CLM_VALUES_5
Description:
All values associated with a claim are stored in the Claim External Value record. The CLM_VALUES_5 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 FHIR_GROUP_IDENTIFIER VARCHAR No
The bulk FHIR group ID for which the claim was received.
3 DEPT_ALT_CODE VARCHAR No
This item stores the alternate code for the department. The alternate code comes from MPI. For Norway, this item stores the IK44 code.
4 PAYER_ENTERPRISE_IDENTIFIER VARCHAR No
Patient's enterprise ID assigned by the payer.
5 ATT_PROV_SPECIALTY VARCHAR No
The specialty of the attending provider.
6 NON_PAYMENT_RSN_DESC VARCHAR No
Claim level denial reason code description.
7 CARRIER_PAYMENT_DNL_CD VARCHAR No
Carrier claim payment denial code.
8 NON_PAYMENT_RSN_CD VARCHAR No
Claim level denial reason code.
9 CARRIER_PAYMENT_DNL_DESC VARCHAR No
Carrier claim payment denial code description.
10 BCDA_GROUP_IDENT VARCHAR No
Claim Group Identifier provided by Beneficiary Claims Data API
11 PRIMARY_PAYER_CD VARCHAR No
Code used to determine if Medicare was the primary payer of this claim.
12 BIL_PROV_SPEC_CODE_SET VARCHAR No
Stores the code set for the Billing Provider Specialty Code.
13 OPER_PROV_TAXONOMY VARCHAR No
Holds the Operating Provider Taxonomy Code for a claim.
14 PREDETERMIN_IDENT VARCHAR No
This is the predetermination of benefits identifier for the claim.
15 ADJ_TO_CLAIM_ID VARCHAR No
Holds the adjustment to claim ID for the claim received from raw data
16 REV_TO_CLAIM_ID VARCHAR No
Holds the reversal to claim ID for the claim received from raw data
17 ADJ_SEQUENCE VARCHAR No
Holds the adjustment sequence for the claim received from raw data
18 PLAN_NAME VARCHAR No
The plan name from raw claims data.
19 CORPORATION_NAME VARCHAR No
Corporation name from raw claims data.
20 NETWORK_LEVEL VARCHAR No
Specifies the network level of the claim.
21 REGION_NAME VARCHAR No
The name of the region associated with the claim.
22 LINE_OF_BUSINESS_NAME VARCHAR No
The name of the line of business associated with the claim.
23 SVC_PROV_IN_NETWORK VARCHAR No
This value indicates if the service provider / pharmacy is in-network.
24 MEDICARE_DRUG_CVG_CODE VARCHAR No
Identifies if a claim was processed under the Medicare Part B benefit or Part D benefit.
25 SVC_FAC_CCN VARCHAR No
Centers for Medicare and Medicaid Services Certification Number (CCN) for the service facility location.
26 PCP_REF_PROV_NAM_LAST VARCHAR No
This item holds the PCP referring provider's last name (NM1*P3).
27 PCP_REF_PROV_NAM_FIRST VARCHAR No
This item holds the PCP referring provider's first name (NM1*P3).
28 PCP_REF_PROV_NAM_MID VARCHAR No
This item holds the PCP referring provider's middle name (NM1*P3).
29 PCP_REF_PROV_NAM_SUF VARCHAR No
This item holds the PCP referring provider's suffix (NM1*P3).
30 PCP_REF_PROV_NPI VARCHAR No
This item holds the PCP referring provider's NPI (NM1*P3).
31 PCP_REF_PROV_TAXONOMY VARCHAR No
This item holds the referring provider's taxonomy code.
32 REF_PROV_FROM_LINE_YN VARCHAR No
Identifies whether the referring provider was received at the header level, or rolled up from the line level.
May contain organization-specific values: No
Category Entries:
No
Yes
33 REN_PROV_FROM_LINE_YN VARCHAR No
Identifies whether the rendering provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
34 OPER_PROV_FROM_LINE_YN VARCHAR No
Identifies whether the operating provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
35 OTHOP_PROV_FROM_LINE_YN VARCHAR No
Identifies whether the other operating provider was received at the header level, or rolled up from the line level.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
36 PAT_RESIDENCE_CODE VARCHAR No
The code identifying the patient's place of residence. This data is only populated for Pharmacy claims.
37 SVC_FAC_CMS_PARTD_FLAG VARCHAR No
Indicates whether the patient resides in a facility that qualifies for the CMS Part D benefit. This data is only populated for Pharmacy claims.
38 BANK_IDENT_NUM VARCHAR No
The card issuer ID or bank ID number used for network routing. This data is only populated for Pharmacy claims.
39 PROCESSOR_CTL_NUM VARCHAR No
The number assigned by the processor. This data is only populated for Pharmacy claims.
40 RX_PRIOR_AUTH_TYPE VARCHAR No
The code clarifying the prior authorization number submitted or benefit/plan exemption.
41 PRESCRIBER_LAST_NAME VARCHAR No
The last name of the prescribing provider. This data is only populated for Pharmacy claims.
42 SNAPSHOT_CEV_YN VARCHAR No
Contains a flag for whether or not the CEV respresents a snapshot of the data sent on an outgoing 837. Snapshot CEV records are created for rejected Tapestry claims that are added to Claim Export workqueues.
The category values for this column were already listed for column: REF_PROV_FROM_LINE_YN
43 SNAPSHOT_CEV_RECORD_ID NUMERIC No
Contains the ID, if one exists, of the CEV containing the data sent on an outgoing 837 for an editable CEV record.
44 PICK_UP_CNTY VARCHAR No
Stores the Ambulance Pick-Up Location County
45 DROP_OFF_CNTY VARCHAR No
Stores the Ambulance Drop-Off Location County
46 LAST_SRP_DATE DATETIME No
The Last Scaling and Root Planing Procedure Date for the claim.
47 NCH_CLAIM_TYPE VARCHAR No
The CMS National Claims History (NCH) code indicating the type of claim submitted.
48 CMS_ADJSTMT_DLTN_CD VARCHAR No
The CMS Adjustment Deletion Code for the claim. This value distinguishes an adjusted or deleted PDE claim from an original.
49 CLAIM_TYPE_OUT_IN VARCHAR No
Claim type for use on Canadian claims
50 COVERAGE_EXPIRY_DATE DATETIME No
Expiry date of the plan registration number, for use with Canadian Claims
51 DECEASED_INDICATOR VARCHAR No
Deceased indicator, for use with Canadian Claims
52 CLAIM_NET_AMOUNT NUMERIC No
The net amount of the claim expected to be paid by the payer to the provider.
53 VALUE_ADDED_TAX NUMERIC No
The total Value Added Tax (VAT) charged on a claim.
54 ENC_TYPE VARCHAR No
The encounter type for a claim. Also known as Admitting Category.
55 ENC_TRANSFER_SOURCE VARCHAR No
The transfer source location for the encounter on the claim. Also known as Point of Origin.
56 ENC_TRANSFER_DEST VARCHAR No
The transfer destination for the encounter on the claim. Also known as Discharge Destination.