RECONCILE_CLM
Description:
This table contains basic information for claim reconciliation records.

Primary Key
Column Name Ordinal Position
CLAIM_REC_ID 1

Column Information
Name Type Discontinued?
1 CLAIM_REC_ID VARCHAR No
The unique ID of the claim reconciliation record.
2 CLAIM_INVOICE_NUM VARCHAR No
The invoice number of the claim.
3 CUR_EPIC_STATUS_C_NAME VARCHAR No
This is the system status of the claim: opened or closed.
May contain organization-specific values: Yes
Category Entries:
Open
Closed
4 PAYOR_ID_PAYOR_NAME VARCHAR No
The name of the payor.
5 BENEFIT_PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
6 LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.
7 DEPARTMENT_ID_EXTERNAL_NAME VARCHAR No
The external name of the department record. This is often used in patient correspondence such as reminder letters.
8 BUCKET_ID NUMERIC No
The hospital liability bucket ID for the claim. This column is populated only for Hospital Billing claims.
9 HSP_ACCOUNT_ID NUMERIC No
The hospital account ID for the claim. This column is populated only for Hospital Billing claims.
10 SERVICE_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
11 EPIC_CLM_STS_C_NAME VARCHAR No
This column stores the status of the claim that created the reconciliation record. This column will indicate whether the claim has been accepted, processed, or rejected in Epic.
May contain organization-specific values: No
Category Entries:
Processed
Errored
Accepted from Run
Rejected
WQ Resubmit
Accept from WQ
Cancelled
12 CLAIM_RUN_ID VARCHAR No
This column stores the claim run ID for the reconciliation record. This column will be populated for records created in the 2010 version and beyond.
13 TOTAL_BILLED NUMERIC No
This column stores the billed amount for the reconciliation record.
14 EXT_STS_RCV_YN VARCHAR No
This column indicates whether at least one external status update has been received for the reconciliation record.
May contain organization-specific values: No
Category Entries:
No
Yes
15 CROSSOVER_CLAIM_YN VARCHAR No
Indicates whether the associated claim is a crossover claim.
The category values for this column were already listed for column: EXT_STS_RCV_YN
16 RECORD_TYPE_C_NAME VARCHAR No
This item indicates whether the record is Interchange Control Header (ISA), Transaction Set Header (ST), or Claim data.
May contain organization-specific values: No
Category Entries:
Interchange
Transaction Set
Claim
17 ISA_CONTROL_NUM INTEGER No
This item holds a unique value used for tracking an interchange for records of type Interchange.
18 GS_CONTROL_NUM INTEGER No
This item holds a unique value used for tracking a transaction set for records of type Transaction Set.
19 NUM_OF_CLAIMS INTEGER No
This item holds the number of claims submitted. It is set for records of type Interchange and Transaction Set.
20 PRINT_USER_ID VARCHAR No
This item holds the user associated with the print event. Set only for records of type Interchange.
21 PRINT_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
22 BHT_REF_NUM INTEGER No
The reference identifier (BHT-03) value from the electronic claim file generated out of Epic. This acts as a link to the receiver level reference identifier (TRN-02) in the claim reconciliation (277CA) response file.
23 POST_ACK_STATUS_YN VARCHAR No
This item indicates whether at least one external status update has been received on or after either four days post claim acceptance or the predicted payment response date if earlier. Claim acknowledgements are generally posted before then.
The category values for this column were already listed for column: EXT_STS_RCV_YN
24 AP_CLAIM_IMPORT_SOURCE_C_NAME VARCHAR No
Used to define the type of source a claim is imported from to drive reporting on the different use cases a single workflow type may have.
May contain organization-specific values: No
Category Entries:
Historical System
Repricing Source
Delegated Payer
Clearinghouse
Other Internal Source
Other External Source
25 SOURCE_GROUP_ID_LOC_NAME VARCHAR No
The name of the revenue location.
26 MC_PROV_ACCT_NUM VARCHAR No
This item stores the provider account number (invoice number) of the rejected claim.
27 REJ_CLM_SVC_DATE DATETIME No
This item stores the service date of the rejected claim.
28 REJ_CLM_MEMBER_ID VARCHAR No
This item stores the matched member of the rejected claim, if one was identified during claim load.
29 REJ_CLM_VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
30 REJ_CLM_PROV_ID_PROV_NAME VARCHAR No
The name of the service provider. This item may be hidden in a public view of the CLARITY_SER table.
31 REJ_CLM_POS_ID_LOC_NAME VARCHAR No
The name of the revenue location.
32 CLAIM_CLOSED_DATE DATETIME No
This item holds the contact date the CRD was marked closed.