CLAIM_INFO2
Description:
This table contains claims information from claim information (CLM) records for both 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 CVR_NUM_TIMES_PREG INTEGER No
Number of pregnancies, for contraceptive vaginal ring (CVR).
3 CVR_NUM_BIRTHS INTEGER No
Number of births, for contraceptive vaginal ring (CVR).
4 NUM_LIVING_CHILDREN INTEGER No
Number of living children, for contraceptive vaginal ring (CVR).
5 CVR_VISIT_TYPE_C_NAME VARCHAR No
Contraceptive vaginal ring (CVR) visit type.
May contain organization-specific values: Yes
Category Entries:
First Annual Exam
Return Annual Exam
Other Medical
Counseling Only
Pregnancy Test Visit
Vasectomy Referral
Supply Only Visit
Infection/Disease/Other Medical
Contraceptive Visit
Off-Site Contraceptive Visit/Other Medical
6 CVR_PRV_COUN_EDU_C_NAME VARCHAR No
Provider of counseling and educational services for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Resource
Physician
7 CVR_CONTRA_BEFORE_C_NAME VARCHAR No
Contraceptive method, before visit for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Female Sterilization
Oral Contraceptives
IUD
Diaphragm/Cervical Cap
Foam and Condoms
Male Condom
Spermicide
Fertility Awareness Method
Other Method
None
Hormone Implant
Hormonal Injection - 1 month
Abstinence
Male Sterilization
IUS
Hormonal Injection - 3 month
Hormonal Patch
Vaginal Ring
Female Condom
Withdrawal
Contraceptive Sponge
LAM
8 CVR_CONTRA_AFTER_C_NAME VARCHAR No
Contraceptive method, after visit for contraceptive vaginal ring (CVR).
The category values for this column were already listed for column: CVR_CONTRA_BEFORE_C_NAME
9 CVR_REASON_CO_C_NAME VARCHAR No
Reason for using no contraceptive method, for contraceptive vaginal ring (CVR).
May contain organization-specific values: Yes
Category Entries:
Planned Pregnancy
High Risk Pregnancy
Seeking Pregnancy
Other Medical Reason
Relying on Partner's Method
Not Sexually Active
Other
Unplanned Pregnancy
10 CVR_INT_CODE INTEGER No
Internal use code, for contraceptive vaginal ring (CVR).
11 CVR_STATUS_C_NAME VARCHAR No
Contraceptive vaginal ring (CVR) status.
May contain organization-specific values: Yes
Category Entries:
Not Reported
Reported
Queued for Reporting
Queued for Voiding
Queued for Resubmittal
Voided not Reported
Reported as Voided
Reported as FPEP
12 TPR_INS_CODE_C_NAME VARCHAR No
The Third Party Resource Insurance Code from Medicare.
May contain organization-specific values: Yes
Category Entries:
Service under deductible
Service not covered by insurance policy
Patient not covered by insurance policy
Insurance coverage cancelled/terminated
Insurance lapsed or not in effect on date of service
Insurance payment went to policy holder
Insurance payment went to patient
Service not authorized or prior authorized by insurance
Service not considered emergency by insurance
Service not provided by primary care provider facility
Maximum benefits used for diagnosis/condition
Requested information not received by insurance from client
Requested information not received by insurance from policy holder
Motor vehicle accident fund maximum benefits exhausted
Insurance mandated under court order not paid within 30 days
Other
Primary Insurance Paid - Secondary Paid
Primary Insurance Paid - Secondary Under Deductible
Primary and Secondary Under Deductible
Primary Insurance Under Deductible-Secondary Paid
Primary Insurance Paid-Secondary Service Not Covered
Primary Insurance Paid-Secondary Patient Not Covered
Primary Insurance Paid-Secondary Canceled/Terminated
Primary Insurance Paid-Secondary Lapsed or Not in effect
Primary Insurance Paid-Secondary Payment went to patient
Primary Insurance Paid-Secondary Payment Went to Policyholder
Primary Insurance Paid-Secondary Denied-Service Not Authorized
Primary Insurance Paid-Secondary Denied-Service Not Considered Emergency
Primary Insurance Paid-Secondary Denied-Svc Not Provided by Primary Care Provider/Fac
Primary Insurance Paid-Secondary Denied-Maximum Benefits Used for Diagnosis/Condition
Primary Insurance Paid-Secondary Denied-Requested Info Not Received from Policyholder
Denied-Requested Information Not Received from Patient
Service Not Covered by Primary or Secondary Insurance
13 BLOOD_FURNISHED INTEGER No
Pints of blood furnished.
