AP_CLAIM_IF_INFO_2
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 BMI_FCTR_SEP_PYBL VARCHAR No
Separately payable portion of bundled BMI factor utilized for cost outlier calculation.
4 BSA VARCHAR No
Body Surface Area (BSA) of patient.
5 BSA_FCTR_SEP_PYBL VARCHAR No
Separately payable portion of bundled BSA factor utilized for cost outlier calculation.
6 AGE_FCTR_BUND_PPS VARCHAR No
Age adjustment utilized for the bundled prospective payment of dialysis services.
7 BMI_FCTR_BUND_PPS VARCHAR No
BMI factor for the bundled prospective payment of dialysis services.
8 BSA_FCTR_BUND_PPS VARCHAR No
BSA factor for the bundled prospective payment of dialysis services.
9 COMORB_FCTR VARCHAR No
Comorbidity adjustment utilized for the prospective payment of dialysis services.
10 COMORB_FCT_SEP_PBL VARCHAR No
Separately payable portion of comorbidity factor utilized for cost outlier calculation.
11 LOW_VOL_ADJ VARCHAR No
Low volume adjustment utilized for the bundled prospective payment of dialysis services.
12 LOW_VOL_ADJ_SEP_PBL VARCHAR No
Separately payable portion of low volume factor utilized for cost outlier calculation.
13 PASS_THRU_PMT VARCHAR No
Additional payment for pass-through expenses.
14 MEAN_LOS VARCHAR No
Mean Length of Stay.
15 ADDL_MEAN_LOS VARCHAR No
Additional Mean Length of Stay
16 DRG_WEIGHT VARCHAR No
DRG-specific weight utilized for patient pricing.
17 PER_DIEM VARCHAR No
Per Diem Reimbursement.
18 TIERED_PER_DIEM VARCHAR No
Tiered Per-Diem Reimbursement.
19 DRG_PAYTYPE VARCHAR No
DRG Specific Pricing Rule.
20 INLIER_RATE VARCHAR No
Inlier Rate.
21 TRANSFER_FLAG VARCHAR No
Transfer Flag.
22 OPR_IME_PMT VARCHAR No
Operating Indirect Medical Education (IME) Payment.
23 OPR_DSH_PMT VARCHAR No
Operating Disproportionate Hospital (DSH) Payment.
24 CAP_IME_PMT VARCHAR No
Capital Indirect Medical Education (IME) Payment.
25 CAP_DSH_PMT VARCHAR No
Capital Disproportionate Hospital (DSH) Payment.
26 REIMB_DRG VARCHAR No
Reimbursement DRG.
27 PAYMENT_CMG VARCHAR No
Contains a payment-related Case Mix Group (CMG).
28 PAYMENT_HIPPS VARCHAR No
Health Insurance Prospective Payment System (HIPPS) code returned by the pricer.
29 PPS_PENALTY_AMT VARCHAR No
This field contains the dollar amount of any applicable penalty.
30 PAYMENT_FLAG_CMG VARCHAR No
Payment flag for Inpatient Rehabilitation Facility (IRF) priced claims.
31 TRANSFER_FLAG_CMG VARCHAR No
Transfer flag for IRF priced claims.
32 PENALTY_FLAG VARCHAR No
Penalty flag.
33 PENALTY_PERCENT VARCHAR No
This field contains the percentage the facility was penalized.
34 HIPPS_WEIGHT VARCHAR No
Relative weight for payment HIPPS code.
35 HIPPS_AVG_LOS VARCHAR No
Average length of stay for payment HIPPS code.
36 OUTLIER_CHRGS VARCHAR No
Charges used to determine applicable cost outlier payments.
37 OUTLIER_THRESHOLD VARCHAR No
Cost outlier threshold for payment HIPPS code.
38 ASSESSMNT_TDATE VARCHAR No
Assessment transmission date.
39 AIDS_ADJ_FACTOR VARCHAR No
AIDS adjustment factor.
40 TOT_THIRD_PARTY_PMT VARCHAR No
Total third party payment is the total reimbursement for this claim minus patient coinsurance.
41 OR_PROC_FOR_DRG VARCHAR No
First three operating room procedures that influenced DRG assignment.
42 NOR_PROC_FOR_DRG VARCHAR No
First and second non-operating room procedures that influenced DRG assignment.
43 COMRBD_DX_FOR_DRG VARCHAR No
Diagnosis code that satisfied the complication/comorbidity (CC) criteria and influenced DRG assignment.
44 DX_FOR_DRG VARCHAR No
First three diagnoses (other than principal) that influenced DRG assignment.
45 NUM_OF_MCCS VARCHAR No
Number of major complications/comorbidities in the claim not excluded by the principle diagnosis.
46 NUM_OF_CCS VARCHAR No
Number of complications/comorbidities in the claim not excluded by the principle diagnosis.
47 ADM_MOTOR_SCR_CALC VARCHAR No
Total motor score calculated from IRF-PAI admission motor scores.
48 ADM_MOTOR_SCR_FLAG VARCHAR No
Admission motor score flag.
49 ADM_COGN_SCR_CALC VARCHAR No
Sum of fields 39N through 39R on the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).
50 ADM_COGN_SCR_FLAG VARCHAR No
Admission cognitive score flag.
51 DEMOG_ERR_CNT VARCHAR No
Count of total demographic errors encountered for the input record.
52 AGE_EDIT VARCHAR No
Age edit.
53 SEX_EDIT VARCHAR No
Sex edit.
54 DISCHRG_DISP_EDIT VARCHAR No
Discharge disposition edit.
55 BWGT_EDIT VARCHAR No
Birthweight edit.
56 MCE_DX_ERR_CNT VARCHAR No
Count of total diagnosis errors encountered.
