AccountsPayableClaimServiceLin
This table summarizes data for AP Claims service lines, with each service line given one row. To link this table’s service line information back to a claim header, join this table to on the column. If you need to report on claim service lines specific to Cost Sharing Reduction (CSR), join this table instead to AP_CLAIM_PROC_IDS_CSR on the column. If you care about neither distinguishing CSR-related service lines nor the ordering of service lines on a claim, you can join back to the claim header on this table's column.
| Column Name | Type | Description |
|---|---|---|
| AllowedAmountAdjustmentReferralRuleLineNumber | INTEGER | The line number of the referral rules table used in determining the allowed amount of the service line on the AP Claim. Join ALWD_AMT_ADJ_RCR and ALWD_AMT_ADJ_RCR_LN to REFERRAL_RCR_LINE.TABLE_ID and REFERRAL_RCR_LINE.LINE for information on the matched line. |
| ClaimBenefitBucketAppliedDate | DATETIME | The date the claim was applied to a benefit bucket. |
| ServiceLineDataSourceType | INTEGER | The data source for the type of service. |
| ServiceCombinationTableTwoSegmentOneToValue | VARCHAR | Returns the AP Claims GL table 2 segment 1 To value matched for this procedure line. |
| PatientPaymentClaimMatchingLineNumber | VARCHAR | The line of the adjudication table that was used to determine the patient portion of the service line on the AP Claim. |
| CalculatedProcedureWithholdingAmount | NUMERIC | The computed withholding amount for the procedure on the accounts payable claim record. |
| ClaimProcedureAdjustedNetPayableAmount | NUMERIC | The adjusted net payable amount after refund for the procedure on the accounts payable claim record. |
| NationalDrugCodeClaimPricingThresholdAmount | NUMERIC | Holds the National Drug Code (NDC) claim-level threshold used to price the service. |
| EssentialHealthBenefitNonCoveredAmount | NUMERIC | The non-covered amount for the service line that was contributed by benefits that were flagged as Essential Health Benefits. |
| IsNationalDrugCodeClaimThresholdMet | VARCHAR | A flag that stores whether or not the National Drug Code (NDC) claim-level threshold was met. If set to 0-No, the threshold was not met. If set to 1-Yes, the threshold was met. |
| ServiceNationalDrugCodePricingMethodIdentifier | INTEGER | Holds the category ID of the contract-level National Drug Code (NDC) pricing method for the service. |
| OperationalAuthorizationEffectiveDate | DATETIME | The effective date column value of the matched row on the operational authorization table. The operational authorization table is found in the Tapestry Profile. |
| SubmittedLineItemControlNumber | VARCHAR | The line item control number from the submitted EDI claim. This is the ID of the service line in the submitter's system. |
| AllowedAmountAdjustmentUsualAndCustomaryFullZipCode | VARCHAR | The ZIP Code that was used in determining the allowed amount of the service line on the AP Claim, if Regional Usual and Customary pricing was used. This column can support both 5 and 9 digit zip codes. |
| ProcedureNonCoveredAmount | NUMERIC | The non-covered amount for the procedure. |
| BedDayTypeMatchedForServiceIdentifier | NUMERIC | Bed day type matched for service. |
| ClaimProcedureRevenueCodeIdentifier | NUMERIC | The unique identifier of the revenue code/procedure associated with the accounts payable claim record. |
| ProcedurePatientPortionOverrideReasonIdentifier | INTEGER | The category ID of the reason for overriding the patient portion on the procedure. |
| ServiceLineNetworkStatus | VARCHAR | Network status at the service level |
| PatientPayBenefitPlanIdentifier | NUMERIC | The benefit plan used to determine the patient portion of the service line on the AP claim. |
| PatientPayBenefitReferralClassifierRecord | VARCHAR | The benefit referral classifier record that was used to determine the patient portion of the service line on the AP Claim. |
| AmbulancePickUpLocationState | VARCHAR | The state of the ambulance pick-up location. |
| NationalDrugCodeBaseRate | NUMERIC | The National Drug Code (NDC) base rate used to price the service. |
| AmbulanceDropOffLocationName | VARCHAR | The name of the ambulance drop-off location. |
| AccountsPayableClaimProcedurePlaceOfServiceTypeCategory | INTEGER | The category value associated with the place of service type of the procedure on the accounts payable claim record. |
