APPEAL_GRV

Description:

This table contains information about an individual appeal or grievance.

Primary Key

Column Name	Ordinal Position
APPEAL_GRV_ID	1

Column Information

	Name	Type	Discontinued?
1	APPEAL_GRV_ID	NUMERIC	No
	The unique identifier (.1 item) for the appeal/grievance record.
2	CM_PHY_OWNER_ID	VARCHAR	No
	The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect.
3	CM_LOG_OWNER_ID	VARCHAR	No
	The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect.
4	RECORD_STATUS_C_NAME	VARCHAR	No
	Stores the record status (hidden, soft-deleted, etc.). May contain organization-specific values: No Category Entries: Soft Deleted Hidden Hidden and Soft Deleted
5	APPEAL_GRV_TYPE_C_NAME	VARCHAR	No
	The type of request this record represents. This is either an appeal or grievance. May contain organization-specific values: No Category Entries: Appeal Grievance
6	SERIES_IDENTIFIER	VARCHAR	No
	The series ID for the appeal/grievance. This value is shared across levels of appeal/grievance.
7	EXTERNAL_IDENTIFIER	VARCHAR	No
	The identifier assigned to an appeal/grievance by an external entity.
8	INITIATED_BY_TYPE_C_NAME	VARCHAR	No
	The type of person which initiated the appeal or grievance. May contain organization-specific values: No Category Entries: Provider Member Representative Health Plan
9	INITIATING_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	INITIATING_REP_MEM_RESP_GUID	VARCHAR	No
	If this record was initiated by an authorized representative this stores their Member Responsible GUID from the member's coverage.
11	SUBMISSION_METHOD_C_NAME	VARCHAR	No
	How this appeal or grievance was submitted. May contain organization-specific values: No Category Entries: CRM Manually Created Tapestry Link MyChart
12	REVIEW_LEVEL_C_NAME	VARCHAR	No
	The level of review within the appeals process. May contain organization-specific values: Yes Category Entries: Level 1 Level 2 Level 3 Level 4 Level 5
13	PAT_ID	VARCHAR	No
	The member associated with the appeal or grievance.
14	APPEAL_SUBJECT_TYPE_C_NAME	VARCHAR	No
	What the appeal was filed about. This is either an authorization or a claim. May contain organization-specific values: No Category Entries: Authorization Claim
15	SUBJECT_AUTH_REQUEST_ID	NUMERIC	No
	Authorization that is being appealed or grieved about.
16	SUBJECT_CLAIM_ID	NUMERIC	No
	The claim being appealed or grieved about.
17	RESULT_AUTH_REQUEST_ID	NUMERIC	No
	The authorization created to effectuate the appeal decision in Epic.
18	RESULT_CLAIM_ID	NUMERIC	No
	The resulting claim for the appeal.
19	RECORD_CREATE_UTC_DTTM	DATETIME (UTC)	No
	The instant that this record was created.
20	RECORD_CREATE_USER_ID	VARCHAR	No
	The unique ID of the user who created this record.
21	RECORD_CREATE_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
22	URGENCY_C_NAME	VARCHAR	No
	The urgency of the appeal or grievance. May contain organization-specific values: No Category Entries: Standard Expedited
23	SUBMISSION_OVRIDE_UTC_DTTM	DATETIME (UTC)	No
	If Submission System Instant (UTC) (I TAG 10010) is incorrect, this stores the override. Stored in UTC.
24	DECISION_SYS_UTC_DTTM	DATETIME (UTC)	No
	The system calculated date and time that a decision was made for the appeal or grievance. Stored in UTC.
25	DECISION_USER_ID	VARCHAR	No
	The unique ID of the user that finalized the appeal decision.
26	DECISION_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
27	DECISION_OVRIDE_UTC_DTTM	DATETIME (UTC)	No
	If the System Calculated Decision Instant (UTC) (I TAG 10100) is incorrect, this will store the override. Stored in UTC.
