Claims In Progress

This Operational Report gives the capability for a user to do the inventory analysis for operations, such as manager or supervisor.

Examples

  • Reviewing, claims pending for a hospital, provider group

  • Dollar value greater than certain limit, for example, greater than $1000

  • Claims pending for members of employer group

This topic gives the available fields and the metadata details for each field of the Claims In Progress Operational Reporting View.

To incorporate dynamic fields related to the base entity of a specific view, generating the reporting view is necessary, as it automatically includes single value dynamic fields.
Table 1. Claims In Progress (Reporting View - Metadata)
Field Table Name Column Name Data Type Searchable? PII/PHI

Claim ID

CLA_CLAIMS

Claim ID

Number

Yes

-

Claim Code

CLA_CLAIMS

Claim

String

Yes

-

Claim Type

CLA_CLAIMS

TYPE

String

Yes

-

Claim Status

CLA_CLAIMS

STATUS

String

Yes

-

Claim Start Date

CLA_CLAIMS

START_DATE

DATE

Yes

-

Claim Intake Date

CLA_CLAIMS

ENTRY_DATE

DATE

Yes

-

Total Claimed Amount

CLA_CLAIMS

TOTAL_CLAIMED_AMOUNT

Number (Contains amount as the currency)

No

-

Claim Lines Count

CLA_CLAIM_LINES

-

Number

Yes

-

Member Code

REL_RELATIONS CLA_CLAIMS

Code

SERVICED_ENTITY_CODE

String

Yes

Yes

Member Name

REL_RELATIONS CLA_CLAIMS

Name

SERVICED_ENTITY_NAME

String

Yes

Yes

Member Gender

REL_GENDER_IDENTITIES_TL

DISPLAY_NAME

String

Yes

Yes

Member DOB

REL_RELATIONS CLA_CLAIMS

DATE_OF_BIRTH SERVICED_ENTITY_DATE

DATE

Yes

Yes

Identifier

REL_RELA_IDENTIFIERS

IDENTIFIER

String

Yes

Yes

Identifier Type

REL_IDENTIFIER_TYPES_TL

DISPLAY_NAME

String

Yes

Yes

Billing Provider Code

REL_PROVIDERS CLA_CLAIMS

PROV_ID_CLAIMANT CLAIMANT_PROV_CODE

String

Yes

-

Billing Provider Name

REL_PROVIDERS CLA_CLAIMS

NAME

CLAIMANT_NAME

String

Yes

Yes

Service Provider Code

REL_PROVIDERS CLA_CLAIMS

PROV_ID_SERVICE SERVICE_PROVIDER_CODE

String

Yes

-

Service Provider Name

REL_PROVIDERS CLA_CLAIMS

NAME

SERVICE_PROVIDER_NAME

String

Yes

Yes

Service Facility Code

REL_PROVIDERS CLA_CLAIMS

PROV_ID_LOCATION LOCATION_PROV_CODE

String

Yes

-

Service Facility Name

REL_PROVIDERS CLA_CLAIMS

NAME

LOCATION_NAME

String

Yes

Yes

Brand

PAS_BRANDS_B

PAS_BRANDS_TL

CODE

DESCR

String

Yes

-

Pend Reasons Code

CLA_PEND_REASONS_B

CODE

String (Metadata Array - JSON Payload with Code & Description)

No

-

Pend Reason Description

CLA_PEND_REASONS_TL

DESCR

String

No

-