RECONCILE_CLAIM_STATUS
Description:
This table contains claim-level status code information for claims reconciliation.

Primary Key
Column Name Ordinal Position
CLAIM_RECON_ID 1
CONTACT_DATE_REAL 2
LINE 3

Column Information
Name Type Discontinued?
1 CLAIM_RECON_ID VARCHAR No
The unique identifier for the claim reconciliation record.
2 CONTACT_DATE_REAL FLOAT No
A unique contact date in decimal format. The integer portion of the number indicates the date of contact. The digits after the decimal distinguish different contacts on the same date and are unique for each contact on that date. For example, .00 is the first/only contact, .01 is the second contact, etc.
3 LINE INTEGER No
The line number for the information associated with this contact. Multiple pieces of information can be associated with this contact.
4 CONTACT_DATE DATETIME No
The date of this contact in calendar format.
5 CLM_STAT_CODE_C_NAME VARCHAR No
Claim level status code received in a reconciliation file if value matches codes in the current claim status code category.
May contain organization-specific values: Yes
Category Entries:
Unmapped code received
6 CLM_STAT_DATA VARCHAR No
Claim level status code received in a reconciliation file. Set only if the value does not match a category abbreviation in the current claim status code category.
7 CLM_CAT_CODE_C_NAME VARCHAR No
Claim level category code received in a reconciliation file if value matches codes in the claim status category code category.
May contain organization-specific values: Yes
Category Entries:
Unmapped code received
8 CLM_CAT_CODE_DATA VARCHAR No
Claim level category code received in a reconciliation file. Set only if the value does not match a category abbreviation in the claim status category code category.
9 CLM_MAPPED_ACT_C_NAME VARCHAR No
Mapped action for the status code.
May contain organization-specific values: No
Category Entries:
No Action
Accept Claim
Send to WQ
10 CLM_ACT_CODE_C_NAME VARCHAR No
Claim level action code received in a reconciliation file if value matches codes in the claim action category.
May contain organization-specific values: Yes
Category Entries:
Accept
Reject
<invalid>
11 CLM_ACT_CODE_DATA VARCHAR No
The claim level action code received in a reconciliation file. It is set when the value received in the file does not match any category abbreviation in the claim action category.
12 CLM_ENTITY_CODE_C_NAME VARCHAR No
Claim level entity code received in a reconciliation file. Set only if the received value matches a category abbreviation in the claim entity code category.
May contain organization-specific values: Yes
Category Entries:
Unmapped code received
13 CLM_ENTITY_DATA VARCHAR No
Claim level entity code received in a reconciliation file. Set only if the value does not match a category abbreviation in the claim entity code category.
14 CLM_INFO_REQ_CODE VARCHAR No
Code that defines additional information being requested.
15 CLM_STATUS_MSG VARCHAR No
Claim level status message received in a reconciliation file.
16 ACK_CODE_C_NAME VARCHAR No
Implementation acknowledgment code received in a Healthcare Acknowledgment (999) file.
May contain organization-specific values: No
Category Entries:
A-Accepted (Transaction Set)
E-Accepted With Errors (Transaction Set)
R-Rejected (Transaction Set)
M-Rejected, MAC Failed (Transaction Set)
W-Rejected, Assurance Failed Validity Tests (Transaction Set)
X-Rejected, Decryption Failed (Transaction Set)
A-Accepted (Functional Group)
E-Accepted With Errors (Functional Group)
R-Rejected (Functional Group)
M-Rejected, MAC Failed (Functional Group)
P-Partially Accepted (Functional Group)
W-Rejected, Assurance Failed Validity Tests (Functional Group)
X-Rejected, Decryption Failed (Functional Group)
A-Accepted (Interchange)
E-Accepted With Errors (Interchange)
R-Rejected (Interchange)