PharmacyClaimDetai
This table contains information from pharmacy claims. Each record represents one pharmacy claim in the managed care system's AP Claims module.
| Column Name | Type | Description |
|---|---|---|
| ClaimServiceStartDate | DATETIME | Service start date for the claim |
| LastClinicalDataFilterDateTime | DATETIME | Last local instant clinical data derivation filters (I CLM 18625) were updated or calculated without changes for this claim. Calculated using EPIC_UTC_TO_LOCAL on I CLM 18626. |
| PrimaryMedicalPayerIdentification | NUMERIC | The primary medical payer. This is only set when the primary medical payer is different than the primary pharmacy payer. |
| TotalPrimaryPatientCoinsurance | NUMERIC | Total prior patient coinsurance |
| IsAdjustmentUnbalancedAmountIndicator | VARCHAR | Identifies whether the adjustment claim was received with credit/debit information that reflect the adjusted amount as opposed to new claim amounts. |
| OverrideInvalidClaimIndicator | VARCHAR | Overrides the INVALID_CLM_YN column and determines if we cannot trust the claim's data for reporting or clinical purposes. This column will store Y if overridden to invalid, N if overridden to valid, or NULL if validity has not been overridden and the value in AP_CLM_RX.INVALID_CLM_YN will be used. |
| ReferenceClaimIdentifier | VARCHAR | Reference claim ID for the original claim |
| TotalPrimaryPatientCopayAmount | NUMERIC | Total prior patient copay |
| ClaimPayerSequenceNumber | VARCHAR | Sequence number of the payer of the claim. |
| TotalNetPayableAmount | NUMERIC | Total net payable |
| ClaimLineOfBusinessIdentifier | VARCHAR | Stores the unique identifier of the line of business associated with the claim. This is the LOB determined at adjudication. |
| Total | NUMERIC | Total coinsurance |
| LastClaimUpdateDatetime | DATETIME | The date when this claim was last updated. This item is updated every time a claim is unlocked, except from conversions and claims exchange searches. |
| TotalPrimaryInsuranceAmount | NUMERIC | Total prior insurance amount |
| TotalRegularTaxAmountPaid | NUMERIC | Flat sales tax amount paid. |
| ClaimRecordStatus | INTEGER | The status of the record in Chronicles. |
| TotalDispensingFeePaidAmount | NUMERIC | Dispensing fee paid. |
| ClaimSourceSystemIdentifier | INTEGER | Returns the processing system that created the claim for filtering in Clarity and Caboodle. |
| BeneficiaryClaimDataApiSplitClaimIndicator | VARCHAR | Flag to indicate that the claim provided by BCDA is a split claim |
| IntraConnectOwningInstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| AttributedMedicalGroupIdentifier | NUMERIC | The attributed medical group on the member's coverage at the time of the claim service |
| ReceivedOwningBusinessSegmentIdentifier | NUMERIC | The owning business segment received for this claim. This might differ from the owning business segment in I CLM 18026 based on the adjustment sequence that this claim is in. |
| SourceOrganizationIdentifier | NUMERIC | The source organization of the external record. |
| ClaimEntryUserIdentifier | VARCHAR | User who entered the claim |
| WorkflowPayerIdentification | NUMERIC | The ID of the workflow payer associated with this claim |
| TotalPercentageTaxAmountPaid | NUMERIC | Percentage tax amount paid. |
| AdjustingClaimIdentification | NUMERIC | If this claim has been adjusted, this column contains the ID of the claim which adjusts this claim. |
| LastIncomingClaimExternalValueIdentifier | NUMERIC | The most recent incoming Claim External Values (CEV) record ID |
| PharmacyClaimIdentifier | NUMERIC | The unique identifier for the claim info record |
| RequisitionDemographicsIdentifier | NUMERIC | Holds a pointer to the REQ record that holds the identifier and demographics that this claim was received with, linking this claim into an ID bundle. |
