ClaimAdjudication
The table contains one record for each claim in the managed care system's AP Claims module.
| Column Name | Type | Description |
|---|---|---|
| ClaimServiceClassificationCode | INTEGER | Represents the clinical classification for the services billed on this claim. |
| ClaimInterestEndDate | DATETIME | The to date for interest calculation for the claim. Used when the associated check which was returned is voided. |
| AssociatedSpecialtyCategory | VARCHAR | The category value corresponding to the specialty associated with the accounts payable claim record. |
| Ambul | VARCHAR | Stores the ZIP code of the ambulance drop-off location. |
| ClaimAccountsPayableStatusIdentifier | INTEGER | Stores the unique category identifier of the claim's AP status or NULL if the claim has not been sent to AP. |
| ClaimFileNumber | VARCHAR | The file number of the claim. |
| IsMedicareSecondaryPayor | VARCHAR | Indicates whether Medicare is listed as a secondary payor on the claim record. 'Y' indicates that Medicare is a secondary payor, 'N' indicates that it is not. |
| TotalDisallowedAmount | NUMERIC | The total disallowed amount for the claim. |
| TotalPrimaryPayorPatientDeductibleAmount | NUMERIC | Displays the amount the primary payors adjudicated as the deductible patient portion. This is applicable only if the claim has been submitted to your facility as the non primary payor (secondary, tertiary, 4th, etc.) |
| ClaimTotalInsuranceAmount | NUMERIC | The total insurance amount associated with the accounts payable claim record. |
| ClaimTotalInterestAmount | NUMERIC | Stores the total interest for the claim, from the constituent service lines. |
| ClaimReenteredFlag | INTEGER | A flag that records whether a claim was re-entered. A value of 1 indicates a re-entered claim. |
| CaseManagementCreationIdentifier | VARCHAR | ID of the case trigger message associated with the claim. |
| IsFinalNaturalKeyAdjustment | VARCHAR | Indicates whether a claim is the final action of an adjustment sequence that is tracking adjustments via natural keys. Natural key adjustments are tracked using superitem CLM 18690. A claim is the final action of its natural key if it has the maximum order value (item 18692) for a given natural key (item 18691). If there is a tie, the claim with the largest claim header id (item 18681) is deemed the final action. |
| TotalClaimCopayAmount | NUMERIC | The total copay for the claim. |
| ClaimInterestAmountOverride | NUMERIC | This stores the override interest amount for the claim. |
| DentalServiceEndDate | DATETIME | This is the dental service span to date. |
| AdmissionDateTime | DATETIME | The date on which the member was admitted to the place of service. |
| AdjudicatingUserIdentifier | VARCHAR | The ID of the user who adjudicated the claim. |
| WorkflowPrintStatus | INTEGER | The category value corresponding to the workflow print status. |
| ClaimDenialPendingExaminerIdentification | VARCHAR | The unique ID of the claims examiner who applied a status of clean, deny, or pend to this claim. |
| OverrideSubmissionPolicyReasonCode | INTEGER | This item provides an explanation as to why the override submission policy item is set. |
| ClaimInBasketTrackingNumber | NUMERIC | In Basket tracking for the claim. |
| TotalAmountDeniedToPatient | NUMERIC | This tracks the total amount denied to the patient across all claim services. It is currently only used for display purposes in the claim workspace. |
| ClaimAllowsNegativeCoordinationOfBenefitsSavingsFlag | INTEGER | Indicates whether the claim allows negative COB savings amounts. |
| PermanentOriginalCorrectedClaimIdentifier | NUMERIC | Stores the unique identifier of the original claim for corrected claims. The value will always persist, even if the claim is voided. If the claim is not a corrected claim, no value will be stored. |
