West Virginia Medicaid Data Dictionary

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Drug
Professional
Eligibility
Facility Header
Facility Detail

Field name

337 fields found.

Adjustment Reason Code (Adjustment_Reason_Code)

Data type: Char
Found in: Drug, Facility Header
Description: Client-specific code for the reason the claim was adjusted.

Adjustment Type Code (Adjustment_Type_Code)

Data type: Char
Found in: Drug, Facility Header
Description: Client-specific code for the type of adjustment for the claim. The corresponding Medstat Advantage Suite standard field is Adjustment Type Code Medstat.

Adjustment Type Code Medstat (Adjustment_Type_Code_Medstat)

Data type: Char
Found in: Drug, Facility Header
Description: The Medstat Advantage Suite standard code for the type of adjustment for the claim.

Admit Source Code UB (Admit_Source_Code_UB)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the admission source on a facility claim.

Admit Type Code UB (Admit_Type_Code_UB)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the type of admission, indicating the priority of the admission or visit, on a facility claim

Aid Category Claim Code (Aid_Category_Claim_Code)

Data type: Char
Found in: Facility Header
Description: Client specific code for he local aid category as reported on the claim record.

Aid Category Code (Aid_Category_Code)

Data type: Char
Found in: Facility Header
Description: Client-specific code for the local aid category.

Allowed Amount Total Claim (Allowed__Amount_Total_Claim)

Data type: Num
Found in: Professional, Facility Header
Description: The total maximum amount allowed by the plan for payment of the claim.

Allowed Amount (Allowed_Amount)

Data type: Num
Found in: Drug, Professional
Description: The maximum amount allowed by the plan for payment. This is the allowed amount at the detail line

Attending Provider ID (Attending_Provider_ID)

Data type: Char
Found in: Facility Header
Description: The identifier of the Attending QNXT Provider ID

Benefit Plan Claim Code (Benefit_Plan_Claim_Code)

Data type: Char
Found in: Facility Header
Description: The benefit Plan for the member that is populated at the time of claim payment.

BHHF Claim Indicator (BHHF_Claim_Indicator)

Data type: Char
Found in: Facility Header
Description: An Indicator that this claim is a BHHF claim. BHHF claims need to be excluded from bottom line calculations for budget.

Bill Type Code UB (Bill_Type_Code_UB)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the billing type on a facility claim, indicating type of facility, bill classification, and frequency of bill.

BMS Provider ID (BMS_Provider_ID)

Data type: Char
Found in: Facility Header

Business Paid Quarter (Business_Paid_Quarter)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The claim period code representing the 6 digit business paid quarter (YYYYnQ).

Calculated FFS Header Amount (Calculated_FFS_Header_Amount)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: Calculated FFS paid amount for an MCO encounter claim at the claim HEADER level and also will include FFS paid amount at the HEADER level

Calculated FFS Line Amount (Calculated_FFS_Line_Amount)

Data type: Num
Found in: Drug, Professional, Facility Detail
Description: Calculated FFS paid amount for an MCO encounter claim at the claim LINE level and also will include FFS paid amount at the LINE level

Capitated Facility Claim Indicator (Capitated_Facility_Claim_Indicat)

Data type: Char
Found in: Facility Header
Description: An indicator that all services on the facility claim were capitated services.

Category of Service Code (Category_of_Service_Code)

Data type: Num
Found in: Facility Header
Description: Client-specific code for the category of service on the claim.

Charge Submitted (Charge_Submitted)

Data type: Num
Found in: Drug, Professional
Description: The submitted or billed charge amount. This is the submitted charge from the detail line.

Charge Submitted Total Claim (Charge_Submitted_Total_Claim)

Data type: Num
Found in: Facility Header
Description: The total submitted or billed charge amount for the claim.

CHIP member Indicator (CHIP_member_Indicator)

Data type: Char
Found in: Eligibility
Description: An indicator that the person is included in the CHIP (Child Health Insurance Program) program.

Claim Header Refund Amount (Claim_Header_Refund_Amount)

Data type: Num
Found in: Facility Header
Description: Total dollar amount refunded by the provider

Claim ID (Claim_ID)

Data type: Char
Found in: Drug, Professional, Facility Header, Facility Detail
Description: The client-specific unique identifier of the claim. The claim identifier must not be duplicated across claim sources or data sources.

Claim ID Original (Claim_ID_Original)

Data type: Char
Found in: Drug, Professional, Facility Header, Facility Detail
Description: The Claim ID of the original claim. This will be populated on a void claim to reference the Original claim.

Claim ID Reversal (Claim_ID_Reversal)

Data type: Char
Found in: Drug, Professional, Facility Header, Facility Detail
Description: The Claim ID of the reversal claim. This will be populated on the adjustment or replacement claim to reference the Reversal or Void claim.

Claim Line Refund Amount (Claim_Line_Refund_Amount)

Data type: Num
Found in: Professional
Description: Amount refunded for this claim line by the provider.

Claim Line Refund Amount char (Claim_Line_Refund_Amount_char)

Data type: Char
Found in: Professional

Claim Source ID Code (Claim_Source_ID_Code)

Data type: Char
Found in: Professional, Facility Header
Description: Stores where claim was created from such as Manual, EDI, MCO encounter or Scanned

Claim Status Code (Claim_Status_Code)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: Client-specific code for the claim payment status at the header.

