AP_CLM_RX
Description:
This table contains information from pharmacy claims. Each record represents one pharmacy claim in the managed care system's AP Claims module.

Primary Key
Column Name Ordinal Position
CLAIM_ID 1

Column Information
Name Type Discontinued?
1 CLAIM_ID NUMERIC No
The unique identifier for the claim info record
2 RX_BATCH_NUM VARCHAR No
National Council for Prescription Drug Programs (NCPDP) file batch number
3 RX_SUBMISSION_NUM INTEGER No
NCPDP file submission number.
4 RECORD_STATUS_EXT_CODE_LST_ID NUMERIC No
Identifies the status of the pharmacy claim (paid, reversed, canceled, etc.). The record status code can be retrieved by joining this column to the EXT_CODE_LST_ID column in table FCL_EXTRNL_CDE_LST.
5 RECORD_STATUS_EXT_CODE_LST_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
6 REJECT_OVRIDE_EXT_CODE_LST_ID NUMERIC No
Indicates reason for paying a pharmacy claim when override is used. The reject override code can be retrieved by joining this column to the EXT_CODE_LST_ID column in table FCL_EXTRNL_CDE_LST.
7 REJECT_OVRIDE_EXT_CODE_LST_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
8 PHARMACY_ID NUMERIC No
Pharmacy associated to the claim.
9 PHARMACY_ID_PHARMACY_NAME VARCHAR No
The name of the pharmacy.
10 PRESC_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 PRESC_PROV_TAXONOMY VARCHAR No
Stores the prescribing provider's taxonomy code for pharmacy claims.
12 TTL_INGRED_COST_PAID NUMERIC No
Drug ingredient cost paid.
13 TTL_DISPENSING_FEE_PAID NUMERIC No
Dispensing fee paid.
14 TTL_REG_TAX_AMT_PAID NUMERIC No
Flat sales tax amount paid.
15 TTL_PCT_TAX_AMT_PAID NUMERIC No
Percentage tax amount paid.
16 TTL_INCENTIVE_AMT_PAID NUMERIC No
Incentive amount paid.
17 TTL_PROF_SVC_FEE_PAID NUMERIC No
Professional service fee paid.
18 OTHER_AMT_RECOGNIZED NUMERIC No
Total amount recognized by the processor of any payment from another source.
19 ALTERNATE_CLM_IDENT VARCHAR No
Alternate Claim ID
20 REF_CLAIM_IDENT VARCHAR No
Reference claim ID for the original claim
21 WORKFLOW_C_NAME VARCHAR No
Claim workflow type (AP claim, paid claim, estimate claim, etc.)
May contain organization-specific values: Yes
Category Entries:
AP claims
Reprice claims
Export only
Shadow claims
Externally paid claims
Externally paid claims with bucket update
Pre-adjudicated external claims
Estimate claims
Adjudicated external claims
22 COVERAGE_ID NUMERIC No
Coverage used to pay the claim
23 PAYER_SEQ_NUMBER_C_NAME VARCHAR No
Sequence number of the payer of the claim.
May contain organization-specific values: No
Category Entries:
Primary
Secondary
Tertiary
Quaternary
Quinary
Senary
Septenary
Octonary
Nonary
Denary
Undenary
24 OWN_BUSINESS_SEGMENT_POS_ID_LOC_NAME VARCHAR No
The name of the revenue location.
25 CLM_SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
26 CLM_STATUS_C_NAME VARCHAR No
Claim status
May contain organization-specific values: No
Category Entries:
New
Pending
Denied
Clean
Void
27 STATUS_SET_DATE DATETIME No
Date when claim status was updated
28 RECEIVED_DATE DATETIME No
The date the claim was received
29 ADJUD_DTTM DATETIME (Local) No
Adjudication date and time
30 SERVICE_START_DATE DATETIME No
Service start date for the claim
31 SERVICE_END_DATE DATETIME No
Service end date for the claim
32 TTL_DEDUCTIBLE NUMERIC No
Total deductible
33 TTL_COPAY NUMERIC No
Total copay
34 TTL_COINS NUMERIC No
Total coinsurance
35 TTL_PAT_AMT NUMERIC No
Total patient amount
36 TTL_PRIM_INS_AMT NUMERIC No
Total prior insurance amount
37 TTL_BILLED NUMERIC No
Total billed amount
38 TTL_ALLOWED_AMT NUMERIC No
Total allowed amount
39 TTL_NET_PAYABLE NUMERIC No
Total net payable
40 ORIG_OF_REV_CLAIM_ID NUMERIC No
If this claim is a reversal claim, this column contains the ID of the claim reversed by this claim.
41 ADJUST_BY_CLAIM_ID NUMERIC No
If this claim has been adjusted, this column contains the ID of the claim which adjusts this claim.
42 ORIG_OF_ADJUST_CLAIM_ID NUMERIC No
If this claim adjusts another claim, this column contains the ID of the claim adjusted by this claim.
43 TTL_PRIM_PAT_DEDUCTIBLE NUMERIC No
Total prior patient deductible
44 TTL_PRIM_PAT_COPAY NUMERIC No
Total prior patient copay
45 TTL_PRIM_PAT_COINS NUMERIC No
Total prior patient coinsurance
46 UNBALANCED_AMOUNTS_YN VARCHAR No
Identifies whether the adjustment claim was received with credit/debit information that reflect the adjusted amount as opposed to new claim amounts.
May contain organization-specific values: No
Category Entries:
No
Yes
47 INVALID_CLM_YN VARCHAR No
If the system determined we cannot trust the claim's data for reporting or clinical purposes, this column will store Y (invalid). Otherwise it will be N (valid) or NULL (has not been evaluated by the system). This column's value can be overridden by AP_CLM_RX.OVERRIDE_INVALID_CLM_YN.
The category values for this column were already listed for column: UNBALANCED_AMOUNTS_YN
48 OVERRIDE_INVALID_CLM_YN VARCHAR No
Overrides the INVALID_CLM_YN column and determines if we cannot trust the claim's data for reporting or clinical purposes. This column will store Y if overridden to invalid, N if overridden to valid, or NULL if validity has not been overridden and the value in AP_CLM_RX.INVALID_CLM_YN will be used.
The category values for this column were already listed for column: UNBALANCED_AMOUNTS_YN
49 IS_INVLD_ADJ_SEQ_RX_YN VARCHAR No
Indicates whether a claim is part of an adjustment sequence that is not valid. An adjustment sequence can be invalid for a number of reasons, such as the sequence ending in a cancellation or the sequence having gaps.
The category values for this column were already listed for column: UNBALANCED_AMOUNTS_YN
50 TOT_NOT_COVERED_AMT NUMERIC No
Total not covered amount
51 MEDICARE_DRUG_CVG_CODE_C_NAME VARCHAR No
Code to distinguish if a claim was paid under Medicare Part B or Part D.
May contain organization-specific values: No
Category Entries:
None
Medicare Part D
Medicare Part B
52 REC_OWN_BUSSEG_POS_ID_LOC_NAME VARCHAR No
The name of the revenue location.
53 CMS_NATURAL_KEY VARCHAR No
The claim natural key for a CMS claim.