AP_CLAIM_PROC_2
Description:
This table summarizes data for AP Claims service lines, with each service line given one row.
To link this table’s service line information back to a claim header, join this table to AP_CLAIM_PROC_IDS on the TX_ID column. If you need to report on claim service lines specific to Cost Sharing Reduction (CSR), join this table instead to AP_CLAIM_PROC_IDS_CSR on the TX_ID column.

Primary Key
Column Name Ordinal Position
TX_ID 1

Column Information
Name Type Discontinued?
1 TX_ID NUMERIC No
The unique ID of the AP Claim procedure transaction.
2 PAT_PAY_CMP_CMG VARCHAR No
The component or component group used to determine the patient portion on service line of the AP claim.
3 PAT_PAY_CMP_CMG_COMPONENT_INDEX_NAME VARCHAR No
The name of the component index record
4 PAT_PAY_CML_LN VARCHAR No
The line of the adjudication table that was used to determine the patient portion of the service line on the AP Claim.
5 PAT_PAY_NET VARCHAR No
The network status of the service line on the AP claim. This column can be joined to column IN_OUT_NET_C in table ZC_IN_OUT_NET in order to translate the category value to the corresponding name or abbreviation.
6 PAT_PAY_CMT NUMERIC No
The benefit tier that was used to determine the patient portion of the service line on the AP Claim.
7 PAT_PAY_CMT_COMPON_TIER_NAME VARCHAR No
The name of the tier record.
8 PAT_PAY_RFL NUMERIC No
The referral attached to the AP claim.
9 PAT_PAY_CMA NUMERIC No
The adjudication formula used to determine the patient portion of the service on the AP claim.
10 PAT_PAY_CMA_ADJUD_FORMULA_NAME VARCHAR No
The name of the adjudication formula
11 PAT_PAY_CMK NUMERIC No
The benefit package used to determine the patient portion of the service line on the AP Claim.
12 PAT_PAY_CMK_BENEFIT_PACKAGE_NM VARCHAR No
The name of the benefit package.
13 PAT_PAY_EPP_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
14 PAT_PAY_COPAY_CAT VARCHAR No
The copay category used in adjudicating the service line of the AP claim. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_COPAY_SERVICE_TYPE_ID.
15 PAT_PAY_DEP_SPEC INTEGER No
The department specialty of the AP claim. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_SPECIALTY_DEP_C.
16 PAT_PAY_PT_AMT VARCHAR No
The patient portion for the service line on the AP claim.
17 PAT_PAY_SRC VARCHAR No
The source of the copay or coinsurance value for the service line on the AP claim. If equal to 1, the value comes from the benefit plan. If equal to a value other than 1, the value comes from a coverage-level override. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_COPAY_AMT_SRC_C.
18 PAT_PAY_COPAY_FLAG VARCHAR No
Stores 1 if the copay was collected at check-in. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_COPAY_COL_SRC_C.
19 PAT_PAY_AUTH INTEGER No
Indicates whether authorization is required for the service line on the AP Claim.
20 PAT_PAY_CFR VARCHAR No
The benefit referral classifier record that was used to determine the patient portion of the service line on the AP Claim.
21 PAT_PAY_CFR_CLASSIFIER_NAME VARCHAR No
The title of the classifier record.
22 PAT_PAY_RFL_LST VARCHAR No
The list of referrals associated with the service line on the AP Claim. This column will be deprecated in a future release and replaced by the Clarity table AP_CLM_PX_PAT_PAY_RFL.
23 PAT_PAY_CML NUMERIC No
The adjudication table used to determine the patient portion of the service line on the AP Claim.
24 PAT_PAY_CML_ADJ_TABLE_NAME VARCHAR No
The name of the adjudication table.
25 PAT_PAY_LFTM_MAX_EX INTEGER No
Stores 1 if the patient's lifetime maximum has been exceeded and null otherwise.
26 PAT_PAY_QTY VARCHAR No
The service line quantity used to adjudicate the AP Claim.
27 ALWD_AMT_ADJ_CMP VARCHAR No
The component or component group from the contract that was used to adjudicate the allowed amount of the service on the AP Claim.
28 ALWD_AMT_ADJ_CMP_COMPONENT_INDEX_NAME VARCHAR No
The name of the component index record
29 ALWD_AMT_ADJ_NCC NUMERIC No
The vendor contract record that was used to determine the allowed amount of the service line on the AP Claim.
30 ALWD_AMT_ADJ_NCC_CONTRACT_NAME VARCHAR No
The name of the Vendor-Network contract.
