BenefitPlans
The table contains basic information about your benefit plans.
| Column Name | Type | Description |
|---|---|---|
| PreventDuplicateCoverageLevel | INTEGER | Level at which the plan will warn or stop the user from creating a coverage with the same payor/plan combination as another coverage on the applicable guarantor or hospital account. If nothing is set, the plan's payor's setting will be used. If nothing is set there, then the guarantor's Service Area's setting will be used. The default is 0-No Prevention. |
| BenefitPlanLifetimeMaximumTotalPercentage | NUMERIC | The lifetime maximum buckets percentage of total threshold for total accumulation of buckets. |
| SingleComponentClaimExtensionIdentifier | NUMERIC | This extension will return a single component for a single component prescription-coverage-adjudicated claim. All subsequent plans will respect the setting at the primary plan level. |
| BenefitPlanPayorIdentifier | NUMERIC | The unique ID of the payor associated with this benefit plan. |
| BenefitPlanReportingGrouperTwentyOne | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanMedigapNumber | VARCHAR | Plan's Medigap Number. Used to populate L2010BB/NM1-09 and L2330B/NM1-09 fields on ANSI 837 format. |
| OverridePayorForMspQuestionnaireIndicator | NUMERIC | Override payor for MSPQ |
| IsPrescriptionBenefitMedicarePartDCreditable | VARCHAR | Indicates whether the prescription drug benefits are equal to or better than Medicare Part D. This is used when determining if a Part D applicant has maintained creditable coverage. |
| PreventModifiersOnGeneratedAuthorizationIndicator | VARCHAR | Indicates whether modifiers are prevented from being populated when service-level authorizations are automatically created for this plan. |
| BenefitPlanReportGrouperThirtyOne | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanState | VARCHAR | The state of the benefit plan. |
| ShowAnesthesiaCodeOnClaimIndicator | VARCHAR | Indicates whether to show ASA code on anesthesia claims. |
| BenefitPlanLifetimeMaximum | NUMERIC | The lifetime maximum buckets limit for out-of-plan buckets. |
| BenefitPlanAlternateClaimCity | VARCHAR | The alternate mailing city for this plan. The address can be used to send claims to an alternate address. The alternate claim address is found in the EPP_ALT_CLM_ADDR table. |
| BenefitPlanEffectiveToDate | DATETIME | The date the benefit plan is effective to. Registration system definition settings may be configured to screen out plans during coverage creation based on this date (I EAF 63613). For all other applications, this date is for reporting use only. |
| BenefitPlanNonPrimaryBankIdentificationNumber | VARCHAR | The Bank Information Number (BIN) used during prescription adjudication for non-primary coverages. Leave this field blank if the same BIN is used regardless of whether the coverage is primary or secondary. If no non-primary BIN is specified, the BIN will be used for non-primary coverages. If blank at the plan level, the payor level BINs are used. |
| IsElectronicVerificationEnabledFlag | VARCHAR | Flag to control if the plan is enabled for electronic verification. |
| ReportingGrouperTwo | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| GenerateExplanationOfBenefitsForAccountsPayableClaimsIndicator | VARCHAR | Indicates if you want to generate an EOB for AP claims of those members using this benefit plan when there is any patient payment on the claim. Y indicates that you want to generate an EOB. A null value indicates that you don't want to generate EOB. An N will not be populated for this column. |
| BenefitPlanPreauthorizationContactPhoneNumber | VARCHAR | The phone number for the authorization contact at this plan. |
| IncludeVoidedTransactionsOnDemandReprintClaimsIndicator | VARCHAR | Indicates whether voided transactions will appear on demand reprint claims. |
| PayorResponsiblePercentage | NUMERIC | Indicates the percentage of the price that the payor is responsible for if Specified Percentage is selected in the Adjudicate Charge Via item. The remaining balance will be charged to the patient. |
| DemandZeroBalanceComponentGroupID | VARCHAR | The component group ID that must be used in order to submit charges with a zero dollar balance on a demand claim. |
| ExcludeFromReferralsAndUtilizationManagementFlag | VARCHAR | If set to Yes, coverages associated with this benefit plan will be excluded from referrals and UM workflows. |
| BenefitPlanReportingGroupSix | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| BenefitPlanReportGrouperEight | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| BenefitPlanStreetAddressLineOne | VARCHAR | The street address of the benefit plan, line 1. |
| IncludeBadDebtChargesFlag | VARCHAR | Flag to allow the inclusion of bad debt charges on claims. Will only affect PB claims processing. |
| BenefitPlanDistrict | INTEGER | The district of the benefit plan. |
| BenefitPlanPricingContractIdentifier | NUMERIC | The unique ID of the pricing contract you have set up with the benefit plan. |
| CapitationAccountsPayableGeneralLedgerSegment | VARCHAR | The G/L segment value for this benefit plan for capitation AP G/L transactions. |
| ReportGrouperThirtyCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| AlternateClaimMailingState | VARCHAR | The alternate mailing state for this plan. The address can be used to send claims to an alternate plan address. The alternate claim address is found in the EPP_ALT_CLM_ADDR table. |
| BenefitPlanReportGrouperTwentyThree | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| PlanDefaultChargeTableIdentifier | VARCHAR | Plan level default charge table ID to use during prescription medication charge calculations. |
| MedicareAdvantagePlanCoveragePartsCategory | INTEGER | Stores the category identifier that describes which parts of Medicare this plan covers for Medicare Advantage. This value is only used for reporting, but that may be expanded in the future. A coverage is considered Medicare Advantage if: - PLAN_GRP.EXCHANGE_C is 3, 4, or 5 for the relevant employer group. - Otherwise, if this value is populated. |
| BenefitPlanReportingGrouperCategoryTwentySeven | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanRep | VARCHAR | The city entered here will be used to create reprice cover sheet for this plan. |
| PhysicalDeploymentOwnerIdentifier | VARCHAR | ID of the physical deployment owner for this record. Physical owners will be where the data is hosted, either on the cross-over server or the owner deployment. |
| MaximumServiceLinesOnClaimForCms | NUMERIC | Stores the maximum number of service lines on a claim for this benefit plan on a CMS claim. |
| PaperClaimPlanCode | VARCHAR | Text for plan code to be printed on paper claims. |
| PrescriptionAdjudicationBankInformationNumber | VARCHAR | The Bank Information Number (BIN) used during prescription adjudication. If blank at the plan level, the payor level BIN is used. |
| MedicareAdvantageContractNumber | VARCHAR | This column contains the Medicare Advantage contract number, which identifies the benefit plan represented by this plan record to CMS. |
| ReportGrouperThirtyTwoCharacter | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| SupplementalMedicarePayorIdentifier | NUMERIC | Payor ID for Medicare for supplemental payment (IME) claims |
| BenefitPlanReportGrouperFortyCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| PlanDenialAppeal | INTEGER | The number of days a plan allows for appeal of denials or underpayments. |
| AllowCareTeamPrimaryCareProviderEditingIndicator | INTEGER | A category value that indicates if users are able to edit Primary Care Providers within the Care Teams activity from outside of Tapestry. |
| LogicalDeploymentOwnerIdentifier | VARCHAR | ID of the logical deployment owner for this record. Logical owners show the deployment where the record was created but doesn't represent if the record is a part of version skew. |
| ReportGrouperThirtyFiveCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| SendZeroDollarRxClaimIndicator | VARCHAR | If this item is set to Yes, when a prescription charge is adjudicated in Willow Ambulatory for a non-primary coverage using this plan, and previous coverages in the filing order have paid the full amount, the system sends a zero-dollar claim to the payor. Some plans require zero-dollar claims for compliance purposes. If this item is blank or set to No, the system doesn't send zero-dollar claims in the scenario described above. However, if the corresponding item is set to Yes at the payor level (I EPM 7260) and this item is not set at the plan level, the system sends zero-dollar claims for all plans associated with that payor. |
| PlanManagedCareCoverageClass | VARCHAR | Managed care coverage class of the plan. |
| SecondaryClaimFilingWindowDays | INTEGER | The number of days a plan allows for initial filing of secondary claim |
| PreferredProviderOrganizationZipCode | VARCHAR | The ZIP Code entered here will be used to create reprice cover sheet for this plan. |
| BenefitPlanIdentifier | NUMERIC | The unique identifier (.1 item) for the benefit plan record. |
| BenefitPlanHouseNumber | VARCHAR | The house number of the benefit plan. |
| BenefitPlanReportGrouperTwelveCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| BenefitPlanReportingGroupOne | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| IsBenefitPlanGenericIndicator | VARCHAR | Indicates whether this benefit plan is generic. |
| BenefitPlanPaymentTypologyCode | INTEGER | This item is being created to store typology codes. |
| BenefitPlanReportGrouperTwenty | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| Benefit | INTEGER | Indicates whether this EPP record is a benefit plan or a benefit plan rider. |
| TotalLifetimeBucketLimit | NUMERIC | The lifetime maximum buckets limit for total accumulation. |
| BenefitPlanReportGrouperFourteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| PreferredProviderOrganizationRepriceCoverSheetPhoneNumber | VARCHAR | The phone number entered here will be used to create reprice cover sheet for this plan. |
| IsPaperClaimOnly | VARCHAR | Indicates whether only paper claims should be created for this plan. |
| BenefitPlanLifetimeMaximumDollarAmountThreshold | NUMERIC | The lifetime maximum buckets dollar amount threshold for total accumulation of buckets. |
| LogicalInstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| BenefitPlanProductTypeCategory | VARCHAR | The product type category number for the benefit plan. |
| RyanWhiteMedicalInsuranceCategory | INTEGER | The category number of the Ryan White Insurance type. This defines the insurance type of this plan as required by the Ryan White Services program for reporting. |
| AlternateBenefitPlanIdentification | VARCHAR | Alternate ID of the plan |
| PlanPayorOrganizationIdentification | VARCHAR | Plan's payor organization ID. Used to populate L2010BB/NM1-09 (Professional), L2010BC/NM1-09 (Institutional), or L2330B/NM1-09 (ANSI 837) fields. |
| BenefitPlanHomeInfusionAdjudicationServiceDateOption | INTEGER | Plan-level setting to determine the service date that should be used for home infusion adjudications |
| BenefitPlanReportGroupSixteenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| BenefitPlanReportGrouperThirteenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| BenefitPlanReportingGrouperTen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| BenefitPlanRecordStatus | INTEGER | The record status of the benefit payor/plan record (e.g. active, inactive, etc.). |
| AlternateRevenueCodePlanIdentifier | VARCHAR | Alternate Plan Identifier for Revenue Code |
| AlternateClaimPhoneNumber | VARCHAR | Stores alternate claim phone number |
| CapitationReconciliationRateTolerance | NUMERIC | Rate tolerance to be used when an incoming capitation reconciliation is done against a coverage with this plan. |
| BenefitPlanReportGrouperThirtyThreeCharacter | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| PayorSheetPrescriptionAdjudicationExtensionIdentifier | NUMERIC | Extension to select what payor sheet to use during prescription adjudication. If the extension does not return a value, the transaction table will be used to find the payor sheet. The plan level payor sheet extension is always checked first, then the plan level table, then the payor level payor sheet extension, and then the payor level table. |
| AlwaysWriteOffPayorAmountIndicator | VARCHAR | Determines whether the system should always post the payor-specified not allowed amount when using the Write Off Payor Amount option and ignore any existing payments and NAA in the liability bucket. |
| ReferralsAreUtilizationManagementFlag | VARCHAR | If set to yes, even if the associated payer is not managed care, associated referrals will be flagged as UM. |
| IsTieredBenefitPlanFlag | VARCHAR | Plan-level flag as tiered benefits plan. |
| BenefitPlanReportingGrouperEleven | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| BenefitPlanReportGrouperFour | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| BenefitPlanIdentifier | NUMERIC | The unique identifier (.1 item) for the benefit plan record. |
| BenefitPlanReportGrouperTwentyFour | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanPhoneNumber | VARCHAR | The phone number of the benefit plan. |
| BenefitPlanReportGrouperTwentyFiveText | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| AllowsZeroBalanceClaimResubmissionIndicator | VARCHAR | Indicates whether this plan accepts claim resubmission with zero insurance balance. |
| PlanOutOfNetworkLifetimeMaximumDollarAmount | NUMERIC | The lifetime maximum buckets dollar amount threshold for out-of-plan buckets. |
| BenefitPlanReportingGrouperTwentyTwo | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the free text report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| PlanAdjudicateChargeMethod | INTEGER | This item specifies how this plan adjudicates prescriptions. |
| AlternateClaimZipCode | VARCHAR | The alternate mailing zip code for this plan. The address can be used to send claims to an alternate plan address. The alternate claim address is found in the EPP_ALT_CLM_ADDR table. |
| BenefitPlanCounty | VARCHAR | The county of the benefit plan. |
| IsPlanUsedInSharedCoverages | VARCHAR | Indicates whether this plan will be used for shared coverages. When this item is set to yes, billing types (I EPP 85) must be set to 3 (can only have one line and must be |
| BenefitPlanReportGrouperFifteenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| PrescriptionAdjudicationProcessorControlNumber | VARCHAR | The Processor Control Number (PCN) used during prescription adjudication. If blank at the plan level the payor level PCN is used. |
| 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. |
| PrintTaxonomyOnClaimIndicator | VARCHAR | Indicates whether the taxonomy code is printed on ANSI institutional claims at the L2000A level and FL 81 on UB04 paper claims. |
| BenefitPlanIdentifier | NUMERIC | The unique ID assigned to the benefit plan record in the system. |
| BenefitPeriodStartDate | DATETIME | Defines when annual benefits reset. |
| PhysicalOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| AlternateProcedureCodeByPlan | VARCHAR | Alternate identifier for Procedure code in the Procedure master file |