| ServiceCombinationTableTwoSegmentOneFromValue | VARCHAR | Returns the AP Claims GL table 2 segment 1 From Value matched for this procedure line. |
| OverrideNotCoveredAmount | NUMERIC | The override not covered amount for the procedure. |
| AllowedAmountVendorContractContactDate | DATETIME | The contact date of the vendor contract that was used to determine the allowed amount of the service line on the accounts payable claim record. |
| ServiceProcedureBeginDate | DATETIME | The beginning service date for the procedure on the accounts payable claim record. |
| ClaimCopayServiceCategoryIdentifier | VARCHAR | The copay category used in adjudicating the service line. |
| ProcedureStartDateTime | DATETIME | The start time of the procedure. |
| ClaimIdentifier | NUMERIC | The claim to which this service associated. For most claim services, this column is equivalent to joining this table's TX_ID column to AP_CLAIM_PROC_IDS.TX_ID and retrieving AP_CLAIM_PROC_IDS.CLAIM_ID. For services related to Cost Sharing Reduction (CSR), this column is equivalent to joining this table's TX_ID column to AP_CLAIM_PROC_IDS_CSR.TX_ID and retrieving AP_CLAIM_PROC_IDS_CSR.CLAIM_ID. |
| OverrideAfterBenefitsProviderPenaltyAmount | NUMERIC | The after benefits provider penalty amount for the procedure, as overridden by the user. |
| PreviousPayerPatientPortionSum | NUMERIC | For non-primary claims (e.g. secondary), the sum of all patient portion amounts specified by previous payors. |
| AllowedAmountUsualAndCustomaryZipCode | INTEGER | The ZIP Code that was used in determining the allowed amount of the service line on the AP Claim, if Regional Usual and Customary pricing was used. |
| PatientCapitatedOutOfPocketAdjustmentAmount | NUMERIC | Amount that the patient out of pocket would have been on a capitated secondary service had the service not been capitated according to the contract. This amount gets displayed on the 835 in the CAS*CO*45 segment. |
| OriginalServiceLineTransactionIdentifier | NUMERIC | Holds the original service line ID for claim line splitting. |
| HealthcareReimbursementAmount | NUMERIC | The healthcare reimbursement amount for the procedure. |
| PrimaryPayerAdjudicatedDeductibleAmount | NUMERIC | For non-primary claims (e.g. secondary), the patient deductible amount adjudicated by the primary insurance company. |
| ProcedureStopTime | DATETIME | The stop time of the procedure. |
| IsRepresentativeLineForSecondaryAdjudication | VARCHAR | Specifies whether this line is used as a representative line for one or more other service lines for the purposes of secondary claim adjudication. |
| PhysicalCommunityOwnerIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| ClaimLinePatientPortionBenefitTier | NUMERIC | The benefit tier that was used to determine the patient portion of the service line on the AP Claim. |
| DurableMedicalEquipmentOverrideRentalRecordIdentifier | NUMERIC | Contains the rental record which this service should use when pricing by durable medical equipment (DME) rental. |
| ClaimProcedureComputedAdjustmentAmount | NUMERIC | The computed adjustment amount for the procedure on the accounts payable claim record. |
| OverrideReasonCategory | INTEGER | The category value associated with the reason for the override. |
| IsLifetimeMaximumExceeded | INTEGER | Stores 1 if the patient's lifetime maximum has been exceeded and null otherwise. |
| OverrideStopLossEvaluationIndicator | VARCHAR | If set to 1-Yes, then the contractual stop loss threshold will not be evaluated when this service is adjudicated, and stop loss will therefore not be applied to this service. If set to 0-No, then stop loss will be applied to this service if applicable to the claim. If left blank, then the claim-level override (CLM 18132) will be used. |
| SubmissionPenaltyAdjudicationString | VARCHAR | The submission penalty adjudication string for the procedure. |
| ProcedureOverrideAllowedAmount | NUMERIC | The override allowed amount for the procedure on the accounts payable claim record. |
| AmbulanceDropOffDistrictIdentifier | INTEGER | Stores the unique identifier for the district associated with the ambulance drop-off location. Join this column to ZC_DISTRICT to translate to the district name. |
| DeprecatedClaimAdjudicationCopayCategory | VARCHAR | The copay category used in adjudicating the service line of the AP claim. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_COPAY_SERVICE_TYPE_ID. |