14 BLOOD_REPLACED INTEGER No
Pints of blood replaced.
15 BLOOD_NOT_REPLACED INTEGER No
Pints of blood not replaced.
16 BLOOD_DEDUCTIBLE INTEGER No
The number of pints of blood that are deductible.
17 PSROUR_APRV_IND_C_NAME VARCHAR No
Professional Standards Review Organization Utilization Review (PSRO/UR) approval indicator.
May contain organization-specific values: No
Category Entries:
Approved As Billed
Automatic Approval As Billed
Partial Approval
Admission Denied
Post-Payment Review Applicable
Admission Preauthorization
18 PSROUR_APRV_FROM_DT DATETIME No
Professional Standards Review Organization Utilization Review (PSRO/UR) approval date.
19 PSROUR_APRV_TO_DT DATETIME No
Professional Standards Review Organization Utilization Review (PSRO/UR) approval expiry date.
20 NUM_OF_GRACE_DAYS INTEGER No
Number of grace days.
21 TREAT_AUTH_CODE VARCHAR No
Treatment authorization code.
22 PART_A_EXHAUST_DT DATETIME No
The date a patient's Medicare Part A benefits are exhausted.
23 PAT_HEIGHT VARCHAR No
Patient height in inches.
24 PAT_WEIGHT VARCHAR No
Patient weight in ounces.
25 BIRTH_WEIGHT_WT NUMERIC No
The patient's birth weight.
26 SYSTOLIC_BP INTEGER No
Blood pressure - systolic.
27 DIASTOLIC_BP INTEGER No
Blood pressure - diastolic.
28 PAT_VISIT_TYPE_C_NAME VARCHAR No
The patient's visit type for the State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: Yes
Category Entries:
New Patient
Extended Visit
Routine Visit
Extended Visit/New Patient
29 PAT_SCREEN_TYPE_C_NAME VARCHAR No
The type of screening performed during the State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: Yes
Category Entries:
Initial Screen
Periodic Visit
30 WIC_STATUS_C_NAME VARCHAR No
The patient's status in the Women, Infants, and Children (WIC) program.
May contain organization-specific values: No
Category Entries:
Enrolled in WIC
Referred to WIC
Neither
31 PAT_SCRN_PARTIAL_C_NAME VARCHAR No
Indicates whether the State of California Child Health and Disability Prevention (CDHP) visit was a partial screening, or a recheck for an earlier screening.
May contain organization-specific values: No
Category Entries:
Neither
Partial Screen
Recheck
32 PAT_PRIOR_SCREEN_DT DATETIME No
Date of prior screening.
33 HEAD_START_YN VARCHAR No
Indicate whether this patient has been referred by a Head Start or a State Preschool program for this State of California Child Health and Disability Prevention (CDHP) visit.
May contain organization-specific values: No
Category Entries:
Yes
No
34 HEAD_START_NUMBER VARCHAR No
The 5 digit Head Start Grantee number, or the 11 digit State Preschool Project number for the program which referred the patient for this State of California Child Health and Disability Prevention (CHDP) visit.
35 FOSTER_CHILD_YN VARCHAR No
Indicates whether the patient is a foster child in the State of California Child Health and Disability Prevention (CHDP) program.
May contain organization-specific values: No
Category Entries:
Yes
No
36 TOBACCO_PASSIV_YN VARCHAR No
Indicates whether tobacco exposure has occurred.
The category values for this column were already listed for column: FOSTER_CHILD_YN
37 TOBACCO_USAGE_YN VARCHAR No
Indicated tobacco usage.
The category values for this column were already listed for column: FOSTER_CHILD_YN
38 TOBACCO_CNSL_YN VARCHAR No
Indicates whether tobacco counseling was given.
The category values for this column were already listed for column: FOSTER_CHILD_YN
39 PAT_NEXT_VISIT_DT DATETIME No
Next visit date.
40 DENTAL_REFERRAL_YN VARCHAR No
Dental referral.
The category values for this column were already listed for column: HEAD_START_YN
41 BLOOD_LEAD_REF_YN VARCHAR No
Blood lead referrals.
The category values for this column were already listed for column: HEAD_START_YN
42 CONTRACEPTIVE_C_NAME VARCHAR No
Contraceptive method the patient is using.
