APPEAL_GRV_2
Description:
This table contains information about an individual appeal or grievance as an extension of APPEAL_GRV.

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 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.
45 REQUESTING_REP_DOCUMENT_REQ_YN VARCHAR No
Whether a document is required for the requesting representative. 'Y' indicates that a document is required. 'N' indicates that a document is not required. 'NULL' indicates that the appeal or grievance was not requested by a representative.
The category values for this column were already listed for column: FILED_LATE_EXCPTNS_ALLOWED_YN