COVERAGE_3
Description:
The COVERAGE_3 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 PAYOR_STATE_C_NAME VARCHAR No
The state of the coverage payer.
May contain organization-specific values: Yes
3 PAYOR_ZIP VARCHAR No
The ZIP code of the coverage payer.
4 PAYOR_PHONE VARCHAR No
The phone number of the coverage payer.
5 PAYOR_CLAIM_OFC_NUM VARCHAR No
The claim office number of the coverage payer.
6 REF_PROV_NAME_ID VARCHAR No
The name of the Health Maintenance Organization's referring physician.
7 REF_PROV_NAME_ID_REFERRING_PROV_NAM VARCHAR No
The name of the referral source.
8 REF_PROV_CITY VARCHAR No
The city of the Health Maintenance Organization's referring physician.
9 REF_PROV_ZIP VARCHAR No
The ZIP code of the Health Maintenance Organization's referring physician.
10 AUTH_NUM VARCHAR No
The authorization number for this coverage.
11 AUTHORIZATION_DTTM DATETIME No
The authorization date and time for this coverage.
12 AUTH_PERSON VARCHAR No
The name of the person who authorized services for this coverage.
13 VERIF_DATETIME DATETIME No
The date and time when authorization was obtained.
14 MED_ASSIST_CARD VARCHAR No
The medical assistance card number.
15 MED_ASSIST_CODE_C_NAME VARCHAR No
The medical assistance code.
May contain organization-specific values: Yes
No Entries Defined
16 MED_ASSIST_STATUS VARCHAR No
The medical assistance status.
17 MED_ASSIST_COV_CODE VARCHAR No
The medical assistance coverage code.
18 IS_CVG_VA_PROG_YN_NAME VARCHAR No
Indicates if the coverage is for a Veterans' Administration program.
May contain organization-specific values: Yes
Category Entries:
Yes
No
UNKNOWN
19 IS_MC_PROGRAM_YN VARCHAR No
Indicates whether the coverage is for a managed care program.
May contain organization-specific values: No
Category Entries:
Yes
No
20 MC_PRIM_PROV VARCHAR No
The primary provider for a managed care coverage.
21 MC_AUTH_NUM VARCHAR No
The authorization number for a managed care coverage.
22 MC_AUTH_PHONE_NUM VARCHAR No
The authorization phone number for a managed care coverage.
23 TYPE_OF_COVERAGE_C_NAME VARCHAR No
The type of coverage.
May contain organization-specific values: Yes
No Entries Defined
24 ALSO_HAS_MCARE_YN VARCHAR No
Indicates whether the coverage subscriber also has Medicare.
The category values for this column were already listed for column: IS_MC_PROGRAM_YN
25 MAJOR_MEDICAL_C_NAME VARCHAR No
Indicates whether the patient has Major Medical coverage.
May contain organization-specific values: Yes
No Entries Defined
26 MCAID_GRP_NO_SUF_C_NAME VARCHAR No
The two letters at the end of the recipient number on the Medicaid card.
May contain organization-specific values: Yes
No Entries Defined
27 CHAMPUS_RANK VARCHAR No
The CHAMPUS/Tricare rank.
28 CHAMPUS_GRADE VARCHAR No
The CHAMPUS/Tricare grade.
29 BC_BS_CNTRCT_ACCT_C_NAME VARCHAR No
The contract account name on a Blue Cross/Blue Shield insurance card.
May contain organization-specific values: Yes
30 MAC_PROV_PHONE_NUM VARCHAR No
The phone number for the primary provider.
31 MAC_AUTH_CNCT_PRSN VARCHAR No
The person who provided authorization information for this visit.
32 MAC_COMMENT VARCHAR No
Comments regarding authorization or denial.
33 MAC_PMP_AUTH_C_NAME VARCHAR No
The authorization for this visit.
The category values for this column were already listed for column: IS_CVG_VA_PROG_YN_NAME
34 MCARE_RR_SUB_NO_P_C_NAME VARCHAR No
The subscriber number for this managed care coverage.
May contain organization-specific values: Yes
No Entries Defined
35 RECIPROCITY_NO VARCHAR No
The reciprocity number for this coverage.
36 MAC_AUTH_ENT_PRSN VARCHAR No
The person who entered the authorization number for this managed care coverage.
37 THERAPY_TYPE_C_NAME VARCHAR No
The therapy type for this coverage.
May contain organization-specific values: Yes
No Entries Defined
38 THERAPY_PLAN_DATE DATETIME No
The date when the therapy plan was established.
39 THERAPY_START_DT DATETIME No
The date when the therapy started.
40 LAST_MENSTRUAL_DATE VARCHAR No
The patient's last menstrual date.
41 AUTH_VALID_FROM_DT DATETIME No
The date when the authorization became valid.
42 AUTH_VALID_TO_DATE DATETIME No
The date when the authorization became invalid.
43 COMMERCIAL_AUTH_NUM VARCHAR No
The commercial authorization number.
44 COMM_AUTH_PRSN VARCHAR No
The person who authorized the commercial coverage.
45 MC_COBRA_STATUS_YN VARCHAR No
Indicated whether a managed care coverage has Consolidated Omnibus Budget Reconciliation Act status.
May contain organization-specific values: No
Category Entries:
Yes
No
46 MC_COBRA_DATE DATETIME No
The date when a managed care coverage received Consolidated Omnibus Budget Reconciliation Act status.
47 PB_ACCT_CREATED_YN VARCHAR No
Indicates whether a premium billing account was created for this coverage.
May contain organization-specific values: No
Category Entries:
Yes
No
48 ALTR_CVG_ATTN VARCHAR No
The alternate name of the organization to which claims submitted under this coverage can be sent.
49 ALTR_CITY VARCHAR No
The alternate city to which claims under this coverage can be sent.
50 ALTR_STATE_C_NAME VARCHAR No
The alternate state to which claims submitted under this coverage can be sent.
The category values for this column were already listed for column: PAYOR_STATE_C_NAME
51 ENROLL_REASON_REG_C_NAME VARCHAR No
The enrollment reason category number for this subscriber with this particular payer or plan.
May contain organization-specific values: Yes
No Entries Defined
52 EXT_UPD_TYPE_C_NAME VARCHAR No
This item stores what kind of change was requested by the external user.
May contain organization-specific values: No
Category Entries:
Edit
Remove
53 EXT_UPDATE_COMMENT VARCHAR No
This item stores the comment that accompanies the external update request.
54 ENROLL_RECV_DATE DATETIME No
The enrollment received date for this coverage.
55 PRIOR_LIS_DATE DATETIME No
The most recent LIS period date.
56 ALT_TRANSPLANT_PAYER_OPT_C_NAME VARCHAR No
Use this item in conjunction with Alternate Payer configuration in the Plan record to help automate claims processing to alternate transplant payers when the relationship between Primary Plan and Alternate Payer/Plan is not 1:1.
May contain organization-specific values: Yes
No Entries Defined
57 PB_PAID_THROUGH_DATE DATETIME No
The date at which the coverage's premium has been fully paid through.