AcknowledgementLetterSentDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when an acknowledgment letter was sent to
the requester.
|
ActualAdmissionDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Actual admission date for the patient.
|
ActualDischargeDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Actual discharge date for the patient.
|
AdmissionNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Notes related to the admission.
|
AdmissionSource |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Where the patient was admitted from, for example, a
clinic or an emergency room.
|
AdmissionType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Type of admission, for example, emergency or
elective.
|
AorReceivedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
-
Date and time when the Appointment of Representative
(AOR) form was received.
|
AorRequestedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
-
Date and time when the AOR form was requested.
|
AppealRequestReasonType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Restricted picklist,
Sort, Update
- Description
- The type of reason associated with the appeal
request.
- Possible values are:
- Service Request
Rejected
- Service Claim
Unpaid
- Rejected - Service
Not Required
- Rejected - No
Coverage Benefit
- Notification
Delayed
- Specialist Referral
Rejected
|
AppointedRepresentativeId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- ID of the appointed representative for the member.
- This is a relationship field.
- Relationship Name
- AppointedRepresentative
- Relationship Type
- Lookup
- Refers To
- Account
|
AppointedRepVerbalContactDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time of verbal contact with the member's
appointed representative.
|
AppointedRepWrittenContactDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time correspondence was sent to the member's
appointed representative.
|
ApprovedLengthOfStay |
- Type
- int
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Approved number of days for the admission.
|
ApprovedLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Approved level of care for the patient, for example,
Hospital-Observaton or
SNF-Rehabilitation.
|
CareRequestCaseId |
- Type
- reference
- Properties
- Create, Filter, Group, Sort
- Description
- Case related to the care request.
A case record can
only be related to a single care request record.
Therefore, ensure that the Case record you specify
in this field isn’t already associated with another
care request.
- This is a relationship field.
- Relationship Name
- CareRequestCase
- Relationship Type
- Lookup
- Refers To
- Case
|
ClaimNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Claim number for the medical service or medication, if
one exists.
|
ClinicalCaseType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Clinical case type for the patient, for example,
High Risk Fall or
Adult Diabetes.
|
CriteriaMet |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Indicates whether criteria for care was met.
|
CumulativeLengthOfStay |
- Type
- int
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Total number of days for the admission.
|
CurrentLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Level of care that the patient is receiving.
|
DecisionDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date by which the decision must be made for the
request.
|
DecisionDaysRemaining |
- Type
- int
- Properties
- Filter, Group, Nillable, Sort
- Description
- Number of days remaining for a decision or
resolution.
|
DecisionLetter |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- The text of the determination letter sent to the member
and provider.
|
DecisionNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
-
Notes related to the decision.
|
DecisionReason |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Reason for the decision.
|
DecisionReasonDescription |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
-
Text describing the reason for the decision.
|
DeniedLengthOfStay |
- Type
- int
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Number of days denied for the admission.
|
DeniedLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Level of care denied for the patient.
|
DispositionNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
-
Notes related to the disposition of the request.
|
DueDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the request is due for completion.
|
EffectiveFrom |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- The start date for an effective-date range.
|
EffectiveTo |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- The end date for an effective-date range.
|
ExpirationDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Expiration date for the request.
|
ExtensionRequestReceivedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time an extension was requested.
|
ExternalComplaintIdentifier |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Complaint ID number.
|
FacilityRecordNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The medical record number used to identify a
patient.
|
FacilityRoomBedType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Type of facility bed for the patient.
|
FacilityRoomNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The facility room number for the patient.
|
FinalLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Final level of care the patient.
|
FirstReviewerId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The name of the person who reviewed the request.
- This is a relationship field.
- Relationship Name
- FirstReviewer
- Relationship Type
- Lookup
- Refers To
- User
|
FirstReviewerNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Notes from the first reviewer related to the case.
|
GeneralPractitionerId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Member's primary or general care practitioner.
- This is a relationship field.