| BedDaysMappingTableLineNumber | NUMERIC | The line number of the bed days mapping table in the Tapestry Profile (I NPR 41040) on which the procedure matched. |
| IsNotCoveredServiceIndicator | VARCHAR | Stores Yes if the service is not covered, No if the service is covered, or NULL if the service was adjudicated prior to this calculation being available. |
| DurableMedicalEquipmentPricingRecordIdentification | NUMERIC | Holds the Durable Medical Equipment (DME) pricing record used during adjudication of the claim. |
| AllowedAmountAdjustmentMedicationRecord | NUMERIC | The medication record used to determine the allowed amount of the service line on the AP Claim. |
| ClaimAdjudicationFormulaIdentifier | NUMERIC | The adjudication formula used to determine the patient portion of the service on the AP claim. |
| PrimaryPayerAdjudicatedPatientCopayAmount | NUMERIC | For non-primary claims (e.g. secondary), the patient copay amount adjudicated by the primary insurance company. |
| OverrideProcedureCoinsuranceAmount | NUMERIC | The override coinsurance amount for the procedure. |
| UnmappedProcedureCodeIndicator | VARCHAR | Indicates if there were procedure codes on the incoming claim that could not be mapped to internal records. |
| ProcedureGeneralLedgerSegmentTwoValue | VARCHAR | Returns the AP claims GL Segment 2 value matched for this procedure line. |
| ClaimServiceLinePatientPortionComponentGroup | VARCHAR | The component or component group used to determine the patient portion on service line of the AP claim. |
| PaymentResponsibilitySplitEffectiveDate | DATETIME | The effective date of the split definition table used in determining the responsibility class of the service line on the AP Claim. |
| AmbulanceDropOffCountryIdentifier | VARCHAR | Stores the unique identifier for the country associated with the ambulance drop-off location. Join this column to ZC_COUNTRY_2 to translate to the country name. |
| ProcedurePricingAttributeCategoryIdentifier | INTEGER | The category ID of the pricing attribute for the procedure (used in conjunction with the vendor contract). |
| DurableMedicalEquipmentRentalIdentification | NUMERIC | Contains the rental linked to this service. |
| ReferralRuleAllowedAmountAdjustment | VARCHAR | The referral rules table used in determining the referral requirements which affect the allowed amount of the service line on the AP Claim. Join ALWD_AMT_ADJ_RCR and ALWD_AMT_ADJ_RCR_LN to REFERRAL_RCR_LINE.TABLE_ID and REFERRAL_RCR_LINE.LINE for information on the matched line. |
| AdjustedInsuranceAmountAfterRefund | NUMERIC | The adjusted insurance amount after refund for the procedure on the accounts payable claim record. |
| ClaimProcedurePatientPortionAmount | NUMERIC | The patient portion for the procedure on the accounts payable claim record. |
| ProratedOverrideInterestAmount | NUMERIC | The prorated, override interest amount for the service line. |
| ClaimProcedureActualAdjustmentAmount | NUMERIC | The actual adjustment taken for this procedure on the accounts payable claim record. |
| SecondaryClaim | NUMERIC | The amount of additional discount on a secondary claim. |
| ClaimProcedureAllowedAmount | NUMERIC | The allowed amount calculated for the procedure on the accounts payable claim record. |
| NationalDrugCodeServiceLevelPricingThreshold | NUMERIC | Holds the National Drug Code (NDC) service-level threshold used to price the service. |
| AmbulanceDropOffHouseNumber | VARCHAR | Stores the house number associated with the ambulance drop-off location. |
| AdjustedProcedureAdjustmentAfterRefundAmount | NUMERIC | The adjusted adjustment amount after refund for the procedure on the accounts payable claim record. |
| RefundAdjustmentTransactionIdentifier | NUMERIC | The unique ID of the adjustment procedure transaction for refund. |
| ReferralBedDayComponentGroupMatchIdentifier | VARCHAR | Stores the matched component group for referral bed days for this service. |
| ClaimLineServiceAreaIdentifier | NUMERIC | The service area of the service line on the AP claim. |
| PayerInitiatedDowncodingReductionAmount | NUMERIC | Payer Initiated Billed Amount Reduction from Emergency Department Claim (EDC) Analyzer as a result of down coding. |
| ExceededBenefitAmount | NUMERIC | The amount on the procedure that exceeds benefits. |
| NationalDrugCodeUnitPrice | NUMERIC | Holds the National Drug Code (NDC) unit price used to price the service. |
| ServiceCombinationTable2LineNumber | NUMERIC | Returns the AP Claims GL table 2 line matched for the procedure line. |