May contain organization-specific values: Yes
Category Entries:
Birth Control Pills
Injections
Implants
IUD
Diaphragm
Cervical Cap
Spermicides
Male Condoms
Female Condoms
Fertility Awareness Methods
Natural Family Planning
Sterilization
Infertility Management
Other: Relying on Partner
None: Seeking Preg;Test w/o Method Use;Deferred Activity
43 CMN_ATTCH_TRNS_CD_C_NAME VARCHAR No
Attachment transmission code for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Previously submitted to payer
Certification included in this claim
Narrative segment included in this claim
No documentation is required
Not specified
44 CMN_PUMP_NUM_C_NAME VARCHAR No
Pump type - question 1 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
External infusion pump (non-disposable)
Reserved for other or future use
Implantable infusion pump
Disposable infusion pump
45 CMN_ADMIN_ROUT_C_NAME VARCHAR No
Administration route - question 4 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Intravenous
Reserved for other or future use
Epidural
Subcutaneous
46 CMN_ADMIN_METH_C_NAME VARCHAR No
Administration method - question 5 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Continuous
Intermittent
Bolus
47 CMN_CANCER_PAIN_C_NAME VARCHAR No
Whether the patient's pain cannot be managed by oral/transdermal narcotics - question 7 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: No
Category Entries:
Yes
No
Does not apply
48 ASSUMED_CARE_DT DATETIME No
The assumed care date of the claim.
49 RELINQ_CARE_DT DATETIME No
The date care was relinquished.
50 DISCHARGE_HOUR_TM DATETIME (Local) No
The time the patient was discharged from inpatient care.
51 BILL_CLASS_C_NAME VARCHAR No
The second digit for the UB bill type.
May contain organization-specific values: No
Category Entries:
Inpatient (Including Medicare Part A)
Inpatient (Medicare Part B only)
Outpatient
Laboratory Services Provided to Non-patients
Intermediate Care - Level I
Intermediate Care - Level II
Subacute Inpatient (discontinued 10/1/2005)
Swing Beds
52 PRINCIPAL_PX_ID_PROC_NAME VARCHAR No
The name of each procedure.
53 PRINCIPLE_PX_DESC VARCHAR No
Principal International Classification of Diseases (ICD) procedure description.
54 PRINCIPLE_PX_DT DATETIME No
Principal International Classification of Diseases (ICD) procedure date.
55 PRINCIPAL_DX_ID_DX_NAME VARCHAR No
The name of the diagnosis.
56 MEDICAID_CRN VARCHAR No
The Medicaid Claim Rejection Number if this claim was rejected by Medicaid (used by some states).
57 MEDICAID_RA VARCHAR No
The Medicaid Remittance Advice cycle number in which this claim appeared if it was rejected by Medicaid (used by some states).
58 MEDICAID_LT_CLM_CD VARCHAR No
The exception code for the claim if the claim is being submitted to Medicaid after the normal filing time limit (used by some states).
59 HEMATOCRIT_CT NUMERIC No
The patient's hematocrit reading, between 18 and 72.
60 HEMOGLOBIN_COUNT NUMERIC No
The patient's hemoglobin reading to the nearest 0.1 gram, between 6.0 and 24.0.
61 BLOOD_PRESSURE VARCHAR No
Blood pressure.
62 LAST_TREATMENT_DT DATETIME No
The last treatment date.
63 LMTD_RETURN_DT DATETIME No
The date of limited return for Workers' Comp.
64 COMP_XRAYS_YN VARCHAR No
Indicate if comparative x-rays were taken for the amputation.
The category values for this column were already listed for column: FOSTER_CHILD_YN
65 AMPUTATION VARCHAR No
Indicate what amputation was present.
66 STUMP_CONDITION_C_NAME VARCHAR No
The condition of the amputation stump.
May contain organization-specific values: No
Category Entries:
Hardy
Tender
67 DISCHRG_CURED_DT DATETIME No
The date the patient was discharged as cured.
68 STOPPED_TREAT_DT DATETIME No
The date the patient stopped treatment without an order.
69 REFUSED_TREAT_DT DATETIME No
The date the patient refused treatment.
70 PROGNOSIS VARCHAR No
The prognosis for the injury.
71 FURTHER_TREATMENT_C_NAME VARCHAR No
The likelihood of further treatment.
May contain organization-specific values: No
Category Entries:
Necessary
Probable
Unlikely
72 TREATMENT_DESC VARCHAR No
The description of the further treatment that should be given to the patient.
73 HEALING_END_YN VARCHAR No
Indicate if the healing period has ended.
The category values for this column were already listed for column: FOSTER_CHILD_YN
74 DISABLED_BODY_PART VARCHAR No
The part of the body that was affected.
75 BODY_PART_DISABLD_C_NAME VARCHAR No
The affected body part.
May contain organization-specific values: Yes
76 MIN_PERM_DISABILITY VARCHAR No
The minimum permanent disability expected if healing has not ended.
