CLAIM_INFO
Description:
This table contains information from claim info records for Hospital and Professional Billing.

Primary Key
Column Name Ordinal Position
CLAIM_ID 1

Column Information
Name Type Discontinued?
1 CLAIM_ID NUMERIC No
The unique ID for the claim information record.
2 CLAIM_NAME VARCHAR No
The description of the claim record.
3 ACCOUNT_ID NUMERIC No
The billing system accounts receivable account ID associated with this claim.
4 CLAIM_TYPE_C_NAME VARCHAR No
The claim type category of the claim. Identifies whether the claim was filed as a workers' compensation or commercial claim.
May contain organization-specific values: Yes
Category Entries:
Commercial
Workers' Compensation
5 USER_ID VARCHAR No
The ID of the staff member who entered the claim into the system.
6 USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
7 ENTRY_DATE DATETIME No
The date on which this claim was entered into the system.
8 COVERAGE_ID NUMERIC No
The coverage ID of the coverage used for this claim. This column can be used to report on coverages that are associated with a hospital account.
9 ADMIT_DATETIME DATETIME (Local) No
The admission date and time for the patient encounter associated with the claim.
10 CLM_PAT_STATUS_C_NAME VARCHAR No
The patient status category ID for the patient for whom this claim was filed.
May contain organization-specific values: Yes
11 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.
12 ADMISSION_SOURCE_C_NAME VARCHAR No
The admission source (e.g., physician referral, clinic referral, Health Maintenance Organization (HMO) referral, transfer from a hospital, transfer from a skilled nursing facility, emergency room, court/law enforcement, information not available) for the encounter associated with this claim.
May contain organization-specific values: Yes
13 ADMISSION_TYPE_C_NAME VARCHAR No
The admission type for the patient encounter associated with this claim (e.g., emergency, urgent, elective, newborn, trauma center, information not available).
May contain organization-specific values: Yes
14 ADMIT_DX_ID_DX_NAME VARCHAR No
The name of the diagnosis.
15 ILL_INJ_LMP_C_NAME VARCHAR No
The category type identifying the claim as resulting from illness, injury or pregnancy (e.g., illness, accident (injury), pregnancy (last menstrual period, or LMP)).
May contain organization-specific values: No
Category Entries:
Illness
Accident (Injury)
Pregnancy (LMP)
16 REL_CONDITION_C_NAME VARCHAR No
The related condition for the claim (e.g. Auto, Other Party Liability, Other Accident Related Injury, Patient Employment, Crime Victim).
May contain organization-specific values: Yes
Category Entries:
Auto
Other Party Liability
Other Accident Related Injury
Patient Employment
Crime Victim
17 DOC_CTRL_NUM VARCHAR No
The document control number (DCN) for the claim record.
18 INJURY_DATETIME DATETIME (Local) No
The date and time on which the injury resulting in the claim occurred.
19 ACCIDENT_TYPE_C_NAME VARCHAR No
The accident type for the injury resulting in the claim (e.g., Workers' Compensation, Automobile).
May contain organization-specific values: Yes
20 IS_EPSDT_YN VARCHAR No
This is a yes/no flag indicating whether or not the patient is being seen for an Early Periodic Screening Diagnosis and Treatment (EPSDT) program.
May contain organization-specific values: No
Category Entries:
No
Yes
21 EPSDT_CODE_C_NAME VARCHAR No
Early Periodic Screening and Diagnosis Treatment (EPSDT) program value.
May contain organization-specific values: Yes
22 WC_CLAIM_NUM VARCHAR No
Workers' Comp Claim Number for the claim record.
23 WC_EMPLOYER_ID VARCHAR No
The ID of the employer associated with a Workers' Comp claim.
24 WC_EMPLOYER_ID_EMPLOYER_NAME VARCHAR No
The name of the employer.
25 TRAN_CODE_C_NAME VARCHAR No
Ambulance transport code.
May contain organization-specific values: Yes
Category Entries:
Initial Trip
Return Trip
Transfer Trip
Round Trip
26 TRAN_REASON_C_NAME VARCHAR No
Ambulance transport reason code.
