REFERRAL_CVG_AUTH
Description:
The REFERRAL_CVG_AUTH contains coverage auth/cert information for referrals.

Primary Key
Column Name Ordinal Position
REFERRAL_ID 1
LINE 2

Column Information
Name Type Discontinued?
1 REFERRAL_ID NUMERIC No
The referral ID for the referral record.
2 LINE INTEGER No
The line number for the information associated with this record. Multiple pieces of information can be associated with this record.
3 AUTH_CERT_CVG_ID NUMERIC No
Coverage ID for Auth/Cert information
4 PRE_CERT_REQ_YN VARCHAR No
Indicates whether pre-cert is required for this coverage
May contain organization-specific values: No
Category Entries:
Yes
No
5 PRE_CERT_STATUS_C_NAME VARCHAR No
Pre-certification status for this coverage
May contain organization-specific values: Yes
6 PRE_CERT_AGENCY_ID VARCHAR No
ID of the agency used for precertification
7 PRE_CERT_AGENCY_ID_AGENCY_NAME VARCHAR No
The name of the agency.
8 PRE_CERT_AGENCY_PH VARCHAR No
Phone number of the agency used for precertification
9 PRE_CERT_CONTACT VARCHAR No
Contact individual for the pre-certification agency
10 PRE_CERT_CALLED_DT DATETIME No
Date on which the payor was called for pre-certification information
11 PRE_CERT_RECV_DT DATETIME No
Date on which pre-certification information was received
12 PRE_CERT_RCV_ID VARCHAR No
User who received pre-certification information
13 PRE_CERT_RCV_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
14 PRE_CERT_FAX VARCHAR No
Fax number for pre-certification information
15 PRE_CERT_BN_REQ_YN VARCHAR No
Indicates whether a pre-certification benefits check is required
The category values for this column were already listed for column: PRE_CERT_REQ_YN
16 PRE_CERT_BEN_STS_C_NAME VARCHAR No
Status of the pre-certification benefits
May contain organization-specific values: Yes
17 PRE_CERT_BEN_CHECK VARCHAR No
Individual from whom pre-cert benefits information was received
18 PRE_CERT_BEN_PHONE VARCHAR No
Phone number to use for pre-cert benefits checking
19 PRE_CERT_BEN_CNCT VARCHAR No
Contact person for pre-cert benefits checking
20 PRE_CERT_BEN_FAX VARCHAR No
Fax number for pre-cert benefits checking
21 PRE_CERT_BEN_CK_DT DATETIME No
Date on which pre-cert benefits were checked
22 PRE_CERT_BN_USR_ID VARCHAR No
ID of user who checked pre-cert benefits information
23 PRE_CERT_BN_USR_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
24 PRE_CERT_CLIN_CNCT VARCHAR No
Contact individual for pre-cert clinical information
25 PRE_CERT_CLIN_PHON VARCHAR No
Phone number for pre-cert clinical information
26 AUTH_FROM_DT DATETIME No
The beginning date of the period authorized by the payor
27 AUTH_TO_DT DATETIME No
The end date of the period authorized by the payor.
28 MAX_OUT_POCKET NUMERIC No
Contains Maximum Out of Pocket Amount: The most you pay in coinsurance during a benefit plan year. After you reach your out-of-pocket maximum, your medical plan option pays 100% (unless balance billing applies) of eligible expenses for the remainder of the benefit plan year
29 LIFETIME_MAX NUMERIC No
Contains Lifetime Maximum Amount: The maximum amount that the insurance company will cover for this patient over the course of their lifetime.
30 TOT_PT_AMOUNT NUMERIC No
Contains Total Patient Amount: The total amount the patient owes for this visit
31 ADM_NOTIF_STAT_C_NAME VARCHAR No
Contains admission notification status: A field that can be used to track the status of the admission notification that needs to be faxed or sent electronically to the payor. This is a customer-owned category list.
May contain organization-specific values: Yes
32 CONC_REV_REQD_YN VARCHAR No
Contains Information on whether a concurrent review (clinical review) is required or not.
May contain organization-specific values: No
Category Entries:
No
Yes
33 IN_NETWORK_YN VARCHAR No
This field is used to track whether or not the patient’s insurance is in Network.
The category values for this column were already listed for column: CONC_REV_REQD_YN
34 DEDUCTIBLE_MET_YN VARCHAR No
A deductible is the amount you must pay before the Plan begins to pay benefits. This field tracks whether or not the patient has paid that amount.
