INV_CLM_LN_ADDL
Description:
This table holds additional line-level information about the invoice (INV) specific to a given invoice including any line-level overrides.

Primary Key
Column Name Ordinal Position
INVOICE_ID 1
LINE 2

Column Information
Name Type Discontinued?
1 INVOICE_ID NUMERIC No
The invoice record ID.
2 LINE INTEGER No
The line number.
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
Procedure code rate.
45 PROC_CODE_RATE_DESC VARCHAR No
The procedure code rate.
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
The invoice line number.
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.