| ClaimPatientPortionBenefit | NUMERIC | The benefit package used to determine the patient portion of the service line on the AP Claim. |
| WasUsualAndCustomaryValueUsed | INTEGER | Determines whether the Usual and Customary value in the contract was used. Join this column to ZC_IS_UC_APPLIED on INTERNAL_ID in order to translate values. |
| OverrideDisallowedAmount | NUMERIC | The override disallowed amount for the procedure. |
| ClaimProcedureServiceTypeCategoryId | INTEGER | The category ID of the type of service associated with the procedure on the accounts payable claim record. |
| ReferralMatchedForServiceIdentification | NUMERIC | Referral matched for service. |
| CommunityLogOriginatingInstanceIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| SecondaryDeniedProviderResponsibilityAmount | NUMERIC | The secondary denied amount if the service is denied to provider responsibility. |
| PenaltyAfterBenefitsOverrideReason | INTEGER | The reason given for setting the provider penalty after benefits override, if any. This should be translated using ZC_PEN_AFT_BEN_OVRIDE_RSN. |
| PatientOutOfPocketAmount | NUMERIC | The total patient out-of-pocket amount for the procedure. |
| ServiceLineTableTwoComponentGroupIdentifier | VARCHAR | The AP Claims GL table 2 component group used for this procedure line. |
| AmbulancePatientCount | INTEGER | The number of patients in the ambulance. |
| ServiceLineNetworkStatus | VARCHAR | The network status of the service line on the AP claim. This column can be joined to column IN_OUT_NET_C in table ZC_IN_OUT_NET in order to translate the category value to the corresponding name or abbreviation. |
| OperationalAuthorizationNetworkStatus | VARCHAR | The column stores the network status value as found by matching on the operational authorization table. The operational authorization table is found in the Tapestry Profile. The stored values can be translated using the ZC_NETWORK_LEVELS table. |
| AllowedAmountAdjudicationComponent | VARCHAR | The component or component group from the contract that was used to adjudicate the allowed amount of the service on the AP Claim. |
| ServiceDepartmentSpecialty | VARCHAR | The specialty of the department where the service was rendered. |
| ProcedureBilledAmount | NUMERIC | The amount billed for the procedure on the accounts payable claim record. |
| AmbulanceDropOffCity | VARCHAR | The city of the ambulance drop-off location. |
| AmbulancePickUpZipCode | VARCHAR | The zip code of the ambulance pick-up location. |
| AfterBenefitsComputedProviderPenaltyAmount | NUMERIC | The after benefits provider penalty amount for the procedure, as computed by the system. |
| AllowedAmountAdjustmentStopLossTermIdentifier | NUMERIC | This column stores the ID stop loss term record (NSL) that was used in determining the allowed amount of this service line. |
| CommunityPhysicalOwnerIdentification | VARCHAR | The Community ID (CID) of the instance that owns this Chronicles record. This is populated only if you use IntraConnect. |
| CoordinationOfBenefitsSavingsMemberPayoutAmount | NUMERIC | The Coordination of Benefits (COB) savings member payout. |
| DeprecatedDepartmentSpecialtyIdentifier | INTEGER | The department specialty of the AP claim. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_SPECIALTY_DEP_C. |
| ServiceEntryUserIdentifier | VARCHAR | Stores the ID of the user who entered this service. |
| DeniedClaimDiscountExplanationOfBenefitsCodeIdentifier | NUMERIC | The unique ID of the denial claim code used when the claim is denied and the discount amount is adjudicated as the billed amount. |
| AdjustedAllowedAmountAfterRefund | NUMERIC | The adjusted allowed amount after refund for the procedure on the accounts payable claim record. |
| RecordOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| OverrideHealthcareReimbursementAmount | NUMERIC | The override healthcare reimbursement amount. |
| AmbulancePickUpHouseNumber | VARCHAR | Stores the house number associated with the ambulance pick-up location. |
| ServiceLineCliaNumber | VARCHAR | Identification of a Clinical Laboratory Improvement Amendment (CLIA) certified facility that contrasts with the claim level. |
| ProcedureNetPayableAmount | NUMERIC | The net payable amount for the procedure on the accounts payable claim record. |
| AmbulanceDropOffZipCode | VARCHAR | The zip code of the ambulance drop-off location. |
