|
Name |
Type |
Discontinued? |
|
1 |
RECORD_ID |
NUMERIC |
No |
|
|
|
This column stores the unique identifier for the claim record. |
|
|
2 |
BIL_PROV_TYP_QUAL |
VARCHAR |
No |
|
|
|
The value indicating whether the billing provider on the claim is a person or a non-person. |
|
|
3 |
BIL_PROV_NAM_LAST |
VARCHAR |
No |
|
|
|
The billing provider's last name (if a person) or the organization name (if a non-person). |
|
|
4 |
BIL_PROV_NAM_FIRST |
VARCHAR |
No |
|
|
|
The billing provider's first name. It is only populated when the billing provider is a person. |
|
|
5 |
BIL_PROV_NAM_MID |
VARCHAR |
No |
|
|
|
The billing provider's middle name. It is only populated when the billing provider is a person. |
|
|
6 |
BIL_PROV_NAM_SUF |
VARCHAR |
No |
|
|
|
The suffix to the billing provider's name (e.g., Jr, III). It is only populated when the billing provider is a person. |
|
|
7 |
BIL_PROV_NPI |
VARCHAR |
No |
|
|
|
The billing provider's National Provider Identifier (NPI). |
|
|
8 |
BIL_PROV_TAXONOMY |
VARCHAR |
No |
|
|
|
The billing provider's taxonomy code. |
|
|
9 |
BIL_PROV_TAXID_QUAL |
VARCHAR |
No |
|
|
|
The qualifier for the billing provider's tax ID defining the type of ID reported as the tax ID. |
|
|
10 |
BIL_PROV_TAXID |
VARCHAR |
No |
|
|
|
The billing provider's tax ID. For individuals, this ID could be the SSN or tax ID. |
|
|
11 |
BIL_PROV_UPIN |
VARCHAR |
No |
|
|
|
The billing provider's unique physician identification number (UPIN). It is only populated when the provider is a person. |
|
|
12 |
BIL_PROV_LIC_NUM |
VARCHAR |
No |
|
|
|
The billing provider's license number. It is only populated when the billing provider is a person. |
|
|
13 |
BIL_PROV_ADDR_1 |
VARCHAR |
No |
|
|
|
The first line of the billing provider's street address. |
|
|
14 |
BIL_PROV_ADDR_2 |
VARCHAR |
No |
|
|
|
The second line of the billing provider's street address. |
|
|
15 |
BIL_PROV_CITY |
VARCHAR |
No |
|
|
|
The billing provider's city. |
|
|
16 |
BIL_PROV_STATE |
VARCHAR |
No |
|
|
|
The billing provider's state. |
|
|
17 |
BIL_PROV_ZIP |
VARCHAR |
No |
|
|
|
The billing provider's ZIP Code. |
|
|
18 |
BIL_PROV_CNTRY |
VARCHAR |
No |
|
|
|
The billing provider's country. It is only populated if the address is outside the United States. |
|
|
19 |
BIL_PROV_CNTRY_SUB |
VARCHAR |
No |
|
|
|
The billing provider's country subdivision (e.g., state, province). It is only populated if the address is outside the United States. |
|
|
20 |
CLM_CVG_SEQ_CD |
VARCHAR |
No |
|
|
|
The code identifying the filing order for the claim (e.g., primary, secondary, tertiary). |
|
|
21 |
CLM_CVG_PYR_NAM |
VARCHAR |
No |
|
|
|
|
22 |
CLM_CVG_GRP_NUM |
VARCHAR |
No |
|
|
|
The group number entered in the coverage record. |
|
|
23 |
CLM_CVG_GRP_NAM |
VARCHAR |
No |
|
|
|
The group name entered in the coverage record. |
|
|
24 |
CLM_CVG_INS_TYP |
VARCHAR |
No |
|
|
|
The insurance type code for the claim. |
|
|
25 |
CLM_CVG_FILING_IND |
VARCHAR |
No |
|
|
|
The indicator identifying the type of claim. |
|
|
26 |
CLM_CVG_PYR_ID_TYP |
VARCHAR |
No |
|
|
|
The qualifier that describes the type of ID used to identify the payer. |
|
|
27 |
CLM_CVG_PYR_ID |
VARCHAR |
No |
|
|
|
The primary ID for the payer. |
|
|
28 |
CLM_CVG_ACPT_ASGN |
VARCHAR |
No |
|
|
|
The indicator that the provider accepts assignment from the payer. |
|
|
29 |
CLM_CVG_AUTH_PMT |
VARCHAR |
No |
|
|
|
The indicator that the insured assigns benefits to the provider. |
|
|
30 |
CLM_CVG_REL_INFO |
VARCHAR |
No |
|
|
|
The indicator that the insured has authorized the release of information to the payer. |
