|
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 |
|
|