ClaimServiceLineDetai
All values associated with a claim are stored in the Claim External Value record. The table holds information about the service lines on the claim.
| Column Name | Type | Description |
|---|---|---|
| ServiceLineAmbulancePickupLocationCity | VARCHAR | Stores Line Ambulance Pick-Up Location City |
| AmbulancePickUpAddressLineTwo | VARCHAR | Stores Line Ambulance Pick-Up Location Street Address Line 2 |
| LineRepricedApprovedHcpcsQualifier | VARCHAR | This item stores the Line Repriced Approved Healthcare common Procedure Coding System (HCPS). |
| SpecialPackagingIndicator | VARCHAR | The code indicating the type of dispensing dose. |
| ServiceLineUnitOfMeasurementCode | VARCHAR | This item stores the Line Unit or Basis for Measurement Code. |
| ServiceLinePatientDeductibleAmount | NUMERIC | Amount of patient deductible. |
| ServiceLine | VARCHAR | This column holds the NUCC Taxonomy Code of the provider that prescribed the medication on this service. |
| ReferringProviderNameSuffix | VARCHAR | This item stores the line's Referring Provider's Name Suffix. |
| LineApprovedDiagnosisRelatedGroupCode | VARCHAR | This item stores the Line's Approved diagnosis related group (DRG) Code. |
| PrescriptionProductDescription | VARCHAR | The description of the product being submitted on the prescription claim. |
| 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. |
| ServiceLineEarliestDate | DATETIME | This item holds the earliest service date represented on the line. |
| ClaimLineOrderingProviderLastName | VARCHAR | This item holds the ordering provider's last name. |
| ServiceLineAssistantSurgeonType | VARCHAR | This item indicates whether the assistant dental surgeon on the line is a person or a non-person. |
| AdjustedRepricedLineItemReferenceNumber | VARCHAR | This item stores the Adjusted Repriced Line Item Reference Number. |
| LineInitialTreatmentDate | DATETIME | Stores Line Initial Treatment Date |
| LineProcedureCode | VARCHAR | This item holds the procedure code for the line. |
| ServiceLineDiagnosisPointerList | VARCHAR | This item holds a comma delimited list of diagnosis pointers. Each piece of the string is a line number from the claim diagnosis table. |
| LineOperatingPhysicianEntityTypeQualifier | VARCHAR | This item stores the Entity Type Qualifier for line's Operating Physician ID. |
| PharmacistConflictResponseCode | VARCHAR | The code describing a pharmacist's action in response to a professional conflict. |
| ClaimLineServiceTaxAmount | NUMERIC | This item stores the line's Service Tax Amount. |
| LineRegulatoryFeeAmount | NUMERIC | Flat sales tax amount paid. |
| SubmittedIngredientAmount | NUMERIC | The amount representing the fee that is submitted by the pharmacy for contractually agreed upon services. |
| LineDurableMedicalEquipmentProcedureCode | VARCHAR | Stores Line durable medical equipment (DME) Procedure Code |
| EstimatedPrescriptionDaysSupply | INTEGER | Estimated number if days the prescription will last. |
| LineOperatingProviderTaxonomyCode | VARCHAR | Stores the Line Operating Provider Taxonomy Code. |
| ClaimLinePricingRate | NUMERIC | This item stores the Line Pricing Rate. |
| OrderingProviderStreetAddressLineTwo | VARCHAR | This item holds the second line of the ordering provider's street address. |
| ServiceFacilityName | VARCHAR | This item holds the name of the external location where the services were performed. |
| ServiceLineAmbulancePickupAddressLineOne | VARCHAR | Stores Line Ambulance Pick-Up Location Street Address Line 1 |
| PharmacistEffortLevelCode | VARCHAR | The code indicating the level of effort as determined by the complexity of decision-making or resources utilized by a pharmacist to perform a professional service. |
| PrescriptionOriginCode | VARCHAR | The code indicating the origin of the prescription. |
| ServiceLineContractCode | VARCHAR | This item holds a code representing the line. |
| SubmissionClarificationCode | VARCHAR | The code indicating that the pharmacist is clarifying the submission. |
| ServiceLineQuantityUnitText | VARCHAR | This item holds the units of quantity string for a service line. |
| ServiceLinePatientPayAmount | NUMERIC | Patient pay amount. |
| ServiceLineOperatingPhysicianLastName | VARCHAR | This item stores the line's Operating Physician's Last Name. |
