|
Name |
Type |
Discontinued? |
|
| 1 |
CLAIM_ID |
NUMERIC |
No |
|
|
|
| The unique identifier for the claim record. |
|
|
| 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 |
TX_HX_TIME_SAVE_TM |
DATETIME (Local) |
No |
|
|
|
| The time the record was saved. |
|
|
| 4 |
TX_HX_PROC_ID_PROC_NAME |
VARCHAR |
No |
|
|
|
| The name of each procedure. |
|
|
| 5 |
TX_HX_SVC_FROM_DT |
DATETIME |
No |
|
|
|
| Transaction history service from date. |
|
|
| 6 |
TX_HX_SVC_TO_DT |
DATETIME |
No |
|
|
|
| Transaction history service to date. |
|
|
| 7 |
TX_HX_PROC_HX |
NUMERIC |
No |
|
|
|
| The history of the procedure on previous versions of the service line. |
|
|
| 8 |
TX_HX_DX_CODES |
VARCHAR |
No |
|
|
|
| The history of diagnosis codes on previous versions of the service line. |
|
|
| 9 |
TX_HX_AMT_BILLED |
NUMERIC |
No |
|
|
|
| The history of the amount billed on previous versions of the service line. |
|
|
| 10 |
TX_HX_ALLOWED_AMT |
NUMERIC |
No |
|
|
|
| The history of the allowed amount on previous versions of the service line. |
|
|
| 11 |
TX_HX_PAT_AMT |
NUMERIC |
No |
|
|
|
| Patient portion of the bill. |
|
|
| 12 |
TX_HX_WITHHOLDINGS |
NUMERIC |
No |
|
|
|
| The history of the withheld amount on previous versions of the service line. |
|
|
| 13 |
TX_HX_DISCOUNTS |
NUMERIC |
No |
|
|
|
| The history of the discount amount on previous versions of the service line. |
|
|
| 14 |
TX_HX_NET_PAYABLE |
NUMERIC |
No |
|
|
|
| The history of the net payable amount on previous versions of the service line. |
|
|
| 15 |
TX_HX_NUM_ID |
NUMERIC |
No |
|
|
|
| Transaction history number in the claim procedure history. |
|
|
| 16 |
TX_HX_TX_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
| AP claims transaction type (for procedure history). |
| 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 |
|
|
| 17 |
TX_HX_MED_ID_MEDICATION_NAME |
VARCHAR |
No |
|
|
|
| The name of this medication record. |
|
|
| 18 |
TX_HX_REV_CODE_ID_PROC_NAME |
VARCHAR |
No |
|
|
|
| The name of each procedure. |
|
|
| 19 |
TX_HX_SVC_START_TM |
DATETIME (Local) |
No |
|
|
|
| Transaction history service start time. |
|
|
| 20 |
TX_HX_SVC_END_TIME |
DATETIME (Local) |
No |
|
|
|
| Transaction history service end time. |
|
|
| 21 |
TX_HX_SVC_ELPSD_TM |
INTEGER |
No |
|
|
|
| Transaction history service elapsed time. |
|
|
| 22 |
TX_HX_DRG_CODE_ID |
VARCHAR |
No |
|
|
|
| Diagnosis Related Group (DRG) code history item. |
|
|
| 23 |
TX_HX_DRG_CODE_ID_DRG_NAME |
VARCHAR |
No |
|
|
|
| The name of the Diagnoses Related Group name. |
|
|
| 24 |
PX_HX_EOB_COMMENT |
VARCHAR |
No |
|
|
|
| Claim procedure history Explanation of Benefits (EOB) comments. |
|
|
| 25 |
TX_HX_POS_TYPES_C_NAME |
VARCHAR |
No |
|
|
|
| Claim procedure history place of service types. |
| 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 |
|
|
| 26 |
TX_HX_TOS_C_NAME |