| ReferenceClaimIdentifier | VARCHAR | Contains the reference claim ID in the ANSI 837 file from Loop 2300, Segment REF02 with identifier F8. This is often used in combination with the claim frequency code. When the claim frequency code indicates the claim needs to be adjusted or voided, the reference claim ID is used to help identify the claim. |
| InvolvesOutsideLaboratoryServicesIndicator | VARCHAR | Indicate if lab services outside the provider's office are involved. |
| TotalPrimaryPayerPatientPortionAmount | NUMERIC | Displays the amount the primary payors adjudicated as the patient portion. This is applicable only if the claim has been submitted to your facility as the secondary payor. |
| TotalPatientOutOfPocketAmount | NUMERIC | The total patient out-of-pocket amount for the claim. |
| AdmissionTypeCategory | VARCHAR | The category value representing the type of admission. |
| ClaimAdjustmentActionTypeCode | INTEGER | Stores the category identifier indicating why the claim was adjusted. |
| ClaimCostSharingReductionStatus | INTEGER | Store the claim status for the CSR (cost sharing reduction) claim associated with this claim. |
| AutoAccidentState | VARCHAR | Specifies the state where the auto accident occurred. |
| TapestryProfileResponsibilityMapMatchLine | INTEGER | Stores the line that the Tapestry Profile responsibility map matched on. |
| LastMenstrualPeriodOrInjuryDate | DATETIME | Date of injury/illness. |
| TotalNotCoveredAmount | NUMERIC | The total not covered amount for the claim. |
| AmbulanceDropOffHouseNumber | VARCHAR | Stores the unique identifier for the house number associated with the ambulance drop-off location. |
| UseUbcRevenueCodeIndicator | VARCHAR | Claim converted for UBC revenue code flag. |
| RawDataClaimHeaderIdentifier | VARCHAR | Holds the claim header ID for the claim received from raw data |
| ClaimVendorTaxonomyCode | VARCHAR | Stores the vendor taxonomy code submitted in a claim. |
| ClaimRecoupmentAndRefundResolutionStatus | INTEGER | Indicates whether a claim has resolved the entirety of its downward adjustment balance. |
| ClaimReentryReason | VARCHAR | The category value corresponding to the reason for re-entering the accounts payable claim record. |
| TotalBeforeBenefitPenaltyAmount | NUMERIC | The total before benefit penalty amount for the claim. |
| ClaimRepricerOrganizationIdentifier | INTEGER | When a matching repricer organization is found, the identification is stored on the claim. |
| AmbulancePickUpCountyIdentifier | VARCHAR | Stores the unique identifier for the county associated with the ambulance pick-up location. Join this column to ZC_COUNTY_2 to translate to the county name. |
| IsClaimFilteredForTransplantServices | VARCHAR | Tracks whether this claim is considered as having transplant services for the purposes of clinical derivation from claims. |
| ClaimAdjudicationEffectiveDate | DATETIME | Stores the effective date of the claim at the time of adjudication. This date is calculated during adjudication based on other days (e.g. service date) and is used to price the claim when a single claim-level date is required, such as to find the correct vendor contract contact. |
| ClaimTotalChronicMedicationAmount | NUMERIC | The total chronic medication amount for the claim. |
| IsClaimDataInvalidIndicator | VARCHAR | If the system determined we cannot trust the claim's data for reporting or clinical purposes, this column will store Y (invalid). Otherwise it will be N (valid) or NULL (has not been evaluated by the system). This column's value can be overridden by AP_CLAIM_3.OVERRIDE_INVALID_YN. |
| ClaimPendTypeCode | INTEGER | The category value of the pend type for this claim |
| DisabilityEndDate | DATETIME | The date the disability ended. |
| ReferringProviderIdentification | VARCHAR | Stores the unique identifier of the referring provider for the claim, if supplied. |
| WasOrthodonticServicePerformedIndicator | VARCHAR | This is to determine if orthodontic services were performed. |
| ClaimOverridePayeeAddressCounty | VARCHAR | Override payee address (County) for the claim. |
