|
Name |
Type |
Discontinued? |
|
| 1 |
TX_ID |
NUMERIC |
No |
|
|
|
| The unique ID of the AP Claim procedure transaction. |
|
|
| 2 |
PROC_ID_PROC_NAME |
VARCHAR |
No |
|
|
|
| The name of each procedure. |
|
|
| 3 |
SVC_FROM_DATE |
DATETIME |
No |
|
|
|
| The beginning service date for the procedure on the accounts payable claim record. |
|
|
| 4 |
SVC_TO_DATE |
DATETIME |
No |
|
|
|
| The ending service date for the procedure on the accounts payable claim record. |
|
|
| 5 |
MODIFIERS |
VARCHAR |
No |
|
|
|
| A list of modifiers used with the procedure on the accounts payable claim record. |
|
|
| 6 |
BILLED_AMT |
NUMERIC |
No |
|
|
|
| The amount billed for the procedure on the accounts payable claim record. |
|
|
| 7 |
ALLOWED_AMT |
NUMERIC |
No |
|
|
|
| The allowed amount calculated for the procedure on the accounts payable claim record. |
|
|
| 8 |
NET_PAYABLE |
NUMERIC |
No |
|
|
|
| The net payable amount for the procedure on the accounts payable claim record. |
|
|
| 9 |
POS_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
| The category value associated with the place of service type of the procedure on the accounts payable claim record. |
| May contain organization-specific values: Yes |
| Category Entries: |
| Telehealth - Provided in Patient's Home |
| Office |
| Home |
| Assisted Living Facility |
| Group Home |
| Mobile Unit |
| Temporary Lodging |
| Walk-in Retail Health Clinic |
| Place of Employment - Worksite |
| Off Campus - Outpatient Hospital |
| Urgent Care Facility |
| Inpatient Hospital |
| On Campus - Outpatient Hospital |
| Emergency Room - Hospital |
| Ambulatory Surgical Center |
| Birthing Center |
| Military Treatment Facility |
| Outreach Site/Street |
| Skilled Nursing Facility |
| Nursing Facility |
| Custodial Care Facility |
| Hospice |
| Adult Living Care Facility |
| Ambulance - Land |
| Ambulance - Air or Water |
| Independent Clinic |
| Federally Qualified Health Center |
| Inpatient Psychiatric Facility |
| Psychiatric Facility - Partial Hospitalization |
| Community Mental Health Center |
| Intermediate Care Facility/ Individuals with Intellectual Disabilities |
| Residential Substance Abuse Treatment Facility |
| Psychiatric Residential Treatment Center |
| Non-residential Substance Abuse Treatment Facility |
| Non-residential Opioid Treatment Facility |
| Mass Immunization Center |
| Comprehensive Inpatient Rehabilitation Facility |
| Comprehensive Outpatient Rehabilitation Facility |
| End-Stage Renal Disease Treatment Facility |
| Programs of All-Inclusive Care for the Elderly (PACE) Center |
| Public Health Clinic |
| Rural Health Clinic |
| Independent Laboratory |
| Other Place of Service |
| Pharmacy |
| Telehealth - Provided Other than in Patient's Home |
| School |
| Homeless Shelter |
| Indian Health Service Free-standing Facility |
| Indian Health Service Provider-based Facility |
| Tribal 638 Free-standing Facility |
| Tribal 638 Provider-based Facility |
| Prison/Correctional Facility |
|
|
| 10 |
OVERRIDE_ALLD_AMT |
NUMERIC |
No |
|
|
|
| The override allowed amount for the procedure on the accounts payable claim record. |
|
|
| 11 |
OVERRIDE_REASON_C_NAME |
VARCHAR |
No |
|
|
|
| The category value associated with the reason for the override. |
| May contain organization-specific values: Yes |
|
|
| 12 |
TYPE_OF_SERVICE_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the type of service associated with the procedure on the accounts payable claim record. |
| May contain organization-specific values: Yes |