May contain organization-specific values: Yes
Category Entries:
Nearest Facility for Care of Symptoms, Complaints, or Both
For the Benefit of a Preferred Physician
For the Nearness of Family Members
For the Care of a Specialist or for Availability of Specialized Equipment
Rehabilitation Facility
27 TRAN_DIST NUMERIC No
Ambulance transport distance.
28 CLM_LOGIN_SA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
29 ILL_INJ_LMP_DT DATETIME No
The date of the onset of illness, the occurrence of the injury, or the patient's last menstrual period (related to pregnancy).
30 AUTO_ACDNT_STATE_C_NAME VARCHAR No
Auto accident State.
May contain organization-specific values: Yes
31 EMPY_RELATED_YN VARCHAR No
Indicates whether patient's condition is related to employment.
The category values for this column were already listed for column: IS_EPSDT_YN
32 FIRST_CONSULT_DT DATETIME No
First consult date.
33 PAT_CHIEF_COMPLAINT VARCHAR No
Patients chief complaint.
34 EMERG_YN VARCHAR No
Indicates whether the procedure is related to an emergency.
The category values for this column were already listed for column: IS_EPSDT_YN
35 LAST_WORKED_DT DATETIME No
Date last worked.
36 RETURN_TO_WORK_DT DATETIME No
Return to work date.
37 DISCHARGE_DT DATETIME No
Discharge date.
38 OUTSIDE_LAB_NAME_C_NAME VARCHAR No
Outside lab name.
May contain organization-specific values: Yes
Category Entries:
Other
39 HLTH_APPR_SCRN_YN VARCHAR No
Routine health appraisal/screening procedure.
May contain organization-specific values: No
Category Entries:
Yes
No
40 SIG_ON_FILE_YN VARCHAR No
Signature on file?
The category values for this column were already listed for column: IS_EPSDT_YN
41 WK_COMP_CLAIM_NUM VARCHAR No
Workers' Comp claim number.
42 WK_COMP_INJ_DESC VARCHAR No
Workers' Comp injury description.
43 WK_COMP_APRV_CODE VARCHAR No
Workers' Comp approval code.
44 WK_COMP_MED_RLS_DT DATETIME No
Workers' Comp medical release date.
45 DF_DELAY_RSN_CODE_C_NAME VARCHAR No
Default delay reason code.
May contain organization-specific values: Yes
Category Entries:
Proof of Eligibility Unknown or Unavailable
Litigation
Authorization Delays
Delay in Certifying Provider
Delay in Supplying Billing Forms
Delay in Delivery of Custom-made Appliances
Third-Party Processing Delay
Delay in Eligibility Determination
Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation
Administration Delay in the Prior Approval Process
Other
Natural Disaster
46 FIRST_NEXT_VISIT_C_NAME VARCHAR No
First/subsequent visit indicator.
May contain organization-specific values: No
Category Entries:
First Visit
Subsequent Visit
47 MED_HX_SOC_WORKER VARCHAR No
Social worker associated with this visit.
48 MED_HX_PSYCHOLOGIST VARCHAR No
Psychologist associated with this visit.
49 MED_HX_SUP_PROV VARCHAR No
Supervising medical doctor for this visit.
50 MED_HX_COUNSELOR VARCHAR No
Counselor associated with this visit.
51 HDH_RFL_CODE_C_NAME VARCHAR No
The referral code for the health and developmental history assessment.
May contain organization-specific values: No
Category Entries:
Physician
Dental
Hearing
Speech
Visual-Visual Problem
Visual-Specific Medical Problem
Other
Behavioral
52 PHY_EXAM_CODE_C_NAME VARCHAR No
The exam code for the physical assessment.
