ADJUDICATION_BENEFITS
Description:
This table contains information about the levels of the adjudication formula that were used to price this service, including how the amounts were divided between those services.

Primary Key
Column Name Ordinal Position
TX_ID 1
LINE 2

Column Information
Name Type Discontinued?
1 TX_ID NUMERIC No
The unique identifier for the transaction 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 BENEFIT_LEVEL VARCHAR No
The level used in adjudication benefits calculation.
4 LIMIT_VARIABLE_ID NUMERIC No
The limit variable used by the level in adjudication benefits calculation.
5 LIMIT_VARIABLE_ID_BEN_VAR_NAME VARCHAR No
The name of the benefit variable.
6 BEN_LMT_VAR_SPEC_C_NAME VARCHAR No
The limit type of the limit variable used by the level in adjudication benefits calculation.
May contain organization-specific values: No
Category Entries:
By Procedure Unit
By Dollar Amount
By Co-insurance
By Visit
7 LIMIT_AMOUNT NUMERIC No
The limit amount at the level in adjudication benefits calculation.
8 LIMIT_REMAINING NUMERIC No
The limit amount remaining at the level in adjudication benefits calculation.
9 PAYMENT_VARIABLE_ID NUMERIC No
The payment variable used by the level in adjudication benefits calculation.
10 PAYMENT_VARIABLE_ID_BEN_VAR_NAME VARCHAR No
The name of the benefit variable.
11 PAY_METHOD_EPP_C_NAME VARCHAR No
The payment type for the payment variable used by the level in adjudication benefits calculation.
May contain organization-specific values: No
Category Entries:
Percent of Price
Amount per Unit
Fixed Amount
Custom Calculation
No Patient Payment
Not Covered
Percent of Fee Schedule
Percent of Price with Exceptions Based on Fee Schedule
12 PAYMENT_AMOUNT NUMERIC No
The payment amount for the payment variable used by the level in adjudication benefits calculation.
13 COVERED_AMOUNT NUMERIC No
The covered amount used by the level in adjudication benefits calculation.
14 COVERED_QUANTITY NUMERIC No
The covered quantity used by the level in adjudication benefits calculation.