| 1 | BENE_ID | Encrypted CCW Beneficiary ID |  |  | 
| 2 | CLM_ID | Claim ID | * |  | 
| 3 | RIC_CD | NCH Near Line Record Identification Code |  | * | 
| 4 | CLM_TYPE | NCH Claim Type Code |  | * | 
| 5 | FROM_DT | Claim From Date |  |  | 
| 6 | THRU_DT | Claim Through Date |  |  | 
| 7 | WKLY_DT | NCH Weekly Claim Processing Date |  |  | 
| 8 | FI_CLM_PROC_DT | FI Claim Process Date |  |  | 
| 9 | QUERY_CD | Claim Query Code |  | * | 
| 10 | PROVIDER | Provider Number |  | * | 
| 11 | FAC_TYPE | Claim Facility Type Code |  | * | 
| 12 | TYPESRVC | Claim Service Classification Type Code |  | * | 
| 13 | FREQ_CD | Claim Frequency Code |  | * | 
| 14 | FI_NUM | FI Number |  | * | 
| 15 | NOPAY_CD | Claim Medicare Non Payment Reason Code |  | * | 
| 16 | PMT_AMT | Claim Payment Amount | * |  | 
| 17 | PRPAYAMT | NCH Primary Payer Claim Paid Amount* |  |  | 
| 18 | PRPAY_CD | NCH Primary Payer Code |  | * | 
| 19 | ACTIONCD | FI or MAC Claim Action Code |  | * | 
| 20 | PRSTATE | NCH Provider State Code |  | * | 
| 21 | ORGNPINM | Organization NPI Number |  |  | 
| 22 | AT_UPIN | Claim Attending Physician UPIN Number |  |  | 
| 23 | AT_NPI | Claim Attending Physician NPI Number |  |  | 
| 24 | AT_PHYSN_SPCLTY_CD | Claim Attending Physician Specialty Code |  | * | 
| 25 | OP_UPIN | Claim Operating Physician UPIN Number |  |  | 
| 26 | OP_NPI | Claim Operating Physician NPI Number |  |  | 
| 27 | OP_PHYSN_SPCLTY_CD | Claim Operating Physician Specialty Code |  | * | 
| 28 | OT_UPIN | Claim Other Physician UPIN Number |  |  | 
| 29 | OT_NPI | Claim Other Physician NPI Number |  |  | 
| 30 | OT_PHYSN_SPCLTY_CD | Claim Other Physician Specialty Code |  | * | 
| 31 | RNDRNG_PHYSN_NPI | Claim Rendering Physician NPI Number |  |  | 
| 32 | RNDRNG_PHYSN_SPCLTY_CD | Claim Rendering Physician Specialty Code |  | * | 
| 33 | MCOPDSW | Claim MCO Paid Switch | * | * | 
| 34 | STUS_CD | Patient Discharge Status Code |  | * | 
| 35 | PPS_IND | Claim PPS Indicator Code |  | * | 
| 36 | TOT_CHRG | Claim Total Charge Amount | * | * | 
| 37 | ADMSN_DT | Claim Admission Date |  |  | 
| 38 | TYPE_ADM | Claim Inpatient Admission Type Code |  | * | 
| 39 | SRC_ADMS | Claim Source Inpatient Admission Code |  | * | 
| 40 | PTNTSTUS | NCH Patient Status Indicator Code |  | * | 
| 41 | PER_DIEM | Claim Pass Thru Per Diem Amount |  |  | 
| 42 | DED_AMT | NCH Beneficiary Inpatient Deductible Amount |  | * | 
| 43 | COIN_AMT | NCH Beneficiary Part A Coinsurance Liability Amount |  | * | 
| 44 | BLDDEDAM | NCH Beneficiary Blood Deductible Liability Amount |  | * | 
| 45 | PCCHGAMT | NCH Professional Component Charge Amount |  | * | 
| 46 | NCCHGAMT | NCH Inpatient Noncovered Charge Amount |  | * | 
| 47 | TDEDAMT | NCH Inpatient Total Deduction Amount |  | * | 
| 48 | PPS_CPTL | Claim Total PPS Capital Amount |  | * | 