| LineServiceFacilityIdentifier | VARCHAR | Stores line service facility location's entity identifier |
| ServiceLineNoteText | VARCHAR | This item holds a line level note. |
| AmbulanceTransportPatientCount | INTEGER | This item holds the number of patients transported in the ambulance when the line represents an ambulance service. |
| OtherCoverageCode | VARCHAR | The code indicating whether or not the patient has other insurance coverage. |
| LineDurableMedicalEquipmentPurchase | NUMERIC | Stores Line durable medical equipment (DME) Purchase Price |
| ServiceLineAdditionalCustomValue8 | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| ServiceLineAdditionalCustomItemOne | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| OrderingProviderState | VARCHAR | This item holds the ordering provider's state. |
| LinePrimaryCarePhysicianReferringProviderNationalProviderIdentifier | VARCHAR | This item stores the line's PCP referring provider's NPI. |
| LineOtherOperatingPhysicianFirstName | VARCHAR | This items stores the line's Other Operating Physician's First Name. |
| ClaimServiceLineProcedureModifierList | VARCHAR | This item holds a comma delimited list of modifiers for the procedure on the line. |
| ServiceLineOperatingPhysicianMiddleName | VARCHAR | This item stores the line's Operating Physician's Middle Name. |
| DosageFormDescriptionCode | VARCHAR | The dosage form of the complete compound mixture. |
| ServiceLineAccommodationDailyRate | NUMERIC | This item holds the daily rate for accommodation revenue code lines. |
| LineExceptionCode | VARCHAR | This item stores the Line Exception Code. |
| ServiceFacilityLocationZipCode | VARCHAR | This item holds the external location's ZIP code. |
| ServiceLinePurchasedProviderNationalIdentifier | VARCHAR | This item holds the purchased service provider's National Provider Identifier (NPI). |
| ServiceLineIngredientCostPaidAmount | NUMERIC | Drug ingredient cost paid. |
| ServiceLineBilledAmount | NUMERIC | This item holds the billed amount for the line. For Uniform Billing (UB) claims, this amount will include both covered and non-covered amounts. |
| SupervisingProviderLastName | VARCHAR | This item holds the supervising provider's last name. |
| ServiceLineAmbulancePickUpZipCode | VARCHAR | Stores Line Ambulance Pick-Up Location Zip Code |
| PharmacyNationalProviderIdentifier | VARCHAR | This item holds the National Provider Identifier (NPI) of the pharmacy that filled the prescription. |
| ServiceLineLastXRayDate | DATETIME | Stores Line Last X-Ray Date |
| DurableMedicalEquipmentCertificationType | VARCHAR | This item identifies the type of certification (initial, renewal, or revised) applies to the line. |
| ServiceLineOtherPayerPaidAmount | NUMERIC | This is the amount that the commercial coverage, if any, paid for this service line. |
| LinePurchasedServiceChargeAmount | NUMERIC | This item holds the purchased service charge amount for the line. |
| ClaimIdentifier | NUMERIC | The unique identifier for the claim record. |
| ClaimLineRevenueCodeDescription | VARCHAR | This item holds a revenue code specific description for the line. |
| ServiceLineTreatmentCompletionDate | DATETIME | The date of the completed treatment for a dental service. |
| ServiceLineFamilyPlanningIndicator | VARCHAR | This item identifies the service on the line as a family planning service. |
| ServiceLineRenderingProviderNationalProviderIdentifier | VARCHAR | This item holds the rendering provider's National Provider Identifier (NPI). |
| ServiceLineAmbulanceDropOffCountryCode | VARCHAR | Stores Line Ambulance Drop-Off Location Country Code |
| ServiceLineRecertificationDate | DATETIME | Store line recertification date |
| ClaimServiceLineAmbulancePickUpLocationState | VARCHAR | Stores Line Ambulance Pick-Up Location State |
| OverrideAdministrationRoute | VARCHAR | An override to the "default" route referenced for the product. For a multi-ingredient compound, it is the route of the complete compound mixture. |
| LineApprovedDiagnosisRelatedGroupAmount | NUMERIC | This item stores the Line Approved diagnosis related group (DRG) Code. |
| ServiceLineOtherAmountSubmitted | NUMERIC | The amount representing the additional incurred costs for a dispensed prescription or service. |
