Header
CREATE TABLE [dbo].[EDI_Claims]( [ID] [bigint] IDENTITY(1,1) NOT NULL, /*File Level Data*/ [Filename] [varchar](100) NULL, [Version] [varchar](12) NULL, [ImageFilePath] [varchar](300) NULL, [ImageFilename] [varchar](100) NULL, [TradingPartnerIDType] [char](2) NULL, [TradingPartnerID] [varchar](15) NOT NULL, [TransactionDate] [date] NULL, [ReceiveDate] [date] NULL, [SubmitterName] [varchar](60) NULL, [SubmitterID] [varchar](30) NULL, [SubmitterContact] [varchar](60) NULL, [SubmitterTel] [varchar](20) NULL, [SubmitterTelExt] [varchar](10) NULL, [SubmitterFax] [varchar](20) NULL, [SubmitterEmail] [varchar](80) NULL, [ReceiverName] [varchar](60) NULL, [ReceiverID] [varchar](30) NULL, [TransactionType] [char](2) NULL, /*Billing Provider*/ [FedTaxID] [varchar](15) NULL, [BillProvIDType] [char](2) NULL, [BillProvID] [varchar](80) NULL, [BillProvNPI] [varchar](12) NULL, [BillProvLast] [varchar](60) NULL, [BillProvFirst] [varchar](35) NULL, [BillProvMiddle] [varchar](25) NULL, [BillProvSuffix] [varchar](10) NULL, [BillProvSpecialty] [varchar](10) NULL, [BillProvAddress] [varchar](55) NULL, [BillProvAddress2] [varchar](55) NULL, [BillProvCity] [varchar](30) NULL, [BillProvState] [char](2) NULL, [BillProvZip] [varchar](15) NULL, [BillProvCountry] [varchar](3) NULL, [BillProvSubdivision] [varchar](3) NULL, [BillProvContact] [varchar](60) NULL, [BillProvTel] [varchar](80) NULL, [BillProvTelExt] [varchar](80) NULL, [BillProvFax] [varchar](80) NULL, [BillProvEmail] [varchar](80) NULL, [BillProvOtherIDQual1] [char](2) NULL, [BillProvOtherID1] [varchar](30) NULL, [BillProvOtherIDQual2] [char](2) NULL, [BillProvOtherID2] [varchar](30) NULL, [BillProvOtherIDQual3] [char](2) NULL, [BillProvOtherID3] [varchar](30) NULL, [BillProvOtherIDQual4] [char](2) NULL, [BillProvOtherID4] [varchar](30) NULL, [BillProvOtherIDQual5] [char](2) NULL, [BillProvOtherID5] [varchar](30) NULL, /*Pay-to Provider*/ [PayToProvIDType] [char](2) NULL, [PayToProvID] [varchar](30) NULL, [PayToProvTaxID] [varchar](12) NULL, [PayToProvNPI] [varchar](12) NULL, [PayToProvLast] [varchar](60) NULL, [PayToProvFirst] [varchar](35) NULL, [PayToProvMiddle] [varchar](25) NULL, [PayToProvSuffix] [varchar](10) NULL, [PayToProvSpecialty] [varchar](10) NULL, [PayToProvAddress] [varchar](55) NULL, [PayToProvAddress2] [varchar](55) NULL, [PayToProvCity] [varchar](30) NULL, [PayToProvState] [char](2) NULL, [PayToProvZip] [varchar](15) NULL, /*Pay-to Payer*/ [PayToPayerIDType] [char](2) NULL, [PayToPayerID] [varchar](80) NULL, [PayToPayerTaxID] [varchar](12) NULL, [PayToPayerLast] [varchar](60) NULL, [PayToPayerFirst] [varchar](35) NULL, [PayToPayerMiddle] [varchar](25) NULL, [PayToPayerSuffix] [varchar](10) NULL, [PayToPayerAddress] [varchar](55) NULL, [PayToPayerAddress2] [varchar](55) NULL, [PayToPayerCity] [varchar](30) NULL, [PayToPayerState] [char](2) NULL, [PayToPayerZip] [varchar](15) NULL, [PayToPayerOtherIDQual] [char](2) NULL, [PayToPayerOtherID] [varchar](30) NULL, /*Subscriber*/ [SubscriberLast] [varchar](60) NULL, [SubscriberFirst] [varchar](35) NULL, [SubscriberMiddle] [varchar](25) NULL, [SubscriberSuffix] [varchar](10) NULL, [SubscriberIDType] [char](2) NULL, [SubscriberID] [varchar](30) NULL, [SubscriberAddress] [varchar](55) NULL, [SubscriberAddress2] [varchar](55) NULL, [SubscriberCity] [varchar](30) NULL, [SubscriberState] [char](2) NULL, [SubscriberZip] [varchar](15) NULL, [SubscriberCountry] [varchar](3) NULL, [SubscriberLocation] [varchar](30) NULL, [SubscriberSubdivision] [varchar](3) NULL, [SubscriberDOB] [varchar](10) NULL, [SubscriberSex] [char](1) NULL, [SubscriberEthnicity] [varchar](75) NULL, [SubscriberMaritalStatus] [char](1) NULL, [SubscriberCollectionMethod] [varchar](30) NULL, [SubscriberSSN] [varchar](12) NULL, [SubscriberAgencyClaimNo] [varchar](50) NULL, [SubscriberMemberID] [varchar](50) NULL, [SubscriberPersonalID] [varchar](50) NULL, [SubscriberContact] [varchar](60) NULL, [SubscriberTel] [varchar](15) NULL, [SubscriberTelExt] [varchar](10) NULL, /*Destination Payer*/ [PayerName] [varchar](60) NULL, [PayerIDType] [char](2) NULL, [PayerID] [varchar](30) NULL, [PayerAddress] [varchar](55) NULL, [PayerAddress2] [varchar](55) NULL, [PayerCity] [varchar](30) NULL, [PayerState] [char](2) NULL, [PayerZip] [varchar](15) NULL, [PayerResponsibility] [char](1) NULL, [PayerOtherIDQual1] [char](2) NULL, [PayerOtherID1] [varchar](30) NULL, [PayerOtherIDQual2] [char](2) NULL, [PayerOtherID2] [varchar](30) NULL, [PayerOtherIDQual3] [char](2) NULL, [PayerOtherID3] [varchar](30) NULL, [GroupNo] [varchar](50) NULL, [GroupName] [varchar](60) NULL, [InsuranceType] [char](2) NULL, [FilingIndicator] [char](2) NULL, [COBIndicator] [char](1) NULL, /*Responsible*/ [ResponsibleLast] [varchar](60) NULL, [ResponsibleFirst] [varchar](35) NULL, [ResponsibleMiddle] [varchar](25) NULL, [ResponsibleSuffix] [varchar](10) NULL, [ResponsibleAddress] [varchar](55) NULL, [ResponsibleAddress2] [varchar](55) NULL, [ResponsibleCity] [varchar](30) NULL, [ResponsibleState] [char](2) NULL, [ResponsibleZip] [varchar](15) NULL, [ResponsibleIDType] [char](2) NULL, [ResponsibleID] [varchar](80) NULL, /*Patient*/ [PatientLast] [varchar](60) NULL, [PatientFirst] [varchar](35) NULL, [PatientMiddle] [varchar](25) NULL, [PatientSuffix] [varchar](10) NULL, [PatientAddress] [varchar](55) NULL, [PatientAddress2] [varchar](55) NULL, [PatientCity] [varchar](30) NULL, [PatientState] [char](2) NULL, [PatientZip] [varchar](15) NULL, [PatientCountry] [varchar](3) NULL, [PatientLocation] [varchar](30) NULL, [PatientSubdivision] [varchar](3) NULL, [PatientIDType] [char](2) NULL, [PatientID] [varchar](30) NULL, [PatientSSN] [varchar](12) NULL, [PatientMemberID] [varchar](50) NULL, [PatientPersonalID] [varchar](50) NULL, [PatientInsurancePolicy] [varchar](50) NULL, [PatientDOB] [varchar](50) NULL, [PatientSex] [char](1) NULL, [PatientEthnicity] [varchar](75) NULL, [PatientMaritalStatus] [char](1) NULL, [PatientCollectionMethod] [varchar](30) NULL, [PatientRelationship] [char](2) NULL, [PatientPaid] [varchar](10) NULL, [PregnancyIndicator] [char](1) NULL, /*Rendering Provider*/ [RendProvIDType] [char](2) NULL, [RendProvID] [varchar](30) NULL, [RendProvNPI] [varchar](12) NULL, [RendProvTaxID] [varchar](12) NULL, [RendProvLast] [varchar](60) NULL, [RendProvFirst] [varchar](35) NULL, [RendProvMiddle] [varchar](25) NULL, [RendProvSuffix] [varchar](10) NULL, [RendProvSpecialty] [varchar](10) NULL, [RendProvOtherIDQual1] [char](2) NULL, [RendProvOtherID1] [varchar](30) NULL, [RendProvOtherIDQual2] [char](2) NULL, [RendProvOtherID2] [varchar](30) NULL, [RendProvOtherIDQual3] [char](2) NULL, [RendProvOtherID3] [varchar](30) NULL, /*Attending Provider*/ [AttendProvLast] [varchar](60) NULL, [AttendProvFirst] [varchar](35) NULL, [AttendProvMiddle] [varchar](25) NULL, [AttendProvSuffix] [varchar](10) NULL, [AttendProvIDType] [char](2) NULL, [AttendProvID] [varchar](30) NULL, [AttendProvTaxID] [varchar](12) NULL, [AttendProvNPI] [varchar](12) NULL, [AttendProvOtherIDQual1] [char](2) NULL, [AttendProvOtherID1] [varchar](30) NULL, [AttendProvSpecialty] [varchar](10) NULL, /*Operating Provider*/ [OperatingProvLast] [varchar](60) NULL, [OperatingProvFirst] [varchar](35) NULL, [OperatingProvMiddle] [varchar](25) NULL, [OperatingProvSuffix] [varchar](10) NULL, [OperatingProvIDType] [char](2) NULL, [OperatingProvID] [varchar](30) NULL, [OperatingProvNPI] [varchar](12) NULL, [OperatingProvTaxID] [varchar](12) NULL, [OperatingProvOtherIDQual1] [char](2) NULL, [OperatingProvOtherID1] [varchar](30) NULL, [OperatingProvSpecialty] [varchar](10) NULL, /*Other Provider*/ [OtherProvLast] [varchar](60) NULL, [OtherProvFirst] [varchar](35) NULL, [OtherProvMiddle] [varchar](25) NULL, [OtherProvSuffix] [varchar](10) NULL, [OtherProvIDType] [char](2) NULL, [OtherProvID] [varchar](30) NULL, [OtherProvTaxID] [varchar](12) NULL, [OtherProvNPI] [varchar](12) NULL, [OtherProvOtherIDQual1] [char](2) NULL, [OtherProvOtherID1] [varchar](30) NULL, [OtherProvSpecialty] [varchar](50) NULL, /*Facility*/ [FacilityType] [char](2) NULL, [FacilityIDType] [char](2) NULL, [FacilityID] [varchar](80) NULL, [FacilityNPI] [varchar](12) NULL, [FacilityTaxID] [varchar](12) NULL, [FacilityOtherIDQual1] [char](2) NULL, [FacilityOtherID1] [varchar](30) NULL, [FacilityName] [varchar](80) NULL, [FacilityAddress] [varchar](55) NULL, [FacilityAddress2] [varchar](55) NULL, [FacilityCity] [varchar](30) NULL, [FacilitySpecialty] [varchar](50) NULL, [FacilityState] [char](2) NULL, [FacilityZip] [varchar](15) NULL, /*Referring Provider*/ [RefProvLast] [varchar](60) NULL, [RefProvFirst] [varchar](35) NULL, [RefProvMiddle] [varchar](25) NULL, [RefProvSuffix] [varchar](10) NULL, [RefProvIDType] [char](2) NULL, [RefProvID] [varchar](80) NULL, [RefProvTaxID] [varchar](12) NULL, [RefProvNPI] [varchar](12) NULL, [RefProvOtherIDQual1] [char](2) NULL, [RefProvOtherID1] [varchar](300) NULL, [RefProvSpecialty] [varchar](20) NULL, /*Supervising Provider*/ [SupervProvLast] [varchar](60) NULL, [SupervProvFirst] [varchar](35) NULL, [SupervProvMiddle] [varchar](25) NULL, [SupervProvSuffix] [varchar](10) NULL, [SupervProvIDType] [char](2) NULL, [SupervProvID] [varchar](30) NULL, [SupervProvTaxID] [varchar](12) NULL, [SupervProvNPI] [varchar](12) NULL, [SupervProvOtherIDQual1] [char](2) NULL, [SupervProvOtherID1] [varchar](50) NULL, [SupervProvSpecialty] [varchar](20) NULL, /*Assistant Surgeon*/ [AssistSurgLast] [varchar](60) NULL, [AssistSurgFirst] [varchar](35) NULL, [AssistSurgMiddle] [varchar](25) NULL, [AssistSurgSuffix] [varchar](10) NULL, [AssistSurgIDType] [char](2) NULL, [AssistSurgID] [varchar](30) NULL, [AssistSurgTaxID] [varchar](12) NULL, [AssistSurgNPI] [varchar](12) NULL, [AssistSurgOtherIDQual1] [varchar](3) NULL, [AssistSurgOtherID1] [varchar](50) NULL, [AssistSurgSpecialty] [varchar](10) NULL, /*Ambulance Pick-up Location*/ [PickUpAddress] [varchar](55) NULL, [PickUpAddress2] [varchar](55) NULL, [PickUpCity] [varchar](30) NULL, [PickUpState] [char](2) NULL, [PickUpZip] [varchar](15) NULL, /*Ambulance Drop-off Location*/ [DropOffName] [varchar](80) NULL, [DropOffAddress] [varchar](55) NULL, [DropOffAddress2] [varchar](55) NULL, [DropOffCity] [varchar](30) NULL, [DropOffState] [char](2) NULL, [DropOffZip] [varchar](15) NULL, /*COB Payer 1*/ [OtherInsuredLast] [varchar](60) NULL, [OtherInsuredFirst] [varchar](35) NULL, [OtherInsuredMiddle] [varchar](25) NULL, [OtherInsuredSuffix] [varchar](10) NULL, [OtherInsuredIDQual] [char](2) NULL, [OtherInsuredID] [varchar](30) NULL, [OtherInsuredAddress] [varchar](55) NULL, [OtherInsuredAddress2] [varchar](55) NULL, [OtherInsuredCity] [varchar](30) NULL, [OtherInsuredState] [char](2) NULL, [OtherInsuredZip] [varchar](15) NULL, [OtherInsuredCountry] [varchar](3) NULL, [OtherInsuredSubdivision] [varchar](3) NULL, [OtherInsuredPolicy] [varchar](50) NULL, [OtherInsuredDOB] [varchar](10) NULL, [OtherInsuredSex] [char](1) NULL, [OtherInsuredRelationship] [char](2) NULL, [OtherInsuredOtherIDQual1] [char](3) NULL, [OtherInsuredOtherID1] [varchar](50) NULL, [OtherInsuredOtherIDQual2] [char](3) NULL, [OtherInsuredOtherID2] [varchar](50) NULL, [OtherInsuredOtherIDQual3] [char](3) NULL, [OtherInsuredOtherID3] [varchar](50) NULL, [OtherPayerResponsibility] [char](1) NULL, [OtherPayerName] [varchar](35) NULL, [OtherPayerIDQual] [char](2) NULL, [OtherPayerID] [varchar](30) NULL, [OtherPayerAddress1] [varchar](55) NULL, [OtherPayerAddress2] [varchar](55) NULL, [OtherPayerCity] [varchar](30) NULL, [OtherPayerState] [char](2) NULL, [OtherPayerZip] [varchar](15) NULL, [OtherPayerPaid] [varchar](10) NULL, [OtherPayerGroupName] [varchar](60) NULL, [OtherPayerGroupNo] [varchar](50) NULL, [OtherPayerInsuranceType] [char](2) NULL, [OtherPayerFilingIndicator] [char](2) NULL, [OtherPayerAdjustmentReasonGroup] [varchar](20) NULL, [OtherPayerAdjustmentReason] [varchar](50) NULL, [OtherPayerAdjustmentAmount] [varchar](120) NULL, [OtherPayerPaidDate] [date] NULL, [OtherPayerInfoRelease] [char](1) NULL, [OtherPayerBenefitAssign] [char](1) NULL, [OtherPayerDocControlNo] [varchar](50) NULL, [OtherPayerPriorAuth] [varchar](50) NULL, [OtherPayerOtherIDQual1] [char](3) NULL, [OtherPayerOtherID1] [varchar](50) NULL, [OtherPayerOtherIDQual2] [char](3) NULL, [OtherPayerOtherID2] [varchar](50) NULL, /*COB Payer 2*/ [OtherInsured2Last] [varchar](60) NULL, [OtherInsured2First] [varchar](35) NULL, [OtherInsured2Middle] [varchar](25) NULL, [OtherInsured2Suffix] [varchar](10) NULL, [OtherInsured2IDQual] [char](2) NULL, [OtherInsured2ID] [varchar](30) NULL, [OtherInsured2Address] [varchar](55) NULL, [OtherInsured2Address2] [varchar](55) NULL, [OtherInsured2City] [varchar](30) NULL, [OtherInsured2State] [char](2) NULL, [OtherInsured2Zip] [varchar](15) NULL, [OtherInsured2Country] [varchar](3) NULL, [OtherInsured2Subdivision] [varchar](3) NULL, [OtherInsured2Policy] [varchar](50) NULL, [OtherInsured2DOB] [varchar](10) NULL, [OtherInsured2Sex] [char](1) NULL, [OtherInsured2Relationship] [char](2) NULL, [OtherInsured2OtherIDQual1] [char](3) NULL, [OtherInsured2OtherID1] [varchar](50) NULL, [OtherInsured2OtherIDQual2] [char](3) NULL, [OtherInsured2OtherID2] [varchar](50) NULL, [OtherInsured2OtherIDQual3] [char](3) NULL, [OtherInsured2OtherID3] [varchar](50) NULL, [OtherPayer2Responsibility] [char](1) NULL, [OtherPayer2Name] [varchar](35) NULL, [OtherPayer2IDQual] [char](2) NULL, [OtherPayer2ID] [varchar](80) NULL, [OtherPayer2Address1] [varchar](55) NULL, [OtherPayer2Address2] [varchar](55) NULL, [OtherPayer2City] [varchar](30) NULL, [OtherPayer2State] [char](2) NULL, [OtherPayer2Zip] [varchar](15) NULL, [OtherPayer2Paid] [varchar](10) NULL, [OtherPayer2GroupName] [varchar](60) NULL, [OtherPayer2GroupNo] [varchar](50) NULL, [OtherPayer2InsuranceType] [char](2) NULL, [OtherPayer2FilingIndicator] [char](2) NULL, [OtherPayer2AdjustmentReasonGroup] [char](20) NULL, [OtherPayer2AdjustmentReason] [varchar](50) NULL, [OtherPayer2AdjustmentAmount] [varchar](120) NULL, [OtherPayer2PaidDate] [date] NULL, [OtherPayer2InfoRelease] [char](1) NULL, [OtherPayer2BenefitAssign] [char](1) NULL, [OtherPayer2DocControlNo] [varchar](50) NULL, [OtherPayer2PriorAuth] [varchar](50) NULL, [OtherPayer2OtherIDQual1] [char](3) NULL, [OtherPayer2OtherID1] [varchar](50) NULL, [OtherPayer2OtherIDQual2] [char](3) NULL, [OtherPayer2OtherID2] [varchar](50) NULL, /*Claim Data*/ [ClaimNo] [varchar](50) NOT NULL, [Amount] [money] NULL, [EstimatedAmountDue] [money] NULL, [PatientEstimatedAmountDue] [money] NULL, [PlaceOfService] [char](2) NULL, [ClaimFrequency] [char](1) NULL, [SubmitReason] [char](1) NULL, [ProviderSignature] [char](1) NULL, [ProviderAcceptsAssignment] [char](1) NULL, [BenefitAssignment] [char](1) NULL, [InfoReleaseCode] [char](1) NULL, [PatientSignatureCode] [char](1) NULL, [RelatedCauses] [char](2) NULL, [RelatedCauses2] [char](2) NULL, [RelatedCausesState] [char](2) NULL, [SpecialProgramCode] [char](3) NULL, [ProviderParticipation] [char](1) NULL, [EOBIndicator] [char](1) NULL, [DelayReasonCode] [char](2) NULL, [ServiceDateFrom] [date] NULL, [ServiceDateTo] [date] NULL, [OnsetDate] [date] NULL, [SimilarSymptomsDate] [date] NULL, [DisabilityBegin] [date] NULL, [DisabilityEnd] [date] NULL, [HospitalizationBegin] [date] NULL, [HospitalizationEnd] [date] NULL, [AccidentDate] [date] NULL, [LastMenstrualPeriod] [date] NULL, [RepricerReceivedDate] [date] NULL, [AdmissionDate] [date] NULL, [AdmissionHour] [time](7) NULL, [AdmissionType] [char](1) NULL, [AdmissionSource] [char](1) NULL, [DischargeHour] [time](7) NULL, [PatientStatus] [char](2) NULL, [CoveredDays] [varchar](4) NULL, [NonCoveredDays] [varchar](4) NULL, [COBDays] [varchar](4) NULL, [LifeTimeReserveDays] [varchar](4) NULL, [PriorAuthorization] [varchar](50) NULL, [ClearingHouseID] [varchar](50) NULL, [MedicalRecordNumber] [varchar](50) NULL, [MothersMedicalRecordNumber] [varchar](50) NULL, [ServiceAuthorizationException] [varchar](50) NULL, [ReferralNumber] [varchar](50) NULL, [PayerClaimControlNumber] [varchar](50) NULL, [AdjustedRepricedClaimNumber] [varchar](50) NULL, [AutoAccidentState] [varchar](50) NULL, [OrigRefNo] [varchar](50) NULL, [ClaimType] [char](1) NULL, [TypeOfBill] [varchar](20) NULL, [Remark1] [varchar](90) NULL, [Remark2] [varchar](90) NULL, [Remark3] [varchar](90) NULL, [Remark4] [varchar](90) NULL, [K3_1] [varchar](80) NULL, [K3_2] [varchar](80) NULL, [K3_3] [varchar](80) NULL, [K3_4] [varchar](80) NULL, [K3_5] [varchar](80) NULL, [K3_6] [varchar](80) NULL, [K3_7] [varchar](80) NULL, [K3_8] [varchar](80) NULL, [K3_9] [varchar](80) NULL, [K3_10] [varchar](80) NULL, [OutsideLab] [char](1) NULL, [LabCharge] [varchar](10) NULL, [Test_Prod] [char](1) NULL, [ReportTypeCode1] [char](2) NULL, [ReportTransmissionCode1] [varchar](2) NULL, [AttachmentControlNumber1] [varchar](80) NULL, /*Dental Claims*/ [Predetermination] [char](2) NULL, [OrthodonticTotal] [varchar](5) NULL, [OrthodonticRemaining] [varchar](5) NULL, [OrthodonticYesNo] [char](1) NULL, [ToothStatus] [varchar](100) NULL, [AppliancePlacementDate] [date] NULL, /*Diagnosis Information*/ [AdmitDiagnosis] [varchar](10) NULL, [ECode] [varchar](30) NULL, [ECode2] [varchar](30) NULL, [ECode3] [varchar](30) NULL, [ECode4] [varchar](30) NULL, [ECode5] [varchar](30) NULL, [ECode6] [varchar](30) NULL, [ECode7] [varchar](30) NULL, [ECode8] [varchar](30) NULL, --[ECode9] [varchar](30) NULL, --[ECode10] [varchar](30) NULL, --[ECode11] [varchar](30) NULL, --[ECode12] [varchar](30) NULL, [ReasonForVisit] [varchar](30) NULL, [ReasonForVisit2] [varchar](30) NULL, [ReasonForVisit3] [varchar](30) NULL, [PrincipalDiagnosis] [varchar](10) NULL, [Diag2] [varchar](10) NULL, [Diag3] [varchar](10) NULL, [Diag4] [varchar](10) NULL, [Diag5] [varchar](10) NULL, [Diag6] [varchar](10) NULL, [Diag7] [varchar](10) NULL, [Diag8] [varchar](10) NULL, [Diag9] [varchar](10) NULL, [Diag10] [varchar](10) NULL, [Diag11] [varchar](10) NULL, [Diag12] [varchar](10) NULL, [Diag13] [varchar](10) NULL, [Diag14] [varchar](10) NULL, [Diag15] [varchar](10) NULL, [Diag16] [varchar](10) NULL, [Diag17] [varchar](10) NULL, [Diag18] [varchar](10) NULL, [Diag19] [varchar](10) NULL, [Diag20] [varchar](10) NULL, [Diag21] [varchar](10) NULL, [Diag22] [varchar](10) NULL, [Diag23] [varchar](10) NULL, [Diag24] [varchar](10) NULL, [Diag25] [varchar](10) NULL, [DRG] [varchar](15) NULL, /*Procedure Information*/ [PrincipalProcedure] [varchar](10) NULL, [PrincipalProcedureDate] [datetime2](0) NULL, [Proc2] [varchar](50) NULL, [Proc2Date] [datetime2](0) NULL, [Proc3] [varchar](10) NULL, [Proc3Date] [datetime2](0) NULL, [Proc4] [varchar](10) NULL, [Proc4Date] [datetime2](0) NULL, [Proc5] [varchar](10) NULL, [Proc5Date] [datetime2](0) NULL, [Proc6] [varchar](10) NULL, [Proc6Date] [datetime2](0) NULL, [Proc7] [varchar](10) NULL, [Proc7Date] [datetime2](0) NULL, [Proc8] [varchar](10) NULL, [Proc8Date] [datetime2](0) NULL, [Proc9] [varchar](10) NULL, [Proc9Date] [datetime2](0) NULL, [Proc10] [varchar](10) NULL, [Proc10Date] [datetime2](0) NULL, [Proc11] [varchar](10) NULL, [Proc11Date] [datetime2](0) NULL, [Proc12] [varchar](10) NULL, [Proc12Date] [datetime2](0) NULL, [Proc13] [varchar](10) NULL, [Proc13Date] [datetime2](0) NULL, [Proc14] [varchar](10) NULL, [Proc14Date] [datetime2](0) NULL, [Proc15] [varchar](10) NULL, [Proc15Date] [datetime2](0) NULL, [Proc16] [varchar](10) NULL, [Proc16Date] [datetime2](0) NULL, [Proc17] [varchar](10) NULL, [Proc17Date] [datetime2](0) NULL, [Proc18] [varchar](10) NULL, [Proc18Date] [datetime2](0) NULL, [Proc19] [varchar](10) NULL, [Proc19Date] [datetime2](0) NULL, [Proc20] [varchar](10) NULL, [Proc20Date] [datetime2](0) NULL, [Proc21] [varchar](10) NULL, [Proc21Date] [datetime2](0) NULL, [Proc22] [varchar](10) NULL, [Proc22Date] [datetime2](0) NULL, [Proc23] [varchar](10) NULL, [Proc23Date] [datetime2](0) NULL, [Proc24] [varchar](10) NULL, [Proc24Date] [datetime2](0) NULL, [Proc25] [varchar](10) NULL, [Proc25Date] [datetime2](0) NULL, /*Value Codes*/ [ValueCode1] [char](3) NULL, [ValueAmount1] [varchar](10) NULL, [ValueCode2] [char](3) NULL, [ValueAmount2] [varchar](10) NULL, [ValueCode3] [char](3) NULL, [ValueAmount3] [varchar](10) NULL, [ValueCode4] [char](3) NULL, [ValueAmount4] [varchar](10) NULL, [ValueCode5] [char](3) NULL, [ValueAmount5] [varchar](10) NULL, [ValueCode6] [char](3) NULL, [ValueAmount6] [varchar](10) NULL, [ValueCode7] [varchar](10) NULL, [ValueAmount7] [varchar](10) NULL, [ValueCode8] [char](3) NULL, [ValueAmount8] [varchar](10) NULL, [ValueCode9] [char](3) NULL, [ValueAmount9] [varchar](10) NULL, [ValueCode10] [char](3) NULL, [ValueAmount10] [varchar](10) NULL, [ValueCode11] [char](3) NULL, [ValueAmount11] [varchar](10) NULL, [ValueCode12] [char](3) NULL, [ValueAmount12] [varchar](10) NULL, --[ValueCode13] [char](3) NULL, --[ValueAmount13] [varchar](10) NULL, --[ValueCode14] [char](3) NULL, --[ValueAmount14] [varchar](10) NULL, --[ValueCode15] [char](3) NULL, --[ValueAmount15] [varchar](10) NULL, --[ValueCode16] [char](3) NULL, --[ValueAmount16] [varchar](10) NULL, --[ValueCode17] [char](3) NULL, --[ValueAmount17] [varchar](10) NULL, --[ValueCode18] [char](3) NULL, --[ValueAmount18] [varchar](10) NULL, --[ValueCode19] [char](3) NULL, --[ValueAmount19] [varchar](10) NULL, --[ValueCode20] [char](3) NULL, --[ValueAmount20] [varchar](10) NULL, --[ValueCode21] [char](3) NULL, --[ValueAmount21] [varchar](10) NULL, --[ValueCode22] [char](3) NULL, --[ValueAmount22] [varchar](10) NULL, --[ValueCode23] [char](3) NULL, --[ValueAmount23] [varchar](10) NULL, --[ValueCode24] [char](3) NULL, --[ValueAmount24] [varchar](10) NULL, /*Condition Codes*/ [ConditionCode1] [varchar](30) NULL, [ConditionCode2] [varchar](30) NULL, [ConditionCode3] [varchar](30) NULL, [ConditionCode4] [varchar](30) NULL, [ConditionCode5] [varchar](30) NULL, [ConditionCode6] [varchar](30) NULL, [ConditionCode7] [varchar](30) NULL, [ConditionCode8] [varchar](30) NULL, [ConditionCode9] [varchar](30) NULL, [ConditionCode10] [varchar](30) NULL, --[ConditionCode11] [varchar](30) NULL, --[ConditionCode12] [varchar](30) NULL, --[ConditionCode13] [varchar](30) NULL, --[ConditionCode14] [varchar](30) NULL, --[ConditionCode15] [varchar](30) NULL, --[ConditionCode16] [varchar](30) NULL, --[ConditionCode17] [varchar](30) NULL, --[ConditionCode18] [varchar](30) NULL, --[ConditionCode19] [varchar](30) NULL, --[ConditionCode20] [varchar](30) NULL, --[ConditionCode21] [varchar](30) NULL, --[ConditionCode22] [varchar](30) NULL, --[ConditionCode23] [varchar](30) NULL, --[ConditionCode24] [varchar](30) NULL, /*Occurrence Codes*/ [OccurranceCode1] [char](3) NULL, [OccurranceDate1] [date] NULL, [OccurranceCode2] [char](3) NULL, [OccurranceDate2] [date] NULL, [OccurranceCode3] [char](3) NULL, [OccurranceDate3] [date] NULL, [OccurranceCode4] [char](3) NULL, [OccurranceDate4] [date] NULL, [OccurranceCode5] [char](3) NULL, [OccurranceDate5] [date] NULL, [OccurranceCode6] [char](3) NULL, [OccurranceDate6] [date] NULL, [OccurranceCode7] [char](3) NULL, [OccurranceDate7] [date] NULL, [OccurranceCode8] [char](3) NULL, [OccurranceDate8] [date] NULL, --[OccurranceCode9] [char](3) NULL, --[OccurranceDate9] [date] NULL, --[OccurranceCode10] [char](3) NULL, --[OccurranceDate10] [date] NULL, --[OccurranceCode11] [char](3) NULL, --[OccurranceDate11] [date] NULL, --[OccurranceCode12] [char](3) NULL, --[OccurranceDate12] [date] NULL, --[OccurranceCode13] [char](3) NULL, --[OccurranceDate13] [date] NULL, --[OccurranceCode14] [char](3) NULL, --[OccurranceDate14] [date] NULL, --[OccurranceCode15] [char](3) NULL, --[OccurranceDate15] [date] NULL, --[OccurranceCode16] [char](3) NULL, --[OccurranceDate16] [date] NULL, --[OccurranceCode17] [char](3) NULL, --[OccurranceDate17] [date] NULL, --[OccurranceCode18] [char](3) NULL, --[OccurranceDate18] [date] NULL, --[OccurranceCode19] [char](3) NULL, --[OccurranceDate19] [date] NULL, --[OccurranceCode20] [char](3) NULL, --[OccurranceDate20] [date] NULL, --[OccurranceCode21] [char](3) NULL, --[OccurranceDate21] [date] NULL, --[OccurranceCode22] [char](3) NULL, --[OccurranceDate22] [date] NULL, --[OccurranceCode23] [char](3) NULL, --[OccurranceDate23] [date] NULL, --[OccurranceCode24] [char](3) NULL, --[OccurranceDate24] [date] NULL, [OccurranceSpanCode1] [char](3) NULL, [OccurranceSpanFrom1] [date] NULL, [OccurranceSpanTo1] [date] NULL, [OccurranceSpanCode2] [char](3) NULL, [OccurranceSpanFrom2] [date] NULL, [OccurranceSpanTo2] [date] NULL, [OccurranceSpanCode3] [char](3) NULL, [OccurranceSpanFrom3] [date] NULL, [OccurranceSpanTo3] [date] NULL, [OccurranceSpanCode4] [char](3) NULL, [OccurranceSpanFrom4] [date] NULL, [OccurranceSpanTo4] [date] NULL, /*CR1*/ [PatientWeight] [varchar](10) NULL, [AmbulanceTransportCode] [char](1) NULL, [AmbulanceTransportReasonCode] [char](1) NULL, [TransportDistance] [varchar](15) NULL, [RoundTripPurposeDescription] [varchar](80) NULL, [StretcherPurposeDescription] [varchar](80) NULL, /* CRC — Ambulance Certification */ [AmbulanceConditionIndicator] [char](1) NULL, [AmbulanceConditionCode1] [char](3) NULL, [AmbulanceConditionCode2] [char](3) NULL, [AmbulanceConditionCode3] [char](3) NULL, [AmbulanceConditionCode4] [char](3) NULL, [AmbulanceConditionCode5] [char](3) NULL, /*Repricing*/ [RepricedClaimNumber] [varchar](50) NULL, [RepricingMethodology] [varchar](3) NULL, [RepricedAmount] [money] NULL, [SavingsAmount] [money] NULL, [RepricerID] [varchar](30) NULL, [RepricingRate] [varchar](9) NULL, [APG_Code] [varchar](30) NULL, [APG_Amount] [money] NULL, [ApprovedRevenueCode] [varchar] (48) NULL, [ApprovedProcedureCode] [varchar] (48) NULL, [ApprovedUnitCode] [char](2) NULL, [ApprovedUnits] [bigint] NULL, [RejectReason] [varchar](3) NULL, [ComplianceCode] [varchar](2) NULL, [ExceptionCode] [varchar](2) NULL /*SQL To EDI*/ --,[ClaimAction] [char](1) NULL, --[ErrorMessage] [varchar](1000) NULL ) ON [PRIMARY]
