AP_CLAIM
Description:
The AP_CLAIM table contains one record for each claim in the managed care system's AP Claims module.

Primary Key
Column Name Ordinal Position
CLAIM_ID 1

Column Information
Name Type Discontinued?
1 CLAIM_ID NUMERIC No
The unique identifier of the accounts payable claim record.
2 ORIG_CLAIM_NUM VARCHAR No
Stores the original claim number after it is changed.
3 STATUS_C_NAME VARCHAR No
Stores the unique category identifier of the claims processing status, such as whether it is pending, clean, denied, or void.
May contain organization-specific values: No
Category Entries:
New
Pending
Denied
Clean
Void
4 AP_STS_C_NAME VARCHAR No
Stores the unique category identifier of the claim's AP status or NULL if the claim has not been sent to AP.
May contain organization-specific values: No
Category Entries:
Released to Accounts Payable
Batched for Payment
EOB Generated
5 DATE_RECEIVED DATETIME No
The date the accounts payable claim was received.
6 ADMISSION_DATE DATETIME No
The date on which the member was admitted to the place of service.
7 ADMISSION_HOUR NUMERIC No
The hour at which the member was admitted to the place of service.
8 ENTRY_DATE DATETIME No
The date the accounts payable claim was entered into Epic.
9 SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
10 NUM_PROC INTEGER No
The number of procedures on the accounts payable claim record.
11 TOT_BILLED_AMT NUMERIC No
The total billed amount on the claim.
12 TOT_PAT_PORTION NUMERIC No
The total patient portion on the claim.
13 TOT_NET_PAYABLE NUMERIC No
The total net payable amount on the claim.
14 COVERAGE_ID NUMERIC No
Stores the identifier of the coverage used to process the claim.
15 SERV_DATE DATETIME No
Stores the service start date for the first service line on the claim.
16 ASSOC_SPEC_C_NAME VARCHAR No
The category value corresponding to the specialty associated with the accounts payable claim record.
May contain organization-specific values: Yes
17 PAT_STATUS_C_NAME VARCHAR No
The category value representing the member's discharge disposition/status as of the service end date.
May contain organization-specific values: Yes
18 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.
19 ADMISSION_SOURCE_C_NAME VARCHAR No
The category value representing the origin or source of admission.
May contain organization-specific values: Yes
20 EXTERNAL_CLAIM_ID VARCHAR No
The external claim identification number. Note: This is not used for linking purposes.
21 PAY_BY_DATE DATETIME No
The date by which the accounts payable claim should be paid.
22 NETWORK_ID VARCHAR No
The unique ID of the network associated with this accounts payable claim record.
23 NETWORK_ID_NETWORK_NAME VARCHAR No
The name of the network.
24 METH_TO_PAY_CLM_C_NAME VARCHAR No
Stores the category identifier of the method used to pay the claim, such as whether it was paid as primary or secondary.
May contain organization-specific values: Yes
Category Entries:
Primary Coverage
Coordination of Benefits
Maintenance of Benefits
COB Savings
Preservation of Benefits
Claim-Level Coordination of Benefits
Claim-Level Maintenance of Benefits
25 TOT_PRIM_INS_AMT NUMERIC No
The amount already paid towards the billed amount on the claim by primary payors. This is applicable only if the claim has been submitted to your facility as the secondary payor.
26 TOT_PRIM_PAT_PORT NUMERIC No
Displays the amount the primary payors adjudicated as the patient portion. This is applicable only if the claim has been submitted to your facility as the secondary payor.
27 TOT_ADJUSTMENT NUMERIC No
The total adjustment amount associated with the accounts payable claims record.
28 ADMISSION_TYPE_C_NAME VARCHAR No
The category value representing the type of admission.
May contain organization-specific values: Yes
29 TOT_INSURANCE_AMT NUMERIC No
The total insurance amount associated with the accounts payable claim record.
30 ADMISSION_DX_ID_DX_NAME VARCHAR No
The name of the diagnosis.