| 49 | CPTL_FSP | Claim PPS Capital FSP Amount |  | * | 
| 50 | CPTLOUTL | Claim PPS Capital Outlier Amount |  | * | 
| 51 | DISP_SHR | Claim PPS Capital Disproportionate Share Amount |  |  | 
| 52 | IME_AMT | Claim PPS Capital IME Amount |  |  | 
| 53 | CPTL_EXP | Claim PPS Capital Exception Amount |  | * | 
| 54 | HLDHRMLS | Claim PPS Old Capital Hold Harmless Amount |  |  | 
| 55 | DRGWTAMT | Claim PPS Capital DRG Weight Number | * |  | 
| 56 | UTIL_DAY | Claim Utilization Day Count |  |  | 
| 57 | COIN_DAY | Beneficiary Total Coinsurance Days Count |  |  | 
| 58 | LRD_USE | Beneficiary LRD Used Count |  |  | 
| 59 | NUTILDAY | Claim Non Utilization Days Count |  |  | 
| 60 | BLDFRNSH | NCH Blood Pints Furnished Quantity |  |  | 
| 61 | NCOVFROM | NCH Verified Noncovered Stay From Date |  |  | 
| 62 | NCOVTHRU | NCH Verified Noncovered Stay Through Date |  |  | 
| 63 | CARETHRU | NCH Active or Covered Level Care Thru Date |  |  | 
| 64 | EXHST_DT | NCH Beneficiary Medicare Benefits Exhausted Date |  |  | 
| 65 | DSCHRGDT | NCH Beneficiary Discharge Date |  |  | 
| 66 | DRG_CD | Claim Diagnosis Related Group Code |  |  | 
| 67 | OUTLR_CD | Claim Diagnosis Related Group Outlier Stay Code |  | * | 
| 68 | OUTLRPMT | NCH DRG Outlier Approved Payment Amount |  |  | 
| 69 | ADMTG_DGNS_CD | Claim Admitting Diagnosis Code |  |  | 
| 70 | PRNCPAL_DGNS_CD | Claim Principal Diagnosis Code |  |  | 
| 71 | ICD_DGNS_CD1 | Claim Diagnosis Code I |  |  | 
| 72 | CLM POA IND SW1 | Claim Diagnosis Code I Diagnosis Present on Admission Indicator Code | * | * | 
| 73 | ICD_DGNS_CD2 | Claim Diagnosis Code II |  |  | 
| 74 | CLM POA IND SW2 | Claim Diagnosis Code II Diagnosis Present on Admission Indicator Code |  | * | 
| 75 | ICD_DGNS_CD3 | Claim Diagnosis Code III |  |  | 
| 76 | CLM POA IND SW3 | Claim Diagnosis Code III Diagnosis Present on Admission Indicator Code |  | * | 
| 77 | ICD_DGNS_CD4 | Claim Diagnosis Code IV |  |  | 
| 78 | CLM POA IND SW4 | Claim Diagnosis Code IV Diagnosis Present on Admission Indicator Code |  | * | 
| 79 | ICD_DGNS_CD5 | Claim Diagnosis Code V |  |  | 
| 80 | CLM POA IND SW5 | Claim Diagnosis Code V Diagnosis Present on Admission Indicator Code |  | * | 
| 81 | ICD_DGNS_CD6 | Claim Diagnosis Code VI |  |  | 
| 82 | CLM POA IND SW6 | Claim Diagnosis Code VI Diagnosis Present on Admission Indicator Code |  | * | 
| 83 | ICD_DGNS_CD7 | Claim Diagnosis Code VII |  |  | 
| 84 | CLM POA IND SW7 | Claim Diagnosis Code VII Diagnosis Present on Admission Indicator Code |  | * | 
| 85 | ICD_DGNS_CD8 | Claim Diagnosis Code VIII |  |  | 
| 86 | CLM POA IND SW8 | Claim Diagnosis Code VIII Diagnosis Present on Admission Indicator Code |  | * | 
| 87 | ICD_DGNS_CD9 | Claim Diagnosis Code IX |  |  | 
| 88 | CLM POA IND SW9 | Claim Diagnosis Code IX Diagnosis Present on Admission Indicator Code |  | * | 
