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 | Header.TransactionDate | Transaction date of Claim.Submission transaction. |
| RA Date | Header.TransactionDate | Transaction date of Remittance.Advice transaction. |
| Rx Number | Observation.Value | Rx Number; value is taken for observation with Observation.Code = Prescription No. |
| Fill Counter | Observation.Value | Fill Counter; value is taken for observation with Observation.Code = Refills or Fill Counter. |
| Code | Activity.Code | Activity code specified by activity type. |
| Type | Activity.Type | Activity type. |
| Description | Activity code description. | |
| Claim ID | Claim.ID | Unique identifier assigned to a claim by the provider. |
| Claim ID Payer | Claim.IDPayer | Unique identifier assigned to a claim by the payer. |
| Activity ID | Activity.ID | Unique identifier of an activity within a claim. |
| Auth. Number | Activity.PriorAuthorizationID | Prior authorization number. |
| Auth. Approval Date | ||
| Service Date | Activity.Start | Start date of an activity. |
| Service Date Time | Activity.Start | Start date and time of an activity. |
| Ord. Clinician License | Activity.OrderingClinician | 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 | Activity.Clinician | 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 | Claim.PayerID | License number of an insurance company that is the payer of a claim. |
| Provider ID | Claim.ProviderID | License number of the provider. |
| Member ID | Claim.MemberID | Insurance card number of the patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number assigned by the provider. |
| Sales Price | Sales price for a drug. It has value only if Activity.Type = 5. | |
| Quantity | Activity.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 | Activity.DenialCode | Denial code for a rejected activity. |
| Denial Reason | Denial code description. | |
| Principal Diagnosis | Diagnosis.Code | Principal diagnosis code. |
| Diagnosis Text | Principal diagnosis description. | |
| Secondary Diagnosis 1...N | Diagnosis.Code | Secondary diagnosis code. |
| Diagnosis Text | Secondary diagnosis description. | |
| Status | Fully Paid Partly Paid Rejected | |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Settlement Date | Claim.DateSettlement | 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 |