line_item

Information about a line item for a health, dental, prescription drug, etc. claim

Primary Key:

• line_item_id

Checks:

• line_item_clean_procedure_code_check - (procedure_code = upper(TRIM(BOTH FROM procedure_code)))

Foreign Keys:

• claim_id => claim.claim_id
• line_item_procedure_code_id => line_item_procedure_code_lookup.line_item_procedure_code_id

Indexes:

• line_item_claim_id_idx - claim_id
• line_item_procedure_code_id_idx - line_item_procedure_code_id

Column	Data Type	Nullable	Indexed	Description
claim_id	bigint	No	Yes	Link to claim record. Generated through expression:
line_number	text	No	No	Number assigned for differentiation within a transaction set (from LX01) Generated through expression:
rev_code	text	No	No	Service line revenue code (from SV201 / UB04 FL42) Generated through expression:
procedure_qualifier	product_service_id_type	Yes	No	Describes the type of service such as HCPCS, ADA code, HIPPS code, etc. (From SV101_01, SV202_01, SV301_01, SV501_01) Generated through expression:
procedure_code	text	No	No	Product or service identifier (from SV101_02, SV202_02, SV301_02, SV501_02 / UB04 FL44 / HCFA item 24d) Generated through expression:
procedure_modifiers	text[]	No	No	Up to four modifiers. This identifies special circumstances related to the performance of the service, as defined by trading partners (from SV101_03-06, SV202_03-06, SV301_03-06, SV501_03-06 / UB04 FL44) Generated through expression:
procedure_description	text	No	No	Free form description of the procedure (from SV101_07, SV202_07, SV301_07, SV501_07 / UB04 FL43) Generated through expression:
billed_amount	numeric	Yes	No	Amount billed (from SV102, SV203, SV302 / UB04 FL47 / HCFA item 24f) Generated through expression:
quantity	numeric	Yes	No	Service unit count (from SV104, SV205 [with unit code UN], and SV306 / UB04 FL46) Generated through expression:
place_of_service	text	No	No	Place of service code (from SV105 / HCFA item 24b) Generated through expression:
facility_non_covered_amount	numeric	Yes	No	Line item denied or non-covered charge amount (from SV207 / UB04 FL48) Generated through expression:
dme_length_of_medical_necessity_quantity	numeric	Yes	No	Length of medical treatment required (From SV503) Generated through expression:
dme_rental_price	numeric	Yes	No	DME rental price (From SV504) Generated through expression:
dme_purchase_price	numeric	Yes	No	DME purchase price (From SV505) Generated through expression:
ambulance_transport_reason	ambulance_transport_reason_type	Yes	No	Reason for ambulance transport (from CR104) Generated through expression:
ambulance_pickup_address_id	bigint	Yes	No	Ambulance pickup location (From NM1 PW loop) Generated through expression:
ambulance_dropoff_address_id	bigint	Yes	No	Ambulance dropoff location (From NM1 45 loop) Generated through expression:
service_date_from	date	Yes	No	Service date start (from DTP qualifier 472 / UB04 FL45 / HCFA item 24a) Generated through expression:
service_date_through	date	Yes	No	Service date end (from DTP qualifier 472 / UB04 FL45 / HCFA item 24a) Generated through expression:
last_seen_date	date	Yes	No	Date last seen (From DTP 304) Generated through expression:
initial_treatment_date	date	Yes	No	Date of initial treatment (From DTP 454) Generated through expression:
line_item_provider_control_number	text	No	No	Provider's unique line item reference number (From REF 6R) Generated through expression:
clia_number	text	No	No	Clinical Lab number (From REF X4) Generated through expression:
drug_ndc	text	No	No	National Drug Code (From LIN02) Generated through expression:
drug_units	unit_type	Yes	No	Drug measurement unit (From CTP05) Generated through expression:
drug_quantity	numeric	Yes	No	Drug unit quantity (From CTP04) Generated through expression:
drug_link_sequence_number	text	No	No	Provider assigned number for piecing together drug components (From REF VY) Generated through expression:
drug_prescription_number	text	No	No	Prescription number which can be used to piece together all components of a drug (From REF XZ) Generated through expression:
data_errors	text[]	No	No	- Generated through expression:
tpa_network_identifier	text	No	No	Network identifier assigned by the TPA (non-EDI) Generated through expression:
tpa_network_name	text	No	No	Network name assigned by the TPA (non-EDI) Generated through expression:
tpa_network_status	text	No	No	Network status according to the TPA (non-EDI) Generated through expression:
