|
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. |
|
|