REFERRAL
Description:
The REFERRAL table is the primary table for referral information stored in system.

Primary Key
Column Name Ordinal Position
REFERRAL_ID 1

Column Information
Name Type Discontinued?
1 REFERRAL_ID NUMERIC No
The unique ID of the referral in database. This is the primary key for the REFERRAL table.
2 EXTERNAL_ID_NUM VARCHAR No
The external identification number used on the referral.
3 PAT_ID VARCHAR No
The ID of the patient associated with the referral.
4 PCP_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.
5 ENTRY_DATE DATETIME No
The date the referral was entered.
6 RFL_STATUS_C_NAME VARCHAR No
The category value representing the status of the referral (I.e. authorized, open, pending, etc.).
May contain organization-specific values: Yes
Category Entries:
Authorized
Open
Pending Review
Canceled
Denied
Closed
New Request
Incomplete
7 REFERRING_PROV_ID VARCHAR No
The unique ID of the referral source (REF) record of the provider who made the referral. This column is frequently used to link to the REFERRAL_SOURCE table. The actual provider (SER) ID can be found in column REF_PROVIDER_ID of table REFERRAL_SOURCE.
8 REFERRING_PROV_ID_REFERRING_PROV_NAM VARCHAR No
The name of the referral source.
9 VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
10 REFERRAL_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.
11 PROV_SPEC_C_NAME VARCHAR No
The category value indicating the provider specialty being referred to.
May contain organization-specific values: Yes
12 RFL_TYPE_C_NAME VARCHAR No
The category value indicating the type of referral.
May contain organization-specific values: Yes
13 RSN_FOR_RFL_C_NAME VARCHAR No
The category value indicating the main (first) reason for the referral. Since multiple reasons can be listed, use table REFERRAL_REASONS to view all of them.
May contain organization-specific values: Yes
14 RFL_CLASS_C_NAME VARCHAR No
The category value indicating the class of the referral.
May contain organization-specific values: No
Category Entries:
Internal
Incoming
Outgoing
15 AUTH_VIS_PERIOD INTEGER No
The number of authorized visits in each visit period.
16 AUTH_PERIOD_TYPE_C_NAME VARCHAR No
The category value indicating the type of period for authorized visits - i.e. hour, day, week, month, year.
May contain organization-specific values: No
Category Entries:
Hour
Day
Week
Month
Year
17 AUTH_NUM_PERIODS INTEGER No
The number of periods authorized for this referral.
18 AUTH_NUM_OF_VISITS NUMERIC No
The number of visits authorized for this referral.
19 ADMISSION_DATE DATETIME No
The admission date associated with the referral.
20 DISCHARGE_DATE DATETIME No
The discharge date associated with the referral.
21 ESTIMATED_DAYS INTEGER No
The authorized length of stay if the patient is being admitted.
22 START_DATE DATETIME No
The start date of the referral.
23 EXP_DATE DATETIME No
The expiration date of the referral.
24 PEND_TO VARCHAR No
The person or pool to whom an In Basket message should be sent about this referral.
25 PEND_RSN_C_NAME VARCHAR No
For pended referrals, the category value indicating the reason for pending.
May contain organization-specific values: Yes
26 DENY_RSN_C_NAME VARCHAR No
For denied referrals, the category value indicating the reason for denial.
May contain organization-specific values: Yes
27 SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.
28 COVERAGE_ID NUMERIC No
The unique ID of the coverage associated with the referral.
29 NUM_PROC NUMERIC No
The number of procedures associated with the referral.
30 SVC_DATE_REAL FLOAT No
If available, this column is populated by the authorized start date (I RFL 85). If not, it is populated by the expiration date on the referral (I RFL 90). If neither of these are available, the column will be empty. The date in this column is based on days since December 31, 1840.
31 CARRIER_ID VARCHAR No
The ID number of the carrier associated with the referral.
32 CARRIER_ID_CARRIER_NAME VARCHAR No
The name of the carrier record.
33 PAYOR_ID_PAYOR_NAME VARCHAR No
The name of the payor.
34 PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
35 SERV_DATE DATETIME No
This column is populated by the authorized start date (I RFL 85) if available. If not, it is populated by the expiration date on the referral (I RFL 90). If neither of these are available, the column will be empty. The date in this column is in MM/DD/YYYY format.