31 TOT_NET_INSURANCE NUMERIC No
The total net insurance amount remaining after deducting all applicable adjustments and other payments from the total insurance amount.
32 E_CODE_ID_DX_NAME VARCHAR No
The name of the diagnosis.
33 TYPE_OF_BILL VARCHAR No
The type of bill associated with the accounts payable claim record.
34 RCVD_BY_CARRIER_DT DATETIME No
The date the accounts payable claim was received by the carrier.
35 HCFA_UNCLEAN_YN VARCHAR No
An indication of whether the CMS claim contained errors.
May contain organization-specific values: No
Category Entries:
Clean
Unclean
36 ORIG_REV_CLM_ID NUMERIC No
The ID number of the original claim related to a reversed claim.
37 ADJST_CLM_ID NUMERIC No
The ID number of an adjustment claim.
38 ORIG_ADJST_CLM_ID NUMERIC No
If a claim is an adjustment claim, this represents the ID number of the original claim being adjusted.
39 REF_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.
40 TOT_U_AND_C_AMT NUMERIC No
The total usual and customary amount for the claim.
41 TOT_DISALLOW_AMT NUMERIC No
The total disallowed amount for the claim.
42 TOT_NOT_COVD_AMT NUMERIC No
The total not covered amount for the claim.
43 TOT_DEDUCTIBLE NUMERIC No
The total deductible for the claim.
44 TOT_COPAY NUMERIC No
The total copay for the claim.
45 TOT_COINS NUMERIC No
The total coinsurance amount for the claim.
46 TOT_PAT_TOTAL NUMERIC No
The total patient portion for the claim.
47 TOT_BBEN_PNLTY NUMERIC No
The total before benefit penalty amount for the claim.
48 TOT_EXD_BEN_AMT NUMERIC No
The total exceeded benefit amount for the claim.
49 TOT_ACUTE_AMT NUMERIC No
The total acute medication amount for the claim.
50 TOT_CHRONIC_AMT NUMERIC No
The total chronic medication amount for the claim.
51 TOT_PAT_AMT NUMERIC No
The total patient medication amount for the claim.
52 IN_OUT_NET_C_NAME VARCHAR No
Indicates the network level of the claim, as computed during adjudication.
May contain organization-specific values: Yes
Category Entries:
In Network
Out of Network
N/A
53 RKP_ID VARCHAR No
The unique ID of the risk panel associated with the claim.
54 RKP_ID_RISK_PANEL_NAME VARCHAR No
The name of the risk panel.
55 CLM_LOB_ID VARCHAR No
Stores the unique identifier of the line of business associated with the claim. This is the LOB determined at adjudication.
56 CLM_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
57 WORKFLOW_C_NAME VARCHAR No
Stores the unique category identifier of the workflow this claim was created as part of. Standard AP Claims processed through Tapestry will store 0 or NULL in this column.
May contain organization-specific values: Yes
Category Entries:
AP claims
Reprice claims
Export only
Shadow claims
Externally paid claims
Externally paid claims with bucket update
Pre-adjudicated external claims
Estimate claims
Adjudicated external claims
58 SENSITIVITY_C_NAME VARCHAR No
Stores the unique category identifier of the sensitivity applied to the claim, if any. This value is used to restrict access within Hyperspace. The values in AP_CLAIM_ANALYTICS_SENS are distinct and intended for use with reporting.
May contain organization-specific values: Yes
59 SERVICE_START_DATE DATETIME No
The earliest service start date among all services on the claim.
60 SERVICE_END_DATE DATETIME No
The service end date for the claim.
61 TOT_COB_SAVING NUMERIC No
The total Coordination of Benefits (COB) savings amount for the claim.
62 TOT_PAT_OUT_PCKT NUMERIC No
The total patient out-of-pocket amount for the claim.
63 SHADOW_RECON_AMT NUMERIC No
The shadow reconciliation threshold amount for the claim.