28	APPEAL_DECISION_C_NAME	VARCHAR	No
	The decision for the appeal. May contain organization-specific values: No Category Entries: Upheld Overturned Partially Overturned Dismissed Closed
29	TIMEFRAME_START_UTC_DTTM	DATETIME (UTC)	No
	The earliest date and time across all relevant timeliness standards that the clock for processing the appeal ot grievance begins based on the table APPEAL_GRV_TAT_MILESTONES. Stored in UTC.
30	SUBMISSION_RPT_UTC_DTTM	DATETIME (UTC)	No
	The compiled date and time an appeal or grievance was submitted to the organization. Equal to the Organization Submission instant (UTC) - Override (I TAG 10011) if it is set, otherwise Organization Submission instant (UTC) (I TAG 10010). Stored in UTC.
31	SUBMISSION_SYS_UTC_DTTM	DATETIME (UTC)	No
	The system calculated date and time that the appeal or grievance was submitted to the organization. Stored in UTC.
32	EXP_REQ_REC_UTC_DTTM	DATETIME (UTC)	No
	The date and time the request to expedite was received. Stored in UTC.
33	WAS_UPGRADED_TO_EXP_YN	VARCHAR	No
	Indicates whether the urgency was changed from standard to expedited for this appeal or grievance. 'Y' indicates that the appeal or grievance was initially submitted with a standard urgency and then later upgraded to an expedited urgency. 'N' or NULL indicates that either the appeal or grievance was initially submitted with an expedited urgency, or the appeal or grievance was initially submitted with a standard priority, and the priority is still standard. May contain organization-specific values: No Category Entries: No Yes
34	EXP_REQ_DEC_UTC_DTTM	DATETIME (UTC)	No
	The date and time that a decision was made on whether to upgrade the appeal or grievance to an expedited priority. Stored in UTC.
35	EXT_REQ_REC_UTC_DTTM	DATETIME (UTC)	No
	The date and time the request to extend the timeframe was received. Stored in UTC.
36	EXT_DAYS	NUMERIC	No
	The number of days the deadline for the appeal or grievance was extended.
37	EXT_REQ_DEC_UTC_DTTM	DATETIME (UTC)	No
	The date and time the decision was made on whether to extend the timeframe. Stored in UTC.
38	EXT_MAX_DAYS	NUMERIC	No
	The maximum number of days the deadline can be extended.
39	EFFECT_SYS_UTC_DTTM	DATETIME (UTC)	No
	The system calculated date and time for when the appeal was effectuated. Stored in UTC.
40	EFFECT_OVR_UTC_DTTM	DATETIME (UTC)	No
	If Effectuation System Instant (UTC) (I TAG 10050) is incorrect, this will store the override. Stored in UTC.
41	EFFECT_RPT_UTC_DTTM	DATETIME (UTC)	No
	The compiled date and time an was effectuated. Equal to the Effectuation override instant (UTC) (I TAG 10051) if it is set, otherwise Effectuation system instant (UTC) (I TAG 10050). Stored in UTC.
42	EFFECT_DUE_UTC_DTTM	DATETIME (UTC)	No
	The date and time an appeal must be effectuated in order to stay compliant with all timeliness standards. Stored in UTC.
43	OVERALL_DUE_UTC_DTTM	DATETIME (UTC)	No
	The date and time that the appeal or grievance must be fully completed in order to stay compliant with all timeliness standards. Stored in UTC.
44	DECISION_RPT_UTC_DTTM	DATETIME (UTC)	No
	The date and time that a decision was made for an appeal or grievance. Equal to Decision Instant (UTC) - Override (I TAG 10101) if it is set, otherwise Decision Instant (UTC) (I TAG 10100). Stored in UTC.
45	DECISION_DUE_UTC_DTTM	DATETIME (UTC)	No
	The date and time a decision must be made on an appeal or grievance in order to stay compliant with all timeliness standards. Stored in UTC.