| PricingStoppingConditionProcedureLine | INTEGER | Stores the procedure line that triggered a stopping condition during pricing. |
| PaymentInfoGrouperRuleIdentifier | VARCHAR | Stores the grouper rule that the Tapestry Profile responsibility map matched on. |
| ClaimCoveredDayCount | NUMERIC | The number of covered days on the claim. |
| ClaimTotalPatientPortionAmount | NUMERIC | The total patient portion for the claim. |
| TotalClaimDeductibleAmount | NUMERIC | The total deductible for the claim. |
| TotalMaintenanceOfBenefitsAmount | NUMERIC | Stores the total Maintenance of Benefits (MOB) amount for all services on the claim. |
| DisabilityStartDate | DATETIME | The date the disability started. |
| ClaimAdjustedNetPaidAmount | NUMERIC | Adjusted net paid for this claim. |
| TotalConvertedReferralBedDays | NUMERIC | To store the total converted bed days on the only attached referral with bed days information in it. |
| ClaimAdjudicationLineOfBusinessIdentifier | VARCHAR | Stores the unique identifier of the line of business associated with the claim. This is the LOB determined at adjudication. |
| ClinicalLaboratoryImprovementAmendmentNumber | VARCHAR | Identification of a Clinical Laboratory Improvement Amendment (CLIA) certified facility that performed CLIA covered laboratory services. |
| TotalExceededBenefitAmount | NUMERIC | The total exceeded benefit amount for the claim. |
| IsClaimClinicallyValidIndicator | VARCHAR | Stores whether a claim is considered valid for the purpose of clinical data derivation |
| TotalAdjustmentAmount | NUMERIC | The total adjustment amount associated with the accounts payable claims record. |
| IsInvalidAdjustmentSequenceIndicator | VARCHAR | Indicates whether a claim is part of an adjustment sequence that is not valid. An adjustment sequence can be invalid for a number of reasons, such as the sequence ending in a cancellation or the sequence having gaps. |
| PrimaryPayerAdjudicatedPatientCoinsuranceAmount | NUMERIC | Displays the amount the primary payors adjudicated as the co-insurance patient portion. This is applicable only if the claim has been submitted to your facility as the non primary payor (secondary, tertiary, 4th, etc.) |
| ClaimAssociatedSpecialtySource | INTEGER | Source of associated specialty. |
| CoverageFindingElectronicDataInterchangeBatchIdentifier | NUMERIC | The EDI batch used to find coverage. |
| IncomingRepricingProfileIdentifier | NUMERIC | This item stores the incoming AIP used to create a real-time repricing claim. |
| OriginalAdjustedClaimIdentifier | NUMERIC | If a claim is an adjustment claim, this represents the ID number of the original claim being adjusted. |
| TotalCoordinationOfBenefitsSavingsPayoutAmount | NUMERIC | The total amount of Coordination of Benefits (COB) savings member payout. |
| AmbulancePickupZip | VARCHAR | Stores the ZIP code of the ambulance pick-up location. |
| ClaimNaturalKeyHashedValue | VARCHAR | The hashed value of the mapped claim natural key. |
| ClaimPayorSequenceNumber | VARCHAR | Sequence number of the payor of the claim. |
| AdmissionTimeHour | NUMERIC | The hour at which the member was admitted to the place of service. |
| ClaimInterestStartDate | DATETIME | Claim-level interest start date. |
| OriginalReversalClaimIdentifier | NUMERIC | Stores the unique identifier of the original claim for reversal claims. The value will always persist, even if the claim is voided. If the claim is not a reversal claim, no value will be stored. |
| CommunityLogicalOwnerIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| DentalServiceStartDate | DATETIME | This is the dental service span from date. |
| ClaimProviderIdentifier | VARCHAR | Stores the unique identifier of the provider associated with the claim. This provider can be set through manual workflows or is matched to during claim load/processing. |
