Table: Claims

Field Size
ClaimRef INT (IDENTITY)
OriginalClaimRef INT
PatientRef INT
PayerRef INT
SecondaryPayerRef INT
TertiaryPayerRef INT
Type VARCHAR(1)
ClaimDate DATE
Status VARCHAR(1)
Notes TEXT
ClaimNumber INT
BillDate DATE
AmountBilled MONEY
AmountExpected MONEY
AmountReceived MONEY
AmountAdjusted MONEY
AmountDue MONEY
AmountCost MONEY
Insured1PatientRelation TINYINT
Insured1ID VARCHAR(20)
Insured1FirstName VARCHAR(15)
Insured1LastName VARCHAR(20)
Insured1Address VARCHAR(40)
Insured1City VARCHAR(20)
Insured1State VARCHAR(2)
Insured1Zip VARCHAR(10)
Insured1Phone VARCHAR(14)
Insured1DOB DATE
Insured1Sex VARCHAR(1)
Insured1Employer VARCHAR(30)
Insured1InsurancePlan VARCHAR(30)
Insured1PolicyNumber VARCHAR(20)
Insured1PriorAuthorization VARCHAR(20)
Insured1PersonCode VARCHAR(3)
Insured1HomePlan VARCHAR(3)
Insured1PlanId VARCHAR(8)
Insured1FacilityId VARCHAR(10)
Insured2PatientRelation TINYINT
Insured2ID VARCHAR(20)
Insured2FirstName VARCHAR(15)
Insured2LastName VARCHAR(20)
Insured2Address VARCHAR(40)
Insured2City VARCHAR(20)
Insured2State VARCHAR(2)
Insured2Zip VARCHAR(10)
Insured2Phone VARCHAR(14)
Insured2DOB DATE
Insured2Sex VARCHAR(1)
Insured2Employer VARCHAR(30)
Insured2InsurancePlan VARCHAR(30)
Insured2PolicyNumber VARCHAR(20)
Insured2PriorAuthorization VARCHAR(20)
Insured2PersonCode VARCHAR(3)
Insured2HomePlan VARCHAR(3)
Insured2PlanId VARCHAR(8)
Insured2FacilityId VARCHAR(10)
Insured3PatientRelation TINYINT
Insured3ID VARCHAR(20)
Insured3FirstName VARCHAR(15)
Insured3LastName VARCHAR(20)
Insured3Address VARCHAR(40)
Insured3City VARCHAR(20)
Insured3State VARCHAR(2)
Insured3Zip VARCHAR(10)
Insured3Phone VARCHAR(14)
Insured3DOB DATE
Insured3Sex VARCHAR(1)
Insured3Employer VARCHAR(30)
Insured3InsurancePlan VARCHAR(30)
Insured3PolicyNumber VARCHAR(20)
Insured3PriorAuthorization VARCHAR(20)
Insured3PersonCode VARCHAR(3)
Insured3HomePlan VARCHAR(3)
Insured3PlanId VARCHAR(8)
Insured3FacilityId VARCHAR(10)
HCFAType TINYINT
HCFAConditionEmployment BIT
HCFAConditionAutoAccident BIT
HCFAAutoAccidentState VARCHAR(2)
HCFAConditionOtherAccident BIT
HCFABox10d VARCHAR(15)
HCFADateOfCurrentIllness DATE
HCFADateOfSimilarIllness DATE
HCFAUnableToWorkFrom DATE
HCFAUnableToWorkTo DATE
HCFAHospitalizationFrom DATE
HCFAHospitalizationTo DATE
HCFABox19 VARCHAR(50)
HCFALab BIT
HCFALabCharges MONEY
HCFAMedicaidCode VARCHAR(10)
HCFAMedicaidOriginal VARCHAR(10)
Diagnosis1 VARCHAR(6)
Diagnosis2 VARCHAR(6)
Diagnosis3 VARCHAR(6)
Diagnosis4 VARCHAR(6)
ConditionEmployment BIT
ConditionAutoAccident BIT
ConditionAccidentState VARCHAR(2)
ConditionOtherAccident BIT

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