| ServicePricingMethodCategory | INTEGER | The category ID of the method used to price the service (e.g. Revenue code, HCPCS code, DRG code). This is set only for UB claims. |
| ClaimProcedureNetInsuranceAmount | NUMERIC | The net insurance amount for this procedure on the accounts payable claim record. |
| EssentialHealthBenefitAllowedAmount | NUMERIC | The allowed amount for the service line that was contributed by benefits that were flagged as Essential Health Benefits. |
| AmbulancePickupLocationDistrictIdentifier | INTEGER | Stores the unique identifier for the district associated with the ambulance pick-up location. Join this column to ZC_DISTRICT to translate to the district name. |
| NationalDrugCodeFeeScheduleIdentifier | NUMERIC | Holds the ID of the National Drug Code (NDC) fee schedule used. |
| ProcedureStatusCode | INTEGER | The category ID of the procedure's status. |
| AdjudicationComponentMatchContactDate | DATETIME | The contact date of the component that was matched during adjudication if the service was matched to a component. |
| ServiceLevelPenaltyAmountOverride | NUMERIC | Overridden penalty amount at the service level. |
| DeprecatedBenefitRequirementReferralList | VARCHAR | The list of referrals satisfying the benefits authorization requirements. This column will be deprecated in a future release. Reporting content should use Clarity table AP_CLM_PX_BEN_AUTH_RFL going forward, which contains one row per linked referral record. |
| ClaimProcedureCoverageIdentification | VARCHAR | The ID of the coverage used to pay the procedure on the claim. |
| RouteDisallowedDiscountToPatientResponsibilityIndicator | VARCHAR | This column stores a Y/N flag if the amount of this service line will route to patient responsibility as a disallowed amount. If Y, the discount amount on a service priced by the line was routed to patient responsibility as a disallowed amount. If N, means the system left the discount amount as provider responsibility. |
| ProcedureServiceGeneralLedgerSegment | VARCHAR | The service combination G/L segment for the procedure. |
| AllowedAmountAdjustmentDiagnosisRelatedGroup | VARCHAR | The DRG record used to determine the allowed amount of the service line on the AP Claim. |
| ContractualAllowedAmount | NUMERIC | The contractual allowed amount for the procedure. |
| ClaimProcedureAdjustmentReasonCategory | INTEGER | The category value of the reason for the adjustment to this procedure on the accounts payable claim record. |
| ServiceCombinationTable2LastPayorPlanIdentifier | NUMERIC | The AP Claims GL table 2 extension matched for this procedure line. |
| DeductibleMetStatus | INTEGER | Displays whether the deductible limit was met, not met, or didn't apply to this service. 11 - Yes indicates that the deductible was met by this service or before the service was adjudicated. 12 - No indicates that a deductible applies to the service, but the limit was not met as of the time the service was adjudicated. 13 - N/A indicates that no deductibles apply to this service. |
| ServiceLineNationalDrugCodePricingUnitPercentage | NUMERIC | Holds the National Drug Code (NDC) percent of unit charge used to price the service. |
| NationalDrugCodeContractualMechanismPrice | NUMERIC | Holds the contractual payment mechanism price that the National Drug Code (NDC) price was compared with or added to during adjudication. |
| ClaimProcedureRevenueCodeIdentifier | NUMERIC | The unique identifier of the revenue code/procedure associated with the accounts payable claim record. |
| Am | NUMERIC | The weight of the patient during ambulance transport. |
| OriginalMatchedResponsibilityIdentifier | NUMERIC | The responsibility class that was originally matched before it got overridden by the system. |
| UsualAndCustomaryAmount | NUMERIC | The usual and customary amount for the procedure. |
| PatientPaymentServiceLineAmount | VARCHAR | The patient portion for the service line on the AP claim. |
| AllowedAmountVendorContractLine | VARCHAR | The line of the vendor contract that was used to determine the allowed amount of the service line on the AP Claim. |
| ProcedureInsuranceAmount | NUMERIC | The calculated insurance amount for the procedure on the accounts payable claim record. |
| PrimaryPayorPaidAmount | NUMERIC | The amount on a non-primary (e.g. secondary) claim that was paid/handled by the primary payor. |
| ChroniclesLogOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this Chronicles record was extracted. This is populated only if you use IntraConnect. |