DetailCREATE TABLE [dbo].[edi_ClaimDetail]( [ID] [bigint] IDENTITY(1,1) NOT NULL, [ClaimID] [bigint] NOT NULL, [LineNumber] [decimal](18, 0) NULL, [LineID] [varchar](50) NULL, [ServiceDateFrom] [datetime2](0) NULL, [ServiceDateTo] [date] NULL, [AssessmentDate] [date] NULL, [FacilityCode] [char](2) NULL, [RevenueCode] [varchar](48) NULL, [ProcedureCode] [varchar](48) NULL, [Amount] [money] NULL, [Unit] [char](2) NULL, [Quantity] [float] NULL, [UnitRate] [money] NULL, [NonCovered] [money] NULL, [Paid] [money] NULL, [PlaceOfService] [char](3) NULL, [Modifier1] [char](3) NULL, [Modifier2] [char](3) NULL, [Modifier3] [char](3) NULL, [Modifier4] [char](3) NULL, [ProcedureDescription] [varchar](80) NULL, [OralCavityDesignation1] [char](3) NULL, [OralCavityDesignation2] [char](3) NULL, [OralCavityDesignation3] [char](3) NULL, [OralCavityDesignation4] [char](3) NULL, [OralCavityDesignation5] [char](3) NULL, [DiagPointer1] [char](1) NULL, [DiagPointer2] [char](1) NULL, [DiagPointer3] [char](1) NULL, [DiagPointer4] [char](1) NULL, [ToothNumber] [char](2) NULL, [Surface] [varchar](10) NULL, [EmergencyIndicator] [char](1) NULL, [ServiceTax] [money] NULL, [FacilityTax] [money] NULL, [SalesTax] [money] NULL, [ApprovedAmount] [money] NULL, [LineK3_01] [varchar](80) NULL, [LineK3_02] [varchar](80) NULL, [LineK3_03] [varchar](80) NULL, [LineK3_04] [varchar](80) NULL, [LineK3_05] [varchar](80) NULL, [LineK3_06] [varchar](80) NULL, [LineK3_07] [varchar](80) NULL, [LineK3_08] [varchar](80) NULL, [LineK3_09] [varchar](80) NULL, [LineK3_10] [varchar](80) NULL, [Remark] [varchar](100) NULL, [AmbulancePatientCount] [bigint] NULL, /****PWK****/ [ReportType] [char](2) NULL, [ReportTransmission] [char](2) NULL, [AttachmentControlNumber] [varchar](80) NULL, /*HCP*/ [RepricingMethodology] [varchar](3) NULL, [RepricedAmount] [money] NULL, [SavingsAmount] [money] NULL, [RepricerID] [varchar](30) NULL, [RepricingRate] [varchar](9) NULL, [APG_Code] [varchar](30) NULL, [APG_Amount] [money] NULL, [ApprovedRevenueCode] [varchar] (48) NULL, [ApprovedProcedureCode] [varchar] (48) NULL, [ApprovedUnitCode] [char](2) NULL, [ApprovedUnits] [bigint] NULL, [RejectReason] [varchar](3) NULL, [ComplianceCode] [varchar](2) NULL, [ExceptionCode] [varchar](2) NULL, /* Drugs */ [DrugCode] [varchar](48) NULL, [DrugUnitPrice] [money] NULL, [DrugUnitCode] [char](2) NULL, [DrugUnits] [float] NULL, [PrescriptionNumber] [varchar](30) NULL, /* CR1 */ [PatientWeight] [varchar](10) NULL, [AmbulanceTransportCode] [char](1) NULL, [AmbulanceTransportReasonCode] [char](1) NULL, [TransportDistance] [varchar](15) NULL, [RoundTripPurposeDescription] [varchar](80) NULL, [StretcherPurposeDescription] [varchar](80) NULL, /* CRC — Ambulance Certification */ [AmbulanceConditionIndicator] [char](1) NULL, [AmbulanceConditionCode1] [char](3) NULL, [AmbulanceConditionCode2] [char](3) NULL, [AmbulanceConditionCode3] [char](3) NULL, [AmbulanceConditionCode4] [char](3) NULL, [AmbulanceConditionCode5] [char](3) NULL, /* Attending Provider */ [AttendingProviderLast] [varchar](35) NULL, [AttendingProviderFirst] [varchar](25) NULL, [AttendingProviderMiddle] [varchar](25) NULL, [AttendingProviderSuffix] [varchar](10) NULL, [AttendingProviderIDQual] [char](2) NULL, [AttendingProviderID] [varchar](35) NULL, [AttendingProviderOtherIDQual] [char](2) NULL, [AttendingProviderOtherID] [varchar](30) NULL, /* Operating Provider */ [OperatingProviderLast] [varchar](35) NULL, [OperatingProviderFirst] [varchar](25) NULL, [OperatingProviderMiddle] [varchar](25) NULL, [OperatingProviderSuffix] [varchar](10) NULL, [OperatingProviderIDQual] [char](2) NULL, [OperatingProviderID] [varchar](35) NULL, [OperatingProviderOtherIDQual] [char](2) NULL, [OperatingProviderOtherID] [varchar](30) NULL, /* Other Provider */ [OtherProviderLast] [varchar](35) NULL, [OtherProviderFirst] [varchar](25) NULL, [OtherProviderMiddle] [varchar](25) NULL, [OtherProviderSuffix] [varchar](10) NULL, [OtherProviderIDQual] [char](2) NULL, [OtherProviderID] [varchar](35) NULL, [OtherProviderOtherIDQual] [char](2) NULL, [OtherProviderOtherID] [varchar](30) NULL, /* Rendering Provider */ [RenderingProviderLast] [varchar](35) NULL, [RenderingProviderFirst] [varchar](25) NULL, [RenderingProviderMiddle] [varchar](25) NULL, [RenderingProviderSuffix] [varchar](10) NULL, [RenderingProviderIDQual] [char](2) NULL, [RenderingProviderID] [varchar](35) NULL, [RenderingProviderOtherIDQual] [char](2) NULL, [RenderingProviderOtherID] [varchar](30) NULL, /* PurchasedService Provider */ [PurchasedServiceProviderLast] [varchar](35) NULL, [PurchasedServiceProviderFirst] [varchar](25) NULL, [PurchasedServiceProviderMiddle] [varchar](25) NULL, [PurchasedServiceProviderSuffix] [varchar](10) NULL, [PurchasedServiceProviderIDQual] [char](2) NULL, [PurchasedServiceProviderID] [varchar](35) NULL, [PurchasedServiceProviderOtherIDQual] [char](2) NULL, [PurchasedServiceProviderOtherID] [varchar](30) NULL, /* Facility