| 89 | ICD_DGNS_CD10 | Claim Diagnosis Code X |  |  | 
| 90 | CLM POA IND SW10 | Claim Diagnosis Code X Diagnosis Present on Admission Indicator Code |  | * | 
| 91 | ICD_DGNS_CD11 | Claim Diagnosis Code XI |  |  | 
| 92 | CLM POA IND SW11 | Claim Diagnosis Code XI Diagnosis Present on Admission Indicator Code |  | * | 
| 93 | ICD_DGNS_CD12 | Claim Diagnosis Code XII |  |  | 
| 94 | CLM POA IND SW12 | Claim Diagnosis Code XII Diagnosis Present on Admission Indicator Code |  | * | 
| 95 | ICD_DGNS_CD13 | Claim Diagnosis Code XIII |  |  | 
| 96 | CLM POA IND SW13 | Claim Diagnosis Code XIII Diagnosis Present on Admission Indicator Code |  | * | 
| 97 | ICD_DGNS_CD14 | Claim Diagnosis Code XIV |  |  | 
| 98 | CLM POA IND SW14 | Claim Diagnosis Code XIV Diagnosis Present on Admission Indicator Code |  | * | 
| 99 | ICD_DGNS_CD15 | Claim Diagnosis Code XV |  |  | 
| 100 | CLM POA IND SW15 | Claim Diagnosis Code XV Diagnosis Present on Admission Indicator Code |  | * | 
| 101 | ICD_DGNS_CD16 | Claim Diagnosis Code XVI |  |  | 
| 102 | CLM POA IND SW16 | Claim Diagnosis Code XVI Diagnosis Present on Admission Indicator Code |  | * | 
| 103 | ICD_DGNS_CD17 | Claim Diagnosis Code XVII |  |  | 
| 104 | CLM POA IND SW17 | Claim Diagnosis Code XVII Diagnosis Present on Admission Indicator Code |  | * | 
| 105 | ICD_DGNS_CD18 | Claim Diagnosis Code XVIII |  |  | 
| 106 | CLM POA IND SW18 | Claim Diagnosis Code XVIII Diagnosis Present on Admission Indicator Code |  | * | 
| 107 | ICD_DGNS_CD19 | Claim Diagnosis Code XIX |  |  | 
| 108 | CLM POA IND SW19 | Claim Diagnosis Code XIX Diagnosis Present on Admission Indicator Code |  | * | 
| 109 | ICD_DGNS_CD20 | Claim Diagnosis Code XX |  |  | 
| 110 | CLM POA IND SW20 | Claim Diagnosis Code XX Diagnosis Present on Admission Indicator Code |  | * | 
| 111 | ICD_DGNS_CD21 | Claim Diagnosis Code XXI |  |  | 
| 112 | CLM POA IND SW21 | Claim Diagnosis Code XXI Diagnosis Present on Admission Indicator Code |  | * | 
| 113 | ICD_DGNS_CD22 | Claim Diagnosis Code XXII |  |  | 
| 114 | CLM POA IND SW22 | Claim Diagnosis Code XXII Diagnosis Present on Admission Indicator Code |  | * | 
| 115 | ICD_DGNS_CD23 | Claim Diagnosis Code XXIII |  |  | 
| 116 | CLM POA IND SW23 | Claim Diagnosis Code XXIII Diagnosis Present on Admission Indicator Code |  | * | 
| 117 | ICD_DGNS_CD24 | Claim Diagnosis Code XXIV |  |  | 
| 118 | CLM POA IND SW24 | Claim Diagnosis Code XXIV Diagnosis Present on Admission Indicator Code |  | * | 
| 119 | ICD_DGNS_CD25 | Claim Diagnosis Code XXV |  |  | 
| 120 | CLM POA IND SW25 | Claim Diagnosis Code XXV Diagnosis Present on Admission Indicator Code |  | * | 
| 121 | FST_DGNS_E_CD | First Claim Diagnosis E Code |  |  | 
| 122 | ICD_DGNS_E_CD1 | Claim Diagnosis E Code I |  |  | 
| 123 | CLM E POA IND SW1 | Claim Diagnosis E Code I Diagnosis Present on Admission Indicator Code |  | * | 
