AP_CLAIM_IF_INFO_3
Description:
Additional information sent to prospective payment systems (PPS) groupers/pricers.

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 CLINICAL_TRIAL_REGISTRY_NUM VARCHAR No
Identifies the clinical trial registry number.
4 DISCHARGE_DATE VARCHAR No
For inpatient, the date the patient was discharged from the facility. For outpatient, the end date of the period covered on the claim.
5 NONCOVERED_CHARGES VARCHAR No
The portion of the claim's total charges that is not recognized for payment.
6 ADMIT_DX_USED VARCHAR No
The admit diagnosis code that was used during processing.
7 ANALYSIS_PAYMENT VARCHAR No
The standard payment for the claim including applicable add-ons or adjustments, but excluding transfers and outliers.
8 CAPITAL_COST_OUTLIER_PAYMENT VARCHAR No
Additional payment for high cost cases, allowing for reimbursement for capital expenses.
9 CAPITAL_COST_OUTLIER_THRESHOLD VARCHAR No
Capital portion of the cost threshold.
10 CAPITAL_COSTS VARCHAR No
Charges reduced to capital portion of costs.
11 CAPITAL_DSH_FACTOR VARCHAR No
Calculated amount that is multiplied by the capital federal specific portion (FSP) payment to derive the capital disproportionate share hospital (DSH) payment.
12 CAPITAL_EXCEPTION_PAYMENT VARCHAR No
A set amount per claim to reimburse for capital expenses.
13 CAPITAL_FSP_PAYMENT VARCHAR No
Federal specific portion payment for capital, the standard prospective payment to reimburse for capital expenses.
14 CAPITAL_HSP_PAYMENT VARCHAR No
The hospital specific portion payment for capital.
15 CAPITAL_IME_FACTOR VARCHAR No
Calculated amount that is multiplied by the capital federal specific portion (FSP) payment to derive the capital indirect medical education (IME) payment.
16 CAPITAL_OLD_HOLD_HARMLESS_PMT VARCHAR No
Cost payment for old capital.
17 CAPITAL_PAYMENT VARCHAR No
The total capital payment for the claim.
18 CLINICAL_TRIAL_ADDON_PAYMENT VARCHAR No
The add-on payment for agency approved procedure codes determined to be a part of clinical trials.
19 DEVICE_AMOUNT VARCHAR No
The vendor credit amount for a replacement device as reported with value code FD.
20 DEVICE_CREDIT_FLAG VARCHAR No
Indicates whether the diagnosis related group is subject to a device credit.
21 DISCHARGE_STATUS_USED VARCHAR No
Indicates the discharge status used in grouping.
22 DSH_PAYMENT VARCHAR No
The disproportionate share hospital payment.
23 HAC_CAT_SATISFIED_COUNT VARCHAR No
Number of unique hospital-acquired condition categories satisfied on the claim.
24 HAC_REDUCTION_PROGRAM_ADJ VARCHAR No
Amount the total claim payment was reduced due to the Hospital-Acquired Condition reduction program.
25 HAC_STATUS VARCHAR No
Indicates overall results of hospital-acquired condition processing at the claim level.
26 HEMOPHILIA_ADDON_PAYMENT VARCHAR No
Add-on payment for blood clotting factor administered to hemophilia inpatients.
27 HOSP_READMIT_REDUCT_PROG_ADJ VARCHAR No
Adjustment to the claim payment in accordance with the hospital readmissions reduction program.
28 ICD_VERSION_QUALIFIER_USED VARCHAR No
Indicates whether the code set used for processing was ICD-9 or ICD-10.
29 INDIRECT_MEDICAL_EDU_PAYMENT VARCHAR No
Reimbursement for indirect medical education.
30 INIT_DX_RELATED_GROUP VARCHAR No
The diagnosis related group (DRG) calculated before CMS Hospital-Acquired Conditions are considered.
31 INIT_MAJOR_DX_CAT VARCHAR No
The major diagnostic category (MDC) assigned before CMS hospital-acquired conditions are considered.
32 INIT_MEDICAL_SURGICAL_DRG_FLAG VARCHAR No
Flag indicating if the initial diagnosis related group (DRG) is medical, surgical, or neither.