VARCHAR |
No |
|
|
|
| Claim procedure history type of service. |
| 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 |
|
|
| 27 |
TX_HX_PRIM_INS_AMT |
NUMERIC |
No |
|
|
|
| Insurance amount from primary for history. |
|
|
| 28 |
TX_HX_PRIM_PAT_PRT |
NUMERIC |
No |
|
|
|
| Patient portion from primary for history. |
|
|
| 29 |
PX_HX_OVRID_AMT_C |
NUMERIC |
No |
|
|
|
| Procedure history for override allowed amounts. |
|
|
| 30 |
PX_HX_OVRID_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| Reason the allowed amount was overridden. |
| May contain organization-specific values: Yes |
|
|
| 31 |
TX_HX_ALLW_CODES_C_NAME |
VARCHAR |
No |
|
|
|
| Procedure history allowed codes. |
| 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 |
|
|
| 32 |
PROC_HX_PAT_CODE_C_NAME |
VARCHAR |
No |
|
|
|
| Procedure history patient portion codes. |
| May contain organization-specific values: No |
| Category Entries: |
| Co-ins |
| Copay |
| Not Covered |
| No Patient Payment |
|
|
| 33 |
TX_HX_CMPTD_WTHLD |
NUMERIC |
No |
|
|
|
| Computed withholding history. |
|
|
| 34 |
TX_HX_WTHLD_MTHD_C_NAME |
VARCHAR |
No |
|
|
|
| Withhold method history. |
| May contain organization-specific values: No |
| Category Entries: |
| Percentage of Net Insurance |
| Fixed Amount |
| Extension |
| None |
| Percentage of Allowed Amount |
|
|
| 35 |
TX_HX_WTHLD_RATE |
VARCHAR |
No |
|
|
|
|
| 36 |
TX_HX_INS_AMT |
NUMERIC |
No |
|
|
|
| Net insurance amount history. |
|
|
| 37 |
TX_HX_NET_INS_AMT |
NUMERIC |
No |
|
|
|
| Net Insurance amount history |
|
|
| 38 |
TX_HX_COMPUTED_ADJ |
NUMERIC |
No |
|
|
|
| Computed adjustment history. |
|
|
| 39 |
TX_HX_ACTUAL_ADJ |
NUMERIC |
No |
|
|
|
| Actual adjustment history. |
|
|
| 40 |
TX_HX_ADJ_REASON_C_NAME |
VARCHAR |
No |
|
|
|
| Adjustment reason history. |
| 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 |
|
|
| 41 |
TX_HX_CODE_EDT_SAV |
NUMERIC |
No |
|
|
|
| Transaction history code edit savings. |
|
|
| 42 |
TX_HX_U_AND_C_AMT |
NUMERIC |
No |
|
|
|
| Usual and customary amount history. |
|
|
| 43 |
TX_HX_CONTRACT_AMT |
NUMERIC |
No |
|
|
|
| Contractual amount history. |
|
|
| 44 |
TX_HX_DISALOWED_AMT |
NUMERIC |
No |
|
|
|
| Disallowed amount history. |
|
|
| 45 |
TX_HX_NOT_COVERED |
NUMERIC |
No |
|
|
|
|
| 46 |
TX_HX_DEDUCTIBLE |
NUMERIC |
No |
|
|
|
| The history of the deductible amount on previous versions of the service line. |
|
|
| 47 |
TX_HX_COPAY |
NUMERIC |
No |
|
|
|
| The history of the copay amount on previous versions of the service line. |
|
|
| 48 |
TX_HX_COINS |
NUMERIC |
No |
|
|
|
|
| 49 |
TX_HX_PAT_TOTAL |
NUMERIC |
No |
|
|
|
|
| 50 |
TX_HX_BFR_BEN_PEN |
NUMERIC |
No |
|
|
|
| History before benefit penalty. |
|
|
| 51 |
TX_HX_AFTR_BEN_PEN |
NUMERIC |
No |
|
|
|
| History after benefit penalty. |
|
|
| 52 |
TX_HX_EXCD_BEN_AMT |
NUMERIC |
No |
|
|
|
