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 |
|
|