| ClaimInbasketMessageRecipient | VARCHAR | The user or pool the In Basket message associated with the claim was sent to. |
| TotalNetInsuranceAmount | NUMERIC | The total net insurance amount remaining after deducting all applicable adjustments and other payments from the total insurance amount. |
| RecordSourceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| ClaimRecordCreationDateTime | DATETIME | The instant when the accounts payable claim record was created. |
| AmbulanceDropOffCity | VARCHAR | Stores the city of the ambulance drop-off location. |
| TotalPrimaryFactorAmount | NUMERIC | The total primary factor amounts from all the services added up. |
| ClaimCustomTraitFive | INTEGER | The fifth custom claim trait, used to classify and group claims. |
| IsClaimScannedFromOpticalCharacterRecognition | VARCHAR | Flags whether the claim was originally paper or scanned into the system through an EDI batch load. |
| 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. |
| IsEmploymentRelated | VARCHAR | Indicates whether patient's condition is related to employment. |
| TotalCoordinationOfBenefitsSavingsAmount | NUMERIC | The total Coordination of Benefits (COB) savings amount for the claim. |
| LifetimeMaximumTransactionData | VARCHAR | The lifetime max transactions data for this claim. |
| PoolTransactionEffectiveDate | DATETIME | Pool transaction effective date. |
| ClaimInterchangeDateTime | DATETIME | Date of interchange. This date is received in the Interchange Control Header (ISA) segment on an incoming ANSI 837 file. |
| MemberPrimaryNetworkIdentification | VARCHAR | The ID of the member's primary network. |
| IsInterfaceClaim | VARCHAR | The real time interface claim flag. |
| ExternalClaimIdentificationNumber | VARCHAR | The external claim identification number. Note: This is not used for linking purposes. |
| ClaimPaidDateTime | DATETIME | The date that the claim was paid, which is determined by the date the claim reaches the AP Status EOB Generated |
| ClaimIdentifier | NUMERIC | The unique identifier for the claim record. |
| AdjustmentInterestStartDate | DATETIME | For adjustment claims, this column stores the interest start date for additional interest, if applicable. |
| OriginalClaimHeaderIdentifier | VARCHAR | Holds the claim header ID for the claim received from raw data. This column differs from AP_CLAIM_3.CLAIM_HEADER_ID in that this will be populated for reversal claims with the claim header ID from the original claim. |
| ClaimOwningBusinessSegmentIdentifier | NUMERIC | The unique ID of the business segment which owns this claim. It is frequently used to join to CLARITY_POS. |
| ClaimHasNoMemberGroupIndicator | VARCHAR | Identifies that the claim does not have a member group. |
| OriginalAdjustmentClaimIdentification | NUMERIC | The original claim ID of the actual adjustment claim. |
| DeprecatedExternalCauseOfInjuryIdentifier | NUMERIC | The ID number representing the external cause of the injury treated by procedures on the claim. This column will be deprecated in the May 2025 release. It is being replaced by column CODE_DX_ID in table EXTERNAL_CAUSES_OF_INJURY. |
| IsAdjustmentToFrozenClaimIndicator | VARCHAR | Indicates whether this claim is an adjustment to a frozen orginal. 'Y' indicates that this claim was loaded as an adjustment to a frozen claim, and has not yet been converted into a standard adjustment. 'N' or NULL indicate that this claim is not an adjustment to a frozen claim. |
| TotalSecondaryProviderResponsibilityAmount | NUMERIC | The total amount of secondary provider responsibility from all the services added up. |
| AmbulanceTransportationDistance | NUMERIC | Transport distance for the CRC segment in the 2300 loop on ANSI claims. |
| ClaimCoinsuranceDaysCount | NUMERIC | The number of coinsurance days on the claim. |
| ClaimAdjustmentSequenceNumber | VARCHAR | Holds the adjustment sequence for the claim received from raw data |
| BeneficiaryCentricDataApiSplitClaimIndicator | VARCHAR | Flag to indicate that the claim provided by BCDA is a split claim |
