ClaimAdjudicationPendCod
Stores summary information about processing codes (also known as claim codes, explanation of benefits codes, or EOB codes).
| Column Name | Type | Description |
|---|---|---|
| RetroadjudicationResolutionMethod | INTEGER | Indicates the method which should be used to resolve this EOB code when a claim containing this EOB code is retroadjudicated. |
| ClaimRemarkCode | VARCHAR | Column to hold corresponding remark code |
| ExplanationOfBenefitsCodeType | INTEGER | The processing code type. |
| ExplanationOfBenefitsCodeStatus | INTEGER | The status of the EOB code record. This specifies whether the EOB code record is inactive, deleted, hidden, inactive and hidden, or deleted and hidden. |
| ClaimPendTypeCode | INTEGER | Specifies the pend type. |
| DenialClaimCodeRankingCategory | INTEGER | Specify the ranking category used to determine which denial claim code is remitted on the 835. |
| ReportingSuspenseType | VARCHAR | Specifies the reporting suspense type. |
| OverrideDenialPendingStatusIndicator | VARCHAR | This setting allows you some flexibility in overriding the standard behavior of denial EOB codes. Normally, a claim which has a claim level EOB code with type of ""Denial"" results in the claim having a status of ""Denied"" regardless of other EOB codes on the claim. If you set this value to ""Yes"", it will override all denial codes, and the claim status will remain ""Pending"" regardless of all other EOB codes on the claim. |
| ExplanationOfBenefitCodeApplicationCategoryIdentifier | INTEGER | Stores the category identifier that indicates what this code can be applied to, such as a claim or procedure. |
| ProcessingCodeName | VARCHAR | The name of the processing code. |
| ContractComparisonBehavior | INTEGER | The category number for the "Contract Comparison Behavior" item. This item determines under which circumstances a claim code is attached to a claim or service during contract comparison. By default, claim codes are kept only if added while adjudicating the selected vendor contract, with few exceptions. This item allows configuring whether a code should always be attached regardless of which contract is selected, or should always be discarded if its contract is not selected regardless of any other considerations. Note that this item does not apply to denial codes. |
| EpicExplanationOfBenefitsCodeCategoryIdentifier | INTEGER | If this code is released by Epic then this column stores the category identifier designated by Epic. Otherwise, this column stores NULL. |
| IsSystemAddedOnly | VARCHAR | Indicates whether or not an EOB code is restricted from being added by end users. 'Y' indicates that this code can only be added by the system and not by users. 'N' or NULL indicate that this code can be added by users or the system. |
| ExplanationOfBenefitsMnemonic | VARCHAR | An abbreviation of the EOB code’s name. |
| DeniedAmountRoutingDestination | INTEGER | Indicates where denied amounts are routed when this EOB code is attached to a claim or service. |
| ClaimCommentFlagIndicator | VARCHAR | Specifies the claim comment flag. |
| 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. |