AUTHORIZATIONS
Description:
This table contains information about authorization records. This includes links to the patient, referral, and coverage/payer.

Primary Key
Column Name Ordinal Position
AUTH_ID 1

Column Information
Name Type Discontinued?
1 AUTH_ID NUMERIC No
The authorization ID for the authorization record.
2 AUTH_FROM_DT DATETIME No
Authorization start date
3 AUTH_TO_DT DATETIME No
Authorization end date
4 PAT_ID VARCHAR No
The patient for whom the authorization record was created. This column is frequently used to link to the PATIENT table.
5 REFERRAL_ID NUMERIC No
Referral associated with this authorization. If this is a UM owned service-level authorization, this column is not populated and, instead, column UM_REFERRAL_ID will be populated. This column is frequently used to link to the REFERRAL table.
6 AUTH_TYPE_C_NAME VARCHAR No
Authorization type category value
May contain organization-specific values: No
Category Entries:
Procedure
Bed Days
Shell
7 NUM_SVCS_APPROVED INTEGER No
Number of services, units or visits approved.
8 NUM_SVCS_REQUESTED INTEGER No
Number of services, units, or visits requested.
9 CVG_ID NUMERIC No
Linked coverage record. This column is frequently used to link to the COVERAGE table.
10 AUTH_NUM VARCHAR No
Authorization number
11 AUTH_COMMENTS VARCHAR No
Free text authorization comment.
12 RECORD_CREATION_DT DATETIME No
Record creation date.
13 CHARGE_COUNTS INTEGER No
Keeps track of number of counts used by charges.
14 AUTH_REF_NUMBER VARCHAR No
The reference number given to us by the payer for this service-level authorization (AUT).
15 AP_CLAIM_COUNT INTEGER No
Number of services, units, or visits used for AP Claims.
16 INTER_NUM_SVCS_APRV INTEGER No
The number of services approved for each interval.
17 INTER_NUM_SVCS_REQ INTEGER No
The number of services requested for each interval.
18 INTER_APRV_FREQ_ID VARCHAR No
The ID of the associated Frequency Record for the approved recurring authorization.
19 INTER_APRV_FREQ_ID_FREQ_NAME VARCHAR No
The name of the frequency record.
20 INTER_REQ_FREQ_ID VARCHAR No
The ID of the associated Frequency Record for the requested recurring authorization.
21 INTER_REQ_FREQ_ID_FREQ_NAME VARCHAR No
The name of the frequency record.
22 INTER_NUM_APRV INTEGER No
The number of times the interval has been approved to repeat.
23 INTER_NUM_REQ INTEGER No
The number of times the interval has been requested to repeat.
24 PARENT_AUTH_ID NUMERIC No
The Parent Authorization that this authorization (AUT) inherits from.
25 AP_CLAIM_COUNT_METHOD_C_NAME VARCHAR No
The counting method for the AP Claim counts.
May contain organization-specific values: No
Category Entries:
Counts not tracked
Once per day
By service quantity
26 UM_STATUS_C_NAME VARCHAR No
The utilization management authorization decision status for the requested service.
May contain organization-specific values: No
Category Entries:
Authorized
Partially Authorized
Pending Review
Withdrawn
Denied
Dismissed
No Authorization Required
Closed
Pending External Review
27 UM_APPROVED_RSN_C_NAME VARCHAR No
The reason the authorized status was assigned to this service.
May contain organization-specific values: Yes
Category Entries:
Overturned on Appeal
28 UM_PART_APRV_RSN_C_NAME VARCHAR No
The reason the partial authorization status was assigned to this service.
May contain organization-specific values: Yes
29 UM_DENIED_RSN_C_NAME VARCHAR No
The reason the denied status was assigned to this service.
May contain organization-specific values: Yes
Category Entries:
Upheld on Appeal
30 UM_DISMISSED_RSN_C_NAME VARCHAR No
The reason the dismissed status was assigned to this service.
May contain organization-specific values: Yes
Category Entries:
Appeal Dismissed
31 UM_NOT_REQUIRED_RSN_C_NAME VARCHAR No
The reason the no auth required status was assigned to this service.
May contain organization-specific values: Yes
32 UM_PENDING_RSN_C_NAME VARCHAR No
The reason the pending status was assigned to this service.
