line_item_repricing

Results of a pricing request for a single service line

Primary Key:

• claim_repricing_id
• line_item_id

Foreign Keys:

• allowed_repricing_code => line_repricing_code_lookup.repricing_code
• claim_repricing_id => claim_repricing.claim_repricing_id
• line_item_id => line_item.line_item_id
• medicare_repricing_code => line_repricing_code_lookup.repricing_code
• medicare_source => medicare_source_lookup.medicare_source

Indexes:

• line_item_repricing_allowed_repricing_code_idx - allowed_repricing_code
• line_item_repricing_line_item_id_idx - line_item_id
• line_item_repricing_medicare_repricing_code_idx - medicare_repricing_code
• line_item_repricing_medicare_source_idx - medicare_source

Column	Data Type	Nullable	Indexed	Description
claim_repricing_id	bigint	No	Yes	-
line_item_id	bigint	No	Yes	Points to the line item which was repriced
medicare_amount	numeric	Yes	No	Amount Medicare would pay for the service
allowed_amount	numeric	Yes	No	Allowed amount based on a contract or RBP pricing
medicare_repricing_code	text	Yes	Yes	Explains the methodology used to calculate Medicare
medicare_repricing_note	text	No	No	Note explaining approach for pricing or reason for error
network_code	text	No	No	The network code used for pricing (is placed into HCP04)
allowed_repricing_code	text	Yes	Yes	Explains the methodology used to calculate allowed amount
allowed_repricing_note	text	No	No	Note explaining approach for pricing or reason for error
allowed_repricing_formula_medicare_percent	numeric	Yes	No	Percentage of the Medicare amount used to calculate the allowed amount
allowed_repricing_formula_billed_percent	numeric	Yes	No	Percentage of the billed amount used to calculate the allowed amount
allowed_repricing_formula_fixed_amount	numeric	Yes	No	Fixed amount used as the allowed amount
technical_component_amount	numeric	Yes	No	Amount Medicare would pay for the technical component
professional_component_amount	numeric	Yes	No	Amount Medicare would pay for the professional component
medicare_std_dev	numeric	Yes	No	Standard deviation of the estimated Medicare amount (estimates service only)
medicare_source	text	Yes	Yes	Source of the Medicare amount (e.g. physician fee schedule, OPPS, etc.)
pricer_result	text	No	No	Pricing service return details
status_indicator	text	No	No	Gives more detail about how Medicare pays for the service (outpatient + professional)
payment_indicator	text	No	No	Explains the type of payment for Medicare (outpatient only)
discount_formula	text	No	No	The multi-procedure discount formula used to calculate the allowed amount (outpatient only)
line_item_denial_or_rejection_flag	text	No	No	Identifies how a line item was denied or rejected and how the rejection can be overridden (outpatient only)
packaging_flag	text	No	No	Indicates if the service is packaged and the reason for packaging (outpatient only)
payment_adjustment_flag	text	No	No	Identifies special adjustments made to the payment (outpatient only)
payment_adjustment_flag2	text	No	No	Identifies special adjustments made to the payment (outpatient only)
payment_method_flag	text	No	No	The method used to calculate the allowed amount (outpatient only)
composite_adjustment_flag	text	No	No	Assists in composite APC determination (outpatient only)
hcpcs_apc	text	No	No	Ambulatory Payment Classification code of the line item HCPCS (outpatient only)
payment_apc	text	No	No	Ambulatory Payment Classification code used for payment (outpatient only)
provider_ccn	text	No	No	CMS Certification Number for the facility
provider_mac	integer	Yes	No	Medicare Administrative Contractor number
provider_locality	integer	Yes	No	Geographic locality number used for pricing
provider_geographic_cbsa	bigint	Yes	No	The Core Based Statistical Area (CBSA) that the provider is located in
provider_state_cbsa	integer	Yes	No	The Core Based Statistical Area (CBSA) that the provider's state is located in
provider_rural_indicator	rural_indicator_type	Yes	No	Indicates whether provider is Rural, Super Rural, or Urban
provider_specialty_type	text	No	No	Medicare provider specialty type
provider_hospital_type	hospital_type	Yes	No	Type of hospital
procedure_edits	text[]	No	No	Detailed description of each procedure code edit error (from outpatient editor)
modifier1_edits	text[]	No	No	Detailed description of each edit error for the first procedure code modifier (from outpatient editor)
modifier2_edits	text[]	No	No	Detailed description of each edit error for the second procedure code modifier (from outpatient editor)
modifier3_edits	text[]	No	No	Detailed description of each edit error for the third procedure code modifier (from outpatient editor)
modifier4_edits	text[]	No	No	Detailed description of each edit error for the fourth procedure code modifier (from outpatient editor)
modifier5_edits	text[]	No	No	Detailed description of each edit error for the fifth procedure code modifier (from outpatient editor)
data_edits	text[]	No	No	Detailed description of each data edit error (from outpatient editor)
revenue_edits	text[]	No	No	Detailed description of each revenue code edit error (from outpatient editor)
allowed_repricing_formula_fee_schedule	numeric	Yes	No	Fee schedule amount used as the allowed amount
allowed_repricing_formula_per_diem	numeric	Yes	No	Per diem rate used to calculate the allowed amount
type_of_service	type_of_service_type	Yes	No	Type of service
rendering_provider_specialty_type	text	No	No	Medicare specialty type for the rendering provider