|
|
31 |
PYR_ADDR_1 |
VARCHAR |
No |
|
|
|
The first line of the payer's street address. |
|
|
32 |
PYR_ADDR_2 |
VARCHAR |
No |
|
|
|
The second line of the payer's street address. |
|
|
33 |
PYR_CITY |
VARCHAR |
No |
|
|
|
|
34 |
PYR_STATE |
VARCHAR |
No |
|
|
|
|
35 |
PYR_ZIP |
VARCHAR |
No |
|
|
|
|
36 |
PYR_CNTRY |
VARCHAR |
No |
|
|
|
The payer's country. It is only populated if the address is outside the United States. |
|
|
37 |
PYR_CNTRY_SUB |
VARCHAR |
No |
|
|
|
The payer's country subdivision (e.g., state, province). It is only populated if the address is outside the United States. |
|
|
38 |
PAT_NAM_LAST |
VARCHAR |
No |
|
|
|
|
39 |
PAT_NAM_FIRST |
VARCHAR |
No |
|
|
|
The patient's first name. |
|
|
40 |
PAT_NAM_MID |
VARCHAR |
No |
|
|
|
The patient's middle name. |
|
|
41 |
PAT_NAM_SUF |
VARCHAR |
No |
|
|
|
The suffix to the patient's name (e.g., Jr, III). |
|
|
42 |
PAT_MRN |
VARCHAR |
No |
|
|
|
The patient's medical record number. |
|
|
43 |
PAT_CVG_MEM_ID |
VARCHAR |
No |
|
|
|
The coverage member ID for the patient. |
|
|
44 |
PAT_REL_TO_INS |
VARCHAR |
No |
|
|
|
The patient's relationship to the coverage subscriber. |
|
|
45 |
PAT_BIRTH_DATE |
DATETIME |
No |
|
|
|
|
46 |
PAT_SEX |
VARCHAR |
No |
|
|
|
|
47 |
PAT_SIG_ON_FILE |
VARCHAR |
No |
|
|
|
The indicator that the patient has signed the necessary release forms and the forms are on file at the provider. |
|
|
48 |
PAT_SIG_SRC |
VARCHAR |
No |
|
|
|
The indicator that the release forms were signed on the patient's behalf. |
|
|
49 |
PAT_DEATH_DATE |
DATETIME |
No |
|
|
|
The date of the patient's death. |
|
|
50 |
PAT_WT |
NUMERIC |
No |
|
|
|
The patient's weight (in pounds) when needed for the claim. |
|
|
51 |
PAT_PREG_IND |
VARCHAR |
No |
|
|
|
The indicator that the patient is pregnant. |
|
|
52 |
PAT_WK_COMP_NUM |
VARCHAR |
No |
|
|
|
The identification number used for workers' comp claims. |
|
|
53 |
PAT_MAR_STAT |
VARCHAR |
No |
|
|
|
The patient's marital status. |
|
|
54 |
PAT_EMPY_STAT |
VARCHAR |
No |
|
|
|
The patient's employment status. |
|
|
55 |
PAT_PH |
VARCHAR |
No |
|
|
|
The patient's phone number. |
|
|
56 |
PAT_ADDR_1 |
VARCHAR |
No |
|
|
|
The first line of the patient's street address. |
|
|
57 |
PAT_ADDR_2 |
VARCHAR |
No |
|
|
|
The second line of the patient's street address. |
|
|
58 |
PAT_CITY |
VARCHAR |
No |
|
|
|
|
59 |
PAT_STATE |
VARCHAR |
No |
|
|
|
|
60 |
PAT_ZIP |
VARCHAR |
No |
|
|
|
|
61 |
PAT_CNTRY |
VARCHAR |
No |
|
|
|
The patient's country. It is only populated if the address is outside the United States. |
|
|
62 |
PAT_CNTRY_SUB |
VARCHAR |
No |
|
|
|
The patient's country subdivision (e.g., state, province). It is only populated if the address is outside the United States. |
|
|
63 |
INV_NUM |
VARCHAR |
No |
|
|
|
The invoice number that uniquely identifies the claim in the billing system. |
|
|
64 |
ICN |
VARCHAR |
No |
|
|
|
The payer's internal control number (ICN) that uniquely identifies the claim in the payer's system. |
|
|
65 |
TTL_CHG_AMT |
NUMERIC |
No |
|
|
|
The total charge amount for the claim. |
|
|
66 |
BILL_TYP_FAC_CD |
VARCHAR |
No |
|
|
|
The facility code portion of the bill type (first and second digits). |
|
|
67 |
BILL_TYP_FREQ_CD |
VARCHAR |
No |
|
|
|
The frequency code portion of the bill type (third digit). |
|
|
68 |
MOMS_MRN |
VARCHAR |
No |
|
|
|
The mother's medical record number when the patient is a newborn. |
|
|
69 |
PAYTO_ADDR_TYP_QUAL |
VARCHAR |
No |
|
|
|
The indicator that the pay-to address entity on the claim is a person or a non-person. |
|
|