|
Name |
Type |
Discontinued? |
|
1 |
APPEAL_GRV_ID |
NUMERIC |
No |
|
|
|
The unique identifier (.1 item) for the appeal/grievance record. |
|
|
2 |
NEXT_OUTST_DECISION_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The date and time of the earliest outstanding decision due requirement, in UTC. If there are no outstanding decision due requirements, this item will be null. |
|
|
3 |
NEXT_OUTST_DECISION_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The date and time of the earliest outstanding decision due requirement. If there are no outstanding decision due requirements, this item will be null. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
4 |
NEXT_OUTST_EFFECT_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The date and time of the earliest outstanding effectuation due requirement, in UTC. If there are no outstanding effectuation due requirements, this item will be null. |
|
|
5 |
NEXT_OUTST_EFFECT_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The date and time of the earliest outstanding effectuation due requirement. If there are no outstanding effectuation due requirements, this item will be null. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
6 |
NEXT_OUTST_NOTIF_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The date and time of the earliest outstanding notification due requirement, in UTC. If there are no outstanding notification due requirements, this item will be null. |
|
|
7 |
NEXT_OUTST_NOTIF_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The date and time of the earliest outstanding notification due requirement. If there are no outstanding notification due requirements, this item will be null. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
8 |
REQUIREMENTS_COMP_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The instant when all required decision, effectuation, and notification requirements were met, in UTC. |
|
|
9 |
REQUIREMENTS_COMP_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The instant when all required decision, effectuation, and notification requirements were met. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
10 |
DECISION_ON_TIME_C_NAME |
VARCHAR |
No |
|
|
|
The on time status category ID of decision timeliness requirements. |
May contain organization-specific values: No |
Category Entries: |
Incomplete |
Completed Late |
Completed On Time |
|
|
11 |
EFFECTUATION_ON_TIME_C_NAME |
VARCHAR |
No |
|
|
|
The on time status category ID of effectuation timeliness requirements. |
The category values for this column were already listed for column: DECISION_ON_TIME_C_NAME |
|
|
12 |
NOTIFICATIONS_ON_TIME_C_NAME |
VARCHAR |
No |
|
|
|
The on time status category ID of notification timeliness requirements. |
The category values for this column were already listed for column: DECISION_ON_TIME_C_NAME |
|
|
13 |
OVERALL_ON_TIME_C_NAME |
VARCHAR |
No |
|
|
|
The overall on time status category ID of the appeal or grievance, including decision, effectuation, and notification requirements. |
The category values for this column were already listed for column: DECISION_ON_TIME_C_NAME |
|
|
14 |
APPEAL_GRV_WKFL_STEP_C_NAME |
VARCHAR |
No |
|
|
|
The current workflow step category ID for the Appeal or Grievance |
May contain organization-specific values: No |
Category Entries: |
Intake (Tapestry Link) |
Intake |
Submission |
Initial Review |
MD Review |
External Decision |
Finalize |
Completed |
|
|
15 |
PAT_ENC_CSN_ID |
NUMERIC |
No |
|
|
|
The unique contact serial number for the patient contact associated with this appeal or grievance used to associate notes. This number is unique across all patient encounters in your system. If you use IntraConnect, this is the Unique Contact Identifier (UCI). |
|
|
16 |
FILED_LATE_EXCPTNS_ALLOWED_YN |
VARCHAR |
No |
|
|
|
Whether exceptions to the timely filing timeframe can be made for any applicable timeliness standard. |
May contain organization-specific values: No |
Category Entries: |
No |
Yes |
|
|
17 |
FILED_LATE_OVERRIDE_YN |
VARCHAR |
No |
|
|
|
Used if the appeal/grievance was filed late, but the system is not automatically marking it as late. Yes means the appeal/grievance was filed outside of the filing timeframe, no or blank means it was not, or the system was able to automatically determine the status in FILED_ON_TIME_C. |
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN |
|
|
18 |
DISMISSED_YN |
VARCHAR |
No |
|
|
|
Stores whether the appeal/grievance was dismissed. |
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN |
|
|
19 |
NEXT_OUTST_ACTION_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The date and time of the earliest outstanding required action, in UTC. If there are no outstanding required actions, this item will be null. |
|
|
20 |
NEXT_OUTST_ACTION_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The date and time of the earliest outstanding required action. If there are no outstanding required actions, this item will be null. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
21 |
CURRENT_REQUESTED_URGENCY_C_NAME |
VARCHAR |
No |
|
|
|
The current requested urgency category ID for the appeal or grievance. |
May contain organization-specific values: No |
Category Entries: |
Standard |
Expedited |
|
|
22 |
REQUESTED_EXP_PROCESSED_STD_YN |
VARCHAR |
No |
|
|
|