| Category Entries: |
| Medical Care |
| Surgery |
| Consultation |
| Diagnostic Radiology |
| Diagnostic Laboratory |
| Therapeutic Radiology |
| Anesthesia |
| Assistant at Surgery |
| Other Medical Items or Services |
| Whole Blood |
| Used Durable Medical Equipment (DME) |
| Ambulatory Surgical Center (Facility usage for Surgical Services) |
| Hospice (Obsolete, Discontinued 1/95) |
| ESRD Supplies |
| Monthly Capitation Payment for Dialysis |
| Kidney Donor |
| Pneumococcal/Flu Vaccine |
| Second Opinion on Elective Surgery (Obsolete) |
| Third Opinion on Elective Surgery (Obsolete) |
| Diagnostic Medical (Obsolete) |
| Ancillaries, Hospital and Nursing Home (Obsolete) |
| Drug Services (Obsolete) |
| Accommodations, Hospital and Nursing Home (Obsolete) |
| Dental (Obsolete) |
| Vision Care and Cataract Lens (Obsolete) |
| Nuclear Medicine (Obsolete) |
| Diagnostic X-Ray (Professional) (Obsolete) |
| Rental of DME |
| Radiation Therapy (Professional) (Obsolete) |
| Diagnostic Lab (Professional) (Obsolete) |
| Diagnostic Medical (Professional) (Obsolete) |
| DME Purchase (Obsolete) |
| CRD Equipment (Obsolete) |
| Pre-Admission Testing (Obsolete) |
| EPSDT |
| High Risk Screening Mammography |
| Low Risk Screening Mammography |
| Ambulance |
| Enteral/Parenteral Nutrients/Supplies |
| Immunosuppressive Drugs |
| Diabetic Shoes |
| Hearing Items and Services |
| Lump Sum Purchase of DME, Prostethics, Orthotics |
| Vision Items or Services |
| Surgical Dressings or Other Medical Supplies |
| Psychological Therapy |
| Occupational Therapy |
| Physical Therapy |
| Medication (Obsolete) |
| Chiropractic Care |
| DME Prescription |
|
|
| 13 |
PRIM_INS_AMOUNT |
NUMERIC |
No |
|
|
|
| For non-primary claims (e.g. secondary), the sum of the insurance amounts paid by previous payors. |
|
|
| 14 |
PRIM_PAT_PORTION |
NUMERIC |
No |
|
|
|
| For non-primary claims (e.g. secondary), the sum of all patient portion amounts specified by previous payors. |
|
|
| 15 |
PROC_INSURANCE_AMT |
NUMERIC |
No |
|
|
|
| The calculated insurance amount for the procedure on the accounts payable claim record. |
|
|
| 16 |
NET_INSURANCE_AMT |
NUMERIC |
No |
|
|
|
| The net insurance amount for this procedure on the accounts payable claim record. |
|
|
| 17 |
WITHHOLD_METHOD_C_NAME |
VARCHAR |
No |
|
|
|
| The category value representing the method of withholding an amount for this procedure. |
| May contain organization-specific values: No |
| Category Entries: |
| Percentage of Net Insurance |
| Fixed Amount |
| Extension |
| None |
| Percentage of Allowed Amount |
|
|
| 18 |
WITHHOLD_RATE |
NUMERIC |
No |
|
|
|
| The rate to be withheld for this procedure. |
|
|
| 19 |
COMP_WITHHOLDING |
NUMERIC |
No |
|
|
|
| The computed withholding amount for the procedure on the accounts payable claim record. |
|
|
| 20 |
COMP_ADJUSTMENT |
NUMERIC |
No |
|
|
|
| The computed adjustment amount for the procedure on the accounts payable claim record. |
|
|
| 21 |
ACTUAL_ADJUSTMENT |
NUMERIC |
No |
|
|
|
| The actual adjustment taken for this procedure on the accounts payable claim record. |
|
|
| 22 |
ADJUST_REASON_C_NAME |
VARCHAR |
No |
|
|
|
| The category value of the reason for the adjustment to this procedure on the accounts payable claim record. |
| May contain organization-specific values: Yes |
| Category Entries: |
| Procedure is capitated |
| Coordination of Benefits |
| Maintenance of Benefits |
| Allowed exceeds amount patient paid |
| Pay by DRG |
|
|
| 23 |
ADJ_BILLED_AMT |
NUMERIC |
No |
|
|
|