| ClaimOutOfNetworkLifetimeMaximumAmount | NUMERIC | The amount applied to the patient's out-of-network lifetime maximum buckets for this claim. |
| SentToAccountsPayableDateTime | DATETIME | The date on which the claim's AP status is changed to sent to AP. |
| SourceOrganizationIdentifier | NUMERIC | The source organization of the external record. |
| TotalClaimBilledAmount | NUMERIC | The total billed amount on the claim. |
| ClaimInterestPenaltyFormulaIdentification | NUMERIC | The formula used to calculate interest and penalty for a claim. |
| ClaimPayeeContactIdentifier | INTEGER | Payee of the claim. |
| FirstServiceLineStartDate | DATETIME | Stores the service start date for the first service line on the claim. |
| StatementCoverageStartDate | DATETIME | Start date for statement covers. |
| IsNonEnrolledMemberClaimIndicator | INTEGER | Specify if this claim belongs to a non-enrolled member. |
| AssistingSurgeonIdentifier | VARCHAR | Stores the unique identifier of the assisting surgeon, if supplied. |
| ClaimElectronicDataInterchangeBatchInformation | VARCHAR | The batch information for the claim if it is loaded by claim EDI load. It is a string delimited by "","". The first piece is the batch type Id and the second one is the batch run number. |
| PatientLastMenstrualPeriodDate | DATETIME | The date of the patient's last menstrual period. |
| TotalAdjustedPatientOutOfPocketAmount | NUMERIC | Amount that the patient out of pocket would have been on a capitated secondary claim had the claim not been capitated according to the contract. |
| IsCoverageTerminatedIndicator | VARCHAR | Flag used to determine if the coverage used to pay the claim was termed at the time. |
| IsClaimInAdjustmentSequenceWithLoopOrSplit | VARCHAR | Indicates whether a claim is part of an adjustment sequence that contains a split claim or an adjustment sequence loop. This CLM does not have to be in the split or loop istelf, just a part of the adjustment sequence. |
| ClaimAdjustmentReasonCategoryIdentifier | INTEGER | The adjustment reason category ID. Entered by a user when adjusting a claim. |
| ClaimTotalDeniedAmount | NUMERIC | This tracks the total denied amount across all claim services. It is currently only used for display purposes in the claim workspace. |
| ClaimRiskPanelIdentifier | VARCHAR | The unique ID of the risk panel associated with the claim. |
| ClaimOwnerBusinessSegmentServiceAreaIdentification | NUMERIC | This is a virtual item that stores computed business segment or service area from items CLM-18025 or CLM-18026. |
| NoncoveredDaysCount | NUMERIC | The number of noncovered days on the claim. |
| ClaimAdjustedPatientPortionAmount | NUMERIC | Adjusted patient portion for this claim. |
| TotalCodeEditSavingsAmount | NUMERIC | The total amount of code edit savings for this claim. |
| FunctionalGroupCreationDate | DATETIME | Functional group creation date. This date is received in the Function Group Header (GS) segment on an incoming ANSI 837 file. |
| VoidingUserIdentifier | VARCHAR | The ID of the user who voided this claim. |
| TotalPrimaryInsuranceAmount | NUMERIC | The amount already paid towards the billed amount on the claim by primary payors. This is applicable only if the claim has been submitted to your facility as the secondary payor. |
| PrimaryPayorAdjudicatedCopayAmount | NUMERIC | Displays the amount the primary payors adjudicated as the copay patient portion. This is applicable only if the claim has been submitted to your facility as the non primary payor (secondary, tertiary, 4th, etc.) |
| ClaimFrequencyTypeCode | INTEGER | Contains the claim frequency type code from the ANSI 837 file. The value comes from Loop 2300, Segment CLM05, Piece 3. |
| ReversalClaimMetadataRecordIdentifier | NUMERIC | Holds the CEV ID containing the KLCT metadata for a reversal claim. |