Indicates whether an expedited urgency was requested, but not granted. 'Y' indicates that there was an expedite request, but the appeal or grievance was still processed on standard timelines. 'N' or NULL indicates that the appeal or grievance was processed as expedited, or there were no requests to expedite. |
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN |
|
|
23 |
MEM_OUT_ORAL_NOTIF_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The UTC date/time that the member was verbally notified of the outcome of the appeal/grievance. |
|
|
24 |
MEM_OUT_ORAL_NOTIF_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The local date/time that the member was verbally notified of the outcome of the appeal/grievance. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
25 |
MEM_OUT_WRIT_NOTIF_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The UTC date/time that the member was notified of the outcome of the appeal/grievance in writing. This includes mail lag if it is configured in the Mail Department activity. |
|
|
26 |
MEM_OUT_WRIT_NOTIF_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The local date/time that the member was notified of the outcome of the appeal/grievance in writing. This includes mail lag if it is configured in the Mail Department activity. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
27 |
QUEUED_COMPLETE_USER_ID |
VARCHAR |
No |
|
|
|
The unique ID of the user that attempted to advance from the Finalize workflow step to the Completed workflow step and queued this appeal/grievance for auto-completion. |
|
|
28 |
QUEUED_COMPLETE_USER_ID_NAME |
VARCHAR |
No |
|
|
|
The name of the user record. This name may be hidden. |
|
|
29 |
COMPLETED_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The UTC datetime that the workflow step (APPEAL_GRV_2.APPEAL_GRV_WKFL_STEP_C) of this appeal or grievance was advanced from the Finalize workflow step to the Completed workflow step (in UTC). Even if this appeal or grievance was previously queued for auto-completion, this is when the workflow step was actually changed. |
|
|
30 |
COMPLETED_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The local datetime that the workflow step (APPEAL_GRV_2.APPEAL_GRV_WKFL_STEP_C) of this appeal or grievance was advanced from the Finalize workflow step to the Completed workflow step. Even if this appeal or grievance was previously queued for auto-completion, this is when the workflow step was actually changed. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
31 |
PROCESSING_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
The processing type category ID for the appeal or grievance |
May contain organization-specific values: No |
Category Entries: |
Standard Review |
Reopening |
Vacated Dismissal |
|
|
32 |
AG_CREATION_METHOD_C_NAME |
VARCHAR |
No |
|
|
|
The creation method category ID for the appeal/grievance. |
May contain organization-specific values: No |
Category Entries: |
Manual |
Tapestry Link |
CRM |
|
|
33 |
REQ_ADDL_REVIEW_C_NAME |
VARCHAR |
No |
|
|
|
Enter the type of additional review required for the appeal. |
May contain organization-specific values: No |
Category Entries: |
No Additional Review |
Internal Medical Director |
External Entity |
|
|
34 |
SUGGESTED_APPEAL_DECISION_C_NAME |
VARCHAR |
No |
|
|
|
The suggested decision category ID for the appeal. |
May contain organization-specific values: No |
Category Entries: |
Upheld |
Overturned |
Partially Overturned |
Dismissed |
Closed |
Upheld Dismissal |
Vacated Dismissal |
|
|
35 |
SUGGESTED_DECISION_USER_ID |
VARCHAR |
No |
|
|
|
The unique ID associated with the user record that made the suggested decision for the appeal. This column is frequently used to link to the CLARITY_EMP table. |
|
|
36 |
SUGGESTED_DECISION_USER_ID_NAME |
VARCHAR |
No |
|
|
|
The name of the user record. This name may be hidden. |
|
|
37 |
SUGGESTED_DECISION_UTC_DTTM |
DATETIME (UTC) |
No |
|
|
|
The date and time (UTC) when the appeal suggested decision was made. |
|
|
38 |
SUGGESTED_DECISION_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The date/time that the appeal suggested decision was made. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|
39 |
EDITED_AFTER_COMPLETION_YN |
VARCHAR |
No |
|
|
|
Indicates whether the appeal or grievance was edited after completion. 'Y' indicates that it was edited after completion. 'N' or NULL indicate that it was not edited after completion. |
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN |
|
|
40 |
DECISION_LOGIN_DEPARTMENT_ID_EXTERNAL_NAME |
VARCHAR |
No |
|
|
|
The external name of the department record. This is often used in patient correspondence such as reminder letters. |
|
|
41 |
SUGGESTED_DECISION_DEPT_ID_EXTERNAL_NAME |
VARCHAR |
No |
|
|
|
The external name of the department record. This is often used in patient correspondence such as reminder letters. |
|
|
42 |
MEDICARE_CVG_TYP_C_NAME |
VARCHAR |
No |
|
|
|
The Medicare part that this appeal/grievance involves. |
May contain organization-specific values: No |
Category Entries: |
Part C |
Part D |
|
|
43 |
IS_PART_B_DRUG_YN |
VARCHAR |
No |
|
|
|
If this appeal/grievance involves a Part B drug. |
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN |
|
|
44 |
LATE_FILING_RCV_LOCAL_DTTM |
DATETIME (Attached) |
No |
|
|
|
The local datetime that the reasons for late filing were received. Stored in the time zone determined by column APPEAL_GRV.TAT_RPT_TIME_ZONE_C. |
|
|