REFERRAL_PX

Description:

This table contains information on procedures associated with referrals. This table is related to the REFERRAL_ORDER_ID table. The REFERRAL_ORDER_ID table contains the list of procedures for the referral. The REFERRAL_PX table contains information on each of those procedures.

Primary Key

Column Name	Ordinal Position
REFERRAL_ID	1
LINE	2

Column Information

	Name	Type	Discontinued?
1	REFERRAL_ID	NUMERIC	No
	The unique ID of the referral in database.
2	LINE	INTEGER	No
	The line number of the procedure associated with the referral. For example, if a referral has two associated procedures, the first procedure will have a line value of 1, while the second procedure will have a line value of 2.
3	PX_ID	NUMERIC	No
	The unique ID of the procedure associated with the referral. This is frequently used to join to the CLARITY_EAP table.
4	UNITS_REQUESTED	INTEGER	No
	The number of units of this procedure that were requested
5	UNITS_APPROVED	INTEGER	No
	The number of units of this procedure that were approved
6	TOTAL_PRICE	NUMERIC	No
	The total price calculated for this procedure using fee schedules or vendor contracts (for outgoing referrals)
7	NET_PAYABLE	NUMERIC	No
	The total net payable calculated for this procedure (the price - the patient portion).
8	PATIENT_PORTION	NUMERIC	No
	The total patient responsibility calculated for this procedure using the benefits engine
9	PROV_ID	VARCHAR	No
	The ID of the provider who will perform the service
10	AUTH_REQ_YN	VARCHAR	No
	A flag that indicates whether the member's benefits require a referral for this service. Yes=> a referral is required, No=> a referral is not required.
11	COVERED	VARCHAR	No
	A flag that indicates whether the procedure is not covered by the member's benefits or it is covered but by supplemental insurance
12	REVENUE_CODE_ID	NUMERIC	No
	Stores the revenue billing code entered on the service.