May contain organization-specific values: Yes
Category Entries:
Appeal Under Review
Requires Appeal Effectuation
33 UM_CANCELED_RSN_C_NAME VARCHAR No
The reason the canceled/withdrawn status was assigned to this service.
May contain organization-specific values: Yes
34 UM_DECISION_DTTM DATETIME (Local) No
The date and time the authorization decision was set on the service level authorization. Note that if a service's status changes from a finalized status to another after the entire authorization request has been finalized, this column does not update with the new instant and will instead reflect the original decision instant.
35 NON_UM_AUTH_ID NUMERIC No
Service authorizations that are created as part of UM workflows will only appear in UM workflows. If the authorization details are needed outside the UM department, then corresponding non-UM service-level authorizations are created. This separation is required to ensure non-UM staff cannot alter authorization decisions rendered by UM staff. This column provides a link between the UM service authorizations and non-UM service-level authorizations. There is a 1-to-1 link between UM and non-UM service-level authorizations.
36 UM_AUTH_REQUEST_ID NUMERIC No
If this is a UM-owned service authorization, this column serves as the pointer to the authorization request record. UM-owned service authorizations do not have direct pointers to referral and coverage. They must be accessed through the authorization request.
37 NON_UM_ORDER_ID NUMERIC No
This is a link between a UM service authorization and an order on the referral.
38 ORDER_ENTRY_ORDER_ID NUMERIC No
When the service is created as part of order entry, this column will be populated as a pointer back to the order.
39 UM_CLOSED_RSN_C_NAME VARCHAR No
The reason the closed status was assigned to this service.
May contain organization-specific values: Yes
40 UM_FINALIZE_USER_ID VARCHAR No
The unique ID associated with the user record that finalized this authorization. This column is frequently used to link to the CLARITY_EMP table.
41 UM_FINALIZE_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
42 FINAL_UM_STATUS_CHANGE_SRC_C_NAME VARCHAR No
The change source category ID that resulted in the finalized status of the service.
May contain organization-specific values: No
Category Entries:
Manual Update
Auto Status Assignment
Imported
278N
278R
INTERNAL PRIOR AUTH
Auto Status Assignment Pre-Check
43 AUTH_STATUS_C_NAME VARCHAR No
The provider-side authorization status category ID for the service.
May contain organization-specific values: No
Category Entries:
Authorized
No Auth Required
Pending
Canceled
Denied
44 UM_MED_DIR_REV_USER_ID VARCHAR No
The user who set the pending review status reason for a medical director review.
45 UM_MED_DIR_REV_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
46 UM_PEND_MED_DIRECTOR_DTTM DATETIME (Local) No
The local date and time of when the authorization pended for review with a reason of medical director review.
47 UM_PEND_MED_DIRECTOR_UTC_DTTM DATETIME (UTC) No
The date and time in UTC of when the authorization pended for review with a reason of medical director review.
48 FIRST_PAT_ENC_CSN_ID NUMERIC No
Ths CSN of the encounter linked to the service level authorization with the earliest encounter instant. If the service level authorization doesn't have any encounters linked directly, it will search the linked referral or auth/cert.
49 LAST_PAT_ENC_CSN_ID NUMERIC No
The CSN of the encounter linked to the service level authorization with the latest encounter instant. If the service level authorization doesn't have any encounters linked directly, it will search the linked referral or auth/cert.
50 APPEALED_SERVICE_AUTH_ID NUMERIC No
The ID of the service that this service was created to appeal.
51 LAST_CVG_GUIDANCE_C_NAME VARCHAR No
When we receive a Coverage Requirements Discovery response message pertaining to this authorization, this item will store the coverage guidance value from that message.
May contain organization-specific values: No
Category Entries:
No Guidance
Not Covered
No Auth Required
Auth Required
Clinical Info Needed
Administrative Info Needed
52 UM_CVG_GUIDANCE_SOURCE_C_NAME VARCHAR No
The coverage guidance source category ID for the coverage guidance request.
May contain organization-specific values: No
Category Entries:
Payer Platform
Payer Internal Request
Link Portal Request
Provider Internal Request
53 UM_CVG_GDNC_REALTIME_TX_CSN_ID NUMERIC No
The unique contact serial number of the real-time transaction that originated the Coverage Requirements Discovery request.