64 DRG_ID VARCHAR No
The unique ID of the Diagnosis Related Group (DRG) associated with the claim.
65 DRG_ID_DRG_NAME VARCHAR No
The name of the Diagnoses Related Group name.
66 TIF_NUM VARCHAR No
The tax increment financing (TIF) number for the claim.
67 LIFEMAX_AMT_IN NUMERIC No
The amount applied to the patient's in-network lifetime maximum buckets for this claim.
68 LIFEMAX_AMT_OUT NUMERIC No
The amount applied to the patient's out-of-network lifetime maximum buckets for this claim.
69 CLAIM_FORMAT_C_NAME VARCHAR No
Indicates the format of the claim (CMS, UB, Rx).
May contain organization-specific values: No
Category Entries:
CMS
UB
Rx
70 OTHER_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 OPERATING_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.
72 ADJ_TIME DATETIME (Local) No
The adjudication date and time of the claim.
73 ATTEND_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.
74 TOT_COB_SV_PAYOUT NUMERIC No
The total amount of Coordination of Benefits (COB) savings member payout.
75 LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.
76 TOT_SEC_DIS NUMERIC No
The total amount of secondary discount from all the services added up.
77 TOT_PRIM_FAC NUMERIC No
The total primary factor amounts from all the services added up.
78 TOT_CODE_EDIT_SAV NUMERIC No
The total amount of code edit savings for this claim.
79 INTEREST_AMT_OVRD NUMERIC No
This stores the override interest amount for the claim.
80 RTF_EOB_NOTE_ID VARCHAR No
Contains the most recently generated rich text explanation of benefits report.
81 INFO_CVG_ID NUMERIC No
The ID of the additional coverage record associated with the accounts payable claim record for informational and reporting purposes.
82 CLM_PRIM_INS_AMT NUMERIC No
Claim-level primary insurance amount to allocate between procedures
83 CLM_PRIM_PAT_AMT NUMERIC No
Claim-level primary patient amount to allocate between procedures
84 STATUS_DATE DATETIME No
The status date of the claim.
85 PEND_TYPE_C_NAME VARCHAR No
The category value of the pend type for this claim
May contain organization-specific values: No
Category Entries:
External
Open
Internal
86 CL_DEN_PEND_EXAM_ID VARCHAR No
The unique ID of the claims examiner who applied a status of clean, deny, or pend to this claim.
87 CL_DEN_PEND_EXAM_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
88 CL_DEN_PEND_DTTM DATETIME (Local) No
The date that a status of clean, deny, or pend was applied to this claim.
89 VOID_EXAMINER_ID VARCHAR No
The ID of the user who voided this claim.
90 VOID_EXAMINER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
91 VOID_CHNG_DATETIME DATETIME (Local) No
The date the claim was voided.
92 ACCIDENT_DT DATETIME No
The date of accident associated with the claim.
93 ER_ENTRY_DATETIME DATETIME (Local) No
The date and time of entry to emergency room.
94 IN_NET_ADJUD_OVRD_C_NAME VARCHAR No
Category value corresponding to the in network adjudication override reason.
May contain organization-specific values: Yes
95 DRG_PRICING_YN VARCHAR No
Indicates whether Diagnosis Related Groups (DRG) were used to price this claim. 'Y' indicates that DRG pricing was used, 'N' indicates that it was not.
May contain organization-specific values: No
Category Entries:
Yes
No
96 WORKFLOW_PAYOR_ID_PAYOR_NAME VARCHAR No
The name of the payor.
97 TOT_BILLED_ENT NUMERIC No
The total billed entered for this claim.
98 TOT_ALLOWED_AMT NUMERIC No
The total allowed amount for this claim.
99 TOT_WITHHOLDING NUMERIC No
The total withholding for this claim.
100 TOT_DISCOUNT NUMERIC No
Total discount amount for this claim.
101 ADJ_NET_PAID NUMERIC No
Adjusted net paid for this claim.