| DeniedUncoveredExplanationOfBenefitsCodeIdentifier | NUMERIC | The unique ID of the denial EOB code if the claim is denied and the billed amount is routed to Patient Not Covered. |
| ClaimServiceLineCoordinationOfBenefitsTransferAmount | NUMERIC | The coordination of benefits (COB) amount for this service that was transferred to other services on the same claim. |
| ProcedureCoordinationOfBenefitsSavingsAmount | NUMERIC | The Coordination of Benefits (COB) savings amount for the procedure. |
| ProcedureDeductibleAmount | NUMERIC | The deductible amount for the procedure. |
| PrimaryClaimPatientCoinsuranceAmount | NUMERIC | For non-primary claims (e.g. secondary), the patient co-insurance amount adjudicated by the primary insurance company. |
| ProcedureAdjustedWithholdingAmountAfterRefund | NUMERIC | The adjusted withholding amount after refund for the procedure on the accounts payable claim record. |
| AuthorizationTerminationDate | DATETIME | The termination date column value of the matched row on the operational authorization table. The operational authorization table is found in the Tapestry Profile. |
| ServiceLinePenaltyAmount | NUMERIC | Computed penalty amount at the service level. |
| MedicationFileIdentifier | NUMERIC | The ID of medication file for the service line. |
| TotalPatientPortionForProcedure | NUMERIC | The total patient portion for the procedure. |
| PatientPaymentAdjudicationString | VARCHAR | The patient payment adjudication string. |
| ProcedureAfterBenefitsProviderPenaltyAmount | NUMERIC | The after benefits provider penalty amount for the procedure. |
| InsurancePaymentRunContactSerialNumber | NUMERIC | A service line can be paid by insurance and Health Reimbursement Account (HRA). This column only shows the contact serial number of the AP run that is paid by the insurance responsibility. |
| ClaimProcedureDiagnosisRelatedGroupIdentifier | VARCHAR | The unique ID of Diagnosis Related Group (DRG) code for the procedure. |
| ClaimProsthesisCrownInlayCode | INTEGER | This is the prosthesis, crown, or inlay code for the service. |
| ProcedureDisallowedAmount | NUMERIC | The disallowed amount for the procedure. |
| ClaimLineAdjudicationSequenceNumber | INTEGER | The service's place in the adjudication order. |
| ProcedureCoinsuranceAmount | NUMERIC | The coinsurance amount for the procedure. |
| ProcedureQuantityOverriddenByUserIndicator | INTEGER | Flag to indicate if the Procedure Quantity was manually overridden by the user. |
| ServiceLineResponsibleAmount | NUMERIC | Stores the responsible amount for this service line, as calculated by custom COB logic. If the payment method (AP_CLAIM.METH_TO_PAY_CLM_C) for the claim this service line is associated with is 1 (Primary Coverage), this column will be null. |
| EssentialHealthBenefitCopayAmount | NUMERIC | The copayment amount for the service line that was contributed by benefits that were flagged as Essential Health Benefits. |
| PaymentInformationComponentIdentifier | VARCHAR | The component or component group of the split definition table used in determining the responsibility class of the service line on the AP Claim. |
| DeprecatedPatientLiabilitySourceIdentifier | VARCHAR | The source of the copay or coinsurance value for the service line on the AP claim. If equal to 1, the value comes from the benefit plan. If equal to a value other than 1, the value comes from a coverage-level override. This column will be deprecated in a future release and replaced by the Clarity column AP_CLAIM_PROC_2.PAT_PAY_COPAY_AMT_SRC_C. |
| AccountsPayableSystemAdjustmentReasonCategory | INTEGER | The category value of the system calculated reason for the adjustment to this procedure on the accounts payable claim record. |
| AmbulanceDropOffState | VARCHAR | The state of the ambulance drop-off location. |
| MedicationTypeClassification | INTEGER | The medication type for this service line. |
| EssentialHealthBenefitCoinsuranceAmount | NUMERIC | The coinsurance amount for the service line that was contributed by benefits that were flagged as Essential Health Benefits. |
| ClaimProcedureTransactionIdentifier | NUMERIC | The unique ID of the AP Claim procedure transaction. |
| TotalProcedureRefundAmount | NUMERIC | The total amount refunded for the procedure. |
| ServiceLineComponentGroupIdentifier | VARCHAR | The AP Claims GL table 1 component group used for this procedure line. |
| ProcedureElapsedTimeInMinutes | NUMERIC | The elapsed time of the procedure in minutes. |