57 PRINC_DX_ERRS VARCHAR No
Principal diagnosis errors.
58 PRINC_DX_SURG_EDIT VARCHAR No
Principal Diagnosis/Surgery Edit.
59 ADMIT_DX_ECODE_ERR VARCHAR No
Admit Diagnosis External Cause of Injury Code/Manifestation Code.
60 MCE_PX_ERR_CNT VARCHAR No
Count of total procedure errors encountered.
61 NON_SPEC_PX_EDIT VARCHAR No
Nonspecific Procedure Edit.
62 BILAT_CODING_EDIT VARCHAR No
Bilateral coding edit.
63 ADMIT_DX_INVALID VARCHAR No
Admit Diagnosis Invalid.
64 ADMIT_DX_AGE_SEX VARCHAR No
Admit Diagnosis Age/Sex
65 ADM_DX_MED_SEC_ALRT VARCHAR No
Admit Diagnosis Medicare as Secondary Payer Alert.
66 MCE_TOT_ERRS VARCHAR No
Total Date-Sensitive Code Editor/Medicare Code Editor errors for this claim.
67 PERCENT_CHRGS VARCHAR No
Percent of Charges Value.
68 GRPR_SEV_ILLNESS VARCHAR No
Identifies severity of illness associated with claim level diagnosis. Data received in GOB1.DRG block on incoming message.
69 GRPR_RSK_MORTALITY VARCHAR No
Identifies risk of mortality associated with claim level diagnosis. Data received in GOB1.DRG block on incoming message.
70 AGE_DAYS_OF_ADMISSION VARCHAR No
Age in days as the number of days between birth date and the date of admission. Required for neonates. Data sent in PCB2.ICD block on the outgoing message.
71 AGE_DAYS_OF_DISCHARGE VARCHAR No
Age in days as the number of days between the birth date and the date of discharge. Required for neonates. Data sent in PCB2.ICD block on the outgoing message.
72 OR_PROC_01 VARCHAR No
Identifies the first three operating room procedures that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
73 NON_OR_PROC_01 VARCHAR No
Identifies the first and second non-operating room procedures that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
74 COMORBIDITY_DX_01 VARCHAR No
Identifies diagnosis code that satisfied the Complication/Comorbidity (CC) criteria and influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
75 DX_FOR_DRG_01 VARCHAR No
Identifies the first three diagnoses (other than principal) that influenced DRG assignment. Data received in GOB1.DRG block on incoming message.
76 ADMISSION_DRG VARCHAR No
Identifies the admission Diagnosis Related Group (DRG). Data received in GOB1.DRG block on incoming message.
77 ADMISSION_SOI VARCHAR No
Identifies level of severity of illness at admission. Data received in GOB1.DRG block on incoming message.
78 ADMISSION_ROM VARCHAR No
Identifies risk of mortality at admission. Data received in GOB1.DRG block on incoming message.
79 ADMIT_MOTOR_SCORE_CALC_2 VARCHAR No
Identifies motor-out score redefined with 3 digits following the decimal. Data received in GOB1.CMG block on incoming message.
80 ADMIT_COGNITIVE_SCORE_CALC_2 VARCHAR No
Identifies cognitive-out score redefined with 3 digits following the decimal. Data received in GOB1.CMG block on incoming message.
81 ICD10_COMORBIDITY_01 VARCHAR No
Identifies comorbidity code that is at the highest comorbidity tier for the case. Data received in GOB1.CMG block on incoming message.
82 ICD10_COMORBIDITY_02 VARCHAR No
Identifies comorbidity code that is at the highest comorbidity tier for the case and part of an ICD-10 code pair. Data received in GOB1.CMG block on incoming message.
83 SHORT_STAY_OUTL_TRIM VARCHAR No
Identifies short stay or day outliers. Data received in POB1.DRG block on incoming message.
84 LONG_STAY_OUTL_TRIM VARCHAR No
Identifies long stay or day outliers. Data received in POB1.DRG block on incoming message.
85 COST_OUTL_THRESHOLD VARCHAR No
Identifies predicted map plus fixed dollar loss amount that is utilized for the cost outlier calculation.
86 TOT_PRED_ESRD_OUTL_PMT VARCHAR No
Identifies total predicted amount of separately payable services per dialysis treatment on monthly bill. For ESRD only. Data received in POB1.APC block on incoming message.
87 NUM_DIALYSIS_LN_ITEM VARCHAR No
Identifies number of dialysis claim lines. For ESRD only. Data received in POB1.APC block on incoming message.
88 CORE_BASE_STAT_AREA VARCHAR No
Identifies core based statistical area. For ESRD only. Data received in POB1.APC block on incoming message.
89 RET_CODE_38_OVR_FLG VARCHAR No
Flag indicating whether or not the claim-level Pricer Return Code 38 (Invalid or Missing Required Claims Data) has been overridden. For ESRD only. Data received in POB1.APC block on incoming message.
90 AGE_EDIT_IND VARCHAR No
Indicates an age edit. Data received in MEB1 block on incoming message.
91 NUM_OF_VISITS VARCHAR No
Identifies total number of visits on the claim.
92 CAPITAL_ADDON VARCHAR No
Identifies total capital add-on for the claim.
93 BLEND_FACTOR VARCHAR No
Identifies portion of Ambulatory Patient Group (APG) payment applied to the claim.
94 RATE_CODE_INDICATOR VARCHAR No
Identifies payment rules applied to the claim, based on the APG rate code supplied on claim.
95 TOTAL_EXISTING_PAYMENT VARCHAR No
Identifies total payment for non-APG portion of visits on claim. Only applies to facility types subject to transitions.