| Exceeded benefit amount history. |
|
|
| 53 |
TX_HX_OVRIDE_DIS_C_NAME |
VARCHAR |
No |
|
|
|
| Override disallowed reason history. |
| May contain organization-specific values: Yes |
|
|
| 54 |
TX_HX_OVRD_DA_AMT |
NUMERIC |
No |
|
|
|
| Override disallowed amount history. |
|
|
| 55 |
TX_HX_OVRD_NC_AMT |
NUMERIC |
No |
|
|
|
| Override not covered amount history. |
|
|
| 56 |
TX_HX_OVRD_DEDUCT |
NUMERIC |
No |
|
|
|
| Override deductible history. |
|
|
| 57 |
TX_HX_OVRIDE_COINS |
NUMERIC |
No |
|
|
|
| Override co-insurance history. |
|
|
| 58 |
TX_HX_OVRIDE_COPAY |
NUMERIC |
No |
|
|
|
|
| 59 |
TX_HX_OVRD_PTAMT_C_NAME |
VARCHAR |
No |
|
|
|
| Override patient amount reason history. |
| May contain organization-specific values: Yes |
|
|
| 60 |
TX_HX_OVRD_PATPO |
NUMERIC |
No |
|
|
|
| Override patient portion history. |
|
|
| 61 |
TX_HX_COB_SAV_AMT |
NUMERIC |
No |
|
|
|
| Coordination of Benefits (COB) Saving amount history. |
|
|
| 62 |
TX_HX_OVRD_BEN_AMT |
NUMERIC |
No |
|
|
|
| Override exceeded benefit amount for transaction history. |
|
|
| 63 |
TX_HX_PRICE_ATTR_C_NAME |
VARCHAR |
No |
|
|
|
| Pricing attribute for transaction history. |
| May contain organization-specific values: Yes |
| Category Entries: |
| PCP |
| Specialist |
|
|
| 64 |
TX_HX_PAT_OUTOF_PC |
NUMERIC |
No |
|
|
|
| Patient out of pocket history. |
|
|
| 65 |
TX_HX_SAVED_DT |
DATETIME |
No |
|
|
|
| The date the transaction history was saved. |
|
|
| 66 |
TX_HX_USER_ID |
VARCHAR |
No |
|
|
|
| Specifies the transaction history user. |
|
|
| 67 |
TX_HX_USER_ID_NAME |
VARCHAR |
No |
|
|
|
| The name of the user record. This name may be hidden. |
|
|
| 68 |
TX_HX_UBC_REVCOD_ID |
VARCHAR |
No |
|
|
|
| This column holds the transaction history for revenue codes in UB Claims. It stores the record ID (this is found in the revenue code master file; it is not the actual revenue code) for revenue codes that were previously entered on the claim. |
|
|
| 69 |
TX_HX_UBC_REVCOD_ID_REVENUE_CODE_NAME |
VARCHAR |
No |
|
|
|
| The name of the revenue code. |
|
|
| 70 |
TX_HX_REIMB_AMT |
NUMERIC |
No |
|
|
|
| Healthcare reimbursement amount history. |
|
|
| 71 |
TX_HX_OVRD_RIMB_AMT |
NUMERIC |
No |
|
|
|
| Override reimbursement amount history. |
|
|
| 72 |
TX_HX_SYS_ADJ_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| System adjustment reason history. |
| The category values for this column were already listed for column: TX_HX_ADJ_REASON_C_NAME |
|
|
| 73 |
TX_HX_AFT_BEN_PEN_OVRIDE |
NUMERIC |
No |
|
|
|
| Override after benefits penalty history. |
|
|
| 74 |
TX_HX_AFT_BEN_PEN_OVRIDE_RSN_C_NAME |
VARCHAR |
No |
|
|
|
| Override after benefits penalty reason history. This should be translated using ZC_PEN_AFT_BEN_OVRIDE_RSN. |
| May contain organization-specific values: Yes |
|
|
| 75 |
TX_HX_COB_SAVINGS_PAYOUT |
NUMERIC |
No |
|
|
|
| COB savings payout history |
|
|