| ReasonForServiceCode | VARCHAR | The code identifying the type of utilization conflict detected or the reason for the pharmacist's professional service. |
| OrderingProviderCountrySubdivision | VARCHAR | This item holds the ordering provider's country subdivision (state, province, etc). It is only populated if the address is outside the United States. |
| ServiceLineAdditionalCustomItemFive | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| AssistantSurgeonNationalProviderIdentifier | VARCHAR | This item holds the assistant dental surgeon's National Provider Identifier (NPI). |
| AssistantSurgeonLastNameOrOrganizationName | VARCHAR | This item holds the assistant dental surgeon's last name (if a person) or the organization name (if a non-person). |
| LineContractPercentage | NUMERIC | This item holds the contract percentage for the line. |
| ServiceLineAdditionalCustomValue10 | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| ServiceLineCopayExemptionStatusCode | VARCHAR | This item identifies when the patient was exempt from a copay for the service on the line. |
| ServiceLinePostageClaimedAmount | NUMERIC | Stores Line Postage Claimed Amount |
| LinePrescriptionDate | DATETIME | Stores Line Prescription Date |
| OrderingProviderCountry | VARCHAR | This item holds the ordering provider's country. It is only populated if the address is outside the United States. |
| DurableMedicalEquipmentDurationInMonths | INTEGER | This item holds the number of months the durable medical equipment (DME) supplies will be needed. |
| LineOtherSourcePaymentAmountRecognized | NUMERIC | Total amount recognized by the processor of any payment from another source. |
| ServiceLineMammographyCertificationNumber | VARCHAR | This item holds the mammography certification number for the line. |
| ClaimIdentifier | NUMERIC | The unique identifier for the claim record. |
| ServiceLinePrescribingProviderNationalIdentifier | VARCHAR | This column holds the National Provider Identifier (NPI) of the provider that prescribed the medication on this service. |
| ClaimLineServiceFacilityNationalProviderIdentifier | VARCHAR | This item holds the National Provider Identifier (NPI) of the external location where the services were performed. |
| LineTotalAmountPaid | NUMERIC | This item holds the total amount paid for the line by all payers. This item is populated for both paper and electronic Professional Billing Centers for Medicare and Medicaid Services (CMS) claims but is only used when printing paper claims. |
| ClaimServiceLineRenderingProviderNameSuffix | VARCHAR | This item holds the suffix to the rendering provider's name (Jr, III, etc). It is only populated when the provider is a person. |
| ServiceLineNetPayerPaymentDue | NUMERIC | Net amount paid to provider by the payer. |
| PrescriptionWrittenDate | DATETIME | The date when the prescription was written. |
| ServiceLineReferringProviderNationalProviderIdentifier | VARCHAR | This item stores the line's Referring Provider's National Provider Identifier (NPI). |
| ServiceLineSupportingDocumentType | VARCHAR | This item holds a code indicating the type of supporting document included with the service line. |
| RenderingProviderFirstName | VARCHAR | This item holds the rendering provider's first name. It is only populated when the provider is a person. |
| ClaimServiceFacilityAddress | VARCHAR | This item holds the first line of the external location street address. |
| ServiceLineProcedureCodeQualifier | VARCHAR | This item holds a code identifying the type of procedure code reported on the line. |
| RepricedLineItemReferenceNumber | VARCHAR | This item stores the Repriced Line Item Reference Number. |
| ServiceLineQualifierCode | VARCHAR | Qualifier code to identify drug code set or the type/source of the descriptive number used in Product/Service ID. |
| ServiceLineClinicalLaboratoryImprovementAmendmentNumber | VARCHAR | This item holds the Clinical Laboratory Improvement Amendment (CLIA) number for the line. |
| ServiceLineNationalDrugCodeUnitQuantity | NUMERIC | This item holds the quantity associated with the National Drug Code (NDC), in terms of the units reported with the NDC. |
