PayorServiceAuthorization
This table contains information about authorization records. This includes links to the patient, referral, and coverage/payer.
| Column Name | Type | Description |
|---|---|---|
| AuthorizationRequestedServiceCount | INTEGER | Number of services, units, or visits requested. |
| CoverageGuidanceCreationUserIdentifier | VARCHAR | The unique ID of the user who created the coverage guidance request, if known. |
| CoverageGuidanceRequestNoteText | VARCHAR | The free-text note text associated with the coverage guidance request. |
| CoverageGuidancePlanIdentification | NUMERIC | The unique ID of the plan associated with the requested coverage guidance. |
| AuthorizationCoverageGuidanceRequestLocationIdentifier | NUMERIC | The unique ID of the location at which the requested service for a coverage guidance request is to occur. |
| GuidanceRequestedServiceDate | DATETIME | The date of the requested service for which guidance is being requested. If no date was provided with the request, the date of the request creation is used. |
| AuthorizationRecordCreationDateTime | DATETIME | Record creation date. |
| UtilizationManagementDecisionUtcDatetime | DATETIME | The date and time (UTC) the authorization finalized status was set on the service level authorization. |
| LinkedCoverageIdentifier | NUMERIC | Linked coverage record. This column is frequently used to link to the COVERAGE table. |
| AuthorizationOwningApplication | INTEGER | The owning application of the authorization record. This column is used to identify UM AUTs that appear in UM authorization entry workflows. |
| AuthorizationMedicalDirectorReviewPendedDateTime | DATETIME | The local date and time of when the authorization pended for review with a reason of medical director review. |
| AuthorizationPartialApprovalReasonCode | INTEGER | The reason the partial authorization status was assigned to this service. |
| AuthorizationPendingReasonCode | INTEGER | The reason the pending status was assigned to this service. |
| IntervalRepeatRequestCount | INTEGER | The number of times the interval has been requested to repeat. |
| AuthorizationCoverageGuidancePayerIdentifier | NUMERIC | The unique ID of the payer associated with the requested coverage guidance. |
| AuthorizationCoverageGuidanceSourceCategory | INTEGER | The coverage guidance source category ID for the coverage guidance request. |
| UtilizationManagementAuthorizationDecisionStatus | INTEGER | The utilization management authorization decision status for the requested service. |
| CoverageGuidanceRealTimeTransactionContactSerialNumber | NUMERIC | The unique contact serial number of the real-time transaction that originated the Coverage Requirements Discovery request. |
| Interval | INTEGER | The number of times the interval has been approved to repeat. |
| AuthorizationDenialReason | INTEGER | The reason the denied status was assigned to this service. |
| CoverageGuidanceRequestingProviderIdentifier | VARCHAR | The unique ID associated with the provider record of the provider that is requesting coverage guidance for a service for this row. This column is frequently used to link to the CLARITY_SER table. |
| ExternalServiceAuthorizationNumber | VARCHAR | the authorization number received by Payer Platform from an external system for this service |
| IntervalNumberOfServicesRequested | INTEGER | The number of services requested for each interval. |
| UtilizationManagementClosedReasonCode | INTEGER | The reason the closed status was assigned to this service. |
| AuthorizationReferenceNumber | VARCHAR | The reference number given to us by the payer for this service-level authorization (AUT). |
| AuthorizationIntervalApprovedServiceCount | INTEGER | The number of services approved for each interval. |
| MedicalDirectorReviewStatusUserId | VARCHAR | The user who set the pending review status reason for a medical director review. |
| AuthorizationIdentifier | NUMERIC | The authorization ID for the authorization record. |
| AuthorizationTypeCategory | INTEGER | Authorization type category value |
| IsSystemDecidedAuthorization | VARCHAR | Indicates if the service was automatically decided by the system. 'Y' indicates that it was automatically decided. 'N' indicates that it was manually decided. A NULL value indicates that it is not yet in a decision status. |
| FinalizationChangeSourceCategoryIdentifier | INTEGER | The change source category ID that resulted in the finalized status of the service. |
| ExternalServiceMessageData | VARCHAR | Service-level MSG data received by Payer Platform from an external system. |
| AuthorizationEndDate | DATETIME | Authorization end date |
| OrderEntryIdentifier | NUMERIC | When the service is created as part of order entry, this column will be populated as a pointer back to the order. |