| The adjusted billed amount after refund for the procedure on the accounts payable claim record. |
|
|
| 24 |
ADJ_ALLOWED_AMT |
NUMERIC |
No |
|
|
|
| The adjusted allowed amount after refund for the procedure on the accounts payable claim record. |
|
|
| 25 |
ADJ_PAT_PORTION |
NUMERIC |
No |
|
|
|
| The adjusted patient portion after refund for the procedure on the accounts payable claim record. |
|
|
| 26 |
ADJ_INS_AMT |
NUMERIC |
No |
|
|
|
| The adjusted insurance amount after refund for the procedure on the accounts payable claim record. |
|
|
| 27 |
ADJ_ADJUSTMENT |
NUMERIC |
No |
|
|
|
| The adjusted adjustment amount after refund for the procedure on the accounts payable claim record. |
|
|
| 28 |
ADJ_NET_INS |
NUMERIC |
No |
|
|
|
| The adjusted net insurance amount after refund for the procedure on the accounts payable claim record. |
|
|
| 29 |
ADJ_WITHHOLDING |
NUMERIC |
No |
|
|
|
| The adjusted withholding amount after refund for the procedure on the accounts payable claim record. |
|
|
| 30 |
ADJ_NET_PAYABLE |
NUMERIC |
No |
|
|
|
| The adjusted net payable amount after refund for the procedure on the accounts payable claim record. |
|
|
| 31 |
PAT_PORTION |
NUMERIC |
No |
|
|
|
| The patient portion for the procedure on the accounts payable claim record. |
|
|
| 32 |
REVENUE_CODE_ID_PROC_NAME |
VARCHAR |
No |
|
|
|
| The name of each procedure. |
|
|
| 33 |
QUANTITY |
NUMERIC |
No |
|
|
|
| The quantity (number of units, procedures, etc.) billed on this service line. |
|
|
| 34 |
REFUND_REVERSAL_ID |
NUMERIC |
No |
|
|
|
| The unique ID of the reversal procedure transaction for refund. |
|
|
| 35 |
REFUND_ADJT_ID |
NUMERIC |
No |
|
|
|
| The unique ID of the adjustment procedure transaction for refund. |
|
|
| 36 |
EOB_COMMENT |
VARCHAR |
No |
|
|
|
| The claim code (explanation of benefit code) comment on the procedure. |
|
|
| 37 |
UC_VALUE |
NUMERIC |
No |
|
|
|
| The usual and customary amount for the procedure. |
|
|
| 38 |
CONTRACT_ALLOWED |
NUMERIC |
No |
|
|
|
| The contractual allowed amount for the procedure. |
|
|
| 39 |
OVRD_DISALW_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the reason for overriding the disallowed amount on the procedure. |
| May contain organization-specific values: Yes |
|
|
| 40 |
OVRD_DISALW_AMT |
NUMERIC |
No |
|
|
|
| The override disallowed amount for the procedure. |
|
|
| 41 |
DISALW_AMT |
NUMERIC |
No |
|
|
|
| The disallowed amount for the procedure. |
|
|
| 42 |
OVRD_NOT_CVD |
NUMERIC |
No |
|
|
|
| The override not covered amount for the procedure. |
|
|
| 43 |
OVRD_DEDUCTIBLE |
NUMERIC |
No |
|
|
|
| The override deductible amount for the procedure. |
|
|
| 44 |
OVRD_COINS |
NUMERIC |
No |
|
|
|
| The override coinsurance amount for the procedure. |
|
|
| 45 |
OVRD_COPAY |
NUMERIC |
No |
|
|
|
| The override copay amount for the procedure. |
|
|
| 46 |
NON_CVD_AMT |
NUMERIC |
No |
|
|
|
| The non-covered amount for the procedure. |
|
|
| 47 |
DEDUCTIBLE |
NUMERIC |
No |
|
|
|
| The deductible amount for the procedure. |
|
|
| 48 |
COPAYMENT |
NUMERIC |
No |
|
|
|
| The copayment amount for the procedure. |
|
|
| 49 |
COINSURANCE |
NUMERIC |
No |
|
|
|
| The coinsurance amount for the procedure. |
|
|
| 50 |
PATIENT_TOT |
NUMERIC |
No |
|
|
|
| The total patient portion for the procedure. |
|
|
| 51 |
OVRD_PAT_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the reason for overriding the patient portion on the procedure. |
| May contain organization-specific values: Yes |
|
|
| 52 |
OVRD_PAT_PORT |
NUMERIC |
No |
|
|
|