Claim Status Code Detail (Claim_Status_Code_Detail)

Data type: Char
Found in: Drug, Professional, Facility Detail
Description: Client-specific code for the claim payment status at the detail line

Claim Type Code (Claim_Type_Code)

Data type: Num
Found in: Drug, Professional
Description: Client-specific code for the claim payment status at the header.

Claim Type Code Medstat (Claim_Type_Code_Medstat)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The Medstat Advantage Suite standard code for the coverage type under which the claim was paid

Claim Type Code MSIS (Claim_Type_Code_MSIS)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The standard MSIS (CMS) code for the claim type.

Condition Code UB 1 (Condition_Code_UB_1)

Data type: Char
Found in: Facility Header
Description: The first standard UB Condition Code on the facility claim.

Condition Code UB 2 (Condition_Code_UB_2)

Data type: Char
Found in: Facility Header
Description: The second standard UB Condition Code on the facility claim.

Condition Code UB 3 (Condition_Code_UB_3)

Data type: Char
Found in: Facility Header
Description: The third standard UB Condition Code on the facility claim.

Condition Code UB 4 (Condition_Code_UB_4)

Data type: Char
Found in: Facility Header
Description: The fourth standard UB Condition Code on the facility claim.

Condition Code UB 5 (Condition_Code_UB_5)

Data type: Char
Found in: Facility Header
Description: The fifth standard UB Condition Code on the facility claim.

Condition Code UB 6 (Condition_Code_UB_6)

Data type: Char
Found in: Facility Header
Description: The sixth standard UB Condition Code on the facility claim.

Condition Code UB 7 (Condition_Code_UB_7)

Data type: Char
Found in: Facility Header
Description: The seventh standard UB Condition Code on the facility claim.

Condition Code UB 8 (Condition_Code_UB_8)

Data type: Char
Found in: Facility Header
Description: The eighth standard UB Condition Code on the facility claim.

Condition Code UB 9 (Condition_Code_UB_9)

Data type: Char
Found in: Facility Header
Description: The ninth standard UB Condition Code on the facility claim.

Contract ID Code (Contract_ID_Code)

Data type: Char
Found in: Facility Header
Description: The contract code associated with the servicing provider. This contract information will be used to calculate the contract dollars for the claim.

Contract Term ID (Contract_Term_ID)

Data type: Char
Found in: Facility Header
Description: The unique identification number of the term under which the claim line was paid. The types of services that the provider can provide.

Copayment (Copayment)

Data type: Num
Found in: Drug, Facility Header
Description: The copayment paid by the subscriber as specified in the plan provision.

County Code (County_Code)

Data type: Num
Found in: Eligibility
Description: The county code for the residence of the person.

County Code Claim (County_Code_Claim)

Data type: Num
Found in: Facility Header
Description: The BMS County code for the member's county at the time of the claim.

Coverage Indicator Dental (Coverage_Indicator_Dental)

Data type: Char
Found in: Eligibility
Description: An indicator of dental benefit coverage for the member or employee

Coverage Indicator Drug (Coverage_Indicator_Drug)

Data type: Char
Found in: Eligibility
Description: An indicator of drug benefit coverage for the member or employee.

Coverage Indicator Hearing (Coverage_Indicator_Hearing)

Data type: Char
Found in: Eligibility
Description: An indicator of hearing benefit coverage for the member or employee.

Coverage Indicator Medical (Coverage_Indicator_Medical)

Data type: Char
Found in: Eligibility
Description: An indicator of medical benefit coverage for the member or employee.

Coverage Indicator MHSA (Coverage_Indicator_MHSA)

Data type: Char
Found in: Eligibility
Description: An indicator of Mental Health and Substance Abuse benefit coverage for the member or employee.

Coverage Indicator Vision (Coverage_Indicator_Vision)

Data type: Char
Found in: Eligibility
Description: An indicator of vision benefit coverage for the member or employee.

Crossover Claim Indicator (Crossover_Claim_Indicator)

Data type: Char
Found in: Facility Header
Description: Indicates if the claims is a Crossover claim.

Data Source Code (Data_Source_Code)

Data type: Char
Found in: Facility Header
Description: A Code indicating the source of the data files (i.e. Molina, Lewin, BPH)

Date Claim Created (Date_Claim_Created)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The date the claim record was created in the WVMMIS

Date Claim Received (Date_Claim_Received)

Data type: Num
Found in: Drug, Professional
Description: The Date of Receipt for the claim.

Date of Adjudication (Date_of_Adjudication)

Data type: Num
Found in: Facility Header
Description: The Date of Adjudication for this claim.

Date of Admit Facility (Date_of_Admit_Facility)

Data type: Num
Found in: Facility Header
Description: The date of admission to a facility.

Date of Birth (Date_of_Birth)

Data type: Num
Found in: Eligibility
Description: The birthdate of the member.

Date of Death (Date_of_Death)

Data type: Num
Found in: Eligibility
Description: The Deathdate of the member.

Date of Discharge Facility (Date_of_Discharge_Facility)

Data type: Num
Found in: Facility Header
Description: Date of Discharge Facility

Date of Eligibility End (Date_of_Eligibility_End)

Data type: Num
Found in: Eligibility
Description: The last date of eligibility within the eligibility month.

Date of Eligibility Start (Date_of_Eligibility_Start)

Data type: Num
Found in: Eligibility
Description: The first date of eligibility within the eligibility month.

Date of First Service (Date_of_First_Service)

Data type: Num
Found in: Professional, Facility Header
Description: The date of the first service reported on the claim or authorization record.

