|
Name |
Type |
Discontinued? |
|
1 |
RECORD_ID |
NUMERIC |
No |
|
|
|
The unique identifier for the claim value 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 |
LN_INGRED_COST_PAID |
NUMERIC |
No |
|
|
|
Drug ingredient cost paid. |
|
|
4 |
LN_DISP_FEE_PAID |
NUMERIC |
No |
|
|
|
|
5 |
LN_PAT_PAY_AMT |
NUMERIC |
No |
|
|
|
|
6 |
LN_COPAY_AMT |
NUMERIC |
No |
|
|
|
|
7 |
LN_COINS_AMT |
NUMERIC |
No |
|
|
|
Amount of patient coinsurance. |
|
|
8 |
LN_DEDUCT_AMT |
NUMERIC |
No |
|
|
|
Amount of patient deductible. |
|
|
9 |
LN_REGLTRY_FEE_AMT |
NUMERIC |
No |
|
|
|
Flat sales tax amount paid. |
|
|
10 |
LN_PCT_TAX_AMT |
NUMERIC |
No |
|
|
|
Percentage tax amount paid. |
|
|
11 |
LN_INCENTIVE_AMT |
NUMERIC |
No |
|
|
|
|
12 |
LN_OTHR_AMT_RECOGZ |
NUMERIC |
No |
|
|
|
Total amount recognized by the processor of any payment from another source. |
|
|
13 |
LN_NET_AMT_DUE |
NUMERIC |
No |
|
|
|
Net amount paid to provider by the payer. |
|
|
14 |
LN_DENT_PROS_QUAL |
VARCHAR |
No |
|
|
|
This item holds a code indicating if the date for a prior crown/prosthesis is estimated or exact. |
|
|
15 |
LN_DENT_PROS_DATE |
DATETIME |
No |
|
|
|
The date a prior crown/prosthesis was previously placed. |
|
|
16 |
SVC_DENIED_STATUS_IDENT |
VARCHAR |
No |
|
|
|
This stores the external identifier for the denial status of this line. |
|
|
17 |
PRCS_IND_CD |
VARCHAR |
No |
|
|
|
Claim line level processing indicator code. |
|
|
18 |
PRCS_IND_CD_DESC |
VARCHAR |
No |
|
|
|
Claim line level processing indicator code description. |
|
|
19 |
LN_OPR_TAXONOMY |
VARCHAR |
No |
|
|
|
Stores the Line Operating Provider Taxonomy Code. |
|
|
20 |
LN_APPLIANCE_REPLACEMENT_DATE |
DATETIME |
No |
|
|
|
The date when an orthodontic appliance was replaced. |
|
|
21 |
LN_TREATMENT_START_DATE |
DATETIME |
No |
|
|
|
The date of the initial treatment for a dental service. |
|
|
22 |
LN_TREATMENT_COMPLETION_DATE |
DATETIME |
No |
|
|
|
The date of the completed treatment for a dental service. |
|
|
23 |
LN_FILL_STATUS |
VARCHAR |
No |
|
|
|
Stores information on whether the prescription was completely or partially filled. |
|
|
24 |
LN_ORD_TAXONOMY |
VARCHAR |
No |
|
|
|
Stores the National Uniform Claim Committee (NUCC) taxonomy code associated with the line-level operating provider |
|
|
25 |
LN_APPLIANCE_PLACEMENT_DATE |
DATETIME |
No |
|
|
|
The date when the orthodontic appliance was placed. |
|
|
26 |
LN_LIN_QUALIFIER |
VARCHAR |
No |
|
|
|
Qualifier code to identify drug code set or the type/source of the descriptive number used in Product/Service ID. |
|
|
27 |
LN_PRESC_PROV_NPI |
VARCHAR |
No |
|
|
|
This column holds the National Provider Identifier (NPI) of the provider that prescribed the medication on this service. |
|
|
28 |
LN_PRESC_PROV_TAXONOMY |
VARCHAR |
No |
|
|
|
This column holds the NUCC Taxonomy Code of the provider that prescribed the medication on this service. |
|
|
29 |
LN_SERV_PROV_NPI |
VARCHAR |
No |
|
|
|
This item holds the National Provider Identifier (NPI) of the pharmacy that filled the prescription. |
|
|
30 |
LN_SERV_PROV_TAXONOMY |
VARCHAR |
No |
|
|
|
This column holds the NUCC Taxonomy Code of the pharmacy that filled the prescription. |
|
|
31 |
LN_DX_PTR_RANK |
VARCHAR |
No |
|
|
|
The comma-delimited list of diagnoses ranks for each diagnosis on a service. Each position here corresponds to the same comma-delimited position of the column LN_DX_PTR from the SVC_LN_INFO table. The rank here specifies the ranking of diagnoses for the specific service. This can be different than the rank of the same diagnoses at the header-level or even the same diagnoses for a different service. |
|
|
32 |
LN_PCP_REF_LAST_NM |
VARCHAR |
No |
|
|
|
This item stores the line's PCP referring provider's last name. |
