AP_CLAIM_4

Description: |
The AP_CLAIM_4 table contains one record for each claim in the managed care system's AP Claims module.

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 record.
2 | TOT_ADDL_ADJ | NUMERIC | No |
Stores the total additional adjustments for the claim.
3 | AP_CLAIM_IMPORT_SOURCE_C_NAME | VARCHAR | No |
Used to define the type of source a claim is imported from to drive reporting on the different use cases a single workflow type may have.
May contain organization-specific values: No
Category Entries:
Historical System
Repricing Source
Delegated Payer
Clearinghouse
Other Internal Source
Other External Source
4 | SOURCE_GROUP_ID_LOC_NAME | VARCHAR | No |
The name of the revenue location.
5 | 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.
May contain organization-specific values: No
Category Entries:
No
Yes
6 | NCH_CLAIM_TYPE_C_NAME | VARCHAR | No |
The National Claims History (NCH) code indicating the type of claim submitted.
May contain organization-specific values: No
Category Entries:
Home Health Agency (HHA) claim
Non swing bed Skilled Nursing Facility (SNF) claim
Swing bed Skilled Nursing Facility (SNF) claim
Hospital Outpatient claim
Hospice claim
Inpatient claim
Inpatient Full Encounter claim
Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim
Local carrier durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim
Durable medical equipment regional carrier (DMERC); non-DMEPOS claim
Durable medical equipment regional carrier (DMERC); DMEPOS claim
7 | PAID_CLM_FILE_INTEREST_AMT | NUMERIC | No |
The total interest amount from the file for an externally paid claim.
8 | PAID_CLM_FILE_PENALTY_AMT | NUMERIC | No |
The total penalty amount from the file for an externally paid claim.
9 | BLK_DTA_MESSAGE_ID | NUMERIC | No |
Contains the indexed AMS pointer to the last bulk data message record to impact this CLM.
10 | REFUND_REASON | VARCHAR | No |
The refund reason for the claim. Will be used on any refund letters generated for the claim.
11 | PAYER_CLM_IDENT | VARCHAR | No |
Stores the ID assigned to the claim from the payer. Currently in use for claims loaded through DINE.
12 | AP_CLM_AR_STATUS_C_NAME | VARCHAR | No |
The accounts receivable status of the AP claim.
May contain organization-specific values: No
Category Entries:
Not Ready for AR
Ready for AR
Released to AR
AR in Progress
AR Completed
Returning Funds
13 | CLAIM_CHECK_MAIL_SENT_DATE | DATETIME | No |
The date that the last check was mailed/sent or disbursed.
14 | CAPITAL_IME_AMOUNT | NUMERIC | No |
The portion of a hospital's Medicare capital payment that is increased to account for indirect medical education costs associated with teaching hospitals.
15 | OPERATING_IME_AMOUNT | NUMERIC | No |
The portion of a hospital's Medicare operating payment that is increased to account for higher indirect medical education costs associated with teaching hospitals.
16 | CAPITAL_DSH_AMOUNT | NUMERIC | No |
The portion of a hospital's Medicare capital payment that is increased to compensate teaching hospitals for higher capital costs associated with serving a disproportionate share of low-income patients.
17 | UNCOMPENSATED_CARE_AMOUNT | NUMERIC | No |
The portion that reimburses a hospital for care provided to uninsured or underinsured patients for which no payment was received.
18 | OPERATING_DSH_AMOUNT | NUMERIC | No |
The portion of a hospital's Medicare operating payment that is increased to compensate teaching hospitals for higher capital costs associated with serving a disproportionate share of low-income patients.
19 | 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.