Date of last Service (Date_of_last_Service)

Data type: Num
Found in: Professional, Facility Header
Description: The date of the last service reported on the claim or authorization record.

Date of Serivce End Detail (Date_of_Serivce_End_Detail)

Data type: Num
Found in: Professional, Facility Detail
Description: The Ending or Through Date of Service for this claim detail line.

Date of Service (Date_of_Service)

Data type: Num
Found in: Drug
Description: The date of service for the financial, drug claim, survey, or lab result record.

Date of Service Facility Detail (Date_of_Service_Facility_Detail)

Data type: Num
Found in: Facility Detail
Description: The date of service for the facility detail record.

Date Paid (Date_Paid)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The date the claim or data record was paid. This date identifies the Paid Category for Advantage Suite reporting.

Date Prescribed (Date_Prescribed)

Data type: Num
Found in: Drug
Description: The date of the prescription for a drug claim.

Date TPL Paid (Date_TPL_Paid)

Data type: Num
Found in: Professional, Facility Header
Description: The date the insurance was paid

Days (Days)

Data type: Num
Found in: Facility Header
Description: The number of inpatient days for the facility claim.

Days Covered (Days_Covered)

Data type: Num
Found in: Facility Header
Description: The number of inpatient days on the claim that are covered by the plan.

Days LTC Hospital Leave (Days_LTC_Hospital_Leave)

Data type: Num
Found in: Facility Header
Description: The number of days the LTC (long term care) recipient was on hospital leave for the month.

Days LTC Therapeutic Leave (Days_LTC_Therapeutic_Leave)

Data type: Num
Found in: Facility Header
Description: The number of Therapeutic Leave days for the LTC claim.

Days Not Covered (Days_Not_Covered)

Data type: Num
Found in: Facility Header
Description: The number of inpatient days on the claim that are not covered by the plan.

Days Supply (Days_Supply)

Data type: Num
Found in: Drug
Description: The number of days of drug therapy covered by this prescription.

Deductible (Deductible)

Data type: Num
Found in: Drug
Description: The Deductible for the claim

Diabetes Education Indicator (Diabetes_Education_Indicator)

Data type: Char
Found in: Eligibility
Description: Indicates the Condition Code for Diabetes Education on the eligibility file

Diabetes Management Indicator (Diabetes_Management_Indicator)

Data type: Char
Found in: Eligibility
Description: Indicates the Condition Code for Diabetes Management on the eligibility file

Diagnosis Code 02 (Diagnosis_Code_02)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 03 (Diagnosis_Code_03)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 04 (Diagnosis_Code_04)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 05 (Diagnosis_Code_05)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 06 (Diagnosis_Code_06)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 07 (Diagnosis_Code_07)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 08 (Diagnosis_Code_08)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 09 (Diagnosis_Code_09)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 10 (Diagnosis_Code_10)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 11 (Diagnosis_Code_11)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 12 (Diagnosis_Code_12)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 13 (Diagnosis_Code_13)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 14 (Diagnosis_Code_14)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 15 (Diagnosis_Code_15)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 16 (Diagnosis_Code_16)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 17 (Diagnosis_Code_17)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 18 (Diagnosis_Code_18)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 19 (Diagnosis_Code_19)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 20 (Diagnosis_Code_20)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 21 (Diagnosis_Code_21)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 22 (Diagnosis_Code_22)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 23 (Diagnosis_Code_23)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 24 (Diagnosis_Code_24)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code 25 (Diagnosis_Code_25)

Data type: Char
Found in: Professional, Facility Header
Description: A secondary diagnosis code for the medical claim.

Diagnosis Code Admit UB (Diagnosis_Code_Admit_UB)

Data type: Char
Found in: Facility Header
Description: A code indicating the ICD-9 admitting diagnosis code on the facility claim record.

Diagnosis Code Principal (Diagnosis_Code_Principal)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The first or principal diagnosis code for a service, claim, or lab result.

Discharge Hour (Discharge_Hour)

Data type: Char
Found in: Facility Header
Description: The hour of discharge from the facility.

Discharge Status Code UB (Discharge_Status_Code_UB)

Data type: Num
Found in: Facility Header
Description: The UB standard patient status code on the facility claim, indicating patient disposition at the time of billing.

DME Indicator (DME_Indicator)

Data type: Num
Found in: Drug, Professional

DRG MCO Recalculated Code (DRG_MCO_Recalculated_Code)

Data type: Char
Found in: Facility Header
Description: DRG code assigned during data aggregation processing by Lewin. This will only be populated on Encounter claims

DRG MS of Payment Code (DRG_MS_of_Payment_Code)

Data type: Char
Found in: Facility Header
Description: The Diagnosis Related Group (MS DRG) code under which the claim was paid, as reported on the facility claim.

DRG Outlier Amount (DRG_Outlier_Amount)

Data type: Num
Found in: Facility Header
Description: The Diagnosis Related Group (DRG) outlier amount as report on the facility claim.

DRG Outlier Indicator (DRG_Outlier_Indicator)

Data type: Char
Found in: Facility Header
Description: This is an indicator that the claims was an outlier or eligible for outlier payment.

DRG Version Number Code (DRG_Version_Number_Code)

Data type: Char
Found in: Facility Header
Description: The DRG Version Number Code is based on the date of service

Drug Basis of Cost Code (Drug_Basis_of_Cost_Code)

Data type: Char
Found in: Drug
Description: Code identifying how the reimbursement amount was calculated for Ingredient cost paid.