|
|
33 |
LN_PCP_REF_FIRST_NM |
VARCHAR |
No |
|
|
|
This item stores the line's PCP referring provider's first name. |
|
|
34 |
LN_PCP_REF_MID_NM |
VARCHAR |
No |
|
|
|
This item stores the line's PCP referring provider's middle name. |
|
|
35 |
LN_PCP_REF_SUFFIX_NM |
VARCHAR |
No |
|
|
|
This item stores the line's PCP referring provider's suffix. |
|
|
36 |
LN_PCP_REF_NPI |
VARCHAR |
No |
|
|
|
This item stores the line's PCP referring provider's NPI. |
|
|
37 |
RX_DATE |
DATETIME |
No |
|
|
|
The date when the prescription was written. |
|
|
38 |
SUB_CLAR_CODE |
VARCHAR |
No |
|
|
|
The code indicating that the pharmacist is clarifying the submission. |
|
|
39 |
RX_ORIGIN_CODE |
VARCHAR |
No |
|
|
|
The code indicating the origin of the prescription. |
|
|
40 |
RX_PHARM_SRV_TYPE |
VARCHAR |
No |
|
|
|
The type of service being performed by a pharmacy when different contractual terms exist between a payer and the pharmacy, or when benefits are based upon the type of service performed. |
|
|
41 |
RX_PROD_DESC |
VARCHAR |
No |
|
|
|
The description of the product being submitted on the prescription claim. |
|
|
42 |
OTHER_CVG_CODE |
VARCHAR |
No |
|
|
|
The code indicating whether or not the patient has other insurance coverage. |
|
|
43 |
RX_SERVICE_LEVEL |
VARCHAR |
No |
|
|
|
The code indicating the type of service the provider rendered. |
|
|
44 |
QTY_PRESCRIBED |
NUMERIC |
No |
|
|
|
The quantity of prescription drug expressed in metric decimal units. |
|
|
45 |
REASON_SVC_CODE |
VARCHAR |
No |
|
|
|
The code identifying the type of utilization conflict detected or the reason for the pharmacist's professional service. |
|
|
46 |
PROF_SRVC_CODE |
VARCHAR |
No |
|
|
|
The code identifying pharmacist intervention when a conflict code has been identified or service has been rendered. |
|
|
47 |
RES_SVC_CODE |
VARCHAR |
No |
|
|
|
The code describing a pharmacist's action in response to a professional conflict. |
|
|
48 |
LEVEL_OF_EFFORT |
VARCHAR |
No |
|
|
|
The code indicating the level of effort as determined by the complexity of decision-making or resources utilized by a pharmacist to perform a professional service. |
|
|
49 |
DOSAGE_FORM_DESC_CD |
VARCHAR |
No |
|
|
|
The dosage form of the complete compound mixture. |
|
|
50 |
DISP_UNIT_FORM_INDICATOR |
VARCHAR |
No |
|
|
|
The NCPDP standard product billing codes. |
|
|
51 |
ADMIN_ROUTE |
VARCHAR |
No |
|
|
|
An override to the "default" route referenced for the product. For a multi-ingredient compound, it is the route of the complete compound mixture. |
|
|
52 |
INGREDIENT_COMPOUND_CNT |
INTEGER |
No |
|
|
|
The count of compound product IDs (both active and inactive) in the compound mixture submitted. |
|
|
53 |
USUAL_CUSTOMARY_CHG |
INTEGER |
No |
|
|
|
The amount charged to cash customers for the prescription exclusive of sales tax or other amounts claimed. |
|
|
54 |
COST_BASIS |
VARCHAR |
No |
|
|
|
The code indicating the method used to calculate the ingredient cost. |
|
|
55 |
INGREDIENT_COST_SUBMITTED |
NUMERIC |
No |
|
|
|
The product component cost of the dispensed prescription. |
|
|
56 |
DISP_FEE_SUBMITTED |
NUMERIC |
No |
|
|
|
The dispensing fee submitted by the pharmacy. |
|
|
57 |
PROF_FEE_SUBMITTED |
NUMERIC |
No |
|
|
|
The amount submitted by the provider for professional services rendered. |
|
|
58 |
INGREDIENT_AMT_SUBMITTED |
NUMERIC |
No |
|
|
|
The amount representing the fee that is submitted by the pharmacy for contractually agreed upon services. |
|
|
59 |
OTHER_AMT_SUBMITTED |
NUMERIC |
No |
|
|
|
The amount representing the additional incurred costs for a dispensed prescription or service. |
|
|
60 |
GROSS_AMOUNT_DUE |
NUMERIC |
No |
|
|
|
The total gross amount submitted on the claim. |
|
|