AP_CLAIM_PX_SL_LEVELS

Description:

This table contains the allowed amount adjudication levels for AP Claim service lines before stop loss was applied. 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
LINE	2

Column Information

	Name	Type	Discontinued?
1	TX_ID	NUMERIC	No
	The unique ID of the AP Claim procedure transaction.
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	PRE_STOP_LOSS_LEVEL	VARCHAR	No
	The allowed amount adjudication levels the procedure would have had if stop loss was not applied. Information from this caret delimited string is parsed out in subsequent columns.
4	PRE_STOP_LOSS_PMT_LV	VARCHAR	No
	The level of payment for the allowed amount of the service line on the AP Claim had stop loss not been applied.
5	PRE_STOP_LOSS_CVD	VARCHAR	No
	The covered number of procedures or units of the allowed number of procedures or units for the service line of the AP Claim had stop loss not been applied.
6	PRE_STOP_LOSS_LM_TYP	INTEGER	No
	The limit type (such as procedure dollar amount or procedure count) of the allowed amount of the service line on the AP Claim had stop loss not been applied. This column is frequently used to link to the ZC_PROV_CONT_LM_TY table.
7	PRE_STOP_LOSS_PMT_MECH	INTEGER	No
	The payment mechanism for the allowed amount of the service line on the AP Claim had stop loss not been applied. This column is frequently used to link to the ZC_SVC_PAY_MECH table.
8	PRE_STOP_LOSS_FSC	VARCHAR	No
	The ID of the fee schedule used to determine the allowed amount of the service line on the AP Claim had stop loss not been applied.
9	PRE_STOP_LOSS_FSC_FEE_SCHEDULE_NAME	VARCHAR	No
	The name of each fee schedule.
10	PRE_STOP_LOSS_PRICE	VARCHAR	No
	The price of the service line allowed amount on the AP Claim had stop loss not been applied.
11	PRE_STOP_LOSS_RATE	VARCHAR	No
	The Diagnosis Related Group (DRG) rate used in determining the allowed amount of the service line on the AP Claim had stop loss not been applied.
12	PRE_STOP_LOSS_HMU	VARCHAR	No
	The ID of the conversion factor table used to price a service line using Relative Value Unit (RVU) pricing had stop loss not been applied.
13	PRE_STOP_LOSS_HMU_TABLE_NAME	VARCHAR	No
	The name for the conversion factor table.
14	PRE_STOP_LOSS_TOS	INTEGER	No
	The type of service used to get the conversion factor in Relative Value Unit (RVU) pricing had stop loss not been applied.
15	PRE_STOP_LOSS_UNITS	VARCHAR	No
	The total number of time units used to determine the price of an anesthesia procedure on an AP Claim had stop loss not been applied.
16	PRE_STOP_LOSS_DSCNT	VARCHAR	No
	Discount percentage used in calculating the allowed amount of the service line on the AP Claim had stop loss not been applied.
17	PRE_STOP_LOSS_MULT	VARCHAR	No
	The multiplier or conversion factor value used in calculating the allowed amount of the service line on the AP Claim had stop loss not been applied.
18	PRE_STOP_LOSS_RVU_VALUE	VARCHAR	No
	The Relative Value Unit (RVU) value of the procedure on the service line of the AP Claim had stop loss not been applied.
19	PRE_STOP_LOSS_LPP_CMMT	VARCHAR	No
	The comment added by the pricing extension, which was used to determine the allowed amount of the service line on the AP Claim had stop loss not been applied.
20	PRE_STOP_LOSS_FSM	NUMERIC	No
	The ID of the fee schedule map used to determine the allowed amount of the service line on the AP Claim had stop loss not been applied.
21	PRE_STOP_LOSS_FSM_FEE_SCHEDULE_MAP_NAME	VARCHAR	No
	The name for the fee schedule map record.
22	PRE_STOP_LOSS_ZIP	VARCHAR	No
	When a fee schedule map is used to determine the allowed amount of the service line on the AP claim, this column contains the postal code where the service was performed had stop loss not been applied.