| SubrogationDemandAmountFromPayer | NUMERIC | This item stores the subrogation demand amount from another payer for a service. |
| AmbulanceDropOffCountyIdentifier | VARCHAR | Stores the unique identifier for the county associated with the ambulance drop-off location. Join this column to ZC_COUNTY_2 to translate to the county name. |
| OverrideExceededBenefitAmount | NUMERIC | The override exceeded benefit amount for the procedure. |
| AllowedAmountAdjustmentRevenueRecordIdentifier | NUMERIC | This column stores the ID of the revenue record (UBC) used in determining the allowed amount of this service line. |
| OverrideUsualCustomaryAmount | NUMERIC | The amount that overrides the usual and customary amount for the procedure. |
| AllowedAmountAdjustmentProcedureIdentifier | NUMERIC | The procedure record used in determining the allowed amount of the service line on the AP Claim. |
| PreviousPayorInsurancePaidAmount | NUMERIC | For non-primary claims (e.g. secondary), the sum of the insurance amounts paid by previous payors. |
| ApClaimsGeneralLedgerTable1ExtensionMatchIdentifier | NUMERIC | The AP Claims GL table 1 extension matched for this procedure line. |
| OverrideCopayAmount | NUMERIC | The override copay amount for the procedure. |
| ServiceCombinationGeneralLedgerTable1LineNumber | NUMERIC | Returns the row number from AP Claims GL table 1 used in computing the GL segment. |
| ServiceBedDayRelativeWeight | NUMERIC | Relative weight of the bed day type mapped to this service. |
| AllowedAmountAdjustmentComponentGroupLine | VARCHAR | The service line from the AP Claim that matched the whole claim component group. |
| OperationalAuthorizationComponentGroupIdentifier | VARCHAR | The unique identifier of the component or component group matched on the operational authorization table for this procedure. The operational authorization table is found in the Tapestry Profile. |
| ReferringClinicalLaboratoryImprovementAmendmentFacilityIdentifier | VARCHAR | Identification of a Clinical Laboratory Improvement Amendment (CLIA) certified facility that was referred to for qualifying tests. |
| ServiceLineRelativeWeightBedDays | NUMERIC | Weight of bed days for service. |
| ClaimLineAdjudicationTableIdentifier | NUMERIC | The adjudication table used to determine the patient portion of the service line on the AP Claim. |
| ClaimBenefitCheckType | INTEGER | The type of benefits check performed when calculating the patient portion. |
| AdjustedNetInsuranceRefundAmount | NUMERIC | The adjusted net insurance amount after refund for the procedure on the accounts payable claim record. |
| OrthodonticAppliancePlacementDate | DATETIME | The date orthodontic appliances were placed. |
| MaximumOutOfPocketMetCategory | INTEGER | Maximum Out-Of-Pockets (MOOPs) apply to this service. |
| AmbulanceTransportDistanceInMiles | NUMERIC | The ambulance transport distance. |
| ProcedureTypeCode | INTEGER | The category ID that indicates the type of procedure. Only AP claim types should appear in this table (e.g. AP claim, AP claim refund, AP claim DRG). |
| ClaimHealthReimbursementArrangementFamilyType | INTEGER | The family type from the Health Reimbursement Arrangement (HRA) used when adjudicating the claim. |
| SubrogationAdjustmentAmount | NUMERIC | This item stores the amount for a service that was not paid due to subrogation demand being less than net payable. |
| ProcedureCopaymentAmount | NUMERIC | The copayment amount for the procedure. |
| ClaimAdjudicationComponentGroupMatchLine | INTEGER | The line of the component group that was matched during adjudication if the service was matched to a component group. |
| ProcedureWithholdingMethodCategory | INTEGER | The category value representing the method of withholding an amount for this procedure. |
| EssentialHealthBenefitServiceLineDeductibleAmount | NUMERIC | The deductible amount for the service line that was contributed by benefits that were flagged as Essential Health Benefits. |
| ProcedureProviderPenaltyBeforeBenefitsAmount | NUMERIC | The before benefits provider penalty amount for the procedure. |
| ClaimProcedureIdentifier | NUMERIC | The unique identifier of the procedure associated with the accounts payable claim record. |
| IsGeneralLedgerAllowedAmountCarveOut | VARCHAR | Stores Y if the service's allowed amount was carved out from GL proration. N or NULL is stored otherwise. |
| ServiceLevelUncleanDays | NUMERIC | Unclean Days at the service level. |
