|
Name |
Type |
Discontinued? |
|
1 |
CLAIM_PRINT_ID |
NUMERIC |
No |
|
|
|
The unique identifier (.1 item) for the claim print record. |
|
|
2 |
LINE |
INTEGER |
No |
|
|
|
The line number for the information associated with this record. Multiple pieces of information can be associated with this record. |
|
|
3 |
CLAIM_PX_LINE_NUM |
INTEGER |
No |
|
|
|
Stores the line number in related group 710 that this detail line corresponds to. If blank, then the patient responsibility detail on this line is for DRG reimbursement. |
|
|
4 |
SERVICE_TYPE_ID |
VARCHAR |
No |
|
|
|
Stores the service type associated with the benefits on this line. If coverage level benefits are used, then the service type will be blank. |
|
|
5 |
SERVICE_TYPE_ID_SERVICE_TYPE_NAME |
VARCHAR |
No |
|
|
|
The name of this benefit service type. |
|
|
6 |
SERVICE_TYPE_SOURCE_DESC |
VARCHAR |
No |
|
|
|
Stores a description of how the service type was calculated for the line. |
|
|
7 |
DEDUCTIBLE_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount of deductible that was applied to this line. |
|
|
8 |
COPAY_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount of copay that was applied to this line. |
|
|
9 |
COINSURANCE_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount of coinsurance that was applied to this line. |
|
|
10 |
NON_COVERED_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount that was not covered by insurance on this line. |
|
|
11 |
NON_COVERED_RSN_C_NAME |
VARCHAR |
No |
|
|
|
Stores the reason that the not covered amount is not covered by insurance. |
May contain organization-specific values: No |
Category Entries: |
Noncovered procedure |
Lifetime insurance maximum reached |
Annual insurance maximum reached |
Visit insurance maximum reached |
|
|
12 |
ANNUAL_MOOP_CONTRIB_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount that this line contributed to the maximum out of pocked accumulation. |
|
|
13 |
VISIT_MOOP_CONTRIB_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the amount that this line contributed to the maximum visit out of pocked accumulation. |
|
|
14 |
OUT_OF_POCKET_LMT_RSN_C_NAME |
VARCHAR |
No |
|
|
|
Stores the reason that the out-of-pocket maximum limited the patient responsibility for the current line. |
May contain organization-specific values: No |
Category Entries: |
Annual out-of-pocket max met on a previous line |
Visit out-of-pocket max met on a previous line |
Annual and visit out-of-pocket max met on a previous line |
Annual out-of-pocket max met on the current line |
Visit out-of-pocket max met on the current line |
Annual and visit out-of-pocket max met on the current line |
|
|