAR | No |
Age in days as the number of days between the birth date and the date of discharge. Required for neonates. Data sent in PCB2.ICD block on the outgoing message.
72 | OR_PROC_01 | VARCHAR | No |
Identifies the first three operating room procedures that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
73 | NON_OR_PROC_01 | VARCHAR | No |
Identifies the first and second non-operating room procedures that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
74 | COMORBIDITY_DX_01 | VARCHAR | No |
Identifies diagnosis code that satisfied the Complication/Comorbidity (CC) criteria and influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
75 | DX_FOR_DRG_01 | VARCHAR | No |
Identifies the first three diagnoses (other than principal) that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
76 | ADMISSION_DRG | VARCHAR | No |
Identifies the admission Diagnosis Related Group (DRG). Data received in GOB1.DRG block on incoming message.
77 | ADMISSION_SOI | VARCHAR | No |
Identifies level of severity of illness at admission. Data received in GOB1.DRG block on incoming message.
78 | ADMISSION_ROM | VARCHAR | No |
Identifies risk of mortality at admission. Data received in GOB1.DRG block on incoming message.
79 | ADMIT_MOTOR_SCORE_CALC_2 | VARCHAR | No |
Identifies motor-out score redefined with 3 digits following the decimal. Data received in GOB1.CMG block on incoming message.
80 | ADMIT_COGNITIVE_SCORE_CALC_2 | VARCHAR | No |
Identifies cognitive-out score redefined with 3 digits following the decimal. Data received in GOB1.CMG block on incoming message.
81 | ICD10_COMORBIDITY_01 | VARCHAR | No |
Identifies comorbidity code that is at the highest comorbidity tier for the case. Data received in GOB1.CMG block on incoming message.
82 | ICD10_COMORBIDITY_02 | VARCHAR | No |
Identifies comorbidity code that is at the highest comorbidity tier for the case and part of an ICD-10 code pair. Data received in GOB1.CMG block on incoming message.
83 | SHORT_STAY_OUTL_TRIM | VARCHAR | No |
Identifies short stay or day outliers. Data received in POB1.DRG block on incoming message.
84 | LONG_STAY_OUTL_TRIM | VARCHAR | No |
Identifies long stay or day outliers. Data received in POB1.DRG block on incoming message.
85 | COST_OUTL_THRESHOLD | VARCHAR | No |
Identifies predicted map plus fixed dollar loss amount that is utilized for the cost outlier calculation.
86 | TOT_PRED_ESRD_OUTL_PMT | VARCHAR | No |
Identifies total predicted amount of separately payable services per dialysis treatment on monthly bill. For ESRD only. Data received in POB1.APC block on incoming message.
87 | NUM_DIALYSIS_LN_ITEM | VARCHAR | No |
Identifies number of dialysis claim lines. For ESRD only. Data received in POB1.APC block on incoming message.
88 | CORE_BASE_STAT_AREA | VARCHAR | No |
Identifies core based statistical area. For ESRD only. Data received in POB1.APC block on incoming message.
89 | RET_CODE_38_OVR_FLG | VARCHAR | No |
Flag indicating whether or not the claim-level Pricer Return Code 38 (Invalid or Missing Required Claims Data) has been overridden. For ESRD only. Data received in POB1.APC block on incoming message.
90 | AGE_EDIT_IND | VARCHAR | No |
Indicates an age edit. Data received in MEB1 block on incoming message.
91 | NUM_OF_VISITS | VARCHAR | No |
Identifies total number of visits on the claim.
92 | CAPITAL_ADDON | VARCHAR | No |
Identifies total capital add-on for the claim.
93 | BLEND_FACTOR | VARCHAR | No |
Identifies portion of Ambulatory Patient Group (APG) payment applied to the claim.
94 | RATE_CODE_INDICATOR | VARCHAR | No |
Identifies payment rules applied to the claim, based on the APG rate code supplied on claim.
95 | TOTAL_EXISTING_PAYMENT | VARCHAR | No |
Identifies total payment for non-APG portion of visits on claim. Only applies to facility types subject to transitions.