| ClaimInNetworkLifetimeMaximumAmount | NUMERIC | The amount applied to the patient's in-network lifetime maximum buckets for this claim. |
| ClaimReconciliationRecordIdentification | VARCHAR | This claim reconciliation record (CRD) for the claim. |
| CoordinationOfBenefitsSavingsPayoutIndicator | VARCHAR | The COB savings payout flag. |
| TotalWeightedBedDays | NUMERIC | Total weight of bed days. |
| PermanentOriginalAdjustmentClaimIdentifier | NUMERIC | Stores the unique identifier of the original claim for adjustment claims. The value will always persist, even if the claim is voided. If the claim is not an adjustment claim, no value will be stored. |
| ClaimPaymentPoolIdentifier | NUMERIC | Pool that claim will be paid from. |
| ClaimPaymentMethodCategory | INTEGER | Stores the category identifier of the method used to pay the claim, such as whether it was paid as primary or secondary. |
| IsClaimCostSharingReductionManualAdjustmentRequired | VARCHAR | Marks a claim as needing to be manually adjusted for CSR. |
| AlternateWorkflowStatusIdentifier | INTEGER | Stores the unique category identifier of a status associated with alternate claims workflows (see WORKFLOW_C). |
| ClaimOutOfNetworkAdjudicationOverrideReason | VARCHAR | The reason for overriding a claim's adjudication network level to Out of Network. |
| ReceivedOwningBusinessSegmentPositionIdentifier | NUMERIC | The owning business segment received for this claim. This might differ from the Owning Business Segment (I CLM 18026) based on the adjustment sequence that this claim is in. |
| AmbulancePickupLocationCity | VARCHAR | Stores the city of the ambulance pick-up location. |
| ClaimServiceLocationIdentifier | NUMERIC | Stores unique identifier of the place of service associated with the claim. |
| ServiceLinePenaltyAmount | NUMERIC | Penalty amount for service line. |
| PrimaryPayorIdentifier | NUMERIC | The unique ID for the primary payor record. |
| ClaimStatusDate | DATETIME | The status date of the claim. |
| AdjustmentClaimIdentifier | NUMERIC | The ID number of an adjustment claim. |
| ClaimNaturalKeyOrderValue | VARCHAR | The ordering value for the claim natural key. |
| TotalSecondaryDiscountAmount | NUMERIC | The total amount of secondary discount from all the services added up. |
| EndStageRenalDiseaseOnsetDate | DATETIME | This item stores the onset date of End Stage Renal Disease. This date is sent on CMS 2728 form in Field 24. |
| OutsideLabChargeAmount | NUMERIC | The cost of services performed at the outside lab. |
| LastClinicalFilterUpdateDate | DATETIME | Last local instant data derivation clinical filters (I CLM 18625) were updated or calculated without changes for this claim. Calculated using EPIC_UTC_TO_LOCAL on I CLM 18626. |
| VoidedClaimChangeDateTime | DATETIME | The date the claim was voided. |
| BenefitsAssignmentIndicator | INTEGER | Stores the benefits assignment indicator. |
| ClaimShadowReconciliationThresholdAmount | NUMERIC | The shadow reconciliation threshold amount for the claim. |
| AmbulancePickUpDistrictIdentifier | 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. |
| ClaimVendorSourceIndicator | INTEGER | Flags whether a claim is sent from an internal or external vendor. |
| VendorNetworkContractIdentifier | NUMERIC | The ID number of the vendor network contract associated with this accounts payable claim record. |
| ClaimInterestFormulaType | INTEGER | The type of formula used for interest calculation. |
| IntraconnectPhysicalRecordOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| SubmitterClaimCreationDate | DATETIME | Date that the original submitter created the claim file from their business application system. This date is received in the Beginning of Hierarchical Transaction (BHT) segment on an incoming ANSI 837 file. |
| ClaimAccountsPayableReady | VARCHAR | This item stores the member group ID if the claim is ready for AP. |
| IntraConnectInstanceCommunityOwnerIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| LastIncomingClaimExternal | NUMERIC | The most recent incoming Claim External Value (CEV) record ID. |