May contain organization-specific values: No
Category Entries:
Completed/Normal
ABN/Treated Abnormal by Screening Provider
ABN/Referred Abnormal
Not Required
Not Performed
53 PHY_EXAM_RFL_CODE_C_NAME VARCHAR No
The referral code for the physical assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
54 VISION_EXAM_CODE_C_NAME VARCHAR No
The exam code for the vision assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
55 VISION_RFL_CODE_C_NAME VARCHAR No
The referral code for the vision assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
56 HEARING_EXAM_CODE_C_NAME VARCHAR No
The exam code for the hearing assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
57 HEARING_RFL_CODE_C_NAME VARCHAR No
The referral code for the hearing assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
58 DEV_EXAM_CODE_C_NAME VARCHAR No
The exam code for the developmental assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
59 DEV_RFL_CODE_C_NAME VARCHAR No
The referral code for the developmental assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
60 NUTRI_EXAM_CODE_C_NAME VARCHAR No
The exam code for the nutritional assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
61 NUTRI_RFL_CODE_C_NAME VARCHAR No
The referral code for the nutritional assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
62 OTHER_TREATMNT_DT DATETIME No
Stores date of other treatment.
63 HOSPITAL_NAME VARCHAR No
Name of the hospital where the patient was admitted.
64 HOSPITAL_ADDRESS VARCHAR No
The street address of the hospital where the patient was admitted.
65 HOSPITAL_CITY VARCHAR No
The city where the hospital to which the patient was admitted is located.
66 HOSPITAL_STATE_C_NAME VARCHAR No
The state where the hospital to which the patient was admitted is located.
The category values for this column were already listed for column: AUTO_ACDNT_STATE_C_NAME
67 HOSPITAL_ZIP VARCHAR No
The ZIP of the hospital to which the patient was admitted.
68 HOSP_REQ_YN VARCHAR No
Flag indicating whether or not hospitalization is required.
May contain organization-specific values: No
Category Entries:
No
Yes
69 ADV_RET_WORK_YN VARCHAR No
Flag to indicate whether a patient was advised to return to work.
The category values for this column were already listed for column: HOSP_REQ_YN
70 ADV_RET_WORK_DT DATETIME No
The date that patient was advised to return to work.
71 REF_PHYS_NAME VARCHAR No
Stores the referring physician's name.
72 REF_PHYS_ADDR VARCHAR No
Stores the referring physician's address.
73 REF_PHYS_CITY VARCHAR No
Stores the referring physician's city.
74 REF_PHYS_STATE_C_NAME VARCHAR No
Stores the referring physician's state.
The category values for this column were already listed for column: AUTO_ACDNT_STATE_C_NAME
75 REF_PHYS_ZIP VARCHAR No
Stores the referring physician's ZIP code.
76 REF_PHYS_SPEC_C_NAME VARCHAR No
Stores referring physician's specialty.
May contain organization-specific values: Yes
77 REF_PHYS_REASON_C_NAME VARCHAR No
Stores the referring physician's reason for the referral.
May contain organization-specific values: Yes
Category Entries:
Consultation
Treatment
78 FIRST_TREAT_HOUR_TM DATETIME (Local) No
First treatment hour. Some extensions add a value code to your claim if this item has a value.
79 PAT_PREV_TREATED_YN VARCHAR No
Is patient previously treated?
May contain organization-specific values: No
Category Entries:
Yes
No
80 IDE_NUM VARCHAR No
Investigational Device Exemption Number.
81 EST_DOB_DT DATETIME No
The estimated date of delivery for the pregnancy.
82 RESPONSIBLE_IND_YN VARCHAR No
Indicate if the patient's condition is due to an accident or illness caused by another party.
The category values for this column were already listed for column: IS_EPSDT_YN
83 REFERRAL_SOURCE_ID VARCHAR No
The referral source for the visit.
84 REFERRAL_SOURCE_ID_REFERRING_PROV_NAM VARCHAR No
The name of the referral source.
85 EMERGENCY_CODE_C_NAME VARCHAR No
The Emergency Service Code for emergency room services. This field is required for Illinois Department of Public Aid claims for emergency related services. It will populate record EA0-05.0 in the Illinois Department of Public Aid NSF 2.00 electronic claim file and box 10b-other on the IDPA 2360 paper claim form.
