AP_CLAIM_IF_INFO_5
Description:
Overflow table for claim data that can be sent or received by prospective payment systems (PPS) 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 contact. Multiple pieces of information can be associated with this contact.
3 MUE_IMPACT VARCHAR No
Impact of MUE edits on grouping results
4 MUE_OPTIONS VARCHAR No
Types of MUE editing to be applied during processing
5 NCCI_IMPACT VARCHAR No
Impact of NCCI edits on grouping results
6 NCCI_OPTIONS VARCHAR No
Types of NCCI editing to be applied during processing
7 BILLING_NOTE VARCHAR No
Remarks needed for adjudicating a claim
8 MDC VARCHAR No
Major Diagnostic Category
9 UNDETER_POA_INTERP VARCHAR No
Indicates the behavior for handling an undetermined POA indicator
10 SCHED_SUBTYPE VARCHAR No
Subtype of the schedule to be used for processing
11 ADD_ON_PAYMENT VARCHAR No
Amount to reimburse for things such as capital costs
12 ADJ_WEIGHT VARCHAR No
Final APR DRG related factor used to calculate the standard payment. Includes any increases due to patient age or facility factors.
13 ADJ_USED_TEXT VARCHAR No
Description associated with the adjuster used to process the claim
14 AUTO_TRANS_PMT VARCHAR No
Hospital specific additional claim payment amount for Inter-Governmental Transfers.
15 CHG_CAP_ADJ VARCHAR No
Amount the total payment is reduced when the total payment exceeds the covered charges.
16 CHG_CAP_CUT VARCHAR No
Difference between the original payment and the charges, when the charge cap is applied.
17 CHG_REDUCT_FACTOR VARCHAR No
Ratio of the total charges to the initial total payment.
18 CLM_ADJ VARCHAR No
Claim adjustment percent used in the claim reimbursement
19 CLM_TYP VARCHAR No
Type of claim being processed
20 COST_OUTLIER VARCHAR No
Portion of the high cost outlier payment for the claim that is the reimbursement for the claim costs above the claim high cost threshold and below the agency second cost threshold.
21 COST_OUTLIER_2 VARCHAR No
Portion of the high cost outlier payment for the claim that is the reimbursement for the claim costs above the agency second cost threshold.
22 COST_CHG_RATIO VARCHAR No
Ratio of costs to charges as defined in the SSM schedule that was used for processing.
23 COVERED_LOS VARCHAR No
The number of days in a claim length of stay that are recognized for payment.
24 EMERG_REDUCT_FLAG VARCHAR No
Indicates that the claim is a preventable ER encounter based on the diagnosis codes.
25 FINAL_SEVERITY VARCHAR No
Final severity
26 FINAL_SEVERITY_DESC VARCHAR No
Description of final severity
27 HIGH_LOS_PMT VARCHAR No
Portion of the total payment for the claim that includes reimbursement for care where the LOS is greater than the agency defined high LOS threshold.
28 HIGH_LOS_THRESHOLD VARCHAR No
Length of stay that if the claim LOS is greater, makes the claim eligible for a High LOS outlier payment.
29 ICU_INTENSITY VARCHAR No
Identifies patients with diagnoses or procedures that are generally associated with the need for treatment in an Intensive Care Unit
30 INITIAL_SEV VARCHAR No
Initial Severity
31 INITIAL_SEV_DESC VARCHAR No
Description for initial severity
32 INT_GV_TRNSFR_ADJ VARCHAR No
Claim adjustment percent used in the claim intergovernmental transfer reimbursement
33 LOW_COST_OUT_REDUCT VARCHAR No
Portion of the claim total payment due to the claim qualifying as a low cost outlier
34 PPC_REDUCT_AMT VARCHAR No
Portion of the total payment that is subtracted from the claim as a result of the PPC ratio adjustment
35 PPR_REDUCT_AMT VARCHAR No
Percent reduction to the claim total payment due to the hospital PPR ratio
36 PREV_MED_DX_FLAG VARCHAR No
Identifies the presence of a diagnosis code indicative of a preventive or screening diagnosis
37 SCHED_DATA_IND VARCHAR No
Indicates how the schedule data, that was provided in the request with the claim data, was used during processing.
38 SDA_APPLIED VARCHAR No
The Standard Dollar Amount utilized to calculate claim payment.
39 SELF_FUND_TRANS_PMT VARCHAR No
Hospital specific additional claim payment amount for Inter-Governmental Transfers.
40 SVC_ADJ_NICU VARCHAR No
Percent the relative weight is incremented due to the facility having an agency designated neonatal intensive care unit
41 SVC_ADJ_OBESTERICS VARCHAR No
Percent the relative weight is incremented due to obstetrical service.
42 THRD_PRTY_LIAB_PMT VARCHAR No
Amount paid by another payer to be subtracted from the claim payment before final adjustments are made.
43 TRNS_PMT VARCHAR No
Portion of the claim total payment due to the claim qualifying as a transfer.
44 TRAUMA_SUPP_PMT VARCHAR No
Portion of the claim total payment associated with the supplemental payment for specific hospitals
45 ADMIT_DX_CODE VARCHAR No
Chief or primary complaint of the patient at admission.
46 ADMIT_DX_CODE_DESC VARCHAR No
Description for Admit Diagnosis Code
47 CODE_VERSION_MAPPING_BASED_ON VARCHAR No
The date that drives the Automatically Determine Code Mapping field.
48 TOTAL_PAYMENT_WITHOUT_ACCESS VARCHAR No
The total payment of the claim without the access payment.
49 SURGICAL_MORTALITY_INDICATOR VARCHAR No
Indicator that drives mortality measures by identifying cases beyond the provider's control.
50 ESRD_PAYER_EXCEPTIONS VARCHAR No
Indicator to apply state-specific editing and grouping rules.
51 MEDSURG_DRG_IND VARCHAR No
Identifies DRGs that are classified as medical or surgical.
52 OUTLIER_DAYS VARCHAR No
The number of days the length of stay is over the high threshold for the returned DRG code.