54 UM_CVG_GUIDANCE_PA_SVC_LN_IDNT INTEGER No
The line number of the service from the real-time transaction that originated the Coverage Requirements Discovery service request.
55 UM_CVG_GUIDANCE_C_NAME VARCHAR No
The coverage guidance determination category ID for the requested service.
The category values for this column were already listed for column: LAST_CVG_GUIDANCE_C_NAME
56 UM_CVG_GUIDANCE_FROM_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.
57 UM_CVG_GUIDANCE_REQ_DATE DATETIME No
The date of the requested service for which guidance is being requested. If no date was provided with the request, the date of the request creation is used.
58 UM_CVG_GUIDANCE_REQ_LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.
59 UM_CVG_GUIDANCE_REQ_VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
60 UM_CVG_GUIDANCE_REQ_DEPT_ID_EXTERNAL_NAME VARCHAR No
The external name of the department record. This is often used in patient correspondence such as reminder letters.
61 UM_CVG_GUIDANCE_REQUEST_NOTE VARCHAR No
The free-text note text associated with the coverage guidance request.
62 UM_CVG_GUIDANCE_LOB_ID VARCHAR No
The unique ID of the line of business associated with the requested coverage guidance.
63 UM_CVG_GUIDANCE_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
64 UM_CVG_GUIDANCE_PAYER_ID_PAYOR_NAME VARCHAR No
The name of the payor.
65 UM_CVG_GUIDANCE_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
66 UM_CVG_GUIDANCE_CREATE_USER_ID VARCHAR No
The unique ID of the user who created the coverage guidance request, if known.
67 UM_CVG_GUIDANCE_CREATE_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
68 DENIAL_REASON_C_NAME VARCHAR No
If this authorization's status is Denied, then this item will contain the rationale given for that denial.
May contain organization-specific values: No
Category Entries:
Not Medically Necessary
Retroactive Referral Request
Not a Covered Benefit
Not in Network
Duplicate Referral Request
System Automatically Denied
Does Not Meet 3rd Party Guidelines
DOES NOT MEET INTERNAL GUIDELINES
Member not covered
Authorized Quantity Exceeded
Exceeds Plan Maximums
No Prior Approval
Requested Information Not Received
Service Inconsistent With Diagnosis
Pre-Existing Condition
Patient is Restricted to Specific Provider
Plan/Contractual Guidelines Not Followed
Plan/Contractual Geographic Restriction
Inappropriate Facility Type
Once in a Lifetime Restriction Applies
Transport Request Denied
Errors in the Request
Excluded Benefit
Appeal Denied
Not Primary Care Physician
Level of Care Not Appropriate
Denial Response Needs Review
Requires Medical Review
Experimental Service or Procedure
Peer to Peer Needed
Time Limits not Met
69 AUTH_BED_DAY_TYPE_ID NUMERIC No
The type of day (TOD record) approved by the payer.
70 AUTH_BED_DAY_TYPE_ID_BED_DAY_TYPE_NAME VARCHAR No
The name of the bed day type record (i.e. ICU or non-authorized.)
71 NUM_DAYS_APPROVED INTEGER No
The number of days approved by the payer for a bed day type. This is calculated as End Date - Start Date + 1.
72 NUM_NIGHTS_APPROVED INTEGER No
The number of nights approved by the payer for a bed day type. This is calculated as : End Date - Start Date.
73 EXT_SVC_MSG VARCHAR No
Service-level MSG data received by Payer Platform from an external system.
74 EXT_SVC_REF_NUM VARCHAR No
the administrative reference number received by Payer Platform from an external system for this service
75 EXT_SVC_AUTH_NUM VARCHAR No
the authorization number received by Payer Platform from an external system for this service
76 UM_CVG_GUIDANCE_RESP_AGENCY_ID VARCHAR No
The unique ID of the responsible entity for determining coverage guidance for the requested service.
77 UM_CVG_GUIDANCE_RESP_AGENCY_ID_AGENCY_NAME VARCHAR No
The name of the agency.
78 AUTH_BED_DAY_TX_STATUS_C_NAME VARCHAR No
Indicates the current transaction status for this bed day
May contain organization-specific values: No
Category Entries:
New
Submitted
Waiting on Payer
Waiting on Provider
Finalized