| 124 | ICD_DGNS_E_CD2 | Claim Diagnosis E Code II |  |  | 
| 125 | CLM E POA IND SW2 | Claim Diagnosis E Code II Diagnosis Present on Admission Indicator Code |  | * | 
| 126 | ICD_DGNS_E_CD3 | Claim Diagnosis E Code III |  |  | 
| 127 | CLM E POA IND SW3 | Claim Diagnosis E Code III Diagnosis Present on Admission Indicator Code |  | * | 
| 128 | ICD_DGNS_E_CD4 | Claim Diagnosis E Code IV |  |  | 
| 129 | CLM E POA IND SW4 | Claim Diagnosis E Code IV Diagnosis Present on Admission Indicator Code |  | * | 
| 130 | ICD_DGNS_E_CD5 | Claim Diagnosis E Code V |  |  | 
| 131 | CLM E POA IND SW5 | Claim Diagnosis E Code V Diagnosis Present on Admission Indicator Code |  | * | 
| 132 | ICD_DGNS_E_CD6 | Claim Diagnosis E Code VI |  |  | 
| 133 | CLM E POA IND SW6 | Claim Diagnosis E Code VI Diagnosis Present on Admission Indicator Code |  | * | 
| 134 | ICD_DGNS_E_CD7 | Claim Diagnosis E Code VII |  |  | 
| 135 | CLM E POA IND SW7 | Claim Diagnosis E Code VII Diagnosis Present on Admission Indicator Code |  | * | 
| 136 | ICD_DGNS_E_CD8 | Claim Diagnosis E Code VIII |  |  | 
| 137 | CLM E POA IND SW8 | Claim Diagnosis E Code VIII Diagnosis Present on Admission Indicator Code |  | * | 
| 138 | ICD_DGNS_E_CD9 | Claim Diagnosis E Code IX |  |  | 
| 139 | CLM E POA IND SW9 | Claim Diagnosis E Code IX Diagnosis Present on Admission Indicator Code |  | * | 
| 140 | ICD_DGNS_E_CD10 | Claim Diagnosis E Code X |  |  | 
| 141 | CLM E POA IND SW10 | Claim Diagnosis E Code X Diagnosis Present on Admission Indicator Code |  | * | 
| 142 | ICD_DGNS_E_CD11 | Claim Diagnosis E Code XI |  |  | 
| 143 | CLM E POA IND SW11 | Claim Diagnosis E Code XI Diagnosis Present on Admission Indicator Code |  | * | 
| 144 | ICD_DGNS_E_CD12 | Claim Diagnosis E Code XII |  |  | 
| 145 | CLM E POA IND SW12 | Claim Diagnosis E Code XII Diagnosis Present on Admission Indicator Code |  | * | 
| 146 | ICD_PRCDR_CD1 | Claim Procedure Code I |  |  | 
| 147 | PRCDR_DT1 | Claim Procedure Code I Date |  |  | 
| 148 | ICD_PRCDR_CD2 | Claim Procedure Code II |  |  | 
| 149 | PRCDR_DT2 | Claim Procedure Code II Date |  |  | 
| 150 | ICD_PRCDR_CD3 | Claim Procedure Code III |  |  | 
| 151 | PRCDR_DT3 | Claim Procedure Code III Date |  |  | 
| 152 | ICD_PRCDR_CD4 | Claim Procedure Code IV |  |  | 
| 153 | PRCDR_DT4 | Claim Procedure Code IV Date |  |  | 
| 154 | ICD_PRCDR_CD5 | Claim Procedure Code V |  |  | 
| 155 | PRCDR_DT5 | Claim Procedure Code V Date |  |  | 
| 156 | ICD_PRCDR_CD6 | Claim Procedure Code VI |  |  | 
| 157 | PRCDR_DT6 | Claim Procedure Code VI Date |  |  | 
| 158 | ICD_PRCDR_CD7 | Claim Procedure Code VII |  |  | 
| 159 | PRCDR_DT7 | Claim Procedure Code VII Date |  |  | 
| 160 | ICD_PRCDR_CD8 | Claim Procedure Code VIII |  |  | 
| 161 | PRCDR_DT8 | Claim Procedure Code VIII Date |  |  | 
