The report shows resubmissions history for claims. It contains only those claims that have related remittance claims. Otherwise a claim is not shown in the report.
The report contains the following worksheets: Activity Report.
Activity Report worksheet
The table below describes columns presented on this worksheet.
| Column | XML Field | Description |
|---|---|---|
| CS Date | Transaction date of Claim.Submission transaction. | |
| RA Date | Transaction date of Remittance.Advice transaction. | |
| Rx Number | ||
| Fill Counter | ||
| Code | Activity code specified by activity type. | |
| Type | Activity type. | |
| Description | Activity code description. | |
| Claim ID | Unique identifier assigned to a claim by the provider. | |
| Claim ID Payer | Unique identifier assigned to a claim by the payer. | |
| Activity ID | Unique identifier of an activity within a claim. | |
| Auth. Number | Prior authorization number. | |
| Auth. Approval Date | ||
| Service Date | Start date of an activity. | |
| Service Date Time | Start date and time of an activity. | |
| Ord. Clinician License | License number of the clinician who ordered an activity or referred the patient for an activity. | |
| Ord. Clinician Name | Full name of the clinician who ordered an activity or referred the patient for an activity. | |
| Disp. Clinician License | License number of the clinician who provided an activity (treatment or care) for the patient. | |
| Disp. Clinician Name | Full name of the clinician who provided an activity (treatment or care) for the patient. | |
| Payer ID | License number of an insurance company that is the payer of a claim. | |
| Provider ID | License number of the provider. | |
| Member ID | Insurance card number of the patient. | |
| MRN | Patient Medical Record Number assigned by the provider. | |
| Sales Price | ||
| Quantity | ||
| Processed Amount | Net amount billed by the provider to the payer for an activity. | |
| Patient Share | ||
| Paid Amount | Amount paid by the payer for an activity. | |
| Paid Amount With Duplicates | ||
| Denied Amount | ||
| Denial Code | Denial code for a rejected activity. | |
| Denial Reason | Denial code description. | |
| Principal Diagnosis | Principal diagnosis code. | |
| Diagnosis Text | Principal diagnosis description. | |
| Secondary Diagnosis 1...N | Secondary diagnosis code. | |
| Diagnosis Text | Secondary diagnosis description. | |
| Status | Fully Paid Partly Paid Rejected | |
| Payment Reference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). | |
| Settlement Date | Date the payer settles a claim. | |
| Resubmission Comments | ||
| Is Resubmitted | Yes if a claim has been resubmitted in another transaction; | |
| Is CS Duplicated | ||
| Claim Status | Original — if this is the initial claim submission; | |
| New Resubmission Type |