Drug Clarification Code (Drug_Clarification_Code)

Data type: Char
Found in: Drug
Description: Code indicating the pharmacist is clarifying the submission. This is set when the pharmacist indicates an emergency.

Drug Name Code (Drug_Name_Code)

Data type: Char
Found in: Drug
Description: The drug name code listed on the claim.

Drug Preferred Status Code (Drug_Preferred_Status_Code)

Data type: Char
Found in: Drug
Description: Code identifies if drug is Preferred or Non-Preferred.

Drug Route (Drug_Route)

Data type: Char
Found in: Drug
Description: The Drug Route

Dual Eligibility MSIS Code (Dual_Eligibility_MSIS_Code)

Data type: Char
Found in: Eligibility
Description: The Dual Eligibility MSIS code.

Emergency Indicator (Emergency_Indicator)

Data type: Char
Found in: Facility Header
Description: Indicates if the claimline is an emergency

Encounter Claim MCO (Encounter_Claim_MCO)

Data type: Char
Found in: Professional, Facility Header
Description: Indicates the MCO associated with the Encounter Claim

ER or Observation Room Flag Code (ER_or_Observation_Room_Flag_Code)

Data type: Char
Found in: Facility Header
Description: The code for the flag indicating a facility claim with ER or Observation Room service.

ESRD Indicator (ESRD_Indicator)

Data type: Char
Found in: Eligibility
Description: Indicates the Condition Code for ESRD on the eligibility file

Ethnicity Code (Ethnicity_Code)

Data type: Char
Found in: Eligibility
Description: Client-specific code for the ethnicity of the member.

Exception Indicator (Exception_Indicator)

Data type: Char
Found in: Facility Header
Description: Indicator to mark claim as an exception.

Gender Code (Gender_Code)

Data type: Char
Found in: Eligibility
Description: Code for the gender of the person.

Glucose Level Indicator (Glucose_Level_Indicator)

Data type: Char
Found in: Eligibility
Description: An Indicator for glucose level

HBPE Indicator (HBPE_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: Indicator to mark claim as a hospital claim.

Health Home 1 Bipolar Pilot (Health_Home_1_Bipolar_Pilot)

Data type: Char
Found in: Eligibility

Health Home 2 Bipolar Indicator (Health_Home_2_Bipolar_Indicator)

Data type: Char
Found in: Eligibility

Health Home 3 Diabetes Pilot (Health_Home_3_Diabetes_Pilot)

Data type: Char
Found in: Eligibility

Hemoglobin A1C Indicator (Hemoglobin_A1C_Indicator)

Data type: Char
Found in: Eligibility
Description: An indicator for hemoglobin A1C test based on Member Attribute table.

HMO Indicator (HMO_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: Indicates that the claim is an HMO claim.

Hospital Indicator (Hospital_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: Indicates that claim is a hospital claim.

ICD Version Code (ICD_Version_Code)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The ICD version or qualifier code that identifies either ICD-9 (9) or ICD-10 (0) diagnosis and procedure codes on the facility claim.

IMD Claim Indicator (IMD_Claim_Indicator)

Data type: Char
Found in: Facility Header
Description: Indicates that the claim is an IMD (Institutes of Mental Diseases) demonstration project claim.

Influenza Vaccination Indicator (Influenza_Vaccination_Indicator)

Data type: Char
Found in: Eligibility
Description: An indicator for influenza vaccination, based on Member Attribute table.

Last Claim Indicator (Last_Claim_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: An indicator that identifies whether this claim record is the last or most recent claim.

Line Adjustment Code Indicator (Line_Adjustment_Code_Indicator)

Data type: Char
Found in: Drug, Professional, Facility Detail
Description: Code indicating line adjustment type

Line Adjustment Reason Code (Line_Adjustment_Reason_Code)

Data type: Char
Found in: Drug, Professional, Facility Detail
Description: Claim adjustment reason codes communicate why a service line was paid differently than it was billed

Line Number (Line_Number)

Data type: Num
Found in: Drug, Professional, Facility Detail
Description: The detail line number for the service on the claim.

Load Date Claim Code (Load_Date_Claim_Code)

Data type: Char
Found in: Professional
Description: The date (month and year) the claim record was was loaded into the DW DSS (YYYYMM).

Mammogram Indicator (Mammogram_Indicator)

Data type: Char
Found in: Eligibility
Description: An Indicator for mammogram screening based on the Member Attribute table.

MCO Capitated Service Indicator (MCO_Capitated_Service_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: An indicator that this service (encounter record) was capitated.

MCO Coinsurance Detail Amount (MCO_Coinsurance_Detail_Amount)

Data type: Num
Found in: Professional, Facility Detail

MCO Coinsurance Header Amount (MCO_Coinsurance_Header_Amount)

Data type: Num
Found in: Professional, Facility Header

MCO Deductible Detail Amount (MCO_Deductible_Detail_Amount)

Data type: Num
Found in: Professional, Facility Detail

MCO Deductible Header Amount (MCO_Deductible_Header_Amount)

Data type: Num
Found in: Professional, Facility Header

MCO Encounter Claim Indicator (MCO_Encounter_Claim_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: Indicates if MCO encounter claim.

MCO Manual Encounter Indicator (MCO_Manual_Encounter_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: Indicates if MCO encounter claim entered manually.

