|
Name |
Type |
Discontinued? |
|
1 |
INVOICE_ID |
NUMERIC |
No |
|
|
|
|
2 |
LINE |
INTEGER |
No |
|
|
|
|
3 |
INVOICE_NUM |
VARCHAR |
No |
|
|
|
The invoice number related to this claim line. |
|
|
4 |
CLM_LN |
INTEGER |
No |
|
|
|
The invoice claim line number. |
|
|
5 |
PROC_OR_REV_CODE |
VARCHAR |
No |
|
|
|
This is the procedure revenue code |
|
|
6 |
REV_CODE_DESCRIPT |
VARCHAR |
No |
|
|
|
This is the revenue code description |
|
|
7 |
POS_CODE |
VARCHAR |
No |
|
|
|
The place of service type for this claim line |
|
|
8 |
CLAIM_STATUS_C_NAME |
VARCHAR |
No |
|
|
|
The claim line status. |
May contain organization-specific values: No |
Category Entries: |
Open |
Closed |
Voided |
Removed |
|
|
9 |
CLAIM_PAID_AMT |
NUMERIC |
No |
|
|
|
The claim line paid amount. |
|
|
10 |
UB_CPT_CODE |
VARCHAR |
No |
|
|
|
This is the Common Procedure Terminology (CPT) code for this institutional claim line. |
|
|
11 |
EOB_ALLOWED_AMOUNT |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits adjustment amount. |
|
|
12 |
EOB_ADJUSTMENT_AMT |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits allowed amount. |
|
|
13 |
EOB_NON_COVRD_AMT |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits non-covered amount. |
|
|
14 |
EOB_COINSURANCE |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits coinsurance amount. |
|
|
15 |
EOB_DEDUCTIBLE |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits deductible. |
|
|
16 |
EOB_ICN |
VARCHAR |
No |
|
|
|
The explanation of benefits internal control number for the claim line. |
|
|
17 |
EOB_INV_LVL_YN |
VARCHAR |
No |
|
|
|
Identifies if this explanation of benefits is for the invoice level. |
May contain organization-specific values: No |
Category Entries: |
No |
Yes |
|
|
18 |
EOB_COPAY |
NUMERIC |
No |
|
|
|
The service line's explanation of benefits copay amount. |
|
|
19 |
EOB_COB |
NUMERIC |
No |
|
|
|
The explanation of benefits coordination of benefits amount. |
|
|
20 |
CLAIM_DENIED_CODE |
VARCHAR |
No |
|
|
|
Claim denied code for this claim line on this invoice. |
|
|
21 |
REMIT_CODE_ID |
VARCHAR |
No |
|
|
|
Remittance code for this claim line on this invoice. |
|
|
22 |
TEXT_MESSAGE |
VARCHAR |
No |
|
|
|
Message associated with the remittance code for this line on this invoice. |
|
|
23 |
TRANSACTION_LIST |
VARCHAR |
No |
|
|
|
The charges associated with the invoice. May hold a comma delimited list of professional transactions if the charges were bundled. |
|
|
24 |
FROM_SVC_DATE |
DATETIME |
No |
|
|
|
The date when the service was first performed. |
|
|
25 |
TO_SVC_DATE |
DATETIME |
No |
|
|
|
The date when the service was last performed. |
|
|
26 |
PROC_ID_PROC_NAME |
VARCHAR |
No |
|
|
|
The name of each procedure. |
|
|
27 |
MODIFIER_ONE |
VARCHAR |
No |
|
|
|
The first modifier associated with the invoice. This is the external modifier, as it was printed on the claim. |
|
|
28 |
MODIFIER_TWO |
VARCHAR |
No |
|
|
|
The second modifier associated with the invoice. This is the external modifier, as it was printed on the claim. |
|
|
29 |
MODIFIER_THREE |
VARCHAR |
No |
|
|
|
The third modifier associated with the invoice. This is the external modifier, as it was printed on the claim. |
|
|
30 |
MODIFIER_FOUR |
VARCHAR |
No |
|
|
|
The fourth modifier associated with the invoice. This is the external modifier, as it was printed on the claim. |
|
|
31 |
QUANTITY |
NUMERIC |
No |
|
|
|
The number of units associated with the invoice. |
|
|
32 |
CHARGE_AMOUNT |
NUMERIC |
No |
|
|
|
The charge amount associated with the claim line. |
|
|
33 |
NONCVD_AMOUNT |
NUMERIC |
No |
|
|
|
The non-covered amount associated with the invoice. |
|
|
34 |
TYPE_OF_SERVICE_C_NAME |
VARCHAR |
No |
|
|
|
The type of service category value for the claim. |
May contain organization-specific values: Yes |
Category Entries: |
Medical Care |
Surgery |
Consultation |
Diagnostic Radiology |
Diagnostic Laboratory |
Therapeutic Radiology |
Anesthesia |
Assistant at Surgery |
Other Medical Items or Services |
Whole Blood |
Used Durable Medical Equipment (DME) |
Ambulatory Surgical Center (Facility usage for Surgical Services) |
Hospice (Obsolete, Discontinued 1/95) |
ESRD Supplies |
Monthly Capitation Payment for Dialysis |
Kidney Donor |
Pneumococcal/Flu Vaccine |
Second Opinion on Elective Surgery (Obsolete) |
Third Opinion on Elective Surgery (Obsolete) |
Diagnostic Medical (Obsolete) |
Ancillaries, Hospital and Nursing Home (Obsolete) |
Drug Services (Obsolete) |