| 162 | ICD_PRCDR_CD9 | Claim Procedure Code IX |  |  | 
| 163 | PRCDR_DT9 | Claim Procedure Code IX Date |  |  | 
| 164 | ICD_PRCDR_CD10 | Claim Procedure Code X |  |  | 
| 165 | PRCDR_DT10 | Claim Procedure Code X Date |  |  | 
| 166 | ICD_PRCDR_CD11 | Claim Procedure Code XI |  |  | 
| 167 | PRCDR_DT11 | Claim Procedure Code XI Date |  |  | 
| 168 | ICD_PRCDR_CD12 | Claim Procedure Code XII |  |  | 
| 169 | PRCDR_DT12 | Claim Procedure Code XII Date |  |  | 
| 170 | ICD_PRCDR_CD13 | Claim Procedure Code XIII |  |  | 
| 171 | PRCDR_DT13 | Claim Procedure Code XIII Date |  |  | 
| 172 | ICD_PRCDR_CD14 | Claim Procedure Code XIV |  |  | 
| 173 | PRCDR_DT14 | Claim Procedure Code XIV Date |  |  | 
| 174 | ICD_PRCDR_CD15 | Claim Procedure Code XV |  |  | 
| 175 | PRCDR_DT15 | Claim Procedure Code XV Date |  |  | 
| 176 | ICD_PRCDR_CD16 | Claim Procedure Code XVI |  |  | 
| 177 | PRCDR_DT16 | Claim Procedure Code XVI Date |  |  | 
| 178 | ICD_PRCDR_CD17 | Claim Procedure Code XVII |  |  | 
| 179 | PRCDR_DT17 | Claim Procedure Code XVII Date |  |  | 
| 180 | ICD_PRCDR_CD18 | Claim Procedure Code XVIII |  |  | 
| 181 | PRCDR_DT18 | Claim Procedure Code XVIII Date |  |  | 
| 182 | ICD_PRCDR_CD19 | Claim Procedure Code XIX |  |  | 
| 183 | PRCDR_DT19 | Claim Procedure Code XIX Date |  |  | 
| 184 | ICD_PRCDR_CD20 | Claim Procedure Code XX |  |  | 
| 185 | PRCDR_DT20 | Claim Procedure Code XX Date |  |  | 
| 186 | ICD_PRCDR_CD21 | Claim Procedure Code XXI |  |  | 
| 187 | PRCDR_DT21 | Claim Procedure Code XXI Date |  |  | 
| 188 | ICD_PRCDR_CD22 | Claim Procedure Code XXII |  |  | 
| 189 | PRCDR_DT22 | Claim Procedure Code XXII Date |  |  | 
| 190 | ICD_PRCDR_CD23 | Claim Procedure Code XXIII |  |  | 
| 191 | PRCDR_DT23 | Claim Procedure Code XXIII Date |  |  | 
| 192 | ICD_PRCDR_CD24 | Claim Procedure Code XXIV |  |  | 
| 193 | PRCDR_DT24 | Claim Procedure Code XXIV Date |  |  | 
| 194 | ICD_PRCDR_CD25 | Claim Procedure Code XXV |  |  | 
| 195 | PRCDR_DT25 | Claim Procedure Code XXV Date |  |  | 
| 196 | IME_OP | Operating Indirect Medical Education (IME) Amount* |  |  | 
| 197 | DSH_OP | Operating Disproportionate Share Amount* |  | * | 
| 198 | DOB_DT | Date of Birth from Claim (Date) |  |  | 
| 199 | GNDR_CD | Gender Code from Claim |  | * | 
| 200 | RACE_CD | Race Code from Claim |  | * | 
| 201 | CNTY_CD | County Code from Claim (SSA) |  |  | 
| 202 | STATE_CD | State Code from Claim (SSA) |  | * | 
| 203 | ZIP_CD | Zip Code of Residence from Claim |  |  | 
| 204 | CLM_MDCL_REC | Claim Medical Record Number |  |  | 
| 205 | CLM_TRTMT_AUTHRZTN_NUM | Claim Treatment Authorization Number |  | * | 
| 206 | CLM_PRCR_RTRN_CD | Claim Pricer Return Code |  | * | 
| 207 | CLM_SRVC_FAC_ZIP_CD | Claim service facility ZIP code (where service was provided) |  | * | 
| 208 | CLM_IP_LOW_VOL_PMT_AMT | Claim Inpatient Low Volume Payment Amount |  | * | 