MCO Paid Date (MCO_Paid_Date)

Data type: Num
Found in: Professional, Facility Header

MCO Paid Detail Amount (MCO_Paid_Detail_Amount)

Data type: Char
Found in: Professional, Facility Detail

MCO Paid Header Amount (MCO_Paid_Header_Amount)

Data type: Num
Found in: Professional, Facility Header

Media Control ID (Media_Control_ID)

Data type: Char
Found in: Facility Header
Description: An identifier of physical media (name or number for the tape, cartridge, CD, etc.) for the claims or other records.

Media Source Code (Media_Source_Code)

Data type: Char
Found in: Facility Header
Description: A description code of the media source of the claim (paper, manual, or electronic).

Medicare Action Code (Medicare_Action_Code)

Data type: Char
Found in: Facility Header
Description: The Medicare Action Code indicates why a claim was denied from Medicare.

Medicare Amount (Medicare_Amount)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The amount paid by Medicare for the claim

Medicare Coinsurance (Medicare_Coinsurance)

Data type: Num
Found in: Professional, Facility Header

Medicare Coinsurance Detail Amount (Medicare_Coinsurance_Detail_Amou)

Data type: Num
Found in: Professional, Facility Detail
Description: The claim line item record dollar amount applied to the Medicare Coinsurance Amount.

Medicare Deductible (Medicare_Deductible)

Data type: Num
Found in: Professional, Facility Header

Medicare Deductible Detail Amount (Medicare_Deductible_Detail_Amoun)

Data type: Num
Found in: Professional, Facility Detail
Description: The claim line item record dollar amount applied to the Medicare Deductible Amount.

Medicare Paid Detail Amount (Medicare_Paid_Detail_Amount)

Data type: Num
Found in: Professional, Facility Detail
Description: The claim line item record dollar amount paid by Medicare.

Medstat Record ID (Medstat_Record_ID)

Data type: Char
Found in: Facility Header
Description: A unique identifier of each facility, professional or drug claim record, as set by Medstat Advantage Suite.

Metric Quantity Billed (Metric_Quantity_Billed)

Data type: Num
Found in: Drug
Description: The provider billed Metric Quantity.

Metric Quantity Dispensed (Metric_Quantity_Dispensed)

Data type: Num
Found in: Drug
Description: The number of units dispensed for the Drug Claim., as defined by the NCPDP standard format. Metric Quantity Dispensed represents the total numbe rof units or volume dispensed without regard to packaging format. For example a value of 100 may refer to the number of tablets, grams, or millimeters. The last two digits of the NDC number identify how the drug is packaged.

MFP Claim Type (MFP_Claim_Type)

Data type: Char
Found in: Professional, Facility Detail

MSIS Basis of Eligibility Code (MSIS_Basis_of_Eligibility_Code)

Data type: Char
Found in: Eligibility
Description: The MSIS Basis of Eligibility code for the member.

MSIS Maint Assist Status Code (MSIS_Maint_Assist_Status_Code)

Data type: Char
Found in: Eligibility
Description: The MSIS Maintenance Assistance Status defines a category of eligibility for the member.

NDC Number Code (NDC_Number_Code)

Data type: Char
Found in: Drug, Professional, Facility Detail
Description: The FDA (Food and Drug Administration) registered number (without the dashes) for the drug, as reported on the prescription drug claims.

Net Payment (Net_Payment)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The actual check amount for the record

Network Paid Indicator (Network_Paid_Indicator)

Data type: Char
Found in: Professional, Facility Header
Description: An indicator of whether the claim was paid at the in-network or out-of-network level

Not Covered Amount (Not_Covered_Amount)

Data type: Num
Found in: Facility Header
Description: The amount that was not covered on the Encounter claim

Not Covered Reason Code (Not_Covered_Reason_Code)

Data type: Char
Found in: Facility Header
Description: The Not covered Reason Code on the Encounter Claim.

Occurrence Code UB 1 (Occurrence_Code_UB__1)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the first occurrence code on the facility claim.

Occurrence Code UB 10 (Occurrence_Code_UB__10)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the tenth occurrence code on the facility claim.

Occurrence Code UB 2 (Occurrence_Code_UB__2)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the second occurrence code on the facility claim.

Occurrence Code UB 3 (Occurrence_Code_UB__3)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the third occurrence code on the facility claim.

Occurrence Code UB 4 (Occurrence_Code_UB__4)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the fourth occurrence code on the facility claim.

Occurrence Code UB 5 (Occurrence_Code_UB__5)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the fifth occurrence code on the facility claim.

Occurrence Code UB 6 (Occurrence_Code_UB__6)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the sixth occurrence code on the facility claim.

Occurrence Code UB 7 (Occurrence_Code_UB__7)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the seventh occurrence code on the facility claim.

Occurrence Code UB 8 (Occurrence_Code_UB__8)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the eighth occurrence code on the facility claim.

Occurrence Code UB 9 (Occurrence_Code_UB__9)

Data type: Char
Found in: Facility Header
Description: The UB standard code for the ninth occurrence code on the facility claim.