102 ADJ_PAT_PORTION NUMERIC No
Adjusted patient portion for this claim.
103 MEM_PRIMARY_NET_ID VARCHAR No
The ID of the member's primary network.
104 MEM_PRIMARY_NET_ID_NETWORK_NAME VARCHAR No
The name of the network.
105 LIFEMAX_ETR_DATA VARCHAR No
The lifetime max transactions data for this claim.
106 INBASKET_MESSAGE_ID VARCHAR No
The ID of the in basket message associated with this claim.
107 STMT_COV_FROM_DATE DATETIME No
Start date for statement covers.
108 STMT_COV_TO_DATE DATETIME No
End date for statement covers.
109 MSP_YN VARCHAR No
Indicates whether Medicare is listed as a secondary payor on the claim record. 'Y' indicates that Medicare is a secondary payor, 'N' indicates that it is not.
May contain organization-specific values: No
Category Entries:
Yes
No
110 CLM_REPRICER_ID NUMERIC No
The ID of the 3rd party claim pricer
111 CLM_REPRICER_ID_RUL_NAME VARCHAR No
The name of the third-party pricing entity, grouper, or rule.
112 COVERED_DAYS NUMERIC No
The number of covered days on the claim.
113 NONCOVERED_DAYS NUMERIC No
The number of noncovered days on the claim.
114 COINS_DAYS NUMERIC No
The number of coinsurance days on the claim.
115 LIFETIME_RESRV_DAYS NUMERIC No
The number of lifetime reserve days for inpatient claims.
116 ILL_INJ_LMP_DATE DATETIME No
Date of injury/illness.
117 INTEREST_TO_DT DATETIME No
The to date for interest calculation for the claim. Used when the associated check which was returned is voided.
118 DISCHRG_HR_UB92_FMT VARCHAR No
The discharge hour listed on UB claims.
119 ADJUSTMENT_USER_ID VARCHAR No
The ID of the user who created the adjustment for this claim.
120 ADJUSTMENT_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
121 ADJST_CREATE_DATE DATETIME No
The date the adjustment claim was created.
122 REFUNDED_FLAG_YN VARCHAR No
Flag indicating if the claim has been refunded.
May contain organization-specific values: No
Category Entries:
Yes
No
123 EMPY_RELATED_YN VARCHAR No
Indicates whether patient's condition is related to employment.
May contain organization-specific values: No
Category Entries:
No
Yes
124 AUTO_ACDNT_STATE_C_NAME VARCHAR No
Specifies the state where the auto accident occurred.
May contain organization-specific values: Yes
125 DISABILITY_FROM_DT DATETIME No
The date the disability started.
126 DISABILITY_TO_DT DATETIME No
The date the disability ended.
127 DISCHARGE_DATE DATETIME No
The date patient was discharged.
128 OUTSIDE_LAB_YN VARCHAR No
Indicate if lab services outside the provider's office are involved.
The category values for this column were already listed for column: EMPY_RELATED_YN
129 OUTSIDE_LAB_CHARGE NUMERIC No
The cost of services performed at the outside lab.
130 RELATED_CONDITION_C_NAME VARCHAR No
Information regarding related condition.
May contain organization-specific values: Yes
Category Entries:
Auto
Other Party Liability
Other Accident Related Injury
Patient Employment
Crime Victim
131 WGT_BED_DAYS NUMERIC No
Total weight of bed days.
132 TOT_CONV_DAYS_RFL NUMERIC No
To store the total converted bed days on the only attached referral with bed days information in it.
133 BENEFIT_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
134 PLAN_GROUP_ID VARCHAR No
Stores the unique identifier of the plan group for the coverage used to pay the claim, as of adjudication.
135 PLAN_GROUP_ID_PLAN_GRP_NAME VARCHAR No
The name of the employer group record
136 ENTRY_INSTANT_DTTM DATETIME (Local) No
The instant when the accounts payable claim record was created.