| The override patient portion amount for the procedure. |
|
|
| 53 |
PRICING_ATTR_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the pricing attribute for the procedure (used in conjunction with the vendor contract). |
| May contain organization-specific values: Yes |
| Category Entries: |
| PCP |
| Specialist |
|
|
| 54 |
PENALTY_BEF_BEN |
NUMERIC |
No |
|
|
|
| The before benefits provider penalty amount for the procedure. |
|
|
| 55 |
PENALTY_AFT_BEN |
NUMERIC |
No |
|
|
|
| The after benefits provider penalty amount for the procedure. |
|
|
| 56 |
EXCEEDED_BEN_AMT |
NUMERIC |
No |
|
|
|
| The amount on the procedure that exceeds benefits. |
|
|
| 57 |
COB_SAVING_AMT |
NUMERIC |
No |
|
|
|
| The Coordination of Benefits (COB) savings amount for the procedure. |
|
|
| 58 |
PAT_OUT_OF_POCKET |
NUMERIC |
No |
|
|
|
| The total patient out-of-pocket amount for the procedure. |
|
|
| 59 |
SUB_PEN_ADJ_STR |
VARCHAR |
No |
|
|
|
| The submission penalty adjudication string for the procedure. |
|
|
| 60 |
ALLOWED_CODE_C_NAME |
VARCHAR |
No |
|
|
|
| The allowed code for the procedure (e.g., claim denied, procedure denied, contracted rate payment). |
| May contain organization-specific values: No |
| Category Entries: |
| Contracted Rate Payment |
| Payment as per Appeals Review Committee |
| Payment as per Duality Review Committee |
| Claim Denied |
| Procedure Denied |
| Secondary Claim Rate |
|
|
| 61 |
WITHHOLDING |
NUMERIC |
No |
|
|
|
| The withholding amount for the procedure. |
|
|
| 62 |
TX_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID that indicates the type of procedure. Only AP claim types should appear in this table (e.g. AP claim, AP claim refund, AP claim DRG). |
| May contain organization-specific values: No |
| Category Entries: |
| Charge |
| Payment |
| Adjustment |
| AP Claim Tx |
| AP Claim Refund Tx |
| AP Claim DRG Tx |
| Pharmacy Claim Tx |
|
|
| 63 |
DRG_ID |
VARCHAR |
No |
|
|
|
| The unique ID of Diagnosis Related Group (DRG) code for the procedure. |
|
|
| 64 |
DRG_ID_DRG_NAME |
VARCHAR |
No |
|
|
|
| The name of the Diagnoses Related Group name. |
|
|
| 65 |
PAT_PORT_CODE_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the type of patient payment for the procedure (e.g., coinsurance, copay, not covered). |
| May contain organization-specific values: No |
| Category Entries: |
| Co-ins |
| Copay |
| Not Covered |
| No Patient Payment |
|
|
| 66 |
DISCOUNT |
NUMERIC |
No |
|
|
|
| The discount amount for the procedure. |
|
|
| 67 |
SECONDARY_DISC_AMT |
NUMERIC |
No |
|
|
|
| The amount of additional discount on a secondary claim. |
|
|
| 68 |
PRIMARY_FACTORS |
NUMERIC |
No |
|
|
|
| The amount on a non-primary (e.g. secondary) claim that was paid/handled by the primary payor. |
|
|
| 69 |
SEC_PROV_RESP |
NUMERIC |
No |
|
|
|
| The secondary denied amount if the service is denied to provider responsibility. |
|
|
| 70 |
UNCVRD_EOB_CODE_ID_EOB_CODE_NAME |
VARCHAR |
No |
|
|
|
| The name of the processing code. |
|
|
| 71 |
DISC_EOB_CODE_ID_EOB_CODE_NAME |
VARCHAR |
No |
|
|
|
| The name of the processing code. |
|
|
| 72 |
PRICE_USING_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the method used to price the service (e.g. Revenue code, HCPCS code, DRG code). This is set only for UB claims. |
| May contain organization-specific values: No |
| Category Entries: |
| HCPCS CODE |
| REVENUE CODE |
| DRG CODE |
|
|
| 73 |
STATUS_C_NAME |
VARCHAR |
No |
|
|
|
| The category ID of the procedure's status. |
| May contain organization-specific values: No |
