AP_CLAIM_IF_INFO
Description:
The table contains information sent to or returned from a prospective payment systems (PPS) pricer.

Primary Key
Column Name Ordinal Position
CLAIM_ID 1
LINE 2

Column Information
Name Type Discontinued?
1 CLAIM_ID NUMERIC No
The unique identifier for the claim info 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 COMM_STAT_C_NAME VARCHAR No
The Interface communication status.
May contain organization-specific values: No
Category Entries:
Successful
Communication timed out
Communication failed
License for interface not found
Required data missing
No service lines were sent out
Invalid diagnosis or procedure type
4 GROUPER_RETURN_CODE VARCHAR No
The Grouper Return Code field from APC Grouper output fields.
5 GROUPER_TYPE VARCHAR No
The Grouper Type field from APC Grouper output fields.
6 GROUPER_VERSION VARCHAR No
The Grouper Version field from APC Grouper output fields.
7 PAT_VISIT_TYPE VARCHAR No
The Patient or Visit Type field from APC Grouper output fields.
8 APC_STATUS_CODE VARCHAR No
The ambulatory payment classification (APC) status code field from APC grouper output fields.
9 PRICER_RETURN_CODE VARCHAR No
The Pricer Return Code field from APC Pricer output fields.
10 PRICER_TYPE VARCHAR No
The Pricer Type field from APC Pricer output fields.
11 BASE_APC_REIMB VARCHAR No
The Base APC Reimbursement field from APC Pricer output fields.
12 PAT_COPAY VARCHAR No
The Patient Co-payment field from APC Pricer output fields.
13 OUTLIER_PMT VARCHAR No
The Outlier Payment field from APC Pricer output fields.
14 PPS_CHRGS VARCHAR No
The PPS Charges field from APC Pricer output fields.
15 PPS_PMT VARCHAR No
The PPS Payment field from APC Pricer output fields.
16 TRANS_COR_HOLD_HARM VARCHAR No
The Transitional Corridor/Hold Harmless Add-on field from APC Pricer output fields.
17 CLM_DEDUCT VARCHAR No
The Claim Deductible field from APC Pricer output fields.
18 TOTAL_APC_REIMB VARCHAR No
The Total APC Reimbursement field from APC Pricer output fields.
19 OUTLIER_FLAG VARCHAR No
The Outlier Flag field from APC Pricer output fields.
20 BASE_RATE_FLAG VARCHAR No
The Base Rate Flag field from APC Pricer output fields.
21 COST_REDUCT_FACTOR VARCHAR No
The Cost Reduction Factor field from APC Pricer output fields.
22 RURAL VARCHAR No
The Rural field from APC Pricer output fields.
23 OUTPAT_RCC VARCHAR No
The outpatient ratio of cost to charge (RCC) field from APC pricer output fields.
24 MARKUP_DISCNT_FACT VARCHAR No
The Mark-up/Discount Factor field from APC Pricer output fields.
25 PRICER_METHOD VARCHAR No
The Method field from APC Pricer output fields.
26 ACE_RETURN_CODE VARCHAR No
The editor return code field from Ambulatory Code Editor (ACE), Medicare Code Editor (MCE), or Medicaid Outpatient Editor (MOE) output fields.
27 ACE_VERSION VARCHAR No
The editor version field from Ambulatory Code Editor (ACE), Medicare Code Editor (MCE), or Medicaid Outpatient Editor (MOE) output fields.
28 ACE_RLS_VERSION VARCHAR No
The ACE Release Version field from ACE output fields.
29 NUM_CLM_ERRORS VARCHAR No
The Number of Claim Errors field from ACE output fields.
30 NUM_DX_ERRORS VARCHAR No
The Number of Diagnosis Errors field from ACE output fields.
31 NUM_PX_ERRORS VARCHAR No
The Number of Procedure Errors field from ACE output fields.
32 NUM_CCI_ERRORS VARCHAR No
The Number of CCI Errors field from ACE output fields.
33 NUM_ADMIT_DX_ERRORS VARCHAR No
The Number of Admit Diagnosis Errors field from ACE output fields.
34 TOT_NUM_ERRORS VARCHAR No
The Total Number of Errors field from ACE output fields.
35 ADMIT_DX_DISP VARCHAR No
The Admit Diagnosis Disposition field from ACE output fields.
36 OVERALL_CLM_DISP VARCHAR No
The Overall Claim Disposition field from ACE output fields.
37 OCE_ERROR_DISP VARCHAR No
The OCE Error Disposition field from ACE output fields.
38 CLM_ERROR_DETAIL VARCHAR No
The Claim Error Detail field from ACE output fields.
39 RSN_VIS_DX_ERRORS VARCHAR No
The Reason for Visit Diagnosis Errors field from ACE output fields.
40 ADJUD_TIME_DTTM DATETIME (Local) No
The timestamp for each communication.
41 OPTIMIZER_RET_VAL VARCHAR No
The Optimizer return value.
42 MOST_RECENT_ADJU_YN VARCHAR No
Indicate if the adjudication is the most recent adjudication that we get APC values.
May contain organization-specific values: No
Category Entries:
No
Yes
43 OUT_FROM_DATE VARCHAR No
The admission from date of the claim.