Occurrence From Date 01 (Occurrence_From_Date_01)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the first occurrence code on the facility claim

Occurrence From Date 02 (Occurrence_From_Date_02)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the second occurrence code on the facility claim

Occurrence From Date 03 (Occurrence_From_Date_03)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the third occurrence code on the facility claim

Occurrence From Date 04 (Occurrence_From_Date_04)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the fourth occurrence code on the facility claim

Occurrence From Date 05 (Occurrence_From_Date_05)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the fifth occurrence code on the facility claim

Occurrence From Date 06 (Occurrence_From_Date_06)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the sixth occurrence code on the facility claim

Occurrence From Date 07 (Occurrence_From_Date_07)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the seventh occurrence code on the facility claim

Occurrence From Date 08 (Occurrence_From_Date_08)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the eighth occurrence code on the facility claim

Occurrence From Date 09 (Occurrence_From_Date_09)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the ninth occurrence code on the facility claim

Occurrence From Date 10 (Occurrence_From_Date_10)

Data type: Num
Found in: Facility Header
Description: The From Date associated with the tenth occurrence code on the facility claim

Occurrence Thru Date 01 (Occurrence_Thru_Date_01)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the first occurrence code on the facility claim

Occurrence Thru Date 02 (Occurrence_Thru_Date_02)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the second occurrence code on the facility claim

Occurrence Thru Date 03 (Occurrence_Thru_Date_03)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the third occurrence code on the facility claim

Occurrence Thru Date 04 (Occurrence_Thru_Date_04)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the fourth occurrence code on the facility claim

Occurrence Thru Date 05 (Occurrence_Thru_Date_05)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the fifth occurrence code on the facility claim

Occurrence Thru Date 06 (Occurrence_Thru_Date_06)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the sixth occurrence code on the facility claim

Occurrence Thru Date 07 (Occurrence_Thru_Date_07)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the seventh occurrence code on the facility claim

Occurrence Thru Date 08 (Occurrence_Thru_Date_08)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the eighth occurrence code on the facility claim

Occurrence Thru Date 09 (Occurrence_Thru_Date_09)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the ninth occurrence code on the facility claim

Occurrence Thru Date 10 (Occurrence_Thru_Date_10)

Data type: Num
Found in: Facility Header
Description: The Thru Date associated with the tenth occurrence code on the facility claim

Ordering Provider ID (Ordering_Provider_ID)

Data type: Char
Found in: Drug, Professional
Description: The ID number of the provider who referred the patient, prescribed the drug, or ordered the test or procedure.

PAAS Provider ID (PAAS_Provider_ID)

Data type: Char
Found in: Facility Header
Description: The PAAS Provider QNXT ID on the claim.

PAP Test Indicator (PAP_Test_Indicator)

Data type: Char
Found in: Eligibility
Description: An indicator for PAP (Papanicolaou smear) test based on Member Attribute table.

Patient Resource Applied Amount (Patient_Resource_Applied_Amount)

Data type: Num
Found in: Facility Header
Description: The Amount of Patient Resource from the Pay Tab of the claim.

Patient Resource Billed Amount (Patient_Resource_Billed_Amount)

Data type: Num
Found in: Facility Header
Description: The Amount of Patient Resource billed on the claim

Pay To Provider County Code Claim (Pay_To_Provider_County_Code_Clai)

Data type: Char
Found in: Facility Header
Description: The Pay To Provider County Code as reported on the claim.

Pay To Provider ID (Pay_To_Provider_ID)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The Internal QNXT Provider ID of the Pay-To provider for this claim.

Payment Methodology Code (Payment_Methodology_Code)

Data type: Char
Found in: Professional
Description: The code that identifies how the claim was paid (DRG, Per Diem, etc.)

PCP Group Name Claim (PCP_Group_Name_Claim)

Data type: Char
Found in: Facility Header
Description: The Group Name of the PCP for this encounter claim.

PCP ID (PCP_ID)

Data type: Char
Found in: Eligibility
Description: An identifier of the provider that was assigned as the PCP for the person

PCP ID Claim (PCP_ID_Claim)

Data type: Char
Found in: Facility Header
Description: The ID for the Patient's Primary Care Provider (PCP) that is populated on the MCO Encounter record.

PCP NPI Claim (PCP_NPI_Claim)

Data type: Char
Found in: Facility Header
Description: The NPI of the PCP for this encounter claim.

PCP Specialty Code Claim (PCP_Specialty_Code_Claim)

Data type: Char
Found in: Facility Header
Description: The Provider Specialty code for the patients PCP that is populated on the MCO Encounter record.

PCP Type Code Medstat (PCP_Type_Code_Medstat)

Data type: Char
Found in: Eligibility
Description: The Medstat Advantage Suie Standard code for the specialty of the PCP

Person ID (Person_ID)

Data type: Char
Found in: Drug, Professional, Eligibility, Facility Header, Facility Detail
Description: The unique identifier of the person or member.

Physical Activity Indicator (Physical_Activity_Indicator)

Data type: Char
Found in: Eligibility
Description: An indicator for physical activity based on Member Attribute table.

Place Of Service Code (Place_Of_Service_Code)

Data type: Char
Found in: Drug, Professional, Facility Header

Place of Service Code Medstat (Place_of_Service_Code_Medstat)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: Standard code indicating the place of service

Plan code (Plan_code)

Data type: Char
Found in: Eligibility, Facility Detail
Description: Client-specific code for the plan or product line of the medical plan package.

Plan Code Claim (Plan_Code_Claim)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The code for the plan that the member is enrolled in reported on the claim or encounter.

Plan Option Code (Plan_Option_Code)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The Plan Option code for the member that is populated on encounter and financial records.

Plan Paid Amount Detail (Plan_Paid_Amount_Detail)

Data type: Num
Found in: Facility Header
Description: The amount paid by the plan to the provider for the Managed Care Encounter at the detail line.

Pneumococcal Vaccination Indicator (Pneumococcal_Vaccination_Indicat)

Data type: Char
Found in: Eligibility

Pregnancy Rx Indicator (Pregnancy_Rx_Indicator)

Data type: Char
Found in: Drug
Description: Indicator to mark the claim as a pregnancy.