| NationalDrugCodeServiceThresholdMetIndicator | VARCHAR | A flag that stores whether or not the National Drug Code (NDC) claim-level threshold was met. If set to 0-No, the threshold was not met. If set to 1-Yes, the threshold was met. |
| InsuranceCheckIdentifier | NUMERIC | A service line can be paid by insurance and Health Reimbursement Account (HRA). This column only shows the check ID that is paid by the insurance responsibility. The AP_CLAIM_PROC_DOFR table contains all the checks for a service. |
| CommunityLogOwnerIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| ProcedureExplanationOfBenefitComment | VARCHAR | The claim code (explanation of benefit code) comment on the procedure. |
| BenefitPlanContactDate | DATETIME | The contact date of the benefit plan that was used during adjudication. |
| ProcedureModifierList | VARCHAR | A list of modifiers used with the procedure on the accounts payable claim record. |
| AmbulatoryPaymentClassificationPrice | NUMERIC | The Ambulatory Payment Classification (APC) price for the procedure. |
| PayerInitiatedReductionOverrideAmount | NUMERIC | Override amount for Payer Initiated Reduction |
| DeprecatedOperationalAuthorizationReferralList | VARCHAR | The list of referrals satisfying the operational authorization requirements. This column will be deprecated in a future release. Reporting content should use Clarity table AP_CLM_PX_OPR_AUTH_RFL going forward, which contains one row per linked referral record. |
| OrthodonticApplianceReplacementDate | DATETIME | Date when orthodontic appliance was replaced. |
| NationalDrugCodeServiceThresholdType | NUMERIC | Holds the National Drug Code (NDC) service-level threshold type. |
| ServiceLineAuthorization | INTEGER | Indicates whether authorization is required for the service line on the AP Claim. |
| IsAuthorizationRequired | INTEGER | This column stores whether or not authorization is required as found by matching on the operational authorization table. The operational authorization table is found in the Tapestry Profile. The stored values can be translated using the ZC_AUTH_REC table. |
| AuthorizationCheckedDuringAdjudicationFlag | INTEGER | Indicates whether authorizations were checked during adjudication. |
| OverrideDisallowedReasonCategory | INTEGER | The category ID of the reason for overriding the disallowed amount on the procedure. |
| RefundReversalTransaction | NUMERIC | The unique ID of the reversal procedure transaction for refund. |
| AllowedAmountAdjudicationString | VARCHAR | The allowed amount adjudication string. |
| OverridePatientPortionAmount | NUMERIC | The override patient portion amount for the procedure. |
| AllowedAmountRegionalUsualCustomaryConversionFactorTable | VARCHAR | The conversion factor table that was used in determining the allowed amount of the service line on the AP Claim, if Regional Usual and Customary pricing was used. |
| NationalDrugCodeServicePrice | NUMERIC | Holds the National Drug Code (NDC) price for the service. |
| ProcedureDiscountAmount | NUMERIC | The discount amount for the procedure. |
| ServiceLineResponsibilityOverrideReasonCode | INTEGER | This is the reason for overriding a responsibility class for a service line. |
| AdjustedPatientPortionAmount | NUMERIC | The adjusted patient portion after refund for the procedure on the accounts payable claim record. |
| AllowedAmountUsualCustomaryFeeScheduleMapIdentifier | NUMERIC | The fee schedule map that was used in determining the allowed amount of the service line on the AP Claim, if Regional Usual and Customary pricing was used. |
| ClaimAdjudicationCopayCollectionLocation | INTEGER | The location where the copay was collected as determined during adjudication. |
| ServiceLineGeneralLedgerSegment3Value | VARCHAR | Returns the AP Claims GL Segment 3 value matched for this procedure line. |
| InterestEligibleNetPayableAmount | NUMERIC | The interest and penalty eligible net payable amount of the service line. |
| ClaimProcedureAllowedCode | INTEGER | The allowed code for the procedure (e.g., claim denied, procedure denied, contracted rate payment). |
| BilledServiceQuantity | NUMERIC | The quantity (number of units, procedures, etc.) billed on this service line. |
| ServiceCombinationTable1InPlanUsedIndicator | VARCHAR | Stores the AP Claims GL table 1 in-plan setting matched for this procedure line. Y indicates that the in-plan setting was used. N indicates it wasn't. |