AP_CLAIM_PROC_5

Description: |
This table summarizes data for AP Claims service lines, with each service line given one row.
To link this table’s service line information back to a claim header, join this table to AP_CLAIM_PROC_IDS on the TX_ID column. If you need to report on claim service lines specific to Cost Sharing Reduction (CSR), join this table instead to AP_CLAIM_PROC_IDS_CSR on the TX_ID column.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
TX_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | TX_ID | NUMERIC | No |
The unique identifier (.1 item) for the transaction record.
2 | ASSISTANT_DENTAL_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.
3 | ASSISTANT_DENTAL_PROV_TAXONOMY | VARCHAR | No |
The taxonomy code for the assistant dental physician associated with the service.
4 | RENDERING_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.
5 | RENDERING_PROV_TAXONOMY | VARCHAR | No |
The taxonomy code for the rendering provider associated with the service.
6 | PURCHASED_SERVICE_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.
7 | SUPERVISING_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.
8 | ORDERING_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.
9 | REFERRING_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.
10 | OPERATING_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.
11 | OTHER_OPERATING_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 | AUTH_DENIED_YN | VARCHAR | No |
Set if the service line was denied during adjudication because the counting requirements for the line could not be fulfilled and there is an attached service authorization with a status of denied.
May contain organization-specific values: No
Category Entries:
No
Yes
13 | FEDERAL_SERVICE_CODE | VARCHAR | No |
Code indicating the type of service, as defined in the CMS Medicare Carrier Manual, for this service line on the claim.
14 | PRIMARY_PAYER_CODE | VARCHAR | No |
The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the service line on the claim. The presence of this code indicates that some other payer besides Medicare covered at least some portion of the charges.
15 | HCPCS_BETOS_CODE | VARCHAR | No |
The Berenson-Eggers Type of Service (BETOS) classification assigned to the Healthcare Common Procedure Coding System (HCPCS) code for the service line.
16 | SVC_AUTH_REQ_COMPONENT_ID | VARCHAR | No |
The UAR service authorization matched component. This is populated from the matched component in I NEC 84010 during adjudication.
17 | SVC_AUTH_REQ_COMPONENT_ID_COMPONENT_NAME | VARCHAR | No |
The name of the component
18 | PROV_AUTH_REQ_COMPONENT_ID | VARCHAR | No |
The UAR provider authorization matched component. This is populated from the matched component in I NEC 84040 during adjudication.
19 | PROV_AUTH_REQ_COMPONENT_ID_COMPONENT_NAME | VARCHAR | No |
The name of the component
20 | SAR_CONS_CLASSIFIER_ID | VARCHAR | No |
The Service Constraints Classifier from the matched NEC line describing constraints on the service.
21 | SAR_CONS_CLASSIFIER_ID_CLASSIFIER_NAME | VARCHAR | No |
The title of the classifier record.
22 | SAR_REQUIREMENTS_NETWORK_C_NAME | NUMERIC | No |
The Network Requirements on the servicing / performing provider for authorization from the matched NEC line.
May contain organization-specific values: No
Category Entries:
No Network Requirements
Out of Network OR Network Status Unknown
In Network
23 | SAR_AUTH_REQ_YN | VARCHAR | No |
This item stores whether authorization is required for this service line, taken from the matched NEC line.
The category values for this column were already listed for column: AUTH_DENIED_YN
24 | SAR_BEN_CLASSIFIER_ID | VARCHAR | No |
This item stores a Benefit Referral Classifier which a referral must satisfy to match against a claim in claim adjudication. This value is taken from the matched NEC line.
25 | SAR_BEN_CLASSIFIER_ID_CLASSIFIER_NAME | VARCHAR | No |
The title of the classifier record.
26 | SAR_EOB_CODE_ID_EOB_CODE_NAME | VARCHAR | No |
The name of the processing code.
27 | SAR_CVG_REQ_C_NAME | NUMERIC | No |
Primary/non-primary coverage requirement category from the matched Service Authorization Requirement NEC line.
May contain organization-specific values: No
Category Entries:
All
Primary
Not Primary
28 | PAR_CONS_CLASSIFIER_ID | VARCHAR | No |
The Service Constraints Classifier describing constraints on the service, taken from the matched NEC line.
29 | PAR_CONS_CLASSIFIER_ID_CLASSIFIER_NAME | VARCHAR | No |
The title of the classifier record.
30 | PAR_REQUIREMENTS_NETWORK_C_NAME | NUMERIC | No |
The network requirements for provider authorization requirements.
The category values for this column were already listed for column: SAR_REQUIREMENTS_NETWORK_C_NAME
31 | PAR_AUTHORIZATION_REQT_C_NAME | NUMERIC | No |
Whether authorization is required for this service when performed by this provider, taken from the matched NEC line.
May contain organization-specific values: No
Category Entries:
Default Authorization Requirement
No Authorization Required
Auto-Authorized
32 | PAR_SVC_PROV_COMPONENT_ID | VARCHAR | No |
Stores the servicing provider component from the matched NEC line. This component identifies the servicing provider records or identifiers that the authorization requirement applies to.
33 | PAR_SVC_PROV_COMPONENT_ID_COMPONENT_NAME | VARCHAR | No |
The name of the component
34 | PAR_REF_PROV_COMPONENT_ID | VARCHAR | No |
Stores the referring provider component from the matched NEC line. This component identifies the referring provider records or identifiers that the authorization requirement applies to.
35 | PAR_REF_PROV_COMPONENT_ID_COMPONENT_NAME | VARCHAR | No |
The name of the component