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Logical NamePhysical Column NameData TypeFHIR Datatype
Appeal IdentifierAppealId PK:2TextIdentifier
Source System CodeSourceSystem PK:1TextCodeableConcept
Appeal TypeAppealTypeCdTextCodeableConcept
Appeal Review TypeAppealReviewTypeTextCodeableConcept
Appeal Sub TypeAppealSubTypeTextCodeableConcept
Appeal Pre Post TypeAppealPrePostIndTextCodeableConcept
Appeal DecisionAppealDecisionCdTextString
Appeal Decision Reason TypeAppealDecisionReasonCdTextCodeableConcept
Appeal Decision Reason 2 TypeAppealDecisionReasonType2TextCodeableConcept
Appeal Decision Reason 3 TypeAppealDecisionReasonType3TextCodeableConcept
Appeal StatusAppealStatusCdTextCodeableConcept
Line of Business CodeLobIdTextCodeableConcept
Business Segment NameBusinessSgmntNmVarchar
Funding TypeFundingTypeTextCodeableConcept
Platform NamePlatformNameTextString
Fiduciary NameFiduciaryNameTextReference or String
Appeal Requested ThruAppealRequestedThruTextReference
Appeal Priority TypeAppealPriorityTypeTextCodeableConcept
Appeal Assigned ToAppealAssgndToTextReference
Submitting State CodeSubmittingStateCdTextCodeableConcept
Governance State CodeGovernanceStateCdTextCodeableConcept
Organization TypeOrgTypeTextReference[Organization]
Provider Tax Id NbrTinIntegerIdentifier
NPINpiTextIdentifier
MPINMpinTextIdentifier
Provider Par NonParParNonParCdTextReference[Practitioner]
Provider Speciality TypeProviderTypeTextReference[Practitioner]
Claim NumberClaimNumberTextReference[Claim]
Claim TypeClaimTypeTextReference[Claim]
Overturned AmountOverturnedAmtDecimalMoney
Denied AmountDeniedAmtDecimalMoney
Fined AmountFinedAmtDecimalMoney
Medical Record Requested IndicatorMrrequestedIndInteger???
Medical Record Requested DateMrrequestedDtTextDateTime
Medical Record Received DateMrreceivedDtTextDateTime
Appeal Received DateAppealReceivedDtTextDateTime
Appeal Decision DateAppealDecisionDtTextDateTime
Appeal Closure DateAppealClosureDtTextDateTime
First Level Appeal DateFirstLevelAppealReceivedDtTextDateTime
First Level Appeal Decision DateFirstLevelAppealDecisionDtTextDateTime
First Level Appeal DecisionFirstLevelAppealDecisionTextText
First Level Appeal Decision ReasonFirstLevelAppealDecisionReasonTextCodeableConcept
Second Level Appeal DateSecondLevelAppealReceivedDtTextDateTime
Second Level Appeal Decision DateSecondLevelAppealDecisionDtTextDateTime
Second Level Appeal DecisionSecondLevelAppealDecisionTextString
Second Level Appeal Decision ReasonSecondLevelAppealDecisionReasonTextCodeableConcept
External Review Decision ReasonExternalReviewDecisionReasonTextCodeableConcept
External Review Organization NameExternalReviewOrgNameTextReference[Organization]
External Review Organization Assign DateExternalReviewOrgAssignDtTextDateTime
External Review DecisionExternalReviewDecisionTextString
External Review Organization Decision DateExternalReviewDecisionDtTextDateTime
Paid DatePaidDtTextDateTime
Acknowledge Letter Due DateAckLetterDueDtTextDateTime
Acknowledge Letter Sent DateAckLetterSentDtTextDateTime
Resolution Letter Due DateRslvLetterDueDtTextDateTime
Resolution Letter Sent DateRslvLetterSentDtTextDateTime
Resolution Letter Completion DateRslvLetterCompletionDtTextDateTime
DOS From DateServiceStartDtTextDateTime
DOS To DateServiceEndDtTextDateTime
ICD TypeICDTypeTextCodeableConceptWhy not refer (provide) the Claim and Response)?
ICD CodeICDCdTextCodeableConcept
CPT CodeCPTCdTextCodeableConcept
Drug NameDrugNameTextCodeableConcept
Claim Denied DateClaimDeniedDtTextDateTime
Appeal Due DateAppealDueDtTextDateTime
Appeal Received YearAppealReceivedYYYYIntegerWhy the breakdown rather than a date?
Appeal Received MonthAppealReceivedMMInteger
Appeal Received DayAppealReceivedDDInteger
Source Create DTTMSrcCreateDTTMText
Source Update DTTMSrcUpdateDTTMText
Case IdentifierCaseIdVarchar
EPIM IdentifierEPIMIdInteger
Tracking IdentifierTrackingIdTextIdentifier