31 ALWD_AMT_NCC_DAT DATETIME No
The contact date of the vendor contract that was used to determine the allowed amount of the service line on the accounts payable claim record.
32 ALWD_AMT_ADJ_NCC_LN VARCHAR No
The line of the vendor contract that was used to determine the allowed amount of the service line on the AP Claim.
33 ALWD_AMT_ADJ_EAP_PROC_NAME VARCHAR No
The name of each procedure.
34 ALWD_AMT_ADJ_ERX_MEDICATION_NAME VARCHAR No
The name of this medication record.
35 ALWD_AMT_ADJ_DRG VARCHAR No
The DRG record used to determine the allowed amount of the service line on the AP Claim.
36 ALWD_AMT_ADJ_DRG_DRG_NAME VARCHAR No
The name of the Diagnoses Related Group name.
37 ALWD_AMT_ADJ_CMC_COMP_GRP_NAME VARCHAR No
The name for the whole claim component group.
38 ALWD_AMT_ADJ_CMC_LN VARCHAR No
The service line from the AP Claim that matched the whole claim component group.
39 SECTION_340B_YN VARCHAR No
Stores Y or N that indicates whether or not the drug was dispensed under the Section 340B Program for NDCs.
May contain organization-specific values: No
Category Entries:
No
Yes
40 COB_AMOUNT NUMERIC No
The calculated Coordination of Benefits (COB) amount for the service line.
41 MOB_AMOUNT NUMERIC No
The calculated Maintenance of Benefits (MOB) amount for the service line.
42 SRC_TYPE_OF_SVC_C_NAME VARCHAR No
The data source for the type of service.
May contain organization-specific values: No
Category Entries:
NO_TOS
TOS_FROM_PROCEDURE
TOS_FROM_MODIFIER
TOS_FROM_USER
43 CLM_BEN_BKT_DATE DATETIME No
The date the claim was applied to a benefit bucket.
44 PRS_CRWN_INLAY_CD_C_NAME VARCHAR No
This is the prosthesis, crown, or inlay code for the service.
May contain organization-specific values: No
Category Entries:
I - Initial Placement
R - Replacement
45 PRIOR_PLACEMENT_DT DATETIME No
This stores the prior placement date (PPD) for a dental claim. The PPD is used for replacement procedures to note when the prosthesis being replaced was previously installed.
46 APPLIANCE_PLACE_DT DATETIME No
The date orthodontic appliances were placed.
47 REPLACEMENT_DT DATETIME No
Date when orthodontic appliance was replaced.
48 AMBU_TXPORT_WT NUMERIC No
The weight of the patient during ambulance transport.
49 AMBU_TXPORT_RSN_C_NAME VARCHAR No
The ambulance transport reason code.
May contain organization-specific values: Yes
Category Entries:
Nearest Facility for Care of Symptoms, Complaints, or Both
For the Benefit of a Preferred Physician
For the Nearness of Family Members
For the Care of a Specialist or for Availability of Specialized Equipment
Rehabilitation Facility
50 AMBU_TXPORT_DIST NUMERIC No
The ambulance transport distance.
51 AMBU_PAT_CNT INTEGER No
The number of patients in the ambulance.
52 AMBU_PICK_UP_CITY VARCHAR No
The city of the ambulance pick-up location.
53 AMBU_PICK_UP_STAT_C_NAME VARCHAR No
The state of the ambulance pick-up location.
May contain organization-specific values: Yes
54 AMBU_PICK_UP_ZIP VARCHAR No
The zip code of the ambulance pick-up location.
55 AMBU_DROP_OFF_CITY VARCHAR No
The city of the ambulance drop-off location.
56 AMBU_DROP_OFF_STA_C_NAME VARCHAR No
The state of the ambulance drop-off location.
The category values for this column were already listed for column: AMBU_PICK_UP_STAT_C_NAME
57 AMBU_DROP_OFF_ZIP VARCHAR No
The zip code of the ambulance drop-off location.
58 AMBU_DROP_OFF_NAME VARCHAR No
The name of the ambulance drop-off location.
59 AMBU_PICK_UP_COUNTRY_C_NAME VARCHAR No
Stores the unique identifier for the country associated with the ambulance pick-up location. Join this column to ZC_COUNTRY_2 to translate to the country name.
May contain organization-specific values: Yes
60 AMBU_PICK_UP_COUNTY_C_NAME VARCHAR No
Stores the unique identifier for the county associated with the ambulance pick-up location. Join this column ZC_COUNTY_2 to translate to the county name.
May contain organization-specific values: Yes
61 AMBU_PICK_UP_DISTRICT_C_NAME VARCHAR No
Stores the unique identifier for the district associated with the ambulance pick-up location. Join this column to ZC_DISTRICT to translate to the district name.
May contain organization-specific values: Yes
62 AMBU_PICK_UP_HOUSE_NUM VARCHAR No
Stores the house number associated with the ambulance pick-up location.
63 AMBU_DROP_OFF_COUNTRY_C_NAME VARCHAR No
Stores the unique identifier for the country associated with the ambulance drop-off location. Join this column to ZC_COUNTRY_2 to translate to the country name.
The category values for this column were already listed for column: AMBU_PICK_UP_COUNTRY_C_NAME
64 AMBU_DROP_OFF_COUNTY_C_NAME VARCHAR No
Stores the unique identifier for the county associated with the ambulance drop-off location. Join this column to ZC_COUNTY_2 to translate to the county name.
The category values for this column were already listed for column: AMBU_PICK_UP_COUNTY_C_NAME
65 AMBU_DROP_OFF_DISTRICT_C_NAME VARCHAR No
Stores the unique identifier for the district associated with the ambulance drop-off location. Join this column to ZC_DISTRICT to translate to the district name.
The category values for this column were already listed for column: AMBU_PICK_UP_DISTRICT_C_NAME
66 AMBU_DROP_OFF_HOUSE_NUM VARCHAR No
Stores the house number associated with the ambulance drop-off location.
67 CLAIM_LN_DTL_SVC_CLASS_C_NAME VARCHAR No
Represents a clinical classification of the billed service.
May contain organization-specific values: No
Category Entries:
Emergency
Durable Medical Equipment
Radiology
Anesthesia
Pharmacy
Medical/Surgical Supplies
Surgery
Observation
Nursery
Room and Board
Behavioral Health
Ambulatory Surgery Center
Oncology
Cardiology
Pulmonary
Gastrointestinal
Nuclear Medicine
Electrocardiogram
Urgent Care
Home Health
Ambulance
Skilled Nursing
Dialysis
Physical Therapy
Occupational Therapy
Speech Pathology
Rehabilitation
Transplant
Pharmacy - High Cost
Blood
Diagnostic Services
Evaluation and Management
Immunizations and Vaccines
Medicine Services and Procedures
Pathology and Laboratory Procedures
Hearing Services
Physician-Administered Medications
Telemedicine
Laboratory
Home Hospice
Inpatient Hospice
Not Classified
68 PAT_PAY_COPAY_SERVICE_TYPE_ID VARCHAR No
The copay category used in adjudicating the service line.
69 PAT_PAY_COPAY_SERVICE_TYPE_ID_SERVICE_TYPE_NAME VARCHAR No
The name of this benefit service type.
70 PAT_PAY_SPECIALTY_DEP_C VARCHAR No
The specialty of the department where the service was rendered.
71 PAT_PAY_COPAY_AMT_SRC_C INTEGER No
The source of the copay amount as determined during adjudication.
72 PAT_PAY_COPAY_COL_SRC_C INTEGER No
The location where the copay was collected as determined during adjudication.
73 PAT_PAY_PROC_SEQ_NUM INTEGER No
The service's place in the adjudication order.
74 PAT_PAY_COB_FROM_OTH_LINES_AMT NUMERIC No
The coordination of benefits (COB) amount for this service that was transferred from other services on the same claim.
75 PAT_PAY_COB_TO_OTH_LINES_AMT NUMERIC No
The coordination of benefits (COB) amount for this service that was transferred to other services on the same claim.
76 PAT_PAY_HRA_DEF_ID NUMERIC No
The ID of the Health Reimbursement Arrangement (HRA) plan used to adjudicate the claim.
77 PAT_PAY_HRA_DEF_ID_HRA_DEF_NAME VARCHAR No
Record name.
78 PAT_PAY_HRA_ACCUMULATE_BY_C INTEGER No
The family type from the Health Reimbursement Arrangement (HRA) used when adjudicating the claim.
79 PAT_PAY_ADJ_BEN_CHECK_TYPE_C INTEGER No
The type of benefits check performed when calculating the patient portion.
80 PAT_PAY_CHECKED_FOR_AUTH_FLAG INTEGER No
Indicates whether authorizations were checked during adjudication.
81 PAT_PAY_MATCHED_CMG_LINE INTEGER No
The line of the component group that was matched during adjudication if the service was matched to a component group.
82 PAT_PAY_CMP_CONTACT_DATE DATETIME No
The contact date of the component that was matched during adjudication if the service was matched to a component.
83 PAT_PAY_BEN_PLAN_CONTACT_DATE DATETIME No
The contact date of the benefit plan that was used during adjudication.