Present on Admit Code 03 (Present_on_Admit_Code_03)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 04 (Present_on_Admit_Code_04)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 05 (Present_on_Admit_Code_05)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 06 (Present_on_Admit_Code_06)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 07 (Present_on_Admit_Code_07)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 08 (Present_on_Admit_Code_08)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 09 (Present_on_Admit_Code_09)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 10 (Present_on_Admit_Code_10)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 11 (Present_on_Admit_Code_11)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 12 (Present_on_Admit_Code_12)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 13 (Present_on_Admit_Code_13)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 14 (Present_on_Admit_Code_14)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 15 (Present_on_Admit_Code_15)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 16 (Present_on_Admit_Code_16)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 17 (Present_on_Admit_Code_17)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 18 (Present_on_Admit_Code_18)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 19 (Present_on_Admit_Code_19)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 2 (Present_on_Admit_Code_2)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 20 (Present_on_Admit_Code_20)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 21 (Present_on_Admit_Code_21)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 22 (Present_on_Admit_Code_22)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 23 (Present_on_Admit_Code_23)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 24 (Present_on_Admit_Code_24)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code 25 (Present_on_Admit_Code_25)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) indicator for the secondary diagnosis code on an inpatient acute care facility claim.

Present on Admit Code Principal (Present_on_Admit_Code_Principal)

Data type: Char
Found in: Facility Header
Description: The Present On Admission (POA) code for the principal diagnosis code on an inpatient acute care facility claim.

Procedure Code (Procedure_Code)

Data type: Char
Found in: Professional, Facility Detail
Description: The procedure code for the service record.

Procedure Code UB Surg 01 (Procedure_Code_UB_Surg_01)

Data type: Char
Found in: Facility Header
Description: The primary surgical procedure code (1) on the facility claim.

Procedure Code UB Surg 02 (Procedure_Code_UB_Surg_02)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (2) for the facility claim.

Procedure Code UB Surg 03 (Procedure_Code_UB_Surg_03)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (3) for the facility claim.

Procedure Code UB Surg 04 (Procedure_Code_UB_Surg_04)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (4) for the facility claim.

Procedure Code UB Surg 05 (Procedure_Code_UB_Surg_05)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (5) for the facility claim.

Procedure Code UB Surg 06 (Procedure_Code_UB_Surg_06)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (6) for the facility claim.

Procedure Code UB Surg 07 (Procedure_Code_UB_Surg_07)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (7) for the facility claim.

Procedure Code UB Surg 08 (Procedure_Code_UB_Surg_08)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (8) for the facility claim.

Procedure Code UB Surg 09 (Procedure_Code_UB_Surg_09)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (9) for the facility claim.

Procedure Code UB Surg 10 (Procedure_Code_UB_Surg_10)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (10) for the facility claim.

Procedure Code UB Surg 11 (Procedure_Code_UB_Surg_11)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (11) for the facility claim.

Procedure Code UB Surg 12 (Procedure_Code_UB_Surg_12)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (12) for the facility claim.

Procedure Code UB Surg 13 (Procedure_Code_UB_Surg_13)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (13) for the facility claim.

Procedure Code UB Surg 14 (Procedure_Code_UB_Surg_14)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (14) for the facility claim.

Procedure Code UB Surg 15 (Procedure_Code_UB_Surg_15)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (15) for the facility claim.

Procedure Code UB Surg 16 (Procedure_Code_UB_Surg_16)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (16) for the facility claim.

Procedure Code UB Surg 17 (Procedure_Code_UB_Surg_17)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (17) for the facility claim.

Procedure Code UB Surg 18 (Procedure_Code_UB_Surg_18)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (18) for the facility claim.

Procedure Code UB Surg 19 (Procedure_Code_UB_Surg_19)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (19) for the facility claim.

Procedure Code UB Surg 20 (Procedure_Code_UB_Surg_20)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (20) for the facility claim.

Procedure Code UB Surg 21 (Procedure_Code_UB_Surg_21)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (21) for the facility claim.

Procedure Code UB Surg 22 (Procedure_Code_UB_Surg_22)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (22) for the facility claim.

Procedure Code UB Surg 23 (Procedure_Code_UB_Surg_23)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (23) for the facility claim.

Procedure Code UB Surg 24 (Procedure_Code_UB_Surg_24)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (24) for the facility claim.

Procedure Code UB Surg 25 (Procedure_Code_UB_Surg_25)

Data type: Char
Found in: Facility Header
Description: The other surgical procedure code (25) for the facility claim.

Procedure Code UB Surg Date 1 (Procedure_Code_UB_Surg_Date_1)

Data type: Num
Found in: Facility Header
Description: The primary surgical procedure code (1) on the facility claim.

Procedure Code UB Surg Date 2 (Procedure_Code_UB_Surg_Date_2)

Data type: Num
Found in: Facility Header
Description: The other surgical procedure code (2) for the facility claim.

Procedure Code UB Surg Date 3 (Procedure_Code_UB_Surg_Date_3)

Data type: Num
Found in: Facility Header
Description: The other surgical procedure code (3) for the facility claim.

Procedure Code UB Surg Date 4 (Procedure_Code_UB_Surg_Date_4)

Data type: Num
Found in: Facility Header
Description: The other surgical procedure code (4) for the facility claim.