| ClaimLinePrescriptionNumberQualifierCode | VARCHAR | This item holds a code distinguishing prescription numbers from sequence numbers used to represent compound drugs. |
| ServiceLinePrimaryCareProviderReferringFirstName | VARCHAR | This item stores the line's PCP referring provider's first name. |
| ServiceLineQuantityUnitCode | VARCHAR | This item holds a code identifying the unit in which the quantity is reported. |
| ServiceLineAssistantDentalSurgeonFirstName | VARCHAR | This item holds the assistant dental surgeon's first name. It is only populated when the provider is a person. |
| ClaimServiceLineOrderingProviderFirstName | VARCHAR | This item holds the ordering provider's first name. |
| LineApprovedServiceUnits | NUMERIC | This item stores the Line Approved Service Units or Inpatient Days. |
| ClaimValueIdentifier | NUMERIC | The unique identifier for the claim value record |
| ServiceLinePatientCop | NUMERIC | Amount of patient copay. |
| ClaimLineRenderingProviderTaxonomyCode | VARCHAR | This item holds the rendering provider's taxonomy code. |
| ServiceLineAmbulanceDropOffCity | VARCHAR | Stores Line Ambulance Drop-Off Location City |
| ClaimServiceLineLocationCity | VARCHAR | This item holds the external location's city. |
| ServiceLineCustomValueTwo | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| PrescriptionServiceLevelCode | VARCHAR | The code indicating the type of service the provider rendered. |
| LineAmbulanceDropOffLocationState | VARCHAR | Stores Line Ambulance Drop-Off Location State |
| ServiceLineReferringProviderFirstName | VARCHAR | This item stores line's Referring Provider's First Name. |
| ServiceLinePrimaryCare | VARCHAR | This item stores the line's PCP referring provider's suffix. |
| ServiceLineOperatingPhysicianFirstName | VARCHAR | This item stores the line's Operating Physician's First Name. |
| LineAmbulanceTransportReasonCode | VARCHAR | Stores Line Ambulance Transport Reason Code |
| ServiceLineDurableMedicalEquipmentRentalUnitPriceIndicator | VARCHAR | Stores Line DME Rental Unit Price Indicator |
| ServiceLineSavingsAmount | NUMERIC | This item stores the Line Savings Amount. |
| ServiceLineIncentiveAmountPaid | NUMERIC | Incentive amount paid. |
| LineAmbulanceRoundTripPurposeDescription | VARCHAR | Stores Line Ambulance Round Trip Purpose Description |
| ServiceLineOralCavityCodeList | VARCHAR | This item holds a comma delimited list of oral cavity codes for the line. |
| ServiceLinePrimaryCarePhysicianReferringProviderLastName | VARCHAR | This item stores the line's PCP referring provider's last name. |
| OrderingProviderNameSuffix | VARCHAR | This item holds the suffix to the ordering provider's name (Jr, III, etc). |
| ServiceLineQuantity | NUMERIC | This item holds the quantity for the service line. |
| AmbulanceDropOffLocationName | VARCHAR | Stores Line Ambulance Drop-Off Location Name |
| ClaimLineAssistantSurgeonNameSuffix | VARCHAR | This item holds the suffix to the assistant dental surgeon's name (Jr, III, etc). It is only populated when the provider is a person. |
| PhysicalRecordOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| DispensingUnitFormIndicator | VARCHAR | The NCPDP standard product billing codes. |
| ServiceLineReferringProviderEntityTypeQualifier | VARCHAR | This item stores the line's Referring Provider's Entity Type Qualifier. |
| CompoundIngredientCount | INTEGER | The count of compound product IDs (both active and inactive) in the compound mixture submitted. |
| ServiceLineImmunizationBatchNumber | VARCHAR | Stores Line Immunization Batch Number |
| ServiceLineRevenueCode | VARCHAR | This item holds the revenue code for the service line. |
| ServiceLineOperatingPhysicianNameSuffix | VARCHAR | This item stores the line's Operating Physician's Name Suffix. |
| ProviderProfessionalFeeSubmittedAmount | NUMERIC | The amount submitted by the provider for professional services rendered. |
| ServiceLineDurableMedicalEquipmentLastCertificationDate | DATETIME | The last certification date for a durable medical equipment (DME) to be printed on the claim. |
| LineOtherOperatingPhysicianQualifier | VARCHAR | This item stores the qualifier for line's Other Operating Physician. |
| LineAmbulanceDropOffCountrySubdivisionCode | VARCHAR | Stores Line Ambulance Drop-Off Location Country Subdivision Code |
| LineObstetricAdditionalUnits | NUMERIC | Stores Line Obstetric Additional Units |
| ServiceLinePricingMethodology | VARCHAR | This item stores the Line Pricing Methodology. |
| ClaimServiceFacilityAddressLineTwo | VARCHAR | This item holds the second line of the external location street address. |
| ClaimServiceLineNumber | INTEGER | The line number for the information associated with this contact. Multiple pieces of information can be associated with this contact. |
| LineAmbulanceDropOffZipCode | VARCHAR | Stores Line Ambulance Drop-Off Location Zip |
| ServiceLineReferringClinicalLaboratoryImprovementAmendmentNumber | VARCHAR | This item holds the Clinical Laboratory Improvement Amendment (CLIA) number of the referring lab for the line. |
| PrescriptionFillNumber | VARCHAR | The code indicating whether the prescription is an original or a refill. |
| ServiceLineAmbulanceDropOffAddressLineOne | VARCHAR | Stores Line Ambulance Drop-Off Location Address Line 1 |
| OrderingProviderZipCode | VARCHAR | This item holds the ordering provider's ZIP code. |
| ClaimLineSupervisingProviderNameSuffix | VARCHAR | This item holds the suffix to the supervising provider's name (Jr, III, etc). |
| ServiceLineNationalDrugCode | VARCHAR | This item holds the National Drug Code (NDC) for the service line. |
| TotalGrossAmountDue | NUMERIC | The total gross amount submitted on the claim. |
| ServiceLineAdditionalItemSeven | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| AmbulanceDropOffStreetAddressLineTwo | VARCHAR | Stores Line Ambulance Drop-Off Location Street Address Line 2 |
| LinePurchasedServiceReferenceIdentifier | VARCHAR | This item holds the purchased service reference identifier for the line. |
| ServiceLineDenialStatusExternalIdentifier | VARCHAR | This stores the external identifier for the denial status of this line. |
| PrescriptionFillStatus | VARCHAR | Stores information on whether the prescription was completely or partially filled. |
| 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. |
| ClaimServiceLineReferringProviderMiddleName | VARCHAR | This item stores the line's Referring Provider's Middle Name. |
| ServiceLinePatientCoinsuranceAmount | NUMERIC | Amount of patient coinsurance. |
| ServiceLineAdditional | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| ClaimLineProcessingIndicatorDescription | VARCHAR | Claim line level processing indicator code description. |
| ServiceLineTypeOfService | VARCHAR | This item holds the type of service for the procedure on the service line. |
| ServiceLineHospiceConditionIndicator | VARCHAR | This item holds the Hospice Condition Indicator. |
| DentalServiceInitialTreatmentDate | DATETIME | The date of the initial treatment for a dental service. |
| ClaimServiceLineNumber | INTEGER | The line number for the information associated with this record. Multiple pieces of information can be associated with this record. |
| OrderingProviderMiddleName | VARCHAR | This item holds the ordering provider's middle name. |
| ServiceLineOtherOperatingProviderNationalProviderIdentifier | VARCHAR | This item stores the line's Other Operating Physician ID. |
| ServiceLineCustomDataSix | VARCHAR | This item holds an additional, customer-defined, value for the service line. |
| ServiceLineSalesTaxAmount | NUMERIC | Stores Line Sales Tax Amount |
| ServiceLineDiagnosisRank | VARCHAR | The comma-delimited list of diagnoses ranks for each diagnosis on a service. Each position here corresponds to the same comma-delimited position of the column LN_DX_PTR from the SVC_LN_INFO table. The rank here specifies the ranking of diagnoses for the specific service. This can be different than the rank of the same diagnoses at the header-level or even the same diagnoses for a different service. |
| ServiceLineDispensingFeePaidAmount | NUMERIC | Dispensing fee paid. |
| ServiceLineNoteTypeCode | VARCHAR | This item holds a code describing the type of note associated with the line. |
| UsualAndCustomaryChargeAmount | INTEGER | The amount charged to cash customers for the prescription exclusive of sales tax or other amounts claimed. |
| ServiceLineAllowedAmount | NUMERIC | This item stores the Line Allowed Amount. |
| IngredientCostCalculationMethodCode | VARCHAR | The code indicating the method used to calculate the ingredient cost. |