| BenefitPlanReportGrouperThirtyNine | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| PermitExternalPrimaryCareProviderAddition | INTEGER | A category value that indicates if users are able to add Primary Care Providers within the Care Teams activity from outside of Tapestry. |
| RespectRemittanceCrossoverFlag | VARCHAR | Flag to allow checking the plan level crossover exceptions, even if the information in the remit file is respected and it says a crossover claim has been sent. |
| PlanCoverageTypeCode | INTEGER | Stores the IRS code for the type of coverage this plan represents. |
| PreferredProviderOrganizationRepriceMailingAddress | VARCHAR | The mailing address in this field will be used to create reprice cover sheet for this plan. |
| BenefitPlanMedicationComponentExclusionGrouperIdentifier | VARCHAR | Plan-specific list of components to exclude from a prescription-coverage-adjudicated claim. |
| BenefitPlanReportGrouperNineteen | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| SubmitDemandClaimOnZeroBalanceIndicator | VARCHAR | Indicates whether charges associated with this benefit plan should be submitted on a demand claim when the insurance balance is zero due to payments or credit adjustments. |
| ZeroDollarInsuranceClaimSubmissionComponentGroupId | VARCHAR | The component group ID that must be used in order to submit charges with a zero dollar balance on insurance claims. |
| ReportGrouperThirtySevenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanCapitationCode | INTEGER | Capitation code which can be used to drive capitation rates for members. |
| BenefitCollectionTrackingLevel | INTEGER | This setting controls whether benefits are tracking at the patient level level and copied between future encounters within a benefit period, or solely at the encounter level. |
| BenefitPlanCity | VARCHAR | The city of the benefit plan. |
| UniformDataSystemCoverageClassCategory | INTEGER | The category number for the UDS coverage class. This defines a coverage as medical, dental, etc. for the purposes of UDS reporting. |
| UsePlanNameOnClaimIndicator | VARCHAR | If the "Claim Mail Code" is set to 3-Send Claim to Payor Plan, this field indicates whether the plan should be used on claims. If this field is set to 2-No, the payor name will be used on claims. |
| AllowsPrescriptionDefaultsIndicator | VARCHAR | Select yes if this plan allows prescription defaults. No is the default if left blank. |
| IntraConnectOwningInstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| ReportGrouperThirtyFourCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| SaveFullGrouperPlusResponseIndicator | VARCHAR | Indicates whether users can save the full details of the APC Grouper Plus responses in the CLP when data is loaded. |
| ResubmitZeroBalanceComponentGroupIdentifier | VARCHAR | The component group ID that must be used in order to resubmit charges with a zero dollar balance. |
| BenefitPlanCarrierIdentifier | VARCHAR | The unique ID of the carrier |
| BenefitPlanConsumerFacingName | VARCHAR | Stores the name of the plan in a patient-friendly, correctly formatted way (not in all caps) |
| BenefitPlanReportGrouperSeven | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP_2 table. |
| CopyImeClaimLinesIndicator | VARCHAR | Indicates whether claim lines from the source claim are copied into the IME claim. |
| ReportGrouperCategoryTwentyEight | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanName | VARCHAR | The name of the benefit plan record. |
| PlanPrescriptionAdjudicationSoftwareVendorIdentification | VARCHAR | The software vendor ID for the plan for prescription adjudication. The plan-level software vendor ID will override the payer-level software vendor ID (in EPM 7240). |
| SupportsPartialPrescriptionFillsIndicator | VARCHAR | Indicates whether the plan supports partial prescription fills. If blank at the plan level, the payor level setting is used. |
| NetworkDeterminationOverrideCode | INTEGER | The override of the manage care system profile setting for in or out of network determination. |
| BenefitPlanClaimMailingCode | INTEGER | Default mail code for coverages with this benefit plan. |
| BenefitPlanLifetimeInNetworkLimit | NUMERIC | The lifetime maximum buckets limit for in-plan buckets. |
| ReportGrouperSeventeenCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table. |
| BenefitPlanZipCode | VARCHAR | The zip code of the benefit plan. |
| BenefitPlanReportGrouperThirtySixCategory | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanReportGrouperThirtyEight | VARCHAR | You have the ability to specify groupers for enterprise reporting, SQL, or report generator reporting. There are free text groupers and category groupers. If you elect to use these groupers, please contact your enterprise reporting representative for assistance. This is one of the category report groupers. There are more report grouper columns in the CLARITY_EPP table and the CLARITY_EPP_OT table. |
| BenefitPlanClaimGroupingPointerIdentifier | NUMERIC | Claim grouping pointer for this benefit plan. |
| BillingApplicationCrossoverRelationship | VARCHAR | Indicates the billing application for which the Medigap setting should represent a crossover relationship. |
| BenefitPlanLogoFilename | VARCHAR | Benefit plan logo filename |