46	TAT_SYS_TIME_ZONE_C_NAME	VARCHAR	No
	The system calculated time zone category ID to use for TAT calculations based on the time zone of where the appeal/grievance record was created. May contain organization-specific values: No Category Entries: Africa/Johannesburg America/Anchorage America/Halifax America/Puerto_Rico America/Chicago America/Regina America/New_York AMERICA/EASTERN_NO_DST Pacific/Honolulu America/Denver America/Phoenix America/Los_Angeles ETC/UNIVERSAL Europe/Amsterdam AMERICA/PACIFIC_NO_DST America/St_Johns Europe/London Europe/Lisbon Europe/Athens Europe/Kaliningrad Australia/Sydney Australia/Brisbane Australia/Lord_Howe America/Sao_Paulo America/Fortaleza Africa/Cairo Asia/Dubai Africa/Abidjan Africa/Accra Africa/Addis_Ababa Africa/Algiers Africa/Asmara Africa/Bamako Africa/Bangui Africa/Banjul Africa/Blantyre Africa/Brazzaville Africa/Bujumbura Africa/Casablanca Africa/Conakry Africa/Dakar Africa/Dar_es_Salaam Africa/Djibouti Africa/Douala Africa/Freetown Africa/Gaborone Africa/Harare Africa/Juba Africa/Kampala Africa/Khartoum Africa/Kigali Africa/Kinshasa Africa/Lagos Africa/Libreville Africa/Lome Africa/Luanda Africa/Lusaka Africa/Maputo Africa/Maseru Africa/Mbabane Africa/Nairobi Africa/Ndjamena Africa/Niamey Africa/Nouakchott Africa/Ouagadougou Africa/Porto-Novo Africa/Tripoli Africa/Tunis Africa/Windhoek America/Argentina/Buenos_Aires America/Asuncion America/Barbados America/Belize America/Bogota America/Caracas America/Chihuahua America/Costa_Rica America/El_Salvador America/Guatemala America/Guayaquil America/Guyana America/Havana America/Hermosillo America/Jamaica America/La_Paz America/Lima America/Managua America/Mexico_City America/Montevideo America/Montreal America/Nassau America/Panama America/Paramaribo America/Port_of_Spain America/Port-au-Prince America/Recife America/Santiago America/Santo_Domingo America/Tegucigalpa America/Tijuana Asia/Aden Asia/Almaty Asia/Amman Asia/Ashgabat Asia/Baghdad Asia/Bahrain Asia/Baku Asia/Bangkok Asia/Beirut Asia/Bishkek Asia/Chongqing Asia/Colombo Asia/Damascus Asia/Dhaka Asia/Dili Asia/Dushanbe Asia/Ho_Chi_Minh Asia/Hong_Kong Asia/Jakarta Asia/Jerusalem Asia/Kabul Asia/Karachi Asia/Kathmandu Asia/Kolkata Asia/Kuala_Lumpur Asia/Kuwait Asia/Manila Asia/Muscat Asia/Nicosia Asia/Phnom_Penh Asia/Qatar Asia/Rangoon Asia/Riyadh Asia/Seoul Asia/Shanghai Asia/Singapore Asia/Taipei Asia/Tashkent Asia/Tbilisi Asia/Tokyo Asia/Ulaanbaatar Asia/Vientiane Asia/Vladivostok Asia/Yekaterinburg Asia/Yerevan Atlantic/Cape_Verde Europe/Belgrade Europe/Berlin Europe/Brussels Europe/Bucharest Europe/Budapest Europe/Chisinau Europe/Copenhagen Europe/Dublin Europe/Helsinki Europe/Istanbul Europe/Kiev Europe/Madrid Europe/Malta Europe/Minsk Europe/Moscow Europe/Oslo Europe/Paris Europe/Prague Europe/Riga Europe/Rome Europe/Sofia Europe/Stockholm Europe/Tallinn Europe/Tirane Europe/Vienna Europe/Vilnius Europe/Warsaw Europe/Zurich Indian/Antananarivo Indian/Mauritius Pacific/Fiji Pacific/Pohnpei Africa/Monrovia America/North_Dakota/Beulah America/Bahia_Banderas America/Goose_Bay America/Araguaina Atlantic/Reykjavik Africa/Malabo Europe/Sarajevo Europe/Zagreb Europe/Skopje Europe/Podgorica Europe/Bratislava Europe/Ljubljana Pacific/Auckland America/Belem Australia/Adelaide Australia/Broken_Hill Australia/Currie Australia/Darwin Australia/Eucla Australia/Hobart Australia/Lindeman Australia/Melbourne Australia/Perth Pacific/Guam (DEMO USE ONLY TIME ZONE)
47	TAT_OVR_TIME_ZONE_C_NAME	VARCHAR	No
	If TAT system time zone (I TAG 10500) is incorrect, this will store the category ID of the override. The category values for this column were already listed for column: TAT_SYS_TIME_ZONE_C_NAME
48	TAT_RPT_TIME_ZONE_C_NAME	VARCHAR	No
