Resubmission Report format

The report shows resubmissions history for claims. It contains only those claims that have related remittance advice. 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	Number of units (quantity) for an activity.
Processed Amount		Net amount billed by the provider to the payer for an activity.
Patient Share		Any fee that the payer is expecting the provider to collect from the patient.
Paid Amount		Amount paid by the payer for an activity.
Paid Amount With Duplicates		Amount paid by the payer for an activity including duplicated activities in other Remittance.Advice transactions.
Denied Amount		Amount denied by the payer for an activity.
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 — a claim is fully paid (Paid Amount >= Processed Amount); Partly Paid — a claim is partly paid (Paid Amount < Processed Amount); Rejected — a claim is fully denied (Paid Amount = 0).
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		Comments left by the provider to resubmission.
Is Resubmitted		Yes if a claim has been resubmitted in another transaction; No otherwise.
Is CS Duplicated		Yes for duplicated claims from Claim.Submission transactions; No for true claims from Claim.Submission transactions.
Claim Status		Original — if this is the initial claim submission; Resubmission 1 — if this is the first claim resubmission; Resubmission N — if this is N claim resubmission.
New Resubmission Type