Provider */ [FacilityName] [varchar](35) NULL, [FacilityIDQual] [char](2) NULL, [FacilityID] [varchar](35) NULL, [FacilityAddress1] [varchar](25) NULL, [FacilityAddress2] [varchar](25) NULL, [FacilityCity] [varchar](30) NULL, [FacilityState] [char](2) NULL, [FacilityZip] [varchar](15) NULL, [FacilityOtherIDQual] [char](2) NULL, [FacilityOtherID] [varchar](30) NULL, /* Supervising Provider */ [SupervisingProviderLast] [varchar](35) NULL, [SupervisingProviderFirst] [varchar](25) NULL, [SupervisingProviderMiddle] [varchar](25) NULL, [SupervisingProviderSuffix] [varchar](10) NULL, [SupervisingProviderIDQual] [char](2) NULL, [SupervisingProviderID] [varchar](35) NULL, [SupervisingProviderOtherIDQual] [char](2) NULL, [SupervisingProviderOtherID] [varchar](30) NULL, /* Ordering Provider */ [OrderingProviderLast] [varchar](35) NULL, [OrderingProviderFirst] [varchar](25) NULL, [OrderingProviderMiddle] [varchar](25) NULL, [OrderingProviderSuffix] [varchar](10) NULL, [OrderingProviderIDQual] [char](2) NULL, [OrderingProviderID] [varchar](35) NULL, [OrderingProviderOtherIDQual] [char](2) NULL, [OrderingProviderOtherID] [varchar](30) NULL, /* Referring Provider */ [ReferringProviderLast] [varchar](35) NULL, [ReferringProviderFirst] [varchar](25) NULL, [ReferringProviderMiddle] [varchar](25) NULL, [ReferringProviderSuffix] [varchar](10) NULL, [ReferringProviderIDQual] [char](2) NULL, [ReferringProviderID] [varchar](35) NULL, [ReferringProviderOtherIDQual] [char](2) NULL, [ReferringProviderOtherID] [varchar](30) NULL, /*COB 1 */ [OtherPayer1ID] [varchar](30) NULL, [OtherPayer1Paid] [money] NULL, [OtherPayer1PaidProcedure] [varchar](30) NULL, [OtherPayer1PaidRevenueCode] [varchar](30) NULL, [OtherPayer1PaidQuantity] [bigint] NULL, [OtherPayer1BundledLine] [int] NULL, [OtherPayer1AdjustmentReasonGroup1] [char](2) NULL, [OtherPayer1AdjustmentReason1] [varchar](5) NULL, [OtherPayer1AdjustmentAmount1] [money] NULL, [OtherPayer1AdjustmentQuantity1] [bigint] NULL, [OtherPayer1AdjustmentReasonGroup2] [char](2) NULL, [OtherPayer1AdjustmentReason2] [varchar](5) NULL, [OtherPayer1AdjustmentAmount2] [money] NULL, [OtherPayer1AdjustmentQuantity2] [bigint] NULL, [OtherPayer1AdjustmentReasonGroup3] [char](2) NULL, [OtherPayer1AdjustmentReason3] [varchar](5) NULL, [OtherPayer1AdjustmentAmount3] [money] NULL, [OtherPayer1AdjustmentQuantity3] [bigint] NULL, [OtherPayer1AdjustmentReasonGroup4] [char](2) NULL, [OtherPayer1AdjustmentReason4] [varchar](5) NULL, [OtherPayer1AdjustmentAmount4] [money] NULL, [OtherPayer1AdjustmentQuantity4] [bigint] NULL, --[OtherPayer1AdjustmentReasonGroup5Plus] [varchar](77) NULL, --[OtherPayer1AdjustmentReason5Plus] [varchar](155) NULL, --[OtherPayer1AdjustmentAmount5Plus] [varchar](493) NULL, --[OtherPayer1AdjustmentQuantity5Plus] [varchar](415) NULL, [OtherPayer1PaidDate] [date] NULL, /*COB 2 */ [OtherPayer2ID] [varchar](30) NULL, [OtherPayer2Paid] [money] NULL, [OtherPayer2PaidProcedure] [varchar](30) NULL, [OtherPayer2PaidRevenueCode] [varchar](30) NULL, [OtherPayer2PaidQuantity] [bigint] NULL, [OtherPayer2BundledLine] [int] NULL, [OtherPayer2AdjustmentReasonGroup1] [char](2) NULL, [OtherPayer2AdjustmentReason1] [varchar](5) NULL, [OtherPayer2AdjustmentAmount1] [money] NULL, [OtherPayer2AdjustmentQuantity1] [bigint] NULL, [OtherPayer2AdjustmentReasonGroup2] [char](2) NULL, [OtherPayer2AdjustmentReason2] [varchar](5) NULL, [OtherPayer2AdjustmentAmount2] [money] NULL, [OtherPayer2AdjustmentQuantity2] [bigint] NULL, [OtherPayer2AdjustmentReasonGroup3] [char](2) NULL, [OtherPayer2AdjustmentReason3] [varchar](5) NULL, [OtherPayer2AdjustmentAmount3] [money] NULL, [OtherPayer2AdjustmentQuantity3] [bigint] NULL, [OtherPayer2AdjustmentReasonGroup4] [char](2) NULL, [OtherPayer2AdjustmentReason4] [varchar](5) NULL, [OtherPayer2AdjustmentAmount4] [money] NULL, [OtherPayer2AdjustmentQuantity4] [bigint] NULL, --[OtherPayer2AdjustmentReasonGroup5Plus] [varchar](77) NULL, --[OtherPayer2AdjustmentReason5Plus] [varchar](155) NULL, --[OtherPayer2AdjustmentAmount5Plus] [varchar](493) NULL, --[OtherPayer2AdjustmentQuantity5Plus] [varchar](415) NULL, [OtherPayer2PaidDate] [date] NULL ) ON [PRIMARY]
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