Accommodations, Hospital and Nursing Home (Obsolete) |
Dental (Obsolete) |
Vision Care and Cataract Lens (Obsolete) |
Nuclear Medicine (Obsolete) |
Diagnostic X-Ray (Professional) (Obsolete) |
Rental of DME |
Radiation Therapy (Professional) (Obsolete) |
Diagnostic Lab (Professional) (Obsolete) |
Diagnostic Medical (Professional) (Obsolete) |
DME Purchase (Obsolete) |
CRD Equipment (Obsolete) |
Pre-Admission Testing (Obsolete) |
EPSDT |
High Risk Screening Mammography |
Low Risk Screening Mammography |
Ambulance |
Enteral/Parenteral Nutrients/Supplies |
Immunosuppressive Drugs |
Diabetic Shoes |
Hearing Items and Services |
Lump Sum Purchase of DME, Prostethics, Orthotics |
Vision Items or Services |
Surgical Dressings or Other Medical Supplies |
Psychological Therapy |
Occupational Therapy |
Physical Therapy |
Medication (Obsolete) |
Chiropractic Care |
DME Prescription |
|
|
35 |
DIAGNOSIS_MAP |
VARCHAR |
No |
|
|
|
Holds a comma-delimited list of pointers to the claim level diagnosis. The first number listed represents the primary diagnosis for the charge. |
|
|
36 |
SPECIAL_GRP_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
The claim grouping type category value for the associated claim grouping rule. Only populated if a claim grouping rule was applied to the invoice. |
May contain organization-specific values: Yes |
Category Entries: |
Inpatient Charge Transfer |
Radiation Therapy by Procedure Treatment Level |
Panel Bundling |
Global Billing Setup |
FQHC Bundling |
Medi-Cal Rural Health Bundling |
FQHC Billing |
FPEP Bundling |
Bilateral Bundling |
Bundle Tax With Original Charges |
Bundle Tax Charges Only |
PQRI Bundle Zero Amount |
Claim Complete |
Professional Claim Line Bundling |
Global Payment Setup |
Professional and Technical Component Bundling |
PB Home Infusion Bundling |
|
|
37 |
GROUP_TX_LIST |
VARCHAR |
No |
|
|
|
This holds a list of transaction IDs for bundled charges. |
|
|
38 |
UB_MIN_SVC_DATE |
DATETIME |
No |
|
|
|
The earliest date any charges were performed for an institutional claim. |
|
|
39 |
UB_MAX_SVC_DATE |
DATETIME |
No |
|
|
|
The latest date any charges were performed for an institutional claim. |
|
|
40 |
OT_REIMB_AMT |
NUMERIC |
No |
|
|
|
Stores reimbursement amount. |
|
|
41 |
CONTRACT_ID |
NUMERIC |
No |
|
|
|
Stores reimbursement contract. |
|
|
42 |
CONTRACT_ID_CONTRACT_NAME |
VARCHAR |
No |
|
|
|
The name of the Vendor-Network contract. |
|
|
43 |
CALC_METHOD_C_NAME |
VARCHAR |
No |
|
|
|
The reimbursement contract method. |
May contain organization-specific values: No |
Category Entries: |
Charge Entry Line Calculation |
Invoice Line Calculation |
Invoice Bundle Calculation |
APC |
|
|
44 |
PROC_CODE_RATE |
VARCHAR |
No |
|
|
|
|
45 |
PROC_CODE_RATE_DESC |
VARCHAR |
No |
|
|
|
|
46 |
REMITTANCE_RMC1_ID |
VARCHAR |
No |
|
|
|
First remittance code ID. |
|
|
47 |
REMITTANCE_RMC1_ID_REMIT_CODE_NAME |
VARCHAR |
No |
|
|
|
The name of each remittance code. |
|
|
48 |
REMITTANCE_RMC2_ID |
VARCHAR |
No |
|
|
|
Second remittance code ID. |
|
|
49 |
REMITTANCE_RMC2_ID_REMIT_CODE_NAME |
VARCHAR |
No |
|
|
|
The name of each remittance code. |
|
|
50 |
REMITTANCE_RMC3_ID |
VARCHAR |
No |
|
|
|
Third remittance code ID. |
|
|
51 |
REMITTANCE_RMC3_ID_REMIT_CODE_NAME |
VARCHAR |
No |
|
|
|
The name of each remittance code. |
|
|
52 |
REMITTANCE_RMC4_ID |
VARCHAR |
No |
|
|
|
Fourth remittance code ID. |
|
|
53 |
REMITTANCE_RMC4_ID_REMIT_CODE_NAME |
VARCHAR |
No |
|
|
|
The name of each remittance code. |
|
|
54 |
CLM_LN_CREAT_DATE |
DATETIME |
No |
|
|
|
Stores the date the claim line is created. |
|
|
55 |
INV_NUM_GRP100LN |
INTEGER |
No |
|
|
|
|
56 |
CLM_LN_PAID_DATE |
DATETIME |
No |
|
|
|
Stores the most recent date the invoice line is paid. |
|
|
57 |
IS_CODE_ONLY |
VARCHAR |
No |
|
|
|
Identifies show only lines. |
|
|
58 |
LN_AUTH_NUM |
VARCHAR |
No |
|
|
|
This item stores the line level authorization number. |
|
|
59 |
LN_REF_NUM |
VARCHAR |
No |
|
|
|
This item stores the line level referral number. |
|
|
60 |
FQHC_BILLOUT_MOD_ID |
VARCHAR |
No |
|
|
|
The modifier added to a bill out line for grouped claim lines. |
|
|
61 |
FQHC_BILLOUT_MOD_ID_MODIFIER_NAME |
VARCHAR |
No |
|
|
|
The name of the modifier record. |
|
|
62 |
CALCULATED_REIMB_AMOUNT |
NUMERIC |
No |
|
|
|
Stores the system calculated reimbursement amount. This may differ from items 395 and 398 if the expected reimbursement amount was manually overridden. |
|
|