The category values for this column were already listed for column: CONC_REV_REQD_YN
35 DEDUCTIBLE_MET_AMT NUMERIC No
Contains Deductible Met Amount. A deductible is the amount you must pay before the Plan begins to pay benefits. This field tracks how much the patient has paid.
36 COINSUR_MET_YN VARCHAR No
Coinsurance is a percentage of an eligible expense that you are required to pay for a covered service. This field tracks whether or not the patient has paid that amount.
The category values for this column were already listed for column: CONC_REV_REQD_YN
37 COINSURANCE_MET_AMT NUMERIC No
Contains coinsurance met amount. Coinsurance is a percentage of an eligible expense that you are required to pay for a covered service. This field tracks how much the patient has paid.
38 OUT_POCKET_MET_YN VARCHAR No
This fields tracks whether or not the patient has paid their out of pocket expenses.
The category values for this column were already listed for column: CONC_REV_REQD_YN
39 OUT_POCKET_MET_AMT NUMERIC No
Contains Out of Pocket Met Amount. This fields tracks how much the patient has paid towards their out of pocket expenses.
40 PREEXIST_COND_YN VARCHAR No
Contains whether or not pre-existing conditions are present. It is used to track whether or not the patient has pre-existing conditions that may impact their benefits.
The category values for this column were already listed for column: CONC_REV_REQD_YN
41 PREEXIST_COND_VAL VARCHAR No
Contains Pre-existing conditions value. If the patient has pre-existing conditions that may impact their benefits, this field is used to document the pre-existing conditions.
42 PRECERT_CMT_NOTE_ID VARCHAR No
The unique ID of the note containing pre-certification comments entered on the referral.
43 PRECERT_BEN_NOTE_ID VARCHAR No
The unique ID of the note containing benefits information entered on the referral.
44 GENERIC_CATEG_1_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
45 GENERIC_CATEG_2_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
46 GENERIC_CATEG_3_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
47 GENERIC_CATEG_4_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
48 GENERIC_CATEG_5_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
49 GENERIC_CATEG_6_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
50 GENERIC_CATEG_7_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
51 GENERIC_CATEG_8_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
52 GENERIC_CATEG_9_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
53 GENERIC_CATG_10_C_NAME VARCHAR No
Generic category for general use
May contain organization-specific values: Yes
No Entries Defined
54 GENERIC_STR_1 VARCHAR No
Generic string item for general use
55 GENERIC_STR_2 VARCHAR No
Generic string item for general use
56 GENERIC_STR_3 VARCHAR No
Generic string item for general use
57 GENERIC_STR_4 VARCHAR No
Generic string item for general use
58 GENERIC_STR_5 VARCHAR No
Generic string item for general use
59 GENERIC_NUM_IT_1 NUMERIC No
Generic numeric item for general use
60 GENERIC_NUM_IT_2 NUMERIC No
Generic numeric item for general use
61 GENERIC_NUM_IT_3 NUMERIC No
Generic numeric item for general use
62 GENERIC_NUM_IT_4 NUMERIC No
Generic numeric item for general use
63 GENERIC_NUM_IT_5 NUMERIC No
Generic numeric item for general use
64 GENERIC_NUM_IT_6 NUMERIC No
Generic numeric item for general use
65 GENERIC_NUM_IT_7 NUMERIC No
Generic numeric item for general use
66 GENERIC_NUM_IT_8 NUMERIC No
Generic numeric item for general use
67 GENERIC_NUM_IT_9 NUMERIC No
Generic numeric item for general use
68 GENERIC_NUM_IT_10 NUMERIC No
Generic numeric item for general use
69 GENERIC_DATE_1_DATE DATETIME No
Generic date item for general use
70 GENERIC_DATE_2_DATE DATETIME No
Generic date item for general use
71 GENERIC_DATE_3_DATE DATETIME No
Generic date item for general use
72 GENERIC_DATE_4_DATE DATETIME No
Generic date item for general use
73 GENERIC_DATE_5_DATE DATETIME No
Generic date item for general use
74 GENERIC_SEC_SINCE_MIDNIGHT_1 NUMERIC No
Generic time item for general use
75 GENERIC_SEC_SINCE_MIDNIGHT_2 NUMERIC No
Generic time item for general use
76 GENERIC_SEC_SINCE_MIDNIGHT_3 NUMERIC No
Generic time item for general use
77 GENERIC_SEC_SINCE_MIDNIGHT_4 NUMERIC No
Generic time item for general use
78 GENERIC_SEC_SINCE_MIDNIGHT_5 NUMERIC No
Generic time item for general use