HSP_CLM_EXP_ALLOW
Description:
This table contains information at a claim line level for expected allowances.

Primary Key
Column Name Ordinal Position
CLAIM_PRINT_ID 1
LINE 2

Column Information
Name Type Discontinued?
1 CLAIM_PRINT_ID NUMERIC No
This column stores the unique identifier for the claim print record.
2 LINE INTEGER No
The claim line number for the information associated with this claim. Multiple claim lines can be associated with this claim.
3 PX_BILLED_AMT NUMERIC No
The billed amount for this claim line.
4 CONTRACT_PRICE NUMERIC No
The contract price for this claim line.
5 EXPECTED_PRICE NUMERIC No
The expected reimbursement amount for this claim line.
6 PYMT_METHOD_C_NAME VARCHAR No
The category number for the payment method that is associated with this claim line.
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
7 PRIMARY_PMT_RATE VARCHAR No
The primary payment rate for this claim line.
8 PRIMARY_CVD_QTY INTEGER No
The primary quantity for this claim line.
9 ADDL_PYMT_MTHDS VARCHAR No
Any additional payment methods for this claim line.
10 ADDL_PYMT_RATES VARCHAR No
Any additional payment rates for this claim line.
11 ADDL_CVD_QTY VARCHAR No
Any additional quantities for this claim line.
12 LINE_PENALTY_PRCNT VARCHAR No
The penalty percent for this claim line.
13 LATE_SUBMIT_DAYS INTEGER No
This column stores how late this claim was submitted, in days.
14 LATE_SUBMIT_PERCENT VARCHAR No
The late submit penalty percent for this claim line.
15 U_AND_C_AMOUNT NUMERIC No
This column stores the Usual and Customary amount for this claim line.
16 CLM_PX_OUTLIER_INFO VARCHAR No
The outlier payment information for this claim line.
17 PX_INS_PORTION NUMERIC No
The portion of the claim line that is the insurance's responsibility.
18 PX_PATIENT_PORTION NUMERIC No
The portion of the claim line that is the patient's responsibility.
19 PX_PYMT_MTHD_DESC VARCHAR No
Free text method description for this claim line.
20 PX_PYMT_TERM_DESC VARCHAR No
Free text term description for this claim line.
21 COMPONENT_ID VARCHAR No
This column stores the unique identifier for the component or component group used in adjudicating this claim line.
22 COMPONENT_ID_COMPONENT_INDEX_NAME VARCHAR No
The name of the component index record
23 CONTRACT_ID NUMERIC No
This column stores the unique identifier for the contract used in adjudicating this claim line.
24 CONTRACT_ID_CONTRACT_NAME VARCHAR No
The name of the Vendor-Network contract.
25 CONTRACT_DATE_REAL FLOAT No
A numerical representation of the contact date for the contract used in adjudicating this claim line. Used to help link to the VEN_NET_CONT_SVC table.
26 CONTRACT_LN INTEGER No
The contract line number used in adjudicating this claim line.
27 PX_ID NUMERIC No
This column stores the unique identifier for the procedure that is associated with this claim line.
28 MEDICATION_ID NUMERIC No
This column stores the unique identifier for the medication that is associated with this claim line.
29 DRG_ID VARCHAR No
This column stores the unique identifier for the diagnosis-related group (DRG) that is associated with this claim line.
30 DRG_ID_DRG_NAME VARCHAR No
The name of the Diagnoses Related Group name.
31 COMPONENT_GROUP_ID VARCHAR No
This column stores the unique identifier for the whole claim component group that is associated with this claim line.
32 PX_COMMENT VARCHAR No
The free text comment about the procedure that is associated with this claim line.
33 PX_TAX_AMT NUMERIC No
The tax amount for a procedure based claim line. Used when tax amounts are calculated using expected reimbursement values.