SERVICE_BENEFITS

Description:

The SERVICE_BENEFITS table contains service-level benefit information about the coverages for the encounter or estimate to which this benefit record is attached.

Primary Key

Column Name	Ordinal Position
RECORD_ID	1
LINE	2

Column Information

	Name	Type	Discontinued?
1	RECORD_ID	NUMERIC	No
	The unique identifier for the benefit 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	CVG_FOR_SVC_TYPE_ID	NUMERIC	No
	This related group contains benefit information specific to a coverage and service type.
4	CVG_SVC_TYPE_ID	VARCHAR	No
	The service type for which the listed insurance benefits apply.
5	CVG_SVC_TYPE_ID_SERVICE_TYPE_NAME	VARCHAR	No
	The name of this benefit service type.
6	EVALUATION_STATUS_C_NAME	VARCHAR	No
	The current evaluated status of the coverage benefits for this service type (coverage, not covered, in progress, etc.). May contain organization-specific values: Yes Category Entries: Covered Not Covered
7	COPAY_AMOUNT	NUMERIC	No
	The copay for this coverage and service type.
8	DEDUCTIBLE_AMOUNT	NUMERIC	No
	Deductible for this coverage and service type.
9	DEDUCTIBLE_MET_AMT	NUMERIC	No
	The amount of the deductible for this coverage and service type that has already been paid.
10	COINS_PERCENT	INTEGER	No
	The coinsurance percentage for this coverage and service type.
11	COINS_AMOUNT	NUMERIC	No
	The coinsurance amount for this coverage and service type.
12	OUT_OF_POCKET_MAX	NUMERIC	No
	The maximum out-of-pocket payment for this coverage and service type.
13	OUT_OF_PCKT_REMAIN	NUMERIC	No
	The remaining out-of-pocket payment for this coverage and service type.
14	OUT_OF_PCKET_MET_YN	VARCHAR	No
	Has the out-of-pocket cost been met for this coverage and service type? May contain organization-specific values: No Category Entries: No Yes
15	OOP_INCL_DEDUCT_YN	VARCHAR	No
	Does the out-of-pocket payment include the deductible cost? The category values for this column were already listed for column: OUT_OF_PCKET_MET_YN
16	COVERED_DAYS	INTEGER	No
	Track covered days -- this is normally used for Medicare.
17	NON_COVERED_DAYS	INTEGER	No
	The non-covered days - this is normally used for Medicare
18	COINS_DAYS	INTEGER	No
	Track the coinsurance days -- this is normally used for Medicare
19	LTR_DAYS	INTEGER	No
	Track the lifetime reserve days -- this is usually used for Medicare.
20	ANNUAL_BEN_MAX_AMT	NUMERIC	No
	The maximum annual benefits for this coverage and service type.
21	ANNUAL_BEN_REMAIN	NUMERIC	No
	The annual benefits remaining for this coverage and service type.
22	LIFETIME_BEN_MAX	NUMERIC	No
	The maximum lifetime benefits for this coverage and service type.
23	LIFETIME_BEN_REMAIN	NUMERIC	No
	The lifetime benefits remaining for this coverage and service type.
24	SPEND_DOWN_AMT	NUMERIC	No
	The spend down amount for this coverage and service type during the defined interval.
25	SPEND_DOWN_REMAIN	NUMERIC	No
	The spend down amount remaining for this coverage and service type during the specified interval.
26	SPEND_DOWN_INTRVL_C_NAME	VARCHAR	No
	The interval at which the spend down amount will reset. May contain organization-specific values: Yes Category Entries: One Week One Month Three Months Six Months One Year
27	PREEXISTING_COND_YN	VARCHAR	No
	Do any pre-existing conditions apply for this coverage and service type? The category values for this column were already listed for column: OUT_OF_PCKET_MET_YN
28	PREEXIST_COND_DESC	VARCHAR	No
	The description of any pre-existing conditions that apply for this coverage and service type.
29	IN_NETWORK_YN	VARCHAR	No
	Is in-network care required for this coverage and service type? The category values for this column were already listed for column: OUT_OF_PCKET_MET_YN
30	PREFERRED_NETWORK	VARCHAR	No
	The preferred network, if any, for this coverage and service type.
31	TRACKING_CODE	VARCHAR	No