36 RETRO_FLAG_YN VARCHAR No
The category value used to mark a referral as being "Retro" entered.
May contain organization-specific values: No
Category Entries:
Yes
No
37 IBNR NUMERIC No
The "Incurred but not reported" amount associated with this referral.
38 AUTO_APPROVED_DATE DATETIME No
The date on which the referral was approved automatically by the system.
39 AUTH_RSN_C_NAME VARCHAR No
The category value indicating the authorization reason associated with the referral.
May contain organization-specific values: Yes
40 REFD_BY_LOC_POS_ID_LOC_NAME VARCHAR No
The name of the revenue location.
41 REFD_TO_LOC_POS_ID_LOC_NAME VARCHAR No
The name of the revenue location.
42 REFD_TO_DEPT_ID_EXTERNAL_NAME VARCHAR No
The external name of the department record. This is often used in patient correspondence such as reminder letters.
43 REFD_TO_SPEC_C_NAME VARCHAR No
The category value indicating the specialty the department was referred to.
May contain organization-specific values: Yes
44 PRIORITY_C_NAME VARCHAR No
The category value indicating the priority of the referral.
May contain organization-specific values: Yes
Category Entries:
Routine
Urgent
Emergency
Elective
Two Week Wait
See Details
45 TOTAL_PRICE NUMERIC No
The total cost of the procedures authorized under the referral.
46 TOTAL_PAYABLE NUMERIC No
The portion of the total price for which your facility is responsible.
47 PATIENT_AMOUNT NUMERIC No
The total patient liability, under the parameters of the primary coverage used, for the procedures authorized under the referral.
48 EXPECT_TO_PAY NUMERIC No
The total amount you expect your facility will pay for the procedures authorized under the referral. This amount entered by you overrides the total payable amount for the purpose of calculating IBNR.
49 IBNR_PAY_UNTIL_DT DATETIME No
The date up to which your facility will pay claims for the procedures approved on this referral.
50 CASE_RATE_YN VARCHAR No
The category value indicating whether this referral involves services that are reimbursed at a specific case rate.
May contain organization-specific values: No
Category Entries:
Yes
No
51 PRIM_LOC_ID_LOC_NAME VARCHAR No
The name of the revenue location.
52 MED_TYPE_C_NAME VARCHAR No
The category value indicating what type of confirmation it is - acute, chronic or PAT.
May contain organization-specific values: No
Category Entries:
Acute
Chronic
PAT
53 ACUTE_AMOUNT NUMERIC No
The amount of the confirmation if the confirmation is acute.
54 CHRONIC_AMOUNT NUMERIC No
The amount of the confirmation if the confirmation is chronic.
55 PAT_AMOUNT NUMERIC No
The amount of the confirmation if the confirmation is an acute medication that was suggested by the pharmacist or over-the-counter medication.
56 RFL_LOB_ID VARCHAR No
ID of the Line of Business (LOB) assigned to the referral.
57 RFL_LOB_ID_LOB_NAME VARCHAR No
The name of the line of business record.
58 ACTUAL_NUM_VISITS NUMERIC No
The actual number of completed visits for this referral.
59 SCHED_NUM_VISITS NUMERIC No
The number of visits scheduled for this referral.
60 REQUEST_NUM_VISITS NUMERIC No
The number of visits requested for this referral.
61 GUIDELINE_DAYS NUMERIC No
Guideline days for this referral.
62 OVRD_ADMIT_DATE DATETIME No
Override admit date for this referral.
63 OVRD_DISCHARGE_DT DATETIME No
Override discharge date for this referral.
64 DISP_VAL_C_NAME VARCHAR No
Whether the referral was accepted ("appointed") or refused ("denied") by the referred-to provider, department or facility.
May contain organization-specific values: No
Category Entries:
Appointed
Denied
65 DISP_RSN_C_NAME VARCHAR No
The reason that a referral's disposition has a status of "denied."
May contain organization-specific values: Yes
Category Entries:
Forwarded to External
Forwarded to Internal
66 DISP_EAF_ID_LOC_NAME VARCHAR No
The name of the revenue location.
67 REFD_BY_DEPT_ID_EXTERNAL_NAME VARCHAR No
The external name of the department record. This is often used in patient correspondence such as reminder letters.
68 CLOSE_RSN_C_NAME VARCHAR No
For closed referrals, the category value indicating the reason for closing.