- Relationship Name
- GeneralPractitioner
- Relationship Type
- Lookup
- Refers To
- Contact
|
GeneralPractitionerVerbalNotifiedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the primary care practitioner was verbally
notified of the decision
|
GeneralPractitionerWrittenNotifiedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the primary care practitioner was notified of
the decision by written correspondence.
|
GrievanceType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Specifies the type of grievance.
|
InfoReceivedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when additional information was received
from the provider or member.
|
InfoRequestedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when additional information was requested
from the provider or member.
|
InitialDenialNotificationDate |
- Type
- date
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Date of initial denial notification.
|
InitialDenialNotificationTime |
- Type
- time
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- The time when the initial care request was denied.
|
IsExtendedRequest |
- Type
- boolean
- Properties
- Create, Defaulted on create, Filter, Group, Sort,
Update
- Description
- Indicates whether a request was extended.
|
IsReadmission |
- Type
- boolean
- Properties
- Create, Defaulted on create, Filter, Group, Sort,
Update
- Description
- Indicates whether the care request is for a
readmission.
- The default value is 'false'.
|
IsServiceOrMedicationReceived |
- Type
- boolean
- Properties
- Create, Defaulted on create, Filter, Group, Sort,
Update
- Description
- Indicates whether the member has already received the
medial service or medication.
|
LastReferencedDate |
- Type
- dateTime
- Properties
- Filter, Nillable, Sort
- Description
- The timestamp for when the current user last viewed a
record related to this record.
|
LastViewedDate |
- Type
- dateTime
- Properties
- Filter, Nillable, Sort
- Description
- The timestamp for when the current user last viewed this
record. If this value is null, it’s possible that this
record was referenced (LastReferencedDate) and not
viewed.
|
MedicalDirectorId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Name of the medical director who reviewed the
request.
- This is a relationship field.
- Relationship Name
- MedicalDirector
- Relationship Type
- Lookup
- Refers To
- User
|
MedicalDirectorNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Notes from the medical director related to the
request.
|
MemberCondition |
- Type
- textarea
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Free-form description of the member's condition.
|
MemberContactDateTime |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when the member was contacted.
|
MemberDateOfBirth |
- Type
- date
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Date of birth of the member.
|
MemberFirstName |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
First name of the member.
|
MemberGender |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Gender of the member.
|
MemberGroupNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Insurance group number for the member.
|
MemberId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Insurance identifier for the member.
- This is a relationship field.
- Relationship Name
- Member
- Relationship Type
- Lookup
- Refers To
- Account
|
MemberIdentificationNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Insurance identification number for the member.
|
MemberLastName |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
-
Last name of the member.
|
MemberPrimaryPlanId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The primary insurance plan of a member associated with
the care request when the member is insured under
multiple plans.
- This is a relationship field.
- Relationship Name
- MemberPrimaryPlan
- Relationship Type
- Lookup
- Refers To
- MemberPlan
|
MemberPrognosis |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Indicator of the provider's prognosis for the
member.
|
MemberSecondaryPlanId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The secondary insurance plan of a member associated with
the care request when the member is insured under
multiple plans.
- This is a relationship field.
- Relationship Name
- MemberSecondaryPlan
- Relationship Type
- Lookup
- Refers To
- MemberPlan
|
MemberStatus |
- Type
- textarea
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The member's status at admission, date of outpatient
service, or start of care.
|
MemberVerbalNotificationDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the member was verbally notified of the
decision.
|
MemberWrittenNotificationDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the member was notified of the decision by
written correspondence.
|
ModificationDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the case was modified.
|
ModifiedLengthOfStay |
- Type
- int
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Modified number of days for the admission.
|
ModifiedLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Modified level of care for the patient.
|
Name |
- Type
- string
- Properties
- Create, Filter, Group, idLookup, Sort, Update
- Description
-
Name of the care request.
|
NextReviewDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the next review is scheduled for completion.
|
OriginalDenialMedicalDirectorId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The name of the medical director who denied the original
request.