| TotalSubrogationAdjustmentAmount | NUMERIC | This item stores the total amount on the claim that was not paid due to subrogation demand being less than net payable. |
| TotalBilledEnteredAmount | NUMERIC | The total billed entered for this claim. |
| ClaimValidityOverrideIndicator | VARCHAR | Overrides the INVALID_YN column and determines if we cannot trust the claim's data for reporting or clinical purposes, this column will store Y (invalid) if overridden to invalid, N (valid) if overridden to valid, or NULL if validity has not been overridden and the value in AP_CLAIM_3.INVALID_YN should be used. |
| StatementCoverageEndDate | DATETIME | End date for statement covers. |
| ClaimInterestCalculationStartDate | INTEGER | The date that the system begins interest and penalty calculation on for this claim. |
| TotalPayerInitiatedBilledAmountReduction | NUMERIC | Total Payer Initiated Billed Amount Reduction from EDC Analyzer. |
| PatientDischargeDate | DATETIME | The date patient was discharged. |
| ClaimTotalAllowedAmount | NUMERIC | The total allowed amount for this claim. |
| EmergencyRoomEntryDateTime | DATETIME | The date and time of entry to emergency room. |
| ClaimPenaltyAmountOverride | NUMERIC | This stores the override penalty amount for the claim. |
| IsClaimInpatientIndicator | VARCHAR | Defines if claim is inpatient/outpatient. |
| ClaimAttributedMedicalGroupIdentifier | NUMERIC | The attributed medical group on the member's coverage at the time of the claim service |
| ClaimServiceAreaIdentifier | NUMERIC | The ID number of the service area associated with this accounts payable claim. |
| OriginalClaimNumber | VARCHAR | Stores the original claim number after it is changed. |
| PricerGrouperIdentifier | NUMERIC | This item stores the grouper that the pricer belongs to. |
| PaymentInformationRuleIdentification | VARCHAR | Stores the rule that the Tapestry Profile responsibility map matched on. |
| ClaimProcessingStatusCode | INTEGER | Stores the unique category identifier of the claims processing status, such as whether it is pending, clean, denied, or void. |
| LifetimeReserveDaysCount | NUMERIC | The number of lifetime reserve days for inpatient claims. |
| ClaimStatusAppliedDateTime | DATETIME | The date that a status of clean, deny, or pend was applied to this claim. |
| IsClaimFrozen | INTEGER | Indicates if the claim is frozen. |
| ClaimServiceClassificationContextCode | INTEGER | Represents the high-level clinical classification context for the services billed on this claim. |
| ClaimTotalHealthReimbursementArrangementAmount | NUMERIC | Stores the total reimbursement amount for all services on the claim. |
| ClaimProcedureCount | INTEGER | The number of procedures on the accounts payable claim record. |
| ClaimSubmitterAuthorizedRepresentativeGlobalUniqueIdentifier | VARCHAR | The GUID of the authorized representative who submitted the claim. |
| 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. |
| CoordinationOfBenefitsTotalResponsibleAmount | NUMERIC | The total responsible amount on the claim from Coordination of Benefits (COB) calculations. |
| ProviderAcceptsAssignmentCode | INTEGER | Stores the provider accept assignment code. |
| ClaimIsRefundedFlag | VARCHAR | Flag indicating if the claim has been refunded. |
| ClaimInvoiceRemainingAmount | NUMERIC | The amount of the claim the system needs to generate invoice for. |
| TotalPatientPortionAmount | NUMERIC | The total patient portion on the claim. |
| OverridePayeeAddressHouseNumber | VARCHAR | Override payee address (House Number) for the claim. |
| ClaimHasErrorsIndicator | VARCHAR | An indication of whether the CMS claim contained errors. |
| ClaimCustomTraitThreeCode | INTEGER | The third custom claim trait, used to classify and group claims. |
| ReversedClaimIdentifier | VARCHAR | Holds the reversal to claim ID for the claim received from raw data |
