Operands

An operand is a dollar amount, number, date, or code used in the reimbursement calculation for the following reimbursement tools:

Formula
If Test
Percentage
Range

Note: A standard value is a dollar amount or number that you may select as an operand in the reimbursement calculation.

An extended value is a date or code you may select as an operand in a reimbursement calculation.

Standard Value Operands

The following table lists the values you may select as operands.

Operand	Description
Admit Date	Date of admission for the account
Admit Time	Time of admission for the current visit. This value is not applicable for HCFA based claims
All OP RA Pat Liab	Deductible plus the co-pay for RA line items having Remark Code "N45" This operand is currently for use with the Anthem payor exclusively. To use this operand, the facility PL_FLAG indicator must be set to "I," indicating the patient liability information comes from RA data. This operand should be used in the Formula reimbursement tool for the All OP service type as follows: Changes in Service Type - All OP RA Pat Liab Patient liability information from the RA is matched by CPT/Revenue code with the same date of service (the charge amount is not considered). This matching only occurs when the claim status code equals 1, 19, 22, or 4.
Average Daily Gross Charges	Gross charges divided by the number of days in the visit
Average Daily Gross Charges Adjusted	Adjusted gross charge divided by the number of days in the visit
Average Hourly Gross Charges	Gross charges divided by the number of hours in the visit
Average Hourly Gross Charges Adjusted	Adjusted gross charges divided by the number of hours in the visit
Calculated Threshold Amount	Total charges based on the threshold, as determined by the 2nd Dollar Stop Loss tool
Calculated Threshold Days	Number of days on a claim before the threshold is reached, as determined by the 2nd Dollar Stop Loss tool
CDM Primary Code	Primary CDM charge code for the visit
Charges in Exclusion Section	Billed charges associated with service type(s) in the exclusion section
Charges in Pass-Through Section	Billed charges associated with service type(s) in the pass-through section
Charges in Range	Amount of the charges in the current range for the current visit (often used with the range tool)
Charges in Service Type	Amount of the charges for the current service type. This references the charges expression within a service type. (e.g. if the charges expression is equal to RevCharges 450, then the charges in the service type equal the charges associated with revenue code 450)
Client Data 1, 2, & 3	Fields from the UB assigned customer-specific values through the data implementation process
Cost Pass-Through Amount	Amount reimbursed in the Pass-Throughs section of the TAC section
CPT4 Primary Code	Primary CPT4 procedure for the visit
Current Amount	Value of the current calculation
Days in Current Range	Number of days in the current range for the current visit (often used with the range tool)
Days in Service Type	Number of days for the current service type. This references the days expression within a service type. Note: For outpatient service types, the Days in Service operand is only valid when the Unique Days token is used in the days expression.
Days in Visit	For inpatients, this equals the service from date to the service to date. For outpatients, this equals the number of unique days in the charge detail
Discharge Date	Service through date of the current visit
Discharge Time	Discharge time of the current visit. This value is not applicable for HCFA based claims
Discount Amount	Difference between gross charges and expected amount
DRG Code	DRG code associated with the visit
DRG Conversion Price	Amount of the DRG conversion. This is used in conjunction with the DRG weight tool and the DRG weight table
DRG High Charge Trim	Amount of the most recent DRG high charge outlier in the current contract document
DRG High LOS Trim	Amount of the most recent DRG high length of stay outlier in the current contract document. This number is populated in the DRG weight table
DRG Low LOS Trim	Amount of the most recent DRG low length of stay outlier in the current contract document. This number is populated in the DRG weight table
DRG Weight	Amount in the weight field in the currently used DRG table
DRG Weight Table Values	Value for each DRG in a DRG Lookup Table associated for the specified column: Capital Amount DRG Differential DRG Disproportionate Share DRG Indirect Medical Education DRG Standard Days
Excluded Amount	Amount calculated in the Exclusions section of the TAC section
Gross Charges	Amount of the gross charges for the current visit
Gross Charges Adjusted	Equals gross charges minus (excluded charges or pass-through charges)
Gross Charges less Exclusions	Total Charges (minus non-covered if any) – Excluded Amount
Gross Charges less Pass Throughts	Total Charges (minus non-covered if any) – Charges in the Pass Through Section
Hours in Current Range	Number of hours within the current range for the current visit
Hours in Service Type	Number of hours in the current service type for the current visit
Hours in Visit	Calculates the difference between the discharge time and the admit time
ICD (Any) Code	Any ICD9 or ICD10 diagnosis or procedure code for the visit (available for the Range tool only).
ICD Primary Code	The primary ICD9 or ICD10 diagnosis or procedure code for the visit
Number of Charge Codes	Number of charge codes for the current visit
Number of Diagnosis Codes	Number of diagnosis codes for the current visit. This operand does not return information; it evaluate the input number or range to limit what is on the claim.
Number of Procedure Codes	Number of procedure codes for the current visit. This operand does not return information. It evaluates the input number or range to limit what is on the claim.
Number of Revenue Codes	Number of revenue codes for the current visit
Original Days in Visit	Number of days in an entire visit, regardless of other terms in the stop loss calculation
Patient Type	Specific patient type: I inpatient; O outpatient; E emergency room patient ;or D deceased
Plan Liability (Reimbursement)	Total amount calculated within the Reimbursement section of the Terms and Conditions (TAC) section.
Remaining Detail Charges Adjusted	Allows you to evaluate what is included in the detail charges.
Revenue Primary Code	Revenue code found first on the claim
StopCap Amount	Current stop cap amount
StopLoss Amount	Current stop loss amount
StopLoss/StopCap Amount	Current stop loss or stop cap amount
Total Cost	Current value of the total cost of the visit
UB Line Charges	Operates on each designated UB line charge (not on the sum of those UB line charges).
Units in Current Range	Number of units in the current service type for the current range
Units in Service Type	Number of units in the current service type for the current visit

Extended Value Operands

The following table explains the available extended values.

Operand (Extended Value)	Description
Admit Date	Date of admission for the account
Admit Time	Time of admission for the current visit. This value is not applicable for HCFA based claims
Calculated Threshold Days	Number of days on a claim before the threshold is reached, as determined by the 2nd Dollar Stop Loss tool
CDM Primary Code	Primary CDM charge code for the visit
CPT4 Primary Code	Primary CPT4 procedure for the visit
Discharge Date	Service through date of the current visit
Discharge Time	Discharge time of the current visit. This value is not applicable for HCFA based claims
DRG Code	DRG code associated with the visit
DRG Weight Table Values	Value for each DRG in a DRG Lookup Table associated for the specified column: Capital Amount DRG Differential DRG Disproportionate Share DRG Indirect Medical Education DRG Standard Days
ICD Primary Code	The primary ICD9 or ICD10 diagnosis or procedure code for the visit
Original Days in Visit	Number of days in an entire visit, regardless of other terms in the stop loss calculation
Patient Type	Specific patient type: I inpatient; O outpatient; E emergency room patient ;or D deceased
Revenue Primary Code	Revenue code found first on the claim