	The compiled time zone category ID to use for TAT calculations. Equal to TAT Override Time Zone (I TAG 10501) if it is set, otherwise TAT System Time Zone (I TAG 10500). The category values for this column were already listed for column: TAT_SYS_TIME_ZONE_C_NAME
49	TIMEFRAME_START_LOCAL_DTTM	DATETIME (Local)	No
	The earliest date and time across all relevant timeliness standards that the clock for processing the appeal or grievance begins based on the table APPEAL_GRV_TAT_MILESTONES. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
50	SUBMISSION_SYS_LOCAL_DTTM	DATETIME (Local)	No
	The system calculated date and time that the appeal or grievance was submitted to the organization. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
51	SUBMISSION_OVR_LOCAL_DTTM	DATETIME (Local)	No
	If Submission System Instant (I TAG 10910) is incorrect, this stores the override. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
52	SUBMISSION_RPT_LOCAL_DTTM	DATETIME (Local)	No
	The compiled date and time an appeal or grievance was submitted to the organization. Equal to the Organization Submission instant - Override (I TAG 10911) if it is set, otherwise Organization Submission instant (I TAG 10910). Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
53	EXP_REQ_REC_LOCAL_DTTM	DATETIME (Local)	No
	The date and time the request to expedite was received. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
54	EXP_DEC_LOCAL_DTTM	DATETIME (Local)	No
	The date and time that a decision was made on whether to upgrade the appeal or grievance to an expedited priority. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
55	EXT_REQ_LOCAL_DTTM	DATETIME (Local)	No
	The date and time the request to extend the timeframe was received. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
56	EXT_DEC_LOCAL_DTTM	DATETIME (Local)	No
	The date and time the decision was made on whether to extend the timeframe. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
57	EFFECT_SYS_LOCAL_DTTM	DATETIME (Local)	No
	The system calculated date and time for when the appeal was effectuated. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
58	EFFECT_OVR_LOCAL_DTTM	DATETIME (Local)	No
	If Effectuation System Instant (I TAG 10950) is incorrect, this will store the override. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
59	EFFECT_RPT_LOCAL_DTTM	DATETIME (Local)	No
	The compiled date and time an appeal was effectuated. Equal to the Effectuation override instant (I TAG 10951) if it is set, otherwise Effectuation system instant (I TAG 10950). Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
60	EFFECT_DUE_LOCAL_DTTM	DATETIME (Local)	No
	The date and time an appeal must be effectuated in order to stay compliant with all timeliness standards. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
61	OVERALL_DUE_LOCAL_DTTM	DATETIME (Local)	No
	The date and time that the appeal or grievance must be fully completed in order to stay compliant with all timeliness standards. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
62	DECISION_LOCAL_DTTM	DATETIME (Local)	No
	The system calculated date and time that a decision was made for the appeal or grievance. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
63	DECISION_OVR_LOCAL_DTTM	DATETIME (Local)	No
	If the System Calculated Decision Instant (I TAG 10990) is incorrect, this will store the override. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
64	DECISION_RPT_LOCAL_DTTM	DATETIME (Local)	No
	The date and time that a decision was made for an appeal or grievance. Equal to Decision Instant - Override (I TAG 10991) if it is set, otherwise Decision Instant (I TAG 10990). Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
65	DECISION_DUE_LOCAL_DTTM	DATETIME (Local)	No