| Category Entries: |
| Denied |
| Deleted |
|
|
| 74 |
CVG_ID |
VARCHAR |
No |
|
|
|
| The ID of the coverage used to pay the procedure on the claim. |
|
|
| 75 |
APC_CODE_ID |
VARCHAR |
No |
|
|
|
| The unique ID of the Ambulatory Payment Classification (APC) code that mapped to the procedure. |
|
|
| 76 |
APC_PRICE |
NUMERIC |
No |
|
|
|
| The Ambulatory Payment Classification (APC) price for the procedure. |
|
|
| 77 |
OVRD_EXCD_BEN_AMT |
NUMERIC |
No |
|
|
|
| The override exceeded benefit amount for the procedure. |
|
|
| 78 |
COB_SAVINGS_PAYOUT |
NUMERIC |
No |
|
|
|
| The Coordination of Benefits (COB) savings member payout. |
|
|
| 79 |
PAT_PAY_ADJ_STR |
VARCHAR |
No |
|
|
|
| The patient payment adjudication string. |
|
|
| 80 |
ALWD_AMT_ADJ_STR |
VARCHAR |
No |
|
|
|
| The allowed amount adjudication string. |
|
|
| 81 |
CMG_MATCHED_ID |
VARCHAR |
No |
|
|
|
| Stores the matched component group for referral bed days for this service. |
|
|
| 82 |
CMG_MATCHED_ID_COMPONENT_GRP_NAME |
VARCHAR |
No |
|
|
|
| The name of the component group |
|
|
| 83 |
NPR_BDTABLE_LINE |
NUMERIC |
No |
|
|
|
| The line number of the bed days mapping table in the Tapestry Profile (I NPR 41040) on which the procedure matched. |
|
|
| 84 |
REL_WT_BED_DAY |
NUMERIC |
No |
|
|
|
| Relative weight of the bed day type mapped to this service. |
|
|
| 85 |
RFL_MATCHED_ID |
NUMERIC |
No |
|
|
|
| Referral matched for service. |
|
|
| 86 |
TOD_MATCHED_ID |
NUMERIC |
No |
|
|
|
| Bed day type matched for service. |
|
|
| 87 |
TOD_MATCHED_ID_BED_DAY_TYPE_NAME |
VARCHAR |
No |
|
|
|
| The name of the bed day type record (i.e. ICU or non-authorized.) |
|
|
| 88 |
WEIGHT_BED_DAYS |
NUMERIC |
No |
|
|
|
| Weight of bed days for service. |
|
|
| 89 |
UBC_REVENUE_CODE_ID |
NUMERIC |
No |
|
|
|
| The unique identifier of the revenue code/procedure associated with the accounts payable claim record. |
|
|
| 90 |
UBC_REVENUE_CODE_ID_REVENUE_CODE_NAME |
VARCHAR |
No |
|
|
|
| The name of the revenue code. |
|
|
| 91 |
CLAIM_ID |
NUMERIC |
No |
|
|
|
| The claim to which this service associated. For most claim services, this column is equivalent to joining this table's TX_ID column to AP_CLAIM_PROC_IDS.TX_ID and retrieving AP_CLAIM_PROC_IDS.CLAIM_ID. For services related to Cost Sharing Reduction (CSR), this column is equivalent to joining this table's TX_ID column to AP_CLAIM_PROC_IDS_CSR.TX_ID and retrieving AP_CLAIM_PROC_IDS_CSR.CLAIM_ID. To retrieve the ordering of service lines on a claim, join to AP_CLAIM_PROC_IDS or AP_CLAIM_PROC_IDS_CSR as appropriate and retrieve the LINE column. |
|
|
| 92 |
PEN_AFT_BEN_COMPUTED |
NUMERIC |
No |
|
|
|
| The after benefits provider penalty amount for the procedure, as computed by the system. |
|
|
| 93 |
PEN_AFT_BEN_OVRIDE |
NUMERIC |
No |
|
|
|
| The after benefits provider penalty amount for the procedure, as overridden by the user. |
|
|
| 94 |
PEN_AFT_BEN_OVRIDE_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| The reason given for setting the provider penalty after benefits override, if any. This should be translated using ZC_PEN_AFT_BEN_OVRIDE_RSN. |
| May contain organization-specific values: Yes |
|
|
| 95 |
POS_TYPE_SRC_C_NAME |
VARCHAR |
No |
|
|
|
| Source of the procedure's Place of Service type |
| May contain organization-specific values: No |
| Category Entries: |
| Profile |
| User |
| Batch Type Definition |
|
|
| 96 |
OVERRIDE_UC_VALUE |
NUMERIC |
No |
|
|
|
| The amount that overrides the usual and customary amount for the procedure. |
|
|