- This is a relationship field.
- Relationship Name
- OriginalDenialMedicalDirector
- Relationship Type
- Lookup
- Refers To
- User
|
ParProvider |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Indicator of whether this provider has entered into an
agreement with the insurance carrier.
|
PlaceOfService |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Place of service for the member's care such as an
inpatient hospital or an ambulatory surgery center.
|
PractitionerContactDateTime |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when the provider was contacted.
|
QuantityType |
- Type
- picklist
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Quantity type for the request such as days, units, or
visits.
|
ReceivedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the request was received.
|
ReconsiderationDenialNotificationDate |
- Type
- date
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The date when the reconsidered care request was
denied.
|
ReconsiderationDenialNotificationTime |
- Type
- time
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- The time when the reconsidered care request was
denied.
|
ReferenceCareRequestCaseId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- The reference care request case number associated with
the care request.
- This is a relationship field.
- Relationship Name
- ReferenceCareRequestCase
- Relationship Type
- Lookup
- Refers To
- Case
|
ReferenceCaseNumber |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Reference authorization number for an appeal, complaint,
or grievance.
|
ReopenedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the request was reopened.
|
ReopenReason |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Reason the request was reopened.
- The possible values are:
-
- Administrative
Error
- Original Decision
Overturned
|
ReopenReasonDescription |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Description of why the request was reopened.
|
RequestedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the request was originally requested.
|
RequestedLengthOfStay |
- Type
- int
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Requested number of days for the admission.
|
RequestedLevelOfCare |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Requested level of care for the patient.
|
RequesterType |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Indicates the role of the individual initiating the
request.
|
RequestingPractitionerId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Ordering or referring practitioner for the request.
- This is a relationship field.
- Relationship Name
- RequestingPractitioner
- Relationship Type
- Lookup
- Refers To
- Contact
|
RequestingPractitionerLicense |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- License type of the practitioner.
|
RequestingPractitionerSpecialty |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Specialty of the practitioner, for example,
Family Practice or
General Surgery.
|
RequestingPractitionerVerbalNotifiedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the practitioner was verbally notified of the
decision.
|
RequestingPractitionerWrittenNotifiedDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the practitioner was notified of the decision
by written correspondence.
|
ResolutionDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date when the complaint, appeal, or grievance was
resolved.
|
ResolutionLetterSentDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date and time when a resolution letter was sent to the
requester.
|
ResolutionNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Resolution notes for the request.
|
ReviewDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Date the review was completed.
|
RootCauseNotes |
- Type
- textarea
- Properties
- Create, Nillable, Update
- Description
- Field for notes related to the root cause for the
request.
|
ScheduledAdmissionDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Anticipated admission date for the patient.
|
ScheduledDischargeDate |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Scheduled discharge date for the patient.
|
ServiceDate |
- Type
- date
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Date when patient received the service.
|
ServicingFacilityId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Facility where the service is being provided.
- This is a relationship field.
- Relationship Name
- ServicingFacility
- Relationship Type
- Lookup
- Refers To
- Account
|
ServicingPractitionerId |
- Type
- reference
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Practitioner administering the service.
- This is a relationship field.
- Relationship Name
- ServicingPractitioner
- Relationship Type
- Lookup
- Refers To
- Contact
|
ServicingPractitionerLicense |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- License type of the practitioner.
|
ServicingPractitionerSpecialty |
- Type
- picklist
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- Specialty of the practitioner.
|
SourceSystem |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- System from which this request was sourced.
|
SourceSystemIdentifier |
- Type
- string
- Properties
- Create, Filter, Group, Nillable, Sort, Update
- Description
- ID of the system from which the request was sourced.
|
SourceSystemModified |
- Type
- dateTime
- Properties
- Create, Filter, Nillable, Sort, Update
- Description
- Timestamp of the most recent update from the source
system.
|