CLM_VALUES_4
Description:
All values associated with a claim are stored in the Claim External Value record. The CLM_VALUES_4 table holds claim-level values set by the system during claims processing or by user edits.

Primary Key
Column Name Ordinal Position
RECORD_ID 1

Column Information
Name Type Discontinued?
1 RECORD_ID NUMERIC No
The unique identifier for the claim value record.
2 REP_CLM_NUM VARCHAR No
The repriced claim reference number.
3 ADJ_REP_CLM_NUM VARCHAR No
The adjusted repriced claim number.
4 CLM_TRANS_INTMD VARCHAR No
The identifier for claim transmission intermediaries.
5 CLM_PRO_APP_NUM VARCHAR No
The Peer Review Organization (PRO) Approval Number for the claim.
6 CLM_PRICING_METHDLG VARCHAR No
The claim pricing methodology.
7 CLM_REP_ALWD_AMT NUMERIC No
The claim re-pricing allowed amount.
8 CLM_REP_SVNG_AMT NUMERIC No
The claim Repriced Saving Amount.
9 CLM_REP_ORGID VARCHAR No
The Repricing Organization Identifier for the claim.
10 REP_PDIEM_FLTRT_AMT NUMERIC No
The Repricing Per Diem or Flat Rate Amount for the claim.
11 REP_APRVD_DRG_CODE VARCHAR No
The Repriced Approved Diagnosis Related Group Code for the claim.
12 REP_APPRVD_AMT NUMERIC No
The Repriced Approved Amount for the claim.
13 REP_APRVD_REV_CODE VARCHAR No
The Repriced Approved Revenue Code for the claim.
14 REP_ASU_MSRMNT_CODE VARCHAR No
The basis of measurement (e.g., Days, Units) for Repriced Approved Service Unit Count.
15 REP_APR_SERV_CNT NUMERIC No
The Repriced Approved Service Unit Count for the claim.
16 PAYTO_PLAN_TAXID VARCHAR No
The Pay-To Plan Tax Identification Number.
17 FIRST_CNCT_DT DATETIME No
The Property and Casualty Date of First Contact.
18 REPRICER_RECVD_DT DATETIME No
The Repricer Received Date.
19 MCARE_XOVER_IND VARCHAR No
The Mandatory Medicare Crossover Indicator.
20 CARE_PLN_NUM VARCHAR No
The Care Plan Oversight Number.
21 HOMEBOUND_COND_QUAL VARCHAR No
The Homebound Condition Qualifier.
22 HOMEBOUND_COND_CD VARCHAR No
The Homebound Condition Code.
23 DENTAL_SVC_FROM_DT DATETIME No
The Dental Service From Date. It will only be populated when using a dental form.
24 DENTAL_SVC_TO_DT DATETIME No
The Dental Service To Date. It will only be populated when using a dental form.
25 DENTAL_SVC_DT_QUAL VARCHAR No
The dental date range qualifier. It will only be populated on a dental form.
26 ORTHO_TREAT_IND VARCHAR No
The Orthodontic Treatment Indicator. This column will only have data when a dental claim has orthodontic services without any months of orthodontic treatment being reported.
27 DENT_PREDET_CODE VARCHAR No
The code identifying whether a claim is a pre-authorization dental claim. If the claim is a predetermination of benefits claim (pre-auth), this column will be populated with "PB". If the claim is a statement of actual services, this column will be null.
28 OTH_ACC_EMER_YN VARCHAR No
The indicator that the claim includes emergency services.
29 STER_ABOR_YN VARCHAR No
The indicator that a visit was related to a sterilization or abortion.
30 PAYEE_NUM VARCHAR No
The payee number for Medicaid.
31 CLM_LVL_TOS VARCHAR No
The claim-level type of service code.
32 CLM_LVL_EPSDT_YN VARCHAR No
The indicator that the claim was related to an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) visit.
33 CLM_LVL_FAM_PLAN_YN VARCHAR No
The indicator that the claim was related to family planning.
34 CLM_LVL_EMER_YN VARCHAR No
The indicator that the claim was related to emergency services.