payment_limit	numeric	Yes	No	The max amount a provider can accept as payment for a line item. Under Medicare this is called the limiting charge (participating providers must accept Medicare as full payment, non-participating providers must accept 109.25% of Medicare, but opt-out providers have no limits on what they must accept as payment). A payment limit is usually enforced under a contract, but RBP and other baseline-based programs can also establish a payment limit through other means. A limiting charge is an important tool to protect patients from egregious charges even when a line item is denied coverage. See https://www.medicareresources.org/glossary/limiting-charge/. Payment Limit + Billed Adjustment = Billed Generated through expression:
billed_adjustment	numeric	Yes	No	Adjustments to the billed charge to get to the established payment limit for the line item. Payment Limit + Billed Adjustment = Billed Generated through expression:
allowed_amount	numeric	Yes	No	Amount covered by the plan for this line item. Note that this includes both plan and member responsibility portions (e.g. copay, coinsurance, deductible). Allowed + Not covered = Payment Limit Generated through expression:
not_covered_amount	numeric	Yes	No	Amount not covered by the plan for this line item. Allowed + Not covered = Payment Limit Generated through expression:
allowed_adjustment_amount	numeric	Yes	No	Adjustments to the allowed amount such as payment discounts, etc. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
plan_payment_amount	numeric	Yes	No	Amount to be paid by the plan for this line item. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
cob_paid_amount	numeric	Yes	No	Amount paid by another plan for this line item. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
copay_amount	numeric	Yes	No	A fixed out-of-pocket amount paid by a member for covered services. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
coinsurance_amount	numeric	Yes	No	The percentage of covered health costs that a member is responsible for paying after meeting their deductible. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
deductible_amount	numeric	Yes	No	The amount a member must pay for covered health services before their health plan begins to pay. Allowed Adjustment + Plan Payment + COB Paid + Copay + Coinsurance + Deductible = Allowed Generated through expression:
payment_identification_code	text	Yes	No	Identifier for the payment transaction. This could be an EFT number, check number, etc. Generated through expression:
payment_method_type	payment_method_type	Yes	No	The method used to make the payment. This could be EFT, check, etc. Generated through expression:
payment_date	date	Yes	No	The date the payment was made Generated through expression:
payment_to_provider	numeric	Yes	No	Payment made to a provider by the plan. A negative amount is a payment from the provider to the plan Generated through expression:
payment_to_member	numeric	Yes	No	Payment made to a member by the plan. A negative amount is a payment from the member to the plan Generated through expression:
diagnosis_code_pointers	smallint[]	No	No	A 1-based array of diagnosis code pointers. Join to 0-based claim_diagnosis.claim_diagnosis_index for details (from SV107, SV311 / HCFA item 24e) Generated through expression:
is_emergency_professional	boolean	Yes	No	Emergency-related indicator (from SV109 / HCFA item 24c) Generated through expression:
is_epsdt_professional	boolean	Yes	No	Indicates whether claim is EPSDT referral (from SV111 / HCFA item 24h) Generated through expression:
is_family_planning_professional	boolean	Yes	No	Family planning involvement indicator (from SV112 / HCFA item 24h) Generated through expression:
dental_prosthesis_crown_or_inlay_placement	dental_prosthesis_crown_or_inlay_placement_type	Yes	No	Reports the placement type for the dental work (From SV305) Generated through expression:
ambulance_transport_distance_quantity	numeric	Yes	No	Distance patient was transported by ambulance (From CR105) Generated through expression:
ambulance_round_trip_purpose_description	text	No	No	Describes why a round trip transport was required (from CR109) Generated through expression:
ambulance_stretcher_purpose_description	text	No	No	Describes why a stretcher was required (From CR110) Generated through expression:
ambulance_patient_count	smallint	Yes	No	Number of patients transported by ambulance (From QTY PT) Generated through expression:
dme_certification_type	certification_type	Yes	No	Type of DME certification (From CR301) Generated through expression:
dme_need_duration_quantity	numeric	Yes	No	Time in months that DME equipment is needed (From CR303) Generated through expression:
dme_certification_date	date	Yes	No	Date of certification or recertification (From DTP 607) Generated through expression:
prescription_date	date	Yes	No	Date of prescription (From DTP 471) Generated through expression:
begin_therapy_date	date	Yes	No	Begin date of therapy (often DME related) (From DTP 463) Generated through expression:
last_certification_date	date	Yes	No	Date of last certification (often DME related) (From DTP 461) Generated through expression:
most_recent_hemoglobin_or_hematocrit_date	date	Yes	No	Date of most recent hemoglobin or hematocrit test (From DTP 738) Generated through expression:
most_recent_serum_creatine_date	date	Yes	No	Date of most recent serum creatine test (From DTP 739) Generated through expression:
shipped_date	date	Yes	No	Date shipped (From DTP 011) Generated through expression:
last_x_ray_date	date	Yes	No	Date of last x-ray (From DTP 455) Generated through expression:
estimated_prior_placement_date	date	Yes	No	Estimated date of prior dental work placement (From DTP 139) Generated through expression:
prior_placement_date	date	Yes	No	Date of prior dental work placement (From DTP 441) Generated through expression:
appliance_placement_date	date	Yes	No	Date of orthodontic applicance placement (From DTP 452) Generated through expression:
replacement_date	date	Yes	No	Date of orthodontic applicance was replaced (From DTP 446) Generated through expression:
treatment_start_date	date	Yes	No	Date of initial impression or preparation for a crown or denture (From DTP 196) Generated through expression:
treatment_completion_date	date	Yes	No	Date of course of treatment was completed (From DTP 198) Generated through expression:
obstetric_anesthesia_additional_units	numeric	Yes	No	Used to report additional complexity beyond the normal services (From QTY FL) Generated through expression:
contract_type	contract_type	Yes	No	Contract type (From CN101) Generated through expression:
contract_amount	numeric	Yes	No	Contract amount (From CN102) Generated through expression:
contract_billed_percentage	numeric	Yes	No	Contract billed percentage (From CN103) Generated through expression:
contract_identification_code	text	No	No	Contract identification code (From CN104) Generated through expression:
contract_version_identifier	text	No	No	Contract version identifier (From CN106) Generated through expression:
repriced_line_item_number	text	No	No	Line number according to the repricing organization or other intermediary (from REF 9A or 9B) Generated through expression:
line_item_prior_authorization_number	text	No	No	Prior authorization number for primary payer (from REF G1) Generated through expression:
mammography_certification_number	text	No	No	Mammography certification number for a certified provider (from REF EW) Generated through expression:
referring_clia_number	text	No	No	Referring clinical Lab number (From REF F4) Generated through expression:
immunization_batch_number	text	No	No	Immunization batch number (From REF BT) Generated through expression:
referral_number	text	No	No	Referral number for primary payer (From REF 9F) Generated through expression:
sales_tax_amount	numeric	Yes	No	Sales tax (From AMT T) Generated through expression:
service_tax_amount	numeric	Yes	No	Goods and services tax (From AMT GT) Generated through expression:
facility_tax_amount	numeric	Yes	No	Facility tax (From AMT N8) Generated through expression:
postage_amount	numeric	Yes	No	Postage amount (From AMT F4) Generated through expression:
purchased_service_provider_identifier	text	No	No	Purchased service provider identifier (From PS101) Generated through expression:
purchased_service_billed_amount	numeric	Yes	No	Purchased service provider charge amount (From PS102) Generated through expression:
reprice_allowed_amount	numeric	Yes	No	Allowed amount according to the repricing organization before adjudication (From HCP02) Generated through expression:
reprice_savings_amount	numeric	Yes	No	Savings amount (From HCP03) Generated through expression:
reprice_organization_id	text	No	No	Code identifying the organization that has repriced the claim (from HCP04) Generated through expression:
reprice_per_diem_or_flat_rate_amount	numeric	Yes	No	Per diem or flat rate amount (From HCP05) Generated through expression:
reprice_approved_revenue_code	text	No	No	Approved revenue code (From HCP08) Generated through expression:
reprice_approved_procedure_code	text	No	No	Approved Procedure Code (From HCP10) Generated through expression:
reprice_approved_units	unit_type	Yes	No	Approved reprice units (From HCP11) Generated through expression:
reprice_approved_quantity	numeric	Yes	No	Approved quantity (From HCP12) Generated through expression:
units	text	No	No	Service unit type (from SV103, SV204, SV306, SV502) Generated through expression:
tpa_processed_date	date	Yes	No	Date TPA processed claim (non-EDI) Generated through expression:
contract_terms_discount_percent	numeric	Yes	No	Percentage discount available if paid before the discount due date (From CN105) Generated through expression:
tpa_line_item_status	text	No	No	Indicates disposition of line item (Paid, Denied, Voided, Rejected, Reversed, etc.). This can be used to differentiate between repeated line items (non-EDI) Generated through expression:
line_item_id	bigint	No	Yes	Snowflake ID assigned to line item. Generated through expression:
line_item_procedure_code_id	bigint	Yes	Yes	Links to the unified procedure code lookup. Generated through expression:
copay_status	copay_status_type	Yes	No	Patient is exempt from co-pay (from SV115, SV308) Generated through expression:
dental_oral_cavity_designations	dental_oral_cavity_designation_type[]	No	No	Describes the quadrant or arch and area of the oral cavity when not uniquely defined by the procedure code (From SV304) Generated through expression:
dme_length_of_medical_necessity_units	unit_type	Yes	No	The units for dme_length_of_medical_necessity_quantity (From SV502) Generated through expression:
dme_rental_billing_frequency	frequency_code	Yes	No	DME rental billing frequency (From SV506) Generated through expression:
ambulance_transport_distance_units	unit_type	Yes	No	Units for ambulance_transport_distance_quantity (From CR104) Generated through expression:
ambulance_applicable_conditions	condition_indicator_type[]	No	No	Ambulance certification of applicable patient conditions (From CRC01:07, CRC02:Y, CRC03/4/5) Generated through expression:
ambulance_not_applicable_conditions	condition_indicator_type[]	No	No	Ambulance certification of not applicable patient conditions (From CRC01:07, CRC02:N, CRC03/4/5) Generated through expression:
dme_need_duration_units	unit_type	Yes	No	The units for dme_duration_needed_quantity (From CR302) Generated through expression:
dme_applicable_conditions	condition_indicator_type[]	No	No	DME certification of applicable patient conditions (From CRC01:07, CRC02:Y, CRC03/4) Generated through expression:
dme_not_applicable_conditions	condition_indicator_type[]	No	No	DME certification of non-applicable patient conditions (From CRC01:07, CRC02:N, CRC03/4) Generated through expression:
rendering_provider_is_hospice_employee	boolean	Yes	No	Indicates whether rendering provider is an employee of the hospice (From CRC01:70, CRC02:Y or N) Generated through expression:
adjusted_repriced_line_item_number	text	No	No	Adjusted line item number according to the repricing organization or other intermediary (from REF 9C or 9D) Generated through expression:
predetermination_of_benefits_identifier	text	No	No	Predetermination of benefits identifier for primary payer (from REF G3) Generated through expression:
reprice_methodology	pricing_methodology_type	Yes	No	Code specifying pricing methodology used for repricing (from HCP01) Generated through expression:
reprice_approved_drg_or_apg_code	text	No	No	Code specifying the approved Diagnosis Related Group or Ambulatory Patient Group (from HCP06) Generated through expression:
reprice_approved_drg_or_apg_amount	numeric	Yes	No	Approved DRG or APG amount (From HCP07) Generated through expression:
reprice_approved_procedure_qualifier	product_service_id_type	Yes	No	Product or Service ID Qualifier (From HCP09) Generated through expression:
reprice_reject_reason	reject_reason_type	Yes	No	Code assigned by issuer to identify reason for rejection (from HCP13) Generated through expression:
reprice_policy_compliance	policy_compliance_type	Yes	No	Code specifying policy compliance (from HCP14) Generated through expression:
reprice_exception	repricing_exception_type	Yes	No	Code specifying the exception reason for consideration of out-of-network health care services (from HCP15) Generated through expression: