COVERAGE_2
Description:
The COVERAGE_2 table contains high-level information on both managed care and indemnity coverage records in your system.

Primary Key
Column Name Ordinal Position
CVG_ID 1

Column Information
Name Type Discontinued?
1 CVG_ID NUMERIC No
The unique identifier for the coverage record.
2 STATUS_C_NAME VARCHAR No
The category number of the status for this coverage record.
May contain organization-specific values: No
Category Entries:
Active
Inactive
Deleted
Inactive and Deleted
Hidden
Inactive and Hidden
Deleted and Hidden
Inactive Deleted and Hidden
3 IS_DEDUCT_MET_C_NAME VARCHAR No
Indicates whether the deductible has been met for this coverage. The deductible can be established on the guarantor account or patient level.
May contain organization-specific values: No
Category Entries:
Deductible Met
Not Met
4 IS_ASGN_CVG_C_NAME VARCHAR No
Indicated whether the provider's assignment status is set to Coverage Assignment for this coverage's payor.
May contain organization-specific values: No
Category Entries:
Accept Assignment
Do Not Accept Assignment
5 SIG_ON_FILE_DATE DATETIME No
The date when the signature was filed.
6 SIG_ON_FILE_LOC VARCHAR No
The location at which the signature was filed.
7 MEDIGAP_AUTH_YN VARCHAR No
Indicates whether the payor for this coverage has Medigap authorization.
May contain organization-specific values: No
Category Entries:
Yes
No
8 TPL_RESOURCE_CODE VARCHAR No
This column lists the Third Party Liability resource code for a specific plan. This code is either returned in the real-time eligibility response or found on the patient's insurance card.
9 THIRD_PARTY_LIAB_YN VARCHAR No
Indicates if there is third-party liability for this coverage.
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
10 BENEFIT_CODE VARCHAR No
The benefit code for this coverage. This can contain any facility-specific benefit code.
11 SCHEDULED_DISCON_DT DATETIME No
The date when the coverage is scheduled to be discontinued.
12 SCHEDULED_ACTV_DT DATETIME No
The date when the coverage is scheduled to be activated.
13 YR_ALLOW_DOL_TOT VARCHAR No
The yearly dollar limit for payments against this coverage's payor.
14 YR_ALLOW_DOL_USE VARCHAR No
The year-to-date payments made against the coverage's payor.
15 ORG_FOR_CLM_SUBMIT VARCHAR No
The title or name of the organization to which submitted claims under this coverage will be sent.
16 FINANCIAL_CLASS_C_NAME VARCHAR No
The financial class for this coverage. This is only used for CMS claims forms and may not be reliably populated for reporting. Reporting should done using the financial class of the payor specified in this coverage.
May contain organization-specific values: Yes
Category Entries:
Commercial
Medicare
Medicaid
Self-Pay
Worker's Comp
Tricare
Champva
Group Health Plan
FECA Black Lung
Blue Shield
Medigap
Other
DK Regional
Client
Received Self-Pay
Sent to Consolidated Self-Pay
Patient Assistance Program
17 COVERAGE_FAX VARCHAR No
The fax number for this coverage.
18 FREE_TXT_PLAN_NAME VARCHAR No
The free-text plan name for this coverage.
19 FREE_TXT_PAYOR_NAME VARCHAR No
The free-text payor name for this coverage.
20 PLAN_FREE_TEXT VARCHAR No
The format of the coverage's free-text plan.
21 TEFRA_PAT_YN VARCHAR No
Indicates whether the patient is TEFRA. A patient is TEFRA if an eligible Medicare beneficiary is covered by a group health plan.
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
22 ADMISSION_SRC_C_NAME VARCHAR No
The category number of the admission source.
May contain organization-specific values: Yes
Category Entries:
Physician Referral
Clinic Referral
HMO Referral
Transfer from Hospital
Transfer from a SNF
Transfer from other Health Care Facility
Emergency Room
Court/Law Enforcement
23 ENROLL_CODE_FBC VARCHAR No
The Federal Employment Program enrollment code.
24 GRP_NUMBER VARCHAR No
The group number for the coverage.
25 HMO_SITE_NUM VARCHAR No
The site number for the coverage's HMO.
26 HMO_SITE_PHONE VARCHAR No
The phone number for the coverage's HMO.
27 COPAY_AMOUNT VARCHAR No
The copay amount for the coverage.
28 CHAMP_SPON_STATUS_C_NAME VARCHAR No
The CHAMPUS/Tricare sponsor's military status, obtained from the military identification card.
May contain organization-specific values: Yes
Category Entries:
Active Military
Retired Military
Deceased
29 SERVICE_BRANCH VARCHAR No
The military service branch for a CHAMPUS/Tricare coverage subscriber.
30 CHAMP_SPON_BRANCH_C_NAME VARCHAR No
A CHAMPUS/Tricare coverage sponsor's military service branch.
May contain organization-specific values: Yes
Category Entries:
Army
Air Force
Marines
Navy
Coast Guard
Public Health Service
NOAA (National Oceanic & Atmospheric Adm.)
31 CHAMP_SPON_GRADE_C_NAME VARCHAR No
A CHAMPUS/Tricare coverage sponsor's military pay grade.
May contain organization-specific values: Yes
Category Entries:
G1 Commissioned
09 Commissioned
08 Commissioned
07 Commissioned
06 Commissioned
05 Commissioned
04 Commissioned
03 Commissioned
02 Commissioned
01 Commissioned
W4 Warrant
W3 Warrant
W2 Warrant
W1 Warrant
E9 Enlisted
E8 Enlisted
E7 Enlisted
E6 Enlisted
E5 Enlisted
E4 Enlisted
E3 Enlisted
E2 Enlisted
E1 Enlisted
Security
NATO
CHAMPVA
32 MCARE_OTHER_INS_CO VARCHAR No
An additional insurance company providing coverage for a Medicare patient.
33 MCARE_REC_DIS_YN VARCHAR No
Indicates if a Medicare patient is receiving disability benefit.
May contain organization-specific values: No
Category Entries:
YES
NO
34 DIS_CVD_BY_EMP_YN VARCHAR No
Indicates if a Medicare patient is receiving disability coverage from their employer.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
35 MCARE_100_EMP_YN VARCHAR No
Indicates if a Medicare employer has over 100 employees.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
36 MCARE_AUTO_YN VARCHAR No
Indicates if the illness or injury for this visit is due to an automobile accident.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
37 MCARE_LIAB_YN VARCHAR No
Indicates if the illness or injury for this visit is due to a liability accident.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
38 MCARE_WK_COMP_YN VARCHAR No
Indicates if a Medicare visit is covered by Workman's Compensation.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
39 MCARE_NON_AUTO_YN VARCHAR No
Indicates if the patient's visit is due to an accident not involving automobiles.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
40 MCARE_BLACK_LUNG_YN VARCHAR No
Indicates whether the illness is covered by the Black Lung program.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
41 MCARE_VA_YN VARCHAR No
Indicates if the illness is covered by a Veterans' Administration program.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
42 MCARE_PARENT_EMP_YN VARCHAR No
Indicates whether the patient's parents or guardians are employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
43 MCARE_CVD_GD_YN VARCHAR No
For large group health plans, indicates if the patient is covered by their parent or guardian.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
44 MCARE_GD_EMP_100_YN VARCHAR No
Indicates whether the employer of this patient's parent or guardian employs over 100 people.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
45 IS_MCARE_VET_ADMN_C_NAME VARCHAR No
Indicates whether this coverage is for a Veterans' Administration program.
May contain organization-specific values: Yes
Category Entries:
Yes
No
UNKNOWN
46 MCARE_EMPLOYED_YN VARCHAR No
Indicates whether the Medicare patient is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
47 MCARE_ENRL_HMO_YN VARCHAR No
Indicates if the Medicare patient is enrolled in an HMO.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
48 MCARE_CVD_EGHP_YN VARCHAR No
Indicates whether the patient is covered by an employer group health plan.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
49 MCARE_EMP_20_YN VARCHAR No
Indicates whether the Medicare patient is employed by an employer with over 20 employees.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
50 MCARE_REN_DIAL_YN VARCHAR No
Indicates whether the patient is a renal dialysis patient in the first 12 months of entitlement.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
51 IS_MCARE_RENAL_DI_C_NAME VARCHAR No
Indicates whether the patient is a renal dialysis patient.
The category values for this column were already listed for column: IS_MCARE_VET_ADMN_C_NAME
52 MCARE_1ST_18MO_YN VARCHAR No
Indicates whether the patient is in the first 18 months of entitlement for renal dialysis.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
53 MCARE_HOME_DIAL_YN VARCHAR No
Indicates whether the patient is a home dialysis patient.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
54 MCARE_SELF_EPO_YN VARCHAR No
Indicates whether this patient self-administers EPO.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
55 MCARE_DISABLE_YN VARCHAR No
Indicates whether a patient's Medicare coverage is due to disability.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
56 MCARE_SPSE_RET_YN VARCHAR No
Indicates whether a Medicare patient's spouse is retired.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
57 MCARE_SPOUSE_RET_DT DATETIME No
The date when a Medicare patient's spouse retired.
58 MCARE_EMPR_INS_YN VARCHAR No
Indicates whether a Medicare patient is insured by their employer.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
59 MCARE_RETIRE_YN VARCHAR No
Indicates whether a Medicare patient is retired.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
60 MCARE_RETIRE_DATE DATETIME No
The date when a Medicare patient retired.
61 MCARE_FAM_EMPY_YN VARCHAR No
Indicates whether a Medicare patient's spouse or another family member is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
62 MCARE_OTHR_CVG_YN VARCHAR No
Indicates whether a Medicare patient is covered because of their spouse or other family member.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
63 MCARE_SPC_EMP_YN VARCHAR No
Indicates whether a Medicare patient's spouse is employed.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
64 MCARE_CVG_FRM_SP_YN VARCHAR No
Indicates whether a Medicare patient is covered through their spouse's employer group health plan.
The category values for this column were already listed for column: MCARE_REC_DIS_YN
65 VERIF_EVS_YN VARCHAR No
Indicates if verification is done through Eligibility Verification Systems (EVS).
The category values for this column were already listed for column: MEDIGAP_AUTH_YN
66 EVS_VERIF_DATE DATETIME No
The date when eligibility was verified with Eligibility Verification Systems (EVS).
67 PAYOR_NAME VARCHAR No
The coverage payor's name.
68 PAYOR_CITY VARCHAR No
The coverage payor's city.
69 EXT_CVG_SRC_ORGANIZATION_ID NUMERIC No
The Organization (DXO) that provided the information for this coverage.
70 EXT_CVG_SRC_ORGANIZATION_ID_EXTERNAL_NAME VARCHAR No
Organization's external name used as the display name on forms and user interfaces.
71 EXT_CVG_FHIR_IDENT VARCHAR No
The FHIR Id of a coverage record on an external system that was used to create this coverage.
72 EXT_CVG_OID VARCHAR No
The OID of a coverage record on an external system that was used to create this coverage.
73 EXT_PAYER_NAME VARCHAR No
Payer name received for a coverage from an external payer system.
74 EXT_PLAN_NAME VARCHAR No
Plan name received for a coverage from an external payer system.