AP_CLAIM_PROC_5
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 identifier (.1 item) for the transaction record.
2 ASSISTANT_DENTAL_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
3 ASSISTANT_DENTAL_PROV_TAXONOMY VARCHAR No
The taxonomy code for the assistant dental physician associated with the service.
4 RENDERING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
5 RENDERING_PROV_TAXONOMY VARCHAR No
The taxonomy code for the rendering provider associated with the service.
6 PURCHASED_SERVICE_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
7 SUPERVISING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
8 ORDERING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
9 REFERRING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
10 OPERATING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
11 OTHER_OPERATING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
12 AUTH_DENIED_YN VARCHAR No
Set if the service line was denied during adjudication because the counting requirements for the line could not be fulfilled and there is an attached service authorization with a status of denied.
May contain organization-specific values: No
Category Entries:
No
Yes
13 FEDERAL_SERVICE_CODE VARCHAR No
Code indicating the type of service, as defined in the CMS Medicare Carrier Manual, for this service line on the claim.
14 PRIMARY_PAYER_CODE VARCHAR No
The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the service line on the claim. The presence of this code indicates that some other payer besides Medicare covered at least some portion of the charges.
15 HCPCS_BETOS_CODE VARCHAR No
The Berenson-Eggers Type of Service (BETOS) classification assigned to the Healthcare Common Procedure Coding System (HCPCS) code for the service line.
16 SVC_AUTH_REQ_COMPONENT_ID VARCHAR No
The UAR service authorization matched component. This is populated from the matched component in I NEC 84010 during adjudication.
17 SVC_AUTH_REQ_COMPONENT_ID_COMPONENT_NAME VARCHAR No
The name of the component
18 PROV_AUTH_REQ_COMPONENT_ID VARCHAR No
The UAR provider authorization matched component. This is populated from the matched component in I NEC 84040 during adjudication.
19 PROV_AUTH_REQ_COMPONENT_ID_COMPONENT_NAME VARCHAR No
The name of the component
20 SAR_CONS_CLASSIFIER_ID VARCHAR No
The Service Constraints Classifier from the matched NEC line describing constraints on the service.
21 SAR_CONS_CLASSIFIER_ID_CLASSIFIER_NAME VARCHAR No
The title of the classifier record.
22 SAR_REQUIREMENTS_NETWORK_C_NAME NUMERIC No
The Network Requirements on the servicing / performing provider for authorization from the matched NEC line.
May contain organization-specific values: No
Category Entries:
No Network Requirements
Out of Network OR Network Status Unknown
In Network
23 SAR_AUTH_REQ_YN VARCHAR No
This item stores whether authorization is required for this service line, taken from the matched NEC line.
The category values for this column were already listed for column: AUTH_DENIED_YN
24 SAR_BEN_CLASSIFIER_ID VARCHAR No
This item stores a Benefit Referral Classifier which a referral must satisfy to match against a claim in claim adjudication. This value is taken from the matched NEC line.
25 SAR_BEN_CLASSIFIER_ID_CLASSIFIER_NAME VARCHAR No
The title of the classifier record.
26 SAR_EOB_CODE_ID_EOB_CODE_NAME VARCHAR No
The name of the processing code.
27 SAR_CVG_REQ_C_NAME NUMERIC No
Primary/non-primary coverage requirement category from the matched Service Authorization Requirement NEC line.
May contain organization-specific values: No
Category Entries:
All
Primary
Not Primary
28 PAR_CONS_CLASSIFIER_ID VARCHAR No
The Service Constraints Classifier describing constraints on the service, taken from the matched NEC line.
29 PAR_CONS_CLASSIFIER_ID_CLASSIFIER_NAME VARCHAR No
The title of the classifier record.
30 PAR_REQUIREMENTS_NETWORK_C_NAME NUMERIC No
The network requirements for provider authorization requirements.
The category values for this column were already listed for column: SAR_REQUIREMENTS_NETWORK_C_NAME
31 PAR_AUTHORIZATION_REQT_C_NAME NUMERIC No
Whether authorization is required for this service when performed by this provider, taken from the matched NEC line.
May contain organization-specific values: No
Category Entries:
Default Authorization Requirement
No Authorization Required
Auto-Authorized
32 PAR_SVC_PROV_COMPONENT_ID VARCHAR No
Stores the servicing provider component from the matched NEC line. This component identifies the servicing provider records or identifiers that the authorization requirement applies to.
33 PAR_SVC_PROV_COMPONENT_ID_COMPONENT_NAME VARCHAR No
The name of the component
34 PAR_REF_PROV_COMPONENT_ID VARCHAR No
Stores the referring provider component from the matched NEC line. This component identifies the referring provider records or identifiers that the authorization requirement applies to.
35 PAR_REF_PROV_COMPONENT_ID_COMPONENT_NAME VARCHAR No
The name of the component