| ClaimLineHospiceEmployeeIndicator | VARCHAR | This item holds the Hospice Employee Indicator. |
| SupervisingProviderMiddleName | VARCHAR | This item holds the supervising provider's middle name. |
| ServiceLineOperatingPhysicianNationalProviderIdentifier | VARCHAR | This item stores the line's Operating Physician's ID. |
| ServiceLineLastDate | DATETIME | This item holds the latest service date represented on the line. It will not be populated if the line only represents a single date. |
| ServiceLineEpsdtIndicator | VARCHAR | This item identifies the service on the line as an Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) service. |
| ServiceLineNationalDrugCodeUnit | VARCHAR | This item holds the units associated with the National Drug Code (NDC). |
| ServiceLinePrescriptionNumber | VARCHAR | This item holds the prescription number for the line. |
| LineRenderingProviderType | VARCHAR | This item indicates whether the rendering provider on the line is a person or a non-person. |
| ClaimServiceLineNumber | INTEGER | The line number for the information associated with this contact. Multiple pieces of information can be associated with this contact. |
| ServiceLineEmergencyIndicator | VARCHAR | This item identifies the service on the line as an emergency service. |
| OrthodonticAppliancePlacementDate | DATETIME | The date when the orthodontic appliance was placed. |
| ClaimServiceLineFacilityCountrySubdivision | VARCHAR | This item holds the external location's country subdivision (state, province, etc). It is only populated if the address is outside the United States. |
| ExtractSourceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| OrderingProviderCity | VARCHAR | This item holds the ordering provider's city. |
| PhysicalOwnerCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| LineContractVersionIdentifier | VARCHAR | This item identifies the version of the contract used for the line. |
| ServiceLineContractAmount | NUMERIC | This item holds the contract amount for the line. |
| LastDentalProsthesisPlacementDate | DATETIME | The date a prior crown/prosthesis was previously placed. |
| ServiceLineRenderingProviderMiddleName | VARCHAR | This item holds the rendering provider's middle name. It is only populated when the provider is a person. |
| ServiceLinePrimaryCarePhysicianReferringProviderMiddleName | VARCHAR | This item stores the line's PCP referring provider's middle name. |
| OrderingProviderAddressLineOne | VARCHAR | This item holds the first line of the ordering provider's street address. |
| ServiceLineDurableMedicalEquipmentConditionIndicator | VARCHAR | This item holds a comma delimited list of durable medical equipment (DME) condition codes for the service line. |
| ServiceLineAmbulanceTransportDistance | NUMERIC | Stores Line Ambulance Transport Distance |
| ServiceFacilityCountry | VARCHAR | This item holds the external location's country. It is only populated if the address is outside the United States. |
| ServiceLinePolicyComplianceCode | VARCHAR | This item stores the Line Policy Compliance Code. |
| ServiceLineContractDiscountPercentage | NUMERIC | This item holds the discount percentage for the line. |
| ServiceLineRenderingProviderLastName | VARCHAR | This item holds the rendering provider's last name (if a person) or the organization name (if a non-person). |
| ServiceLineRejectionReasonCode | VARCHAR | This item stores the Line Reject Reason Code. |
| ServiceLineOtherOperatingPhysicianMiddleName | VARCHAR | This item stores the line's Other Operating Physician's Middle Name. |
| ClaimServiceLineSubmittedIngredientCost | NUMERIC | The product component cost of the dispensed prescription. |
| ProfessionalServiceCode | VARCHAR | The code identifying pharmacist intervention when a conflict code has been identified or service has been rendered. |
| ServiceLineProcedureDescription | VARCHAR | This item holds a procedure specific description for the line. |
| LineRepricingOrganizationIdentificationNumber | VARCHAR | This item stores the Line Repricing Organization Identification Number. |
| ServiceLineAmbulanceStretcherDescription | VARCHAR | Stores Line Ambulance Stretcher Purpose Description |
| LineApprovedRevenueCode | VARCHAR | This item stores the Line Approved Revenue Code. |