May contain organization-specific values: No
Category Entries:
Obstetrical crises and/or labor
Acute trauma
Reparative surgery necessitated by antecedent trauma
Hemorrhage or threat of hemorrhage
Serious infection
Severe pain
Shock or impending shock
Decompensated vital functions or threat to vital functions
Congenital defects in a newborn infant
Any condition requiring prompt diagnostic procedures
Any other condition causing serious pain or possible death
Child/adult abuse
Sexual assault
Not an emergency
86 DISABILITY_LEVEL_C_NAME VARCHAR No
The extent of the disability caused by the incident.
May contain organization-specific values: Yes
Category Entries:
Short Term Disability
Long Term Disability
Permanent/Total Disability
No Disability
87 DISABILITY_FROM_DT DATETIME No
The date the disability started.
88 DISABILITY_TO_DT DATETIME No
The date the disability ended.
89 OUTSIDE_LAB_YN VARCHAR No
Indicate if lab services outside the provider's office are involved.
The category values for this column were already listed for column: IS_EPSDT_YN
90 OUTSIDE_LAB_CHARGE NUMERIC No
The cost of services performed at the outside lab.
91 FAM_PLANNING_YN VARCHAR No
Indicate whether the patient is being seen for family planning care.
The category values for this column were already listed for column: IS_EPSDT_YN
92 SPECIAL_PROGRAM_C_NAME VARCHAR No
The special program under which the services rendered to the patient were performed.
May contain organization-specific values: No
Category Entries:
Special Federal Funding
Disability
PPV/Medicare 100% Payment
Induced Abortion - Danger to Woman's Life
Induced Abortion - Victim of Rape/Incest
Second Opinion/Surgery
TRICARE Program for the Disabled
Physically Handicapped Children's Program
Medicare Demonstration Project for Lung Volume Reduction Surgery
93 PGM_FOR_HANDICAP_C_NAME VARCHAR No
Indicates the patient's relationship to the sponsor for the program that benefits people with handicaps.
May contain organization-specific values: No
Category Entries:
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child, PFTH Number Unknown
Sponsor
Spouse
Widow/Widower
94 EMPLOYER_LOB VARCHAR No
A free text nature/line of business for the employer.
95 OTH_INFO VARCHAR No
Any additional free text information that should be recorded in conjunction with the claim.
96 AUTH_DT DATETIME No
Authorization date.
97 CHIR_FIRST_TREAT_DT DATETIME No
The initiation date of the course of treatment for chiropractic services.
98 CHIR_X_RAY_DT DATETIME No
The X-ray date for chiropractic services.
99 NAT_OF_COND_C_NAME VARCHAR No
Stores the nature of condition code for Spinal Manipulation.
May contain organization-specific values: Yes
Category Entries:
Acute Condition
Chronic Condition
Non-acute
Non-Life Threatening
Routine
Symptomatic
Acute Manifestation of a Chronic Condition
100 CHIR_ACUTE_MANI_DT DATETIME No
Stores the acute manifestation date for the spinal manipulation therapy.
101 HBG_HCT_TEST_INCL_C_NAME VARCHAR No
Indicate whether hemoglobin/hematocrit (HGB/HCT) test is included.
May contain organization-specific values: No
Category Entries:
No
Yes
Completed/Normal
ABN/Treated Abnormal by Screening Provider
ABN/Referred Abnormal
Not Required
Not Performed
ABN/Not Referred Abnormal
102 URINALYSIS_INCL_C_NAME VARCHAR No
Indicate whether Urinalysis test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
103 TUBERCULOSIS_INCL_C_NAME VARCHAR No
Indicate whether tuberculosis test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
104 LEAD_TEST_INCL_C_NAME VARCHAR No
Indicate whether lead test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
105 SICKLE_CELL_INCL_C_NAME VARCHAR No
Indicate whether sickle-cell test is included.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
106 IMMNZTN_INCL_C_NAME VARCHAR No
The exam code for the immunizations.
