HSP_CLAIM_DETAIL1
Description:
This table contains claim print record information for claims associated with a given hospital account or liability bucket.

Primary Key
Column Name Ordinal Position
CLAIM_PRINT_ID 1

Column Information
Name Type Discontinued?
1 CLAIM_PRINT_ID NUMERIC No
Stores the claim record ID associated with a single hospital account.
2 CLAIM_CAT_C_NAME VARCHAR No
The claim category.
May contain organization-specific values: Yes
Category Entries:
Capitated
Noncapitated
DME
3 MAIL_NAME VARCHAR No
The mailing name for this claim.
4 MAIL_CITY_STATE_ZIP VARCHAR No
The mailing city, state, and ZIP code for this claim.
5 MAIL_PHONE VARCHAR No
The mailing phone number for this claim.
6 SRC_OF_ADDR_C_NAME VARCHAR No
The source of the mailing address for this claim.
May contain organization-specific values: Yes
Category Entries:
Payor
Account
Plan
Coverage
Override
7 LINE_SOURCE_CLP_ID VARCHAR No
The source claim record for resubmit and demand claims.
8 PARTIAL_CLAIM_YN VARCHAR No
Indicates whether the claim is a partial resubmit.
May contain organization-specific values: No
Category Entries:
No
Yes
9 ORIG_HAR_RES_ACT_ID NUMERIC No
Stores the original hospital account when research charges have been added to the account.
10 EXPECTED_PYMT NUMERIC No
Claim level expected reimbursement.
11 DRG_ID VARCHAR No
Diagnosis related group for this claim.
12 DRG_ID_DRG_NAME VARCHAR No
The name of the Diagnoses Related Group name.
13 CLAIM_BILLED_AMOUNT NUMERIC No
Billed amount determined from reimbursement information for Diagnosis Related Group priced claims.
14 CLM_CONTRACTUAL NUMERIC No
The contract price for this claim.   If the expected reimbursement is calculated with an Epic contract and is priced by DRG, this is the reimbursement amount calculated for the DRG before any reimbursement caps are applied. If the expected reimbursement is calculated from an external source that supports line-level reimbursement, this is the claim's total payment amount.
15 CLM_EXPECTED_PRICE NUMERIC No
The expected reimbursement amount for this claim.   If the expected reimbursement is calculated with an Epic contract and is priced by DRG, this is the reimbursement amount calculated for the DRG after any reimbursement caps are applied. If the expected reimbursement is calculated from an external source that supports line-level reimbursement, this is the claim's total payment amount.
16 CLAIM_PMT_METHOD_C_NAME VARCHAR No
Payment method determined from reimbursement information for Diagnosis Related Group priced claims.
May contain organization-specific values: No
Category Entries:
Fee Schedule
Capitation Table
Percent of Billed
Per Diem
Percent of Fee Schedule
Minimum of Fee Schedules
Weighted Fee Schedule
Global Case Rate
None
Minimum of Options
Percentage After Threshold
Case Rate
Percent of Billed - Apply Modifiers
PPS Pricing
Extension Only
Maximum of Fee Schedules
Maximum of Options
Minimum of Fee Schedules with Floor Price
APC/APG Weight x Rate
DME Rental
DME Rental - Legacy Pricing
Percent of Invoice/External Amount
Medicare Pricing
17 CLAIM_PRIM_PMT_RATE VARCHAR No
Primary payment rate determined from reimbursement information for Diagnosis Related Group priced claims.
18 CLM_PRIMARY_CVD_QTY NUMERIC No
Quantity covered by primary method. Determined from reimbursement information for Diagnosis Related Group priced claims.
19 CLM_ADDL_PMT_MTHDS VARCHAR No
Additional payment methods. Determined from reimbursement information for Diagnosis Related Group priced claims.
20 CLM_ADDL_PMT_RATES VARCHAR No
Additional payment rates. Determined from reimbursement information for Diagnosis Related Group priced claims.
21 CLM_ADDL_CVD_QTY VARCHAR No
Additional payment quantity. Determined from reimbursement information for Diagnosis Related Group priced claims.
22 CLM_LINE_PNLTY_PER VARCHAR No
Line/Service level penalties imposed on the claim. Determined from reimbursement information for Diagnosis Related Group priced claims.
23 CLAIM_LATE_DAYS INTEGER No
Late submission days. Determined from reimbursement information for Diagnosis Related Group priced claims.
24 CLM_SUB_PNLTY_PER VARCHAR No
Late submission penalty percent applied. Determined from reimbursement information for Diagnosis Related Group priced claims.
25 CLM_U_AND_C_AMT NUMERIC No
Usual and customary amount for the claim. Determined from reimbursement information for Diagnosis Related Group priced claims.
26 CLAIM_INS_PORTION NUMERIC No
Insurance portion of the expected amount. Determined from reimbursement information for Diagnosis Related Group priced claims.
27 CLM_PATIENT_PORTION NUMERIC No
Portion of the expected amount the patient is responsible for. Determined from reimbursement information for Diagnosis Related Group priced claims.
28 CLAIM_MTHD_DESC VARCHAR No
A text description of the method used to price the claim. Determined from reimbursement information for Diagnosis Related Group priced claims.
29 CLAIM_TERM_DESC VARCHAR No
This item stores the term description from the matching contract line.
30 OPERATING_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
31 CONTRACT_ID NUMERIC No
The unique ID of the contract that was used for this claim. Zero means that the contract is from an external system.
32 CONTRACT_ID_CONTRACT_NAME VARCHAR No
The name of the Vendor-Network contract.
33 CONTRACT_DATE_REAL FLOAT No
A numerical representation of the contact date for the contract used in this claim. Used to help link to the VEN_NET_CONT_SVC table.
34 CONTRACT_USED_DT DATETIME No
The date that the contract was used for this claim.
35 CONTRACT_NOT_USED VARCHAR No
Indicates whether the contract was used for this claim. Y indicates that the contract was not used.
36 EDITED_TOB VARCHAR No
Indicates the claim type of bill was edited.
37 EDITED_EOB VARCHAR No
Indicates the claim explanation of benefits was edited.
38 MAIL_ADDR1 VARCHAR No
First line of the mailing address for a given claim record.
39 MAIL_ADDR2 VARCHAR No
Second line of the mailing address for a given claim record.
40 REIMB_COST_THRESH NUMERIC No
The cost threshold of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
41 REIMB_COST_OUT NUMERIC No
The cost outlier of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
42 REIMB_DAY_THRESH NUMERIC No
The day threshold of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
43 REIMB_DAY_OUT NUMERIC No
The day outlier of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
44 REIMB_OTH_THRESH NUMERIC No
The other threshold of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
45 REIMB_OTH_OUT NUMERIC No
The other outlier of this claim's outlier data. Determined from reimbursement information for Diagnosis Related Group priced claims.
46 MAIL_COUNTRY_C_NAME VARCHAR No
Stores the mailing address country.
May contain organization-specific values: Yes
47 EXPECT_PAT_RESP_AMT NUMERIC No
Stores the total expected patient responsibility for the claim.
48 CLM_CAP_XR_REDUCT NUMERIC No
Amount that the expected reimbursement was reduced due to a reimbursement cap. If the expected reimbursement is calculated with an Epic contract, this is the difference between claim contractual amount and expected amount if DRG pricing is used. Otherwise, this is the sum of the differences of the line contractual amounts and line expected amount. If expected reimbursement is calculated from an external source or manually overridden, this will always return zero.