33 INITIAL_RETURN_CODE VARCHAR No
Error return code for the initial diagnosis related group assignment.
34 LENGTH_OF_STAY VARCHAR No
The number of days the patient was hospitalized.
35 LOW_VOLUME_ADDON_PAYMENT VARCHAR No
The portion of the total payment that is additional due to the provider qualifying as a Medicare low volume hospital.
36 LOW_VOLUME_ADJ_PERCENT VARCHAR No
The percentage adjustment used to determine the Low Volume Add-on Payment.
37 MARGINAL_COST_FACTOR VARCHAR No
The variable is used in the calculation of an outlier payment.
38 MEDICAL_SURGICAL_DRG_FLAG VARCHAR No
Indicates if the Diagnosis Related Group is medical, surgical, or neither.
39 NATIONAL_FSP_AMOUNT VARCHAR No
The operating base rate, which is multiplied by the weight to determine the Operating Federal Specific Portion payment.
40 NEW_TECHNOLOGY_ADDON_PAYMENT VARCHAR No
Add-on payment for certain devices, which CMS approves for an additional payment.
41 OPERATING_COST_OUTLIER_PAYMENT VARCHAR No
Extra payment for a high cost case to reimburse operating expenses.
42 OPERATING_COST_OUTLIER_THRESH VARCHAR No
Operating portion of the cost threshold.
43 OPERATING_COSTS VARCHAR No
Charges reduced to operating portion of costs.
44 OPERATING_DSH_FACTOR VARCHAR No
Used to determine if the hospital qualifies for a Disproportionate Share Hospital (DSH) adjustment and the size of capital and operating DSH adjustments.
45 OPERATING_FSP_PAYMENT VARCHAR No
The federal specific portion reimbursed for operating expenses.
46 OPERATING_HSP_PAYMENT VARCHAR No
The hospital specific portion reimbursed for operating expenses.
47 OPERATING_IME_FACTOR VARCHAR No
A calculated value based around the provider intern to bed ratio, which is multiplied by the relative weight to calculate the operating indirect medical education (IME) payment.
48 PAYMENT_STATUS VARCHAR No
Payment status for the claim.
49 POST_ACUTE_CARE_TRANSFER_DRG VARCHAR No
Indicates whether or not the DRG is subject to the post acute care transfer reimbursement policy.
50 PX_USED_COUNT VARCHAR No
Number of procedure codes used for grouping.
51 SECONDARY_DX_USED_COUNT VARCHAR No
Number of secondary diagnosis codes and External Cause of Injury Codes that were used during processing.
52 SERVICE_LOCATION_ID_IN VARCHAR No
A unique identifier for the facility service location.
53 SPEC_POST_ACUTE_CARE_TRANS_DRG VARCHAR No
Indicates whether or not the DRG is subject to the special post acute care transfer reimbursement policy.
54 SUGGESTED_PRINCIPAL_PX VARCHAR No
The suggested principal procedure based on coding practice and policies.
55 TOTAL_EXCL_PASS_THROUGH_PMT VARCHAR No
The total expected payment without miscellaneous per diem amounts.
56 TOTAL_OPERATING_PAYMENT VARCHAR No
Claim reimbursement for operating expenses.
57 TOTAL_PAYMENT VARCHAR No
The total payment for the claim.
58 TRANSFER_IMPACT VARCHAR No
Amount calculated for transfer claims to show the change in payment caused by the transfer status.
59 UNCOMPENSATED_CARE_PAYMENT VARCHAR No
Interim uncompensated care payment according to the Affordable Care Act for disproportionate share hospital payments.
60 VBP_PROGRAM_ADJ VARCHAR No
Adjustment to the total payment in accordance with the Hospital Value-Based Purchasing Program.
61 PROV_MEDICARE_NUM VARCHAR No
The Medicare number of the provider associated with the claim.
62 DISCHRG_STAT_RET_CD VARCHAR No
Error code assigned to the discharge status mapping assignment.
63 BIRTH_WEIGHT VARCHAR No
The birth weight, in grams.