35 PAT_LOCATION_IDENT VARCHAR No
The county code corresponding to the patient address.
36 PAT_PERSONAL_IDENT VARCHAR No
The combination of patient name characters and digits from their SSN used by the Statewide Planning and Research Cooperative System (SPARCS) to identify the patient.
37 DRG_SOI VARCHAR No
The Severity Of Illness (SOI) of Diagnosis Related Group (DRG) determined for the claim.
38 DRG_ROM VARCHAR No
The Risk Of Mortality (ROM) of Diagnosis Related Group (DRG) determined for the claim.
39 CAS_SVC_POS_NUM INTEGER No
The position number within the service line in the source claim CEV.
40 CLM_RECORD_INDICATOR VARCHAR No
The action to be taken on the claim.
41 LINE_OF_BUSINESS_CODE VARCHAR No
The line of business (LOB) code under which claim was paid.
42 BENEFIT_ID VARCHAR No
The identifier for a set of parameters, benefits, or coverage criteria used to adjudicate a claim.
43 PLAN_TYPE VARCHAR No
The type of plan identifier.
44 PRESC_PROV_TAXONOMY VARCHAR No
The prescribing provider taxonomy code.
45 ADJUD_DATE DATETIME No
The date the claim was processed.
46 ADJUD_TM DATETIME (Local) No
The time the claim was processed.
47 REJECT_OVERRIDE_CODE VARCHAR No
The reason for paying a claim when override is used.
48 CROSS_REF_ICN VARCHAR No
The ID associated with the original claim for adjustment claims.
49 PAYMENT_CLARIFICATION_CODE VARCHAR No
The additional information on the status of the payment of the claim.
50 ADJUSTMENT_TYPE VARCHAR No
The type of adjustment whether debit or credit.
51 STER_ABOR_CODE VARCHAR No
The single-letter sterilization/abortion code appearing in field 22D on the eMedNY 150003 claim form
52 POSSIBLE_DISABILITY_YN VARCHAR No
The indicator that the service was for treatment of a condition which appeared to be of a disabling nature for field 22F on the eMedNY 150003.
53 PMT_SRC_MCR_INVOLVE VARCHAR No
The single-digit source code indicator that indicates Medicare's involvement in paying for these charges for field 23B box M on the eMedNY 150003 claim form.
54 PMT_SRC_OTHR_INVOLV VARCHAR No
The single-digit code indicating whether the patient has a coverage besides Medicare and Medicaid for field 23B box O on the eMedNY 150003 claim form.
55 PMT_SRC_INS_CODE VARCHAR No
The two-digit insurance code for the commercial coverage, if any, for field 23B box O on the eMedNY 150003 claim form.
56 LOCATOR_CODE VARCHAR No
The locator code assigned by Medicaid for the address where the service was performed for field 25C on the eMedNY 150003 paper claim form.
57 MEM_SUBMIT_PMT_RELEASE_DATE DATETIME No
The date the member submitted claim became payable, which could differ from the check date.
58 CHECK_DATE DATETIME No
The claim check date.
59 PAT_DEM_CODE_QUAL VARCHAR No
The patient demographic code qualifier.
60 PAT_DEM_CODE VARCHAR No
The patient demographic code.
61 DRG_CODE_SET VARCHAR No
The code set of the Diagnosis Related Group (e.g., APR-DRG, MS-DRG).
62 CLM_STATUS VARCHAR No
The submitter's claim status (e.g., clean, denied).
63 DRG_CODE_VERSION VARCHAR No
The version of the code set that the Diagnosis Related Group (DRG) code on the claim is associated with (e.g., Version 31, Version 32)
64 IS_CLINICALLY_INVALID_IDENT VARCHAR No
The external identifier representing if the claim is clinically invalid or not.
65 DRG_CODE_SET_IDENT VARCHAR No
The external identifier representing the Diagnosis Related Group (DRG) code set.
66 DRG_CODE_VER_IDENT VARCHAR No
The external identifier representing the Diagnosis Related Group (DRG) version.