	The date and time a decision must be made on an appeal or grievance in order to stay compliant with all timeliness standards. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
66	GRIEVANCE_SUBJECT_TYPE_C_NAME	VARCHAR	No
	The subject type category ID for the grievance. This specifies what the grievance is about. May contain organization-specific values: Yes Category Entries: Authorization Claim Appeal Grievance Provider Facility Employee Coverage Resource Location Place of Service Business Segment Region Group
67	REASON_FOR_GRIEVANCE_C_NAME	VARCHAR	No
	The reason category ID for the grievance. May contain organization-specific values: Yes Category Entries: Quality of Care Appeals Process Authorization Request Process Claims Process Cost Change Copayment Amount TrOOP (True Out-of-Pocket) Costs Pharmacy Benefits Difficulty Contacting Plan Involuntary Disenrollment Plan Benefit Design Decision to Not Expedite Interpersonal Aspects of Care Customer Service Access to Care
68	SUBJECT_APPEAL_APPEAL_GRV_ID	NUMERIC	No
	The unique ID of the appeal that is the subject of this grievance.
69	SUBJECT_GRIEVANC_APPEAL_GRV_ID	NUMERIC	No
	The unique ID of the grievance that is the subject of this grievance.
70	SUBJECT_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.
71	SUBJECT_FACILITY_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
72	SUBJECT_EMPLOYEE_USER_ID	VARCHAR	No
	The unique ID of the employee that is the subject of this grievance.
73	SUBJECT_EMPLOYEE_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
74	SUBJECT_RESOURCE_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.
75	SUBJECT_LOC_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
76	SUBJECT_POS_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
77	SUBJECT_BUS_SEG_POS_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
78	SUBJECT_REGION_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
79	SUBJECT_GROUP_ID_LOC_NAME	VARCHAR	No
	The name of the revenue location.
80	SUBJECT_COVERAGE_ID	NUMERIC	No
	The unique ID of the coverage related to this grievance.
81	GRIEVANCE_INCIDENT_UTC_DTTM	DATETIME (UTC)	No
	The UTC date and time that the incident occurred for this grievance.
82	GRIEVANCE_INCIDENT_LOCAL_DTTM	DATETIME (Local)	No
	The local date and time that the incident occurred for this grievance. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.
83	EXTENSION_INITIATED_BY_TYPE_C_NAME	VARCHAR	No
	Whether the extension was initiated by the health plan, or the appeal or grievance submitter. The category values for this column were already listed for column: INITIATED_BY_TYPE_C_NAME
84	DECISION_OVR_USER_ID	VARCHAR	No
	If the Decision User ID System (I TAG 10103) is incorrect, this will store the override value.
85	DECISION_OVR_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
86	DECISION_RPT_USER_ID	VARCHAR	No
	Stores the Decision User ID Override (I TAG 10104) if it is set. Otherwise stores the Decision User ID System (I TAG 10103).
87	DECISION_RPT_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
88	AG_REVIEW_TYPE_C_NAME	VARCHAR	No
	If the appeal/grievance is being reviewed internally or externally. May contain organization-specific values: No Category Entries: Internal External
89	REVIEW_AGENCY_ID	VARCHAR	No
	The unique ID of the agency responsible for processing the appeal/grievance.
90	REVIEW_AGENCY_ID_AGENCY_NAME	VARCHAR	No
	The name of the agency.
91	CASE_SENT_REVW_ENTITY_UTC_DTTM	DATETIME (UTC)	No
	The UTC date and time that the appeal/grievance case file information was sent to the review entity.
92	CASE_SENT_REVW_ENTY_LOCAL_DTTM	DATETIME (Local)	No
	The local date and time that the appeal/grievance case file information was sent to the review entity. Stored in the time zone determined by column TAT_RPT_TIME_ZONE_C.