| ClaimMemberGroupId | VARCHAR | The unique ID of the member group associated with the claim. |
| PrimaryPayorPatientNotCoveredAmount | NUMERIC | Displays the amount the primary payors adjudicated as the not covered patient portion. This is applicable only if the claim has been submitted to your facility as the non primary payor (secondary, tertiary, 4th, etc.) |
| BulkFastHealthcareInteroperabilityResourcesRunIdentifier | VARCHAR | GUID uniquely identifying the bulk FHIR run the CEV was created from |
| AdjudicatedCoveragePlanGroupIdentifier | VARCHAR | Stores the unique identifier of the plan group for the coverage used to pay the claim, as of adjudication. |
| ClaimAdjudicationNetworkLevel | VARCHAR | Indicates the network level of the claim, as computed during adjudication. |
| ClaimInbasketMessageIdentifier | VARCHAR | The ID of the in basket message associated with this claim. |
| ClaimAdjustmentCreatedByUserIdentifier | VARCHAR | The ID of the user who created the adjustment for this claim. |
| AdjudicationInNetworkOverrideCode | VARCHAR | Indicates the override network level when adjudicating the claims as in network. |
| AmbulanceDropOffLocationName | VARCHAR | Stores the last name or organization name of the ambulance drop-off location. |
| ClaimEntryUserIdentifier | VARCHAR | The ID number of the user who entered the accounts payable claim. |
| HasDentalInformationIndicator | VARCHAR | This is to determine if the claim has dental information. |
| ExternalCausePresentOnAdmissionIndicator | INTEGER | Present on Admission (POA) indicator for the external cause of injury diagnosis code. |
| ClaimServiceRegionIdentifier | NUMERIC | The attributed region on the member's coverage at the time of the claim service |
| ClaimAdjudicationDateTime | DATETIME | The adjudication date and time of the claim. |
| AdjustedToClaimIdentification | VARCHAR | Holds the adjustment to claim ID for the claim received from raw data |
| ClaimFormatIndicator | INTEGER | Indicates the format of the claim (CMS, UB, Rx). |
| AdjustmentClaimCreation | DATETIME | The date the adjustment claim was created. |
| ClaimRenderingProviderIdentifier | VARCHAR | Stores the unique identifier of the rendering provider for the claim, if supplied. |
| TotalAfterBenefitPenaltyAmount | NUMERIC | The total after benefit penalty amount for the claim. |
| ClaimRecordIdentifier | NUMERIC | The unique identifier of the accounts payable claim record. |
| IsClaimAssociatedWithOverridePool | VARCHAR | A yes/no flag that indicates whether the claim is associated with an override pool. |
| LastPaidCheckIdentifier | NUMERIC | Stores the unique ID of the final check for the claim, accounting for DOFR. In the event of multiple services paid by different checks, this will be the check that changed the claim's AP status to EOB Generated. |
| ClaimProcessingSystemCode | INTEGER | Returns the processing system that created the claim for filtering in Clarity and Caboodle. |
| IsEpsdtReferralGivenOnClaim | VARCHAR | Stores if an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) referral was given to the patient on the claim. |
| ThirdPartyPricingDueDate | DATETIME | This item stores the due date for the third-party pricing. |
| ClaimOverridePayeeZipCode | VARCHAR | Override payee address (zip code) for the claim. |
| DeploymentOwnerIdentifier | 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. |
| TotalSubrogationDemandAmountFromPayer | NUMERIC | This item stores the total subrogation demand amount from another payer. |
| OtherProviderIdentification | VARCHAR | Stores the unique identifier of the other provider on the claim, if supplied. |
| PatientRelationshipToCoveredMember | INTEGER | The patient's relation to the covered (insured) member that the claim is paid under. If the patient is the member, this is not set. If it is set, this value defines the relation to the covered member for the patient who received the services. |