| AuthorizationServiceDecisionDateTime | DATETIME | The date and time the authorization decision was set on the service level authorization. Note that if a service's status changes from a finalized status to another after the entire authorization request has been finalized, this column does not update with the new instant and will instead reflect the original decision instant. |
| AuthorizationStartDate | DATETIME | Authorization start date |
| AssociatedReferralIdentifier | NUMERIC | Referral associated with this authorization. If this is a UM owned service-level authorization, this column is not populated and, instead, column UM_REFERRAL_ID will be populated. This column is frequently used to link to the REFERRAL table. |
| ApprovedRecurringAuthorizationFrequencyIdentification | VARCHAR | The ID of the associated Frequency Record for the approved recurring authorization. |
| AuthorizationComment | VARCHAR | Free text authorization comment. |
| AuthorizationBedDayTypeIdentifier | NUMERIC | The type of day (TOD record) approved by the payer. |
| ExternalServiceReferenceNumber | VARCHAR | the administrative reference number received by Payer Platform from an external system for this service |
| AuthorizationInitialAutomaticStatusAssignmentHistoryLine | INTEGER | The line in AUTH_UM_STATUS_HX that represents the earliest instant that automatic status assignment was performed on the service. |
| AppealedServiceAuthorizationIdentifier | NUMERIC | The ID of the service that this service was created to appeal. |
| AuthorizationRequestIdentifier | NUMERIC | If this is a UM-owned service authorization, this column serves as the pointer to the authorization request record. UM-owned service authorizations do not have direct pointers to referral and coverage. They must be accessed through the authorization request. |
| IsRecordDeletedFlag | VARCHAR | Flag to indicate if authorization record has been deleted. |
| CoverageGuidanceDeterminationCategoryIdentifier | INTEGER | The coverage guidance determination category ID for the requested service. |
| OwningInstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| AuthorizationApprovedReasonCode | INTEGER | The reason the authorized status was assigned to this service. |
| NoAuthorizationRequiredReasonCode | INTEGER | The reason the no auth required status was assigned to this service. |
| AuthorizationNumber | VARCHAR | Authorization number |
| AuthorizationCoverageGuidanceRequestVendorIdentifier | VARCHAR | The unique ID of the vendor with which the requested service for a coverage guidance request is to occur. |
| AuthorizationClaimServiceCount | INTEGER | Number of services, units, or visits used for AP Claims. |
| AuthorizationFinalizingUserIdentifier | VARCHAR | The unique ID associated with the user record that finalized this authorization. This column is frequently used to link to the CLARITY_EMP table. |
| AuthorizationClaimCountingMethodCode | INTEGER | The counting method for the AP Claim counts. |
| ApprovedNightCount | INTEGER | The number of nights approved by the payer for a bed day type. This is calculated as : End Date - Start Date. |
| ApprovedServiceCount | INTEGER | Number of services, units or visits approved. |
| AuthorizationPatientIdentifier | VARCHAR | The patient for whom the authorization record was created. This column is frequently used to link to the PATIENT table. |
| NonUtilizationManagementAuthorizationIdentifier | NUMERIC | Service authorizations that are created as part of UM workflows will only appear in UM workflows. If the authorization details are needed outside the UM department, then corresponding non-UM service-level authorizations are created. This separation is required to ensure non-UM staff cannot alter authorization decisions rendered by UM staff. This column provides a link between the UM service authorizations and non-UM service-level authorizations. There is a 1-to-1 link between UM and non-UM service-level authorizations. |
| ChargeUsageCount | INTEGER | Keeps track of number of counts used by charges. |
| CoverageGuidanceServiceLineIdentifier | INTEGER | The line number of the service from the real-time transaction that originated the Coverage Requirements Discovery service request. |
| AssociatedReferralIdentifier | NUMERIC | The unique ID of the referral record associated with this authorization. This column is populated for both UM and non-UM owned authorizations. |
| LastPatientEncounterContactSerialNumber | NUMERIC | The CSN of the encounter linked to the service level authorization with the latest encounter instant. If the service level authorization doesn't have any encounters linked directly, it will search the linked referral or auth/cert. |
| AuthorizationPendedMedicalDirector | DATETIME | The date and time in UTC of when the authorization pended for review with a reason of medical director review. |
| AuthorizationDenialReasonCode | INTEGER | If this authorization's status is Denied, then this item will contain the rationale given for that denial. |
| AuthorizationRequestFrequencyIdentifier | VARCHAR | The ID of the associated Frequency Record for the requested recurring authorization. |