TransactionExplanationOfBenefits
The table contains the Explanation of Benefits information given a transaction ID. It contains data that is not multiple response given a transaction ID.
| Column Name | Type | Description |
|---|---|---|
| TransactionCoinsuranceAmount | NUMERIC | The coinsurance amount for that transaction. |
| TransactionSummaryAmount | VARCHAR | Contains any paid, adjustment, copay, coinsurance, or allowed amount for a transaction. |
| PaymentExplanationProcedureIdentifier | NUMERIC | The ID of the procedure on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the procedure from the charge transaction. |
| TransactionDeductibleAmount | NUMERIC | The deducted amount for that transaction. |
| TransactionInvoiceNumber | VARCHAR | The invoice number for the transaction. |
| PaymentExplanationOfBenefitsActionNameIdentifier | INTEGER | The Explanation Of Benefits action category ID for the transaction. |
| PaymentCrossoverScenario | INTEGER | Indicates the crossover scenario of this payment transaction at the time of payment posting. The crossover scenario value describes whether this payment transaction is a regular payment, a primary payment (and whether or not the crossover payor has paid), or a crossover payment (and whether or not the primary payor has paid). |
| TransactionNonCoveredAmount | NUMERIC | The non-covered amount for that transaction. |
| ExplanationOfBenefitsAccountIdentifier | NUMERIC | The Account Id of the transfer to self-pay action or next responsible party to self-pay action performed in insurance payment posting. |
| InvoicePlaceOfServiceIdentifier | NUMERIC | The ID of the Place of Service on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the Place of Service from the charge. |
| ExplanationOfBenefitsPatientIdentifier | VARCHAR | The ID of the patient on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the patient from the charge transaction. |
| ExplanationOfBenefitsTransactionIdentifier | NUMERIC | The transaction ID of the matching charge. |
| BadDebtRecoveryOverride | VARCHAR | Auto Bad Debt Recovery Side Override. |
| PaymentEobBillingProviderIdentifier | VARCHAR | The ID of the billing provider on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the billing provider from the charge. |
| TransactionLineNumber | INTEGER | The line number for the information associated with this record. Multiple pieces of information can be associated with this record. |
| ChargePaymentMatchDate | DATETIME | The date when the charge was matched to the payment. |
| UserDeterminedNonPrimaryPaymentIndicator | VARCHAR | Indicates whether the user determines this payment transaction as a non-primary payment at the time of payment posting. The value of the Non-primary posting (user) is usually the same as the system determined non-primary posting value. However, users can override the system determined non-primary posting value based on the EOB information. Y indicates the user determines this payment transaction as a non-primary payment at the time of payment posting. |
| InvoiceGuarantorAccountNumber | NUMERIC | The ID of the guarantor on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the guarantor from the charge. |
| ExplanationOfBenefitsInvoiceIdentifier | NUMERIC | Invoice ID that is associated with one payment Explanation of Benefits line. Use this field along with INV_LINE to link to the proper record in the INV_CLM_LN_ADDL table. |
| ExplanationOfBenefitsActionCode | VARCHAR | The Explanation of Benefits code for actions (next responsible party or resubmit) in payment posting associated with the transaction. |
| IsSystemDeterminedNonPrimaryPayment | VARCHAR | Indicates whether the system determines this payment transaction as a non-primary payment at the time of payment posting based on crossover information, invoice information, and previous payments information. Y indicates the system determines this payment transaction as a non-primary payment at the time of payment posting based on crossover information, invoice information, and previous payments information. A null value indicates the system does not determine this payment transaction as a non-primary payment at the time of payment posting based on crossover information, invoice information, and previous payments information. |
| TransactionCopayAmount | NUMERIC | The copay amount for that transaction. |
| ActionWinningRemittanceCodeIdentifier | VARCHAR | The Action Winning RMC Code. |
| PhysicalDeploymentOwnerIdentification | 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. |
| ReimbursementNotEqualAllowedAmountIndicator | INTEGER | Indicates whether the allowed amount from the EOB matches the calculated reimbursement amount. The value of 1 indicates that a reimbursement amount has been calculated and does not match the allowed amount from the EOB. |
| CoordinationOfBenefitsAmount | NUMERIC | The Coordination of Benefits amount for that transaction. |
| AutoTransferToInsuranceIndicator | VARCHAR | Indicates whether to auto transfer to the insurance company. Y indicates to auto transfer to the insurance company. A null value indicates not to auto transfer to the insurance company. |
| ExplanationOfBenefitsTransactionComments | VARCHAR | The comments associated the Explanation of Benefits for a transaction. |
| ExplanationOfBenefitsMatchingChargeTransactionIdentification | NUMERIC | The ID of the first matching charge transaction on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the charge from the Explanation of Benefits master file. |
| InvoiceRevenueLocationIdentifier | NUMERIC | The ID of the revenue location on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the revenue location from the charge transaction. |
| TransactionInternalControlNumber | VARCHAR | The internal control number for that transaction. |
| InvoiceDepartmentIdentifier | NUMERIC | The ID of the department on the invoice associated with the payment. If there is no associated invoice, this column stores the ID of the department from the charge. |
| ChargeMatchedPaymentTransactionDetailLinkIdentifier | NUMERIC | The TDL_ID of the TDL detail type 20 record (Charge matched to Payment). This column can be used to link this payment information back to the charge related information. |
| TransactionPaidAmount | NUMERIC | The paid amount for that transaction. |
| ExplanationOfBenefitPlanIdentifier | NUMERIC | The ID of the benefit plan on the invoice associated with the payment. If there is no associated invoice, this column will be blank. |
| TransactionCoveredAmount | NUMERIC | The covered amount for that transaction. |
| InvoiceRecordLineCount | INTEGER | Line count of one invoice record for internal calculation use. It is different from claim form line. Use this field along with INV_ID to link to the associated record in the INV_CLM_LN_ADDL table. |
| ExplanationOfBenefitClaimInvoiceNumber | NUMERIC | The claim invoice index. |
| 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. |
| HasNoMatchedChargesIndicator | VARCHAR | This column is set to Y when all charges associated with this EOB line have been unmatched from the payment. |