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.