	The tracking code for payor communication about this coverage and service type.
32	DEDUCT_REMAIN_AMT	NUMERIC	No
	The amount of the deductible for this coverage and service type that has yet to be paid.
33	DAILY_COPAY_AMOUNT	NUMERIC	No
	The amount that is multiplied by the length of stay to calculate the total inpatient copay for this coverage and service type. This is different from the visit copay amount.
34	MAX_DAILY_COPAY	NUMERIC	No
	The maximum total amount the patient may be charged in daily copays for this coverage and service type.
35	FAMILY_TIER_SVC_C_NAME	VARCHAR	No
	Family tier for this line's coverage and service type. May contain organization-specific values: Yes Category Entries: N/A Individual Family
36	MAX_VISITS	INTEGER	No
	The maximum number of visits for this coverage and service type.
37	REMAINING_VISITS	INTEGER	No
	The remaining number of visits for this coverage and service type.
38	NET_LVL_SVC_C_NAME	VARCHAR	No
	Network level of this line's coverage and service type. May contain organization-specific values: Yes Category Entries: In Out Out of Area N/A
39	NON_COVERED_SVC_C_NAME	VARCHAR	No
	Notes when a service is not covered by the payor for this encounter. May contain organization-specific values: No Category Entries: Covered Not Covered
40	PAYOR_ID	NUMERIC	No
	This is the payor for these service-level benefits. This item is used when recording benefits before a coverage record has been created, such as for estimates for prospective patients.
41	SVC_ANNUAL_BEN_USED_AMT	NUMERIC	No
	The amount that has already been used for this coverage and service type for a given year.
42	RTE_COPAY_AMOUNT	NUMERIC	No
	Stores the last copay value filed by RTE at the service level
43	RTE_DEDUCT_AMOUNT	NUMERIC	No
	Stores the last deductible amount filed by RTE at the service level
44	RTE_DEDUCT_MET	NUMERIC	No
	Stores the last deductible met amount filed by RTE at the service level
45	RTE_DEDUCT_REMAIN	NUMERIC	No
	Stores the last deductible remaining amount filed by RTE at the service level
46	RTE_COINS_PERCENT	INTEGER	No
	Stores the last coinsurance percent filed by RTE at the service level
47	RTE_OOP_MAX	NUMERIC	No
	Stores the last OOP max amount filed by RTE at the service level
48	RTE_OOP_REMAIN	NUMERIC	No
	Stores the last OOP remaining amount filed by RTE at the service level
49	PAYER_BEN_CAT	VARCHAR	No
	The benefit category identifier used by the payer. It will only be set for reference benefit records.
50	VISIT_BEN_MAX_AMT	NUMERIC	No
	The maximum visit benefits for this coverage and service type.
51	VISIT_OUT_OF_POCKET_MAX_AMT	NUMERIC	No
	The maximum visit out-of-pocket payment for this coverage and service type.
52	BENEFITS_LAST_UPDATE_UTC_DTTM	DATETIME (UTC)	No
	The instant that benefits data for this line's service type and coverage was last collected. This instant reflects the time that these benefits were entered originally, even if that entry was made on a different benefits record and the benefits were later copied to the current one.
53	BENEFITS_LAST_UPDATE_USER_ID	VARCHAR	No
	The user who last made changes to this line's service type benefits values. This reflects the time that these benefits were entered originally, even if that entry was made on a different benefits record and the benefits were later copied to the current one.
54	BENEFITS_LAST_UPDATE_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
55	BENEFITS_LAST_UPDATE_SRC_C_NAME	VARCHAR	No
	The method that was last used to make changes to this line's service type benefits values. This reflects the original entry of the benefits, even if the entry was made on a different benefits record and the benefits were later copied to the current one. May contain organization-specific values: No Category Entries: Manual Update Eligibility Query Previous Eligibility Query Automatic population from benefits engine Reference BEN for Estimates