The category values for this column were already listed for column: HBG_HCT_TEST_INCL_C_NAME
107 CARDIO_EXAM_CODE_C_NAME VARCHAR No
The exam code for the cardiovascular assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
108 CARDIO_RFL_CODE_C_NAME VARCHAR No
The referral code for the cardiovascular assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
109 URINARY_EXAM_CODE_C_NAME VARCHAR No
The exam code for the genital/urinary tract assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
110 URINARY_RFL_CODE_C_NAME VARCHAR No
The referral code for the genital/urinary tract assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
111 DIABETE_EXAM_CODE_C_NAME VARCHAR No
The exam code for the diabetes assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
112 DIABETE_RFL_CODE_C_NAME VARCHAR No
The referral code for the diabetes assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
113 DENTAL_EXAM_CODE_C_NAME VARCHAR No
The exam code for the dental assessment.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
114 DENTAL_RFL_CODE_C_NAME VARCHAR No
The referral code for the dental assessment.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
115 IMMNZTN_RFL_CODE_C_NAME VARCHAR No
The referral code for the immunizations.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
116 EDU_EXAM_CODE_C_NAME VARCHAR No
The exam code for health education.
The category values for this column were already listed for column: PHY_EXAM_CODE_C_NAME
117 EDU_RFL_CODE_C_NAME VARCHAR No
The referral code for health education.
The category values for this column were already listed for column: HDH_RFL_CODE_C_NAME
118 ONLY_CAUSE_YN VARCHAR No
Flag to distinguish whether or not this injury is the only cause of the patient's condition.
The category values for this column were already listed for column: HOSP_REQ_YN
119 PAT_BURNED_YN VARCHAR No
Flag to determine whether or not patient has been burned.
The category values for this column were already listed for column: HOSP_REQ_YN
120 XRAY_BY_WHOM VARCHAR No
The name of the person or entity that performed x-rays.
121 WC_XRAY_DT DATETIME No
The date comparative x-rays were taken.
122 POLIO_IMMNZTN_C_NAME VARCHAR No
The immunization status for Polio.
May contain organization-specific values: No
Category Entries:
Given/Up to date
Given/Not up to date
Not Given/Up to date
Not Given/Refused
Not Given/Omitted
123 DPT_TD_IMMNZTN_C_NAME VARCHAR No
The immunization status for Diphtheria, pertussis, and tetanus (DPT)/tetanus and diphtheria (DT).
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
124 MEASLES_IMMNZTN_C_NAME VARCHAR No
The immunization status for Measles.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
125 MUMPS_IMMNZTN_C_NAME VARCHAR No
The immunization status for Mumps.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
126 RUBELLA_IMMNZTN_C_NAME VARCHAR No
The immunization status for Rubella.
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
127 HIB_IMMNZTN_C_NAME VARCHAR No
The immunization status for Haemophilus influenzae type B (HIB).
The category values for this column were already listed for column: POLIO_IMMNZTN_C_NAME
128 CHAMP_NONAVAIL_YN VARCHAR No
Indicate if the provider has a signed Tricare statement of non-availability on file indicating that the services associated with this claim were not available at a military treatment facility.
The category values for this column were already listed for column: IS_EPSDT_YN
129 CHAMP_NONAV_STMT_NO VARCHAR No
The number of the Tricare non-availability statement.
130 CHAMPUS_ORG VARCHAR No
Tricare Organization.
131 CHAMPUS_STATION VARCHAR No
Tricare Station.
132 CHAMP_MILIT_ACC_YN VARCHAR No
Indicate if the services performed were treatment as a result of a military accident.
The category values for this column were already listed for column: IS_EPSDT_YN
133 ALTERNATE_CLM_ID VARCHAR No
Alternate Claim ID.
134 REF_PROVIDER_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.
135 MC_CLAIMS_WKFLOW_C_NAME VARCHAR No
Indicates the workflow associated with the claim (shadow claims, Accounts Payable claims, export only claims, 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
136 CLM_SENSITIVITY_C_NAME VARCHAR No
Indicates the sensitivity type of the claim.
May contain organization-specific values: Yes
137 PLACE_OF_SERVICE_ID_LOC_NAME VARCHAR No
The name of the revenue location.
138 LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.