AP_CLM_RX_2

Description: |
This table contains information from pharmacy claims.

Primary Key

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

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | CLAIM_ID | NUMERIC | No |
The unique identifier for the claim info record
2 | PRIM_PAYOR_ID_PAYOR_NAME | VARCHAR | No |
The name of the payor.
3 | BCDA_GROUP_IDENT | VARCHAR | No |
Claim group identifier provided by Beneficiary Claims Data API (BCDA)
4 | TOT_PAT_PORTION | NUMERIC | No |
Total patient portion
5 | MOST_RECENT_INCOMING_CEV_ID | NUMERIC | No |
The most recent incoming Claim External Values (CEV) record ID
6 | CLAIM_HEADER_ID | VARCHAR | No |
Holds the claim header ID for the claim received from raw data
7 | ADJ_SEQUENCE | VARCHAR | No |
Holds the adjustment sequence for the claim received from raw data
8 | ADJ_TO_CLAIM_ID | VARCHAR | No |
Holds the adjustment to claim ID for the claim received from raw data
9 | REV_TO_CLAIM_ID | VARCHAR | No |
Holds the reversal to claim ID for the claim received from raw data
10 | IS_CLINICALLY_VALID_YN | VARCHAR | No |
Stores whether a claim is considered valid for the purpose of clinical data derivation
May contain organization-specific values: No
Category Entries:
No
Yes
11 | KLCTCEV_RECORD_ID | NUMERIC | No |
Holds the CEV ID containing the KLCT metadata for a reversal claim.
12 | WORKFLOW_PAYOR_ID_PAYOR_NAME | VARCHAR | No |
The name of the payor.
13 | SOURCE_ORG_ID | NUMERIC | No |
The source organization of the external record.
14 | SOURCE_ORG_ID_EXTERNAL_NAME | VARCHAR | No |
Organization's external name used as the display name on forms and user interfaces.
15 | LOOP_OR_SPLIT_YN | VARCHAR | No |
Indicates whether a claim is part of an adjustment sequence that contains a split claim or an adjustment sequence loop. This CLM does not have to be in the split or loop istelf, just a part of the adjustment sequence.
The category values for this column were already listed for column: IS_CLINICALLY_VALID_YN
16 | EXTERNAL_DEMOG_ID | NUMERIC | No |
Holds a pointer to the REQ record that holds the identifier and demographics that this claim was received with, linking this claim into an ID bundle.
17 | BENEFIT_PLAN_ID_BENEFIT_PLAN_NAME | VARCHAR | No |
The name of the benefit plan record.
18 | CLM_LOB_ID | VARCHAR | No |
Stores the unique identifier of the line of business associated with the claim. This is the LOB determined at adjudication.
19 | CLM_LOB_ID_LOB_NAME | VARCHAR | No |
The name of the line of business record.
20 | IN_OUT_OF_NET_C_NAME | VARCHAR | No |
Contains the network level of a claim.
May contain organization-specific values: Yes
Category Entries:
In Network
Out of Network
N/A
21 | CLAIM_PAID_DATE | DATETIME | No |
The date that the claim was paid, which is determined by the date the claim reaches the AP Status EOB Generated
22 | CLAIM_NAT_KEY_HASH | VARCHAR | No |
The hashed value of the mapped claim natural key.
23 | CLAIM_NAT_KEY_ORDER | VARCHAR | No |
The ordering value for the claim natural key.
24 | CLM_ADJ_TYPE_C_NAME | VARCHAR | No |
The Claim Adjustment Type Code
May contain organization-specific values: No
Category Entries:
Original
Adjustment
Reversal
25 | NAT_KEY_FINAL_YN | VARCHAR | No |
Indicates whether a claim is the final action of an adjustment sequence that is tracking adjustments via natural keys. Natural key adjustments are tracked using superitem CLM 18690. A claim is the final action of its natural key if it has the maximum order value (item 18692) for a given natural key (item 18691). If there is a tie, the claim with the largest claim header id (item 18681) is deemed the final action.
The category values for this column were already listed for column: IS_CLINICALLY_VALID_YN
26 | CLAIM_SVC_CLASS_CTX_C_NAME | VARCHAR | No |
Represents a high-level clinical classification context of the services billed for on this claim.
May contain organization-specific values: No
Category Entries:
Inpatient
Outpatient
Professional Services
Pharmacy
Lab Services
Hospice
Not Classified
27 | CLAIM_SVC_CLASS_C_NAME | VARCHAR | No |
Represents a clinical classification for the services billed on this claim.
May contain organization-specific values: No
Category Entries:
Acute Inpatient
Other Inpatient
Skilled Nursing
Inpatient Psychiatric Care
Inpatient Rehabilitation Care
Hospice
Home Health
Outpatient
Emergency
Specimen Only
Pharmacy
Observation
Urgent Care
Surgery
Nursing Facility
Residential Facility Services
Office Visit
Substance Abuse and Behavioral Health Services
Ambulance
Telemedicine
Home Visit
Outpatient Rehabilitation Services
Independent Laboratory
Inpatient Part B
Inpatient Part B Preventive Services
Skilled Nursing Part B
Skilled Nursing Part B Preventive Services
Not Classified
28 | CLIN_FILTER_UTC_DTTM | DATETIME (UTC) | No |
Last UTC instant clinical data derivation filters (I CLM 18625) were updated or calculated without changes for this claim.
29 | CLIN_FILTER_DTTM | DATETIME (Local) | No |
Last local instant clinical data derivation filters (I CLM 18625) were updated or calculated without changes for this claim. Calculated using EPIC_UTC_TO_LOCAL on I CLM 18626.
30 | REGION_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
31 | MEDICAL_GROUP_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
32 | SERVICE_DATE_FROM_LINE_YN | VARCHAR | No |
Indicates whether the service date was received at the header level, or was determined based on service lines.
The category values for this column were already listed for column: IS_CLINICALLY_VALID_YN
33 | NAT_KEY_ORIG_CLAIM_ID | NUMERIC | No |
Identifies the original claim of an adjustment sequence that is tracking adjustments via natural keys. Natural key adjustments are tracked using superitem CLM 18690. A claim is the original of its natural key if it has the minimum order value (item 18692) for a given natural key (item 18691). If there is a tie, the claim with the smallest claim header ID (item 18681) is deemed the original.