|
Name |
Type |
Discontinued? |
|
1 |
IMAGE_ID |
VARCHAR |
No |
|
|
|
This is the ID for the remittance image record. |
|
|
2 |
INV_NO |
VARCHAR |
No |
|
|
|
The invoice number for the remittance image. |
|
|
3 |
CLM_STAT_CD_C_NAME |
VARCHAR |
No |
|
|
|
This is the code identifying the status of an entire claim. |
May contain organization-specific values: No |
Category Entries: |
Processed as Primary |
Processed as Secondary |
Processed as Tertiary |
Denied |
Pended |
Received, but not in process |
Suspended |
Suspended-investigation with field |
Suspended-return with material |
Suspended-review pending |
Processed as Primary, Forwarded to additional Payer(s) |
Processed as Secondary, Forwarded to additional Payer(s) |
Processed as Tertiary, Forwarded to additional Payer(s) |
Reversal of previous payment |
Not Our Claim, Forwarded to additional Payer(s) |
Predetermination pricing only, No payment |
Reviewed |
|
|
4 |
CLAIM_CHRG_AMT |
NUMERIC |
No |
|
|
|
This is the amount for submitted charges on this claim. |
|
|
5 |
CLAIM_PAID_AMT |
NUMERIC |
No |
|
|
|
This is the amount paid on the claim. |
|
|
6 |
PAT_RESP_AMT |
NUMERIC |
No |
|
|
|
This is the patient responsibility amount for the claim. |
|
|
7 |
CLM_FILING_CODE_C_NAME |
VARCHAR |
No |
|
|
|
This is a code identifying the type of claim. |
May contain organization-specific values: No |
Category Entries: |
Preferred provider organization (PPO) |
Point of service (POS) |
Exclusive provider organization (EPO) |
Indemnity Insurance |
Health maintenance organization (HMO) medicare risk |
Automobile medical |
Tricare |
Disability |
Health maintenance organization |
Liability medical |
Medicare part A |
Medicare part B |
Medicaid |
Other federal program |
Title V |
Veteran administration plan |
Workers' compensation health claim |
Dental Maintenance Organization |
Champus |
Mutually Defined |
|
|
8 |
ICN_NO |
VARCHAR |
No |
|
|
|
This is the payer's internal control number for the claim. |
|
|
9 |
FAC_CODE_VAL |
VARCHAR |
No |
|
|
|
This is the facility code used when the submitted code has been modified through adjudication. |
|
|
10 |
CLAIM_FREQ_C_NAME |
VARCHAR |
No |
|
|
|
This is the frequency code of the claim. |
May contain organization-specific values: No |
Category Entries: |
Non-Payment/Zero |
ORIGINAL |
CORRECTED |
REPLACEMENT |
VOID |
Late Charge(s) Only |
Interim - First Claim |
Interim - Continuing Claim |
Interim - Last Claim |
Final Claim for a Home Health PPS Episode |
Admission/Election Notice |
Hospice/Demonstration (CMS Coord, Centers of Ex, Prov Part)/Rel Non-Med Care Inst |
Hospice Change of Provider Notice |
Hospice/Demonstration (CMS Coord, Centers of Ex, Prov Part)/Rel Non-Med Care Inst V/C |
Hospice Change of Ownership |
Beneficiary Initiated Adjustment |
CWF Initiated Adjustment Claim |
CMS Initiated Adjustment |
Intermediary Adjustment Claim (Other than QIO or Provider) |
Initiated Adjustment Claim - Other |
OIG Initiated Adjustment Claim |
MSP Initiated Adjustment Claim |
Nonpayment/Zero Claims |
QIO Adjustment Claim |
Claim Submitted for Reconsideration Outside of Timely Limits |
Void/Cancel a Prior Abbreviated Encounter Submission |
Replacement of Prior Abbreviated Encounter Submission |
New Abbreviated Encounter Submission |
|
|
11 |
DRG_CODE |
VARCHAR |
No |
|
|
|
This is the Diagnosis Related Group (DRG) code indicating a patient's diagnosis group based on a patient's illnesses, diseases, and medical problems. |
|
|
12 |
DRG_WGT |
NUMERIC |
No |
|
|
|
The diagnosis related group weight. |
|
|
13 |
DISCHRG_FRAC |
NUMERIC |
No |
|
|
|
The discharge fraction expressed as a decimal. |
|
|
14 |
FILE_INV_NUM |
VARCHAR |
No |
|
|
|
Contains the actual invoice number that came in the file. |
|
|