| ClaimWorkflowType | INTEGER | Claim workflow type (AP claim, paid claim, estimate claim, etc.) |
| PharmacyClaimStatusIdentifier | NUMERIC | Identifies the status of the pharmacy claim (paid, reversed, canceled, etc.). The record status code can be retrieved by joining this column to the EXT_CODE_LST_ID column in table FCL_EXTRNL_CDE_LST. |
| AlternateClaimIdentifier | VARCHAR | Alternate Claim ID |
| OriginalClaimHeaderIdentifier | VARCHAR | Holds the claim header ID for the claim received from raw data. This item differs from AP_CLM_RX_2.CLAIM_HEADER_ID in that this will be populated for reversal claims with the claim header ID from the original claim. |
| PrescribingProviderIdentification | VARCHAR | Prescribing provider. |
| InstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| TotalPatientAmount | NUMERIC | Total patient amount |
| BulkFastHealthcareInteroperabilityResourcesRunIdentifier | VARCHAR | GUID uniquely identifying the bulk FHIR run the CEV was created from |
| MedicareDrugCoverageCode | INTEGER | Code to distinguish if a claim was paid under Medicare Part B or Part D. |
| Claim | VARCHAR | The ordering value for the claim natural key. |
| BulkFhirRequestInstant | DATETIME | Instant that the Bulk FHIR request was kicked off that generated this claim. |
| ReplacedByClaimsExchangeFlag | VARCHAR | This flag is set for a Chronicles Claims Loader claim that has been replaced by a Claims Exchange claim. This claim will no longer derive any clinical information. |
| 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. |
| ClaimServiceClassificationCode | INTEGER | Represents a clinical classification for the services billed on this claim. |
| ClaimNetworkLevel | VARCHAR | Contains the network level of a claim. |
| ClaimPaymentCoverageIdentifier | NUMERIC | Coverage used to pay the claim |
| ClaimTotalAllowedAmount | NUMERIC | Total allowed amount |
| PharmacyClaimTotalDeductibleAmount | NUMERIC | Total deductible |
| ClaimAdjustmentSequenceLoopOrSplitIndicator | 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. |
| OtherSourcePaymentAmountRecognized | NUMERIC | Total amount recognized by the processor of any payment from another source. |
| TotalIngredientCostPaid | NUMERIC | Drug ingredient cost paid. |
| PharmacyClaimRejectOverrideReasonIdentifier | NUMERIC | Indicates reason for paying a pharmacy claim when override is used. The reject override code can be retrieved by joining this column to the EXT_CODE_LST_ID column in table FCL_EXTRNL_CDE_LST. |
| TotalBilledAmount | NUMERIC | Total billed amount |
| ClaimBenefitPlanIdentifier | NUMERIC | This is the ID of the benefit plan used to adjudicate a claim. |
| TotalPrimaryPatientDeductible | NUMERIC | Total prior patient deductible |
| TotalCopaymentAmount | NUMERIC | Total copay |
| OriginalAdjustedClaimIdentifier | NUMERIC | If this claim adjusts another claim, this column contains the ID of the claim adjusted by this claim. |
| PharmacyIdentification | NUMERIC | Pharmacy associated to the claim. |
| ClaimOwningInstanceCommunityIdentifier | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| ClaimMemberIdentifier | VARCHAR | Claim member |
| PrescribingProviderTaxonomyCode | VARCHAR | Stores the prescribing provider's taxonomy code for pharmacy claims. |
| OriginalReversedClaimIdentification | NUMERIC | If this claim is a reversal claim, this column contains the ID of the claim reversed by this claim. |
| PharmacyClaimSubmissionNumber | INTEGER | NCPDP file submission number. |
| TotalProfessionalServiceFeePaidAmount | NUMERIC | Professional service fee paid. |
| ClaimStatusIdentifier | INTEGER | Claim status |
| ClaimReceivedDate | DATETIME | The date the claim was received |