44 OUT_THRU_DATE VARCHAR No
The admission through date of the claim.
45 OUT_BIRTH_DATE VARCHAR No
The patient birth date.
46 OUT_PROV VARCHAR No
The provider of the claim. If your organization uses Tapestry's generic APC interface, this column saves the vendor identity ID of the claim.
47 OUT_PAYOR VARCHAR No
The payor of the claim.
48 OUT_AGE VARCHAR No
The patient age.
49 OUT_SEX VARCHAR No
The patient sex.
50 OUT_MRN VARCHAR No
The patient medical record number.
51 OUT_PAT_CONTROL_NUM VARCHAR No
The patient control number.
52 OUT_TOB VARCHAR No
The type of bill of the claim.
53 OUT_DISCHRG_STAT VARCHAR No
The patient discharge status of the claim.
54 OUT_TTL_CHRG VARCHAR No
The total charge of the claim.
55 OUT_LEN_STAY VARCHAR No
The length of stay of the claim.
56 OUT_ADMIT_SRC VARCHAR No
The source of admission listed on the claim.
57 OUT_ADMSN_DX VARCHAR No
The admission diagnosis of the claim.
58 OUT_ADMSN_TYPE VARCHAR No
The admission type of the claim.
59 OUT_NPI VARCHAR No
The National Provider Identifier (NPI) of the claim.
60 OUT_TAXONOMY VARCHAR No
The taxonomy of the claim.
61 OUT_COND_CODES VARCHAR No
The condition codes of the claim.
62 OUT_ACE_OVRIDE VARCHAR No
The ACE override ID of the claim.
63 CCI_EDIT_SUM VARCHAR No
The Correct Coding Initiative (CCI) edit summary returned by the APC interface.
64 OCE_EDIT_SUM VARCHAR No
The outpatient code editor (OCE) edit summary returned by the APC interface.
65 TRACE_INFO VARCHAR No
The trace info of the claim.
66 OUT_PAT_ID_NUM VARCHAR No
The patient identity ID of the claim.
67 OUT_PROV_ID_NUM VARCHAR No
The provider identity ID of the claim.
68 OUT_POS_ID_NUM VARCHAR No
The ID of the Place of Service (POS) on the claim.
69 OUT_CLM_SVC_DATE VARCHAR No
The claim service date.
70 OUT_AUTHCODE VARCHAR No
Authorization code
71 OUT_ADMIT_DATE VARCHAR No
Admission date.
72 OUT_ESRD_ONSET_DATE VARCHAR No
End-stage Renal Disease (ESRD) onset date sent to the Prospective Payment System (PPS) pricer.
73 ALTERNATE_HHRG VARCHAR No
Alternate home health resource group (HHRG) for home health agency (HHA) pricer.
74 ALTERNATE_HHRG_FLAG VARCHAR No
Alternate HHRG flag.
75 HOME_HEALTH_RES_GRP VARCHAR No
HHRG - Home Health Resource Group.
76 NON_RESRC_SUPPLIES VARCHAR No
Non-resource supplies code.
77 TREATMNT_AUTH_VALID VARCHAR No
Treatment authorization code validity flag.
78 MAJOR_DIAG_CATEGORY VARCHAR No
Major Diagnostic Category.
79 DRG VARCHAR No
Diagnostic Related Group (DRG).
80 ALTERNATE_DRG VARCHAR No
Alternate diagnosis related group (DRG)
81 RIC VARCHAR No
Rehabilitation Impairment Category.
82 CLINICAL_CMG VARCHAR No
Original/Clinical Casemix Group.
83 HIPPS VARCHAR No
Health Insurance Prospective Payment System (HIPPS) code
84 COMORBIDITY_CODE VARCHAR No
Comorbidity code used for health insurance prospective payment system (HIPPS) assignment.
85 ALTERNATE_PMT VARCHAR No
Alternate payment.
86 ALT_ADDON_PMT VARCHAR No
Alternate add-on payment.
87 COMORBIDITY_CAT VARCHAR No
Comorbidity category.
88 QUALITY_FLAG VARCHAR No
Quality flag.
89 ADJUSTED_BASE_RATE VARCHAR No
Adjusted base rate without patient-case mix adjustment.
90 ADJUSTED_OUTL_MAP VARCHAR No
Outlier services Medicare anticipated payment used for cost outlier calculation.
91 AVG_PERTREAT VARCHAR No
Actual amount of formerly separately payable services per dialysis treatment on monthly bill.
92 AVG_PERTREAT_BLEND VARCHAR No
Predicted amount of separately payable services per dialysis treatment on monthly bill.
93 DISPENSE_FEE VARCHAR No
Dispensing fee for oral-only drugs with an injectable equivalent.
94 FIXED_LOSS_AMT VARCHAR No
Fixed dollar loss amount that is added to the predicted Medicare Allowable Payment to determine the cost outlier threshold.
95 MONTHLY_SERV_AMT VARCHAR No
Total amount of formerly separately payable services utilized for the cost outlier calculation.
96 AGE_FCTR_SEP_PYBL VARCHAR No
Separately payable portion of bundled age adjustment utilized for cost outlier calculation.
97 BMI VARCHAR No
The Body Mass Index (BMI) of the patient.