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. If the expected reimbursement is calculated with an Epic contract, this is the reimbursement amount calculated for the claim line 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 line's payment amount.
5	EXPECTED_PRICE	NUMERIC	No
	The expected reimbursement amount for this claim line.   If the expected reimbursement is calculated with an Epic contract, this is the reimbursement amount calculated for the claim line 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 line's payment amount.
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_PROC_NAME	VARCHAR	No
	The name of each procedure.
28	MEDICATION_ID_MEDICATION_NAME	VARCHAR	No
	The name of this medication record.
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_COMP_GRP_NAME	VARCHAR	No
	The name for the whole claim component group.
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.