| 209 | CLM_CARE_IMPRVMT_MODEL_CD1 | Claim Care Improvement Model 1 Code (bundled payment) |  | * | 
| 210 | CLM_CARE_IMPRVMT_MODEL_CD2 | Claim Care Improvement Model 2 Code |  | * | 
| 211 | CLM_CARE_IMPRVMT_MODEL_CD3 | Claim Care Improvement Model 3 Code |  | * | 
| 212 | CLM_CARE_IMPRVMT_MODEL_CD4 | Claim Care Improvement Model 4 Code |  | * | 
| 213 | CLM_BNDLD_MODEL_1_DSCNT_PCT | Claim Bundled Model 1 Discount Percent |  | * | 
| 214 | CLM_BASE_OPRTG_DRG_AMT | Claim Base Operating DRG Amount |  |  | 
| 215 | CLM_VBP_PRTCPNT_IND_CD | Claim Value-Based Purchasing (VBP) Participant Indicator Code |  | * | 
| 216 | CLM_VBP_ADJSTMT_PCT | Claim VBP Adjustment Percent |  | * | 
| 217 | CLM_HRR_PRTCPNT_IND_CD | Claim Hospital Readmission Reduction (HRR) Participant Indicator Code |  | * | 
| 218 | CLM_HRR_ADJSTMT_PCT | Claim HRR Adjustment Percent |  | * | 
| 219 | CLM_MODEL_4_READMSN_IND_CD | Claim Model 4 Readmission Indicator Code |  | * | 
| 220 | CLM_UNCOMPD_CARE_PMT_AMT | Claim Uncompensated Care Payment Amount |  | * | 
| 221 | CLM_BNDLD_ADJSTMT_PMT_AMT | Claim Bundled Adjustment Payment Amount |  | * | 
| 222 | CLM_VBP_ADJSTMT_PMT_AMT | Claim Value Based Purchasing Adjustment Payment Amount |  | * | 
| 223 | CLM_HRR_ADJSTMT_PMT_AMT | Claim Hospital Readmission Reduction (HRR) Adjustment Payment Amount |  | * | 
| 224 | EHR_PYMT_ADJSTMT_AMT | Claim Electronic Health Record (EHR) Payment Adjustment Amount |  | * | 
| 225 | PPS_STD_VAL_PYMT_AMT | Standard Payment Amount |  | * | 
| 226 | FINL_STD_AMT | Claim Final Standard Payment Amount |  | * | 
| 227 | HAC_PGM_RDCTN_IND_SW | Claim Hospital Acquired Condition (HAC) Program Reduction Indicator Switch |  | * | 
| 228 | EHR_PGM_RDCTN_IND_SW | Claim Electronic Health Records (EHR) Program Reduction Indicator Switch |  | * | 
| 229 | CLM_SITE_NTRL_PYMT_CST_AMT | Claim Site Neutral Payment Based on Cost Amount |  | * | 
| 230 | CLM_SITE_NTRL_PYMT_IPPS_AMT | Claim Site Neutral Payment Based on inpatient prospective payment system (IPPS) Amounts |  | * | 
| 231 | CLM_FULL_STD_PYMT_AMT | Claim Full Standard Payment Amount |  | * | 
| 232 | CLM_SS_OUTLIER_STD_PYMT_AMT | Claim Short Stay Outlier (SSO) Standard Payment Amount |  | * | 
| 233 | CLM_NEXT_GNRTN_ACO_IND_1_CD | Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP) |  | * | 
| 234 | CLM_NEXT_GNRTN_ACO_IND_2_CD | Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth |  | * | 
| 235 | CLM_NEXT_GNRTN_ACO_IND_3_CD | Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits |  | * | 
| 236 | CLM_NEXT_GNRTN_ACO_IND_4_CD | Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver |  | * | 
| 237 | CLM_NEXT_GNRTN_ACO_IND_5_CD | Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation |  | * | 
| 238 | ACO_ID_NUM | Claim Accountable Care Organization (ACO) Identification Number |  |  |