May contain organization-specific values: Yes
69 SCHED_STATUS_C_NAME VARCHAR No
Scheduling status of the referral to keep track of internally schedulable referrals. For category list use ZC_SCHED_STATUS.
May contain organization-specific values: Yes
Category Entries:
Do not change
70 SCHED_BY_DATE DATETIME No
Indicates deadline to schedule a referral.
71 PREAUTH_REQ_C_NAME VARCHAR No
For referrals created from an order, indicates if a preauthorization number must be collected before scheduling.
May contain organization-specific values: No
Category Entries:
Prior Authorization Number Required
Prior Authorization Number Collected
Prior Authorization Number Not Collected
Prior Authorization Number Processed
72 NOT_COLLCTD_RSN_C_NAME VARCHAR No
Reason indicating why the preauth number will not be collected for this referral.
May contain organization-specific values: Yes
73 PROCESSED_RSN_C_NAME VARCHAR No
Reason indicating why the preauth number is marked as processed for this referral.
May contain organization-specific values: Yes
74 PREAUTH_CHG_EMP_ID VARCHAR No
The unique ID of the user who last changed the preauthorization data.
75 PREAUTH_CHG_EMP_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
76 PREAUTH_CHNGD_DTTM DATETIME (Local) No
Date/time stamp for last time the preauthorization data was changed.
77 AUTH_NUM VARCHAR No
Authorization number.
78 PRE_CERT_NUM VARCHAR No
Pre-certification number.
79 NON_PREF_PROV_RSN_C_NAME VARCHAR No
Stores the reason why a non preferred level provider was chosen.
May contain organization-specific values: Yes
80 EXT_REF_DATE DATETIME No
This is the external referring date.
81 EOW_ID VARCHAR No
The unique EOW ID associated with the referral.
82 REQ_VIS_PER_PERIOD INTEGER No
The requested visits per period on the referral.
83 REQ_PERIOD_TYPE_C_NAME VARCHAR No
The requested period type on the referral.
The category values for this column were already listed for column: AUTH_PERIOD_TYPE_C_NAME
84 REQ_NUM_OF_PERIODS INTEGER No
The requested number of periods on the referral.
85 REF_TO_PROV_ADDR_ID VARCHAR No
This stores the address ID of the referred to provider. The format is as follows: ProvID-AddressID. AddressID is the line number of the multiple response address items in the SER masterfile. To use this column, join to CLARITY_SER_ADDR on REFERRAL.REF_TO_PROV_ADDR_ID = CLARITY_SER_ADDR.ADDR_UNIQUE_ID. If you use IntraConnect, also join on REFERRAL.REFERRAL_PROV_ID = CLARITY_SER_ADDR.PROV_ID.
86 DECISION_DATE DATETIME No
Date on which the referral's current status was assigned.
87 NUM_CLMS_EXPECTED INTEGER No
Number of claims expected to be filed on this referral.
88 RFL_STATCHG_RSN_C_NAME VARCHAR No
The reason category number describing why the referral status was changed.
May contain organization-specific values: Yes
Category Entries:
Canceled Order
TPL Created
Order Added
Order Modified
Order Deleted
Build Change
Coverage Change
Treatment Department Change
Diagnosis Change
Create AUTs for new coverage
Day/Cycle Copied
TPL Reactivated
89 TOTAL_EST_DAYS NUMERIC No
Total estimated days for the referral.
90 TOTAL_OVERRIDE_DAYS NUMERIC No
The total number of override days on the referral.
91 TOTAL_CONVTD_DAYS NUMERIC No
The total number of converted days on the referral.
92 AMT_CLMS_ADJUDICTD NUMERIC No
The amount of claims adjudicated.
93 AMT_CLMS_PAID NUMERIC No
The amount of claims paid.
94 ADJ_VENDOR_ID_VENDOR_NAME VARCHAR No
The name of the vendor.
95 ADJ_MEMBER_GROUP_ID_MEM_GRP_NAME VARCHAR No
The name of the member group
96 ADJ_NET_STATUS_C_NAME VARCHAR No
Adjudication network status.
May contain organization-specific values: Yes
Category Entries:
In Network
Out of Network
N/A
97 NO_CLAIMS_PAID NUMERIC No
The number of claims paid on the claim.
98 ADJUD_SERV_AREA_ID_LOC_NAME VARCHAR No
The name of the revenue location.