AP_CLAIM_REVIEW

Description: |
The AP_CLAIM_REVIEW table contains a row for each review on a claim.

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 | AP_CLAIM_REVIEW_TYPE_C_NAME | VARCHAR | No |
The review type category ID for the review on the claim.
May contain organization-specific values: Yes
Category Entries:
High Dollar
Medical Necessity
Random Audit
Recovery Action
Potential Bundle
Appealed
Unpaid Capitation
Pre-Pay Audit (External)
Pre-Pay Audit Update (External)
4 | ATTACH_COMMENT | VARCHAR | No |
The comment associated with a review when it is attached to a claim.
5 | AP_CLAIM_REVIEW_STATUS_C_NAME | VARCHAR | No |
The review status category ID for the review on the claim.
May contain organization-specific values: No
Category Entries:
Under Review
Rejected
Not Applicable
Approved
6 | ATTACH_DTTM | DATETIME (Local) | No |
The date and time the associated review was attached to the claim.
7 | COMPLETION_COMMENT | VARCHAR | No |
The comment entered by the user who completed the associated review.
8 | COMPLETION_DTTM | DATETIME (Local) | No |
The completion date and time for the associated review.
9 | REJECTION_EOB_CODE_ID_EOB_CODE_NAME | VARCHAR | No |
The name of the processing code.
10 | ADDED_MANUALLY_YN | VARCHAR | No |
Indicates whether this review was added manually by an end user. 'Y' indicates that the review was added manually. 'N' or NULL indicate that the review was added by the system.
May contain organization-specific values: No
Category Entries:
No
Yes
11 | REVIEW_STATUS_REASON_C_NAME | VARCHAR | No |
The review status reason category ID for the review on the claim.
May contain organization-specific values: No
Category Entries:
Claim Pending
Rules No Longer Match
Non-Recovery Review Added
Auto-Approve Rule Met
External Action Taken