77 PERCENT_DISABILITY INTEGER No
The percentage of disability.
78 SURGERY_PERF_YN VARCHAR No
Indicate if surgery was performed as a result of the injury.
The category values for this column were already listed for column: FOSTER_CHILD_YN
79 SURGERY_TYPE VARCHAR No
The type of surgery performed.
80 PREVIOUS_DISABILITY VARCHAR No
The previous disability before the injury.
81 CMN_INIT_CERT_DT DATETIME No
Initial certification date for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
82 CMN_REV_CERT_DT DATETIME No
Revised certification date for the External Infusion Pump Certificate of Medical Necessity (CMN) form.
83 CMN_NUM_MONTH INTEGER No
Estimated length of need, in months, for the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
84 CMN_HCPCS_CODE VARCHAR No
Healthcare Common Procedure Coding System (HCPCS) code - question 2 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
85 CMN_NON_SPEC_CODE VARCHAR No
Drug name for non-specific drug codes - question 3 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
86 CMN_DRG_INF_DUR INTEGER No
Total duration of infusion, in hours, per 24-hour period - question 6 on the 09.02 External Infusion Pump Certificate of Medical Necessity (CMN) form.
87 CMN_ROUTE_0903_C_NAME VARCHAR No
Administration route - question 3 on the 09.03 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: Yes
Category Entries:
Intravenous
Subcutaneous
Epidural
Other
88 CMN_METHOD_0903_C_NAME VARCHAR No
Administration method - question 4 on the 09.03 External Infusion Pump Certificate of Medical Necessity (CMN) form.
May contain organization-specific values: Yes
Category Entries:
Continuous
Intermittent
89 PLACE_OF_INJURY_C_NAME VARCHAR No
Place of injury.
May contain organization-specific values: Yes
Category Entries:
Work
Home
90 CITY VARCHAR No
City in which the accident happened.
91 ZIP VARCHAR No
Zip code of the place where the accident happened.
92 INFORMANT VARCHAR No
Informant of the accident.
93 ACCOMP_PERSON VARCHAR No
The person the patient was accompanied by.
94 POLICE_NOTIFIER VARCHAR No
The person the police were notified by.
95 ACC_COUNTY_C_NAME VARCHAR No
Accident county.
May contain organization-specific values: Yes
96 OUT_CLM_YN VARCHAR No
Used to track charges and claims outside of the system.
The category values for this column were already listed for column: FOSTER_CHILD_YN
97 TPL_STATUS_C_NAME VARCHAR No
The third party liability status.
May contain organization-specific values: Yes
Category Entries:
Lien
Non-Lien
98 WCAB_NUM VARCHAR No
The number assigned by the appeals board.
99 CUMU_TRAUMA_YN VARCHAR No
Indicates whether the claim is a cumulative trauma.
The category values for this column were already listed for column: FOSTER_CHILD_YN
100 AUTO_ACDNT_NUMBER VARCHAR No
Auto Accident Claim Number.
101 E_CODE_ID_DX_NAME VARCHAR No
The name of the diagnosis.
102 OTHER_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.
103 OPERATING_PHYSIC_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.
104 ATTEND_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.
105 AUTH_NUM VARCHAR No
Authorization Number: Used on claims for identifying patient referrals and affected reimbursements.
106 UB92_TOB_OVERRIDE VARCHAR No
Override for the type of bill, a numeric code that provides encounter information to payers.
107 AMBULANCE_PICK_CITY VARCHAR No
Stores the city of the ambulance pick-up location.
108 AMBULANCE_PICK_ST_C_NAME VARCHAR No
Stores the state of the ambulance pick-up location.
May contain organization-specific values: Yes
109 AMBULANCE_PICK_ZIP VARCHAR No
Stores the ZIP code of the ambulance pick-up location.
110 AMBULANCE_DROP_CITY VARCHAR No
Stores the city of the ambulance drop-off location.
111 AMBULANCE_DROP_ST_C_NAME VARCHAR No
Stores the state of the ambulance drop-off location.
The category values for this column were already listed for column: AMBULANCE_PICK_ST_C_NAME
112 AMBULANCE_DROP_ZIP VARCHAR No
Stores the ZIP code of the ambulance drop-off location.
113 AMBULANCE_DROP_NM VARCHAR No
Stores the last name or organization name of the ambulance drop-off location.
114 AMBULANCE_PAT_CNT NUMERIC No
Stores number of patients in the ambulance.
115 WC_JURSD_STATE_C_NAME VARCHAR No
Workers' Comp insurance's state of jurisdiction.
The category values for this column were already listed for column: AMBULANCE_PICK_ST_C_NAME