Procedure Modifier Code 1 (Procedure_Modifier_Code_1)

Data type: Char
Found in: Professional, Facility Detail
Description: The 2-character code of the first procedure code modifier on the claim.

Procedure Modifier Code 2 (Procedure_Modifier_Code_2)

Data type: Char
Found in: Professional, Facility Detail
Description: The 2-character code of the second procedure code modifier on the claim.

Procedure Modifier Code 3 (Procedure_Modifier_Code_3)

Data type: Char
Found in: Professional, Facility Detail
Description: The 2-character code of the third procedure code modifier on the claim.

Procedure Modifier Code 4 (Procedure_Modifier_Code_4)

Data type: Char
Found in: Professional, Facility Detail
Description: The 2-character code of the fourth procedure code modifier on the claim.

Procedure Modifier Code 5 (Procedure_Modifier_Code_5)

Data type: Char
Found in: Professional, Facility Detail
Description: The 2-character code of the fifth procedure code modifier on the claim.

Proceedure System Code (Proceedure_System_Code)

Data type: Char
Found in: Professional
Description: Code indicating the procedure coding system

Program ID Claim Code (Program_ID_Claim_Code)

Data type: Char
Found in: Facility Header
Description: The identifier for the provider of service (facility, physician, professional, pharmacy, lab, etc.).

Prov Billing Taxonomy Code Claim (Prov_Billing_Taxonomy_Code_Claim)

Data type: Char
Found in: Facility Header
Description: The Provider Taxonomy code for the Billing provider reported on the claim.

Prov Pay To Taxonomy Code Claim (Prov_Pay_To_Taxonomy_Code_Claim)

Data type: Char
Found in: Facility Header
Description: The Provider Taxonomy code for the Pay To provider reported on the claim.

Prov Referring Taxonomy Code Cla (Prov_Referring_Taxonomy_Code_Cla)

Data type: Char
Found in: Facility Header
Description: The Provider Taxonomy code for the Referring provider reported on the claim.

Prov Rendering Group Name Claim (Prov_Rendering_Group_Name_Claim)

Data type: Char
Found in: Facility Header
Description: The Group Name for the rendering provider, reported on the encounter claim.

Prov Rendering Taxonomy Code Claim (Prov_Rendering_Taxonomy_Code_Cla)

Data type: Char
Found in: Facility Header
Description: The Provider Taxonomy code for the Rendering provider reported on the claim.

Provider County Code Claim (Provider_County_Code_Claim)

Data type: Num
Found in: Facility Header
Description: The county code of the provider as reported on the claim.

Provider ID (Provider_ID)

Data type: Char
Found in: Drug, Professional, Facility Header
Description: The identifier for the provider of service

Provider NPI ID Claim (Provider_NPI_ID_Claim)

Data type: Char
Found in: Facility Detail
Description: The National Provider Identifier (NPI) for the rendering provider as reported on the claim record.

Provider Rendering NPI (Provider_Rendering_NPI)

Data type: Char
Found in: Facility Header, Facility Detail
Description: The Rendering Provider NPI

Provider Specialty Code Claim (Provider_Specialty_Code_Claim)

Data type: Char
Found in: Facility Header
Description: Client-specific code for the provider specialty (Serviing Provider) on the claim record.

Provider Type Code Claim (Provider_Type_Code_Claim)

Data type: Num
Found in: Facility Header

Provider Type Code Claim Medstat (Provider_Type_Code_Claim_Medstat)

Data type: Num
Found in: Facility Header

Provider Zip Code (Provider_Zip_Code)

Data type: Char
Found in: Facility Header
Description: The 5-digit zip code corresponding to the Provider ID.

Provider Zip Code Claim (Provider_Zip_Code_Claim)

Data type: Char
Found in: Facility Header
Description: The original provider zip code as reported on the claim.

Race Code (Race_Code)

Data type: Char
Found in: Eligibility
Description: Client-specific code for the race of the person.

Rate Code Claim (Rate_Code_Claim)

Data type: Char
Found in: Professional
Description: The Member Rate Code under which this claim was processed, in accordance with the BMS-defined hierarchy of Rate Codes.

Rate Code Previous (Rate_Code_Previous)

Data type: Char
Found in: Eligibility
Description: The previous primary rate code for the member.

Rate Code Primary (Rate_Code_Primary)

Data type: Char
Found in: Eligibility
Description: The primary internal rate code for the member for the month of eligibility, based on the BMS-specified hierarchy.

Rate Code Primary Sort Order (Rate_Code_Primary_Sort_Order)

Data type: Char
Found in: Eligibility
Description: The sorting order under which member rate codes will be displayed on reports

Rate Code10 (Rate_Code10)

Data type: Char
Found in: Eligibility

Rate Code3 (Rate_Code3)

Data type: Char
Found in: Eligibility

Rate Code4 (Rate_Code4)

Data type: Char
Found in: Eligibility

Rate Code5 (Rate_Code5)

Data type: Char
Found in: Eligibility

Rate Code6 (Rate_Code6)

Data type: Char
Found in: Eligibility

Rate Code7 (Rate_Code7)

Data type: Char
Found in: Eligibility

Rate Code8 (Rate_Code8)

Data type: Char
Found in: Eligibility

Rate Code9 (Rate_Code9)

Data type: Char
Found in: Eligibility

Region Code (Region_Code)

Data type: Char
Found in: Eligibility
Description: Client-specific code for the geographic region of the person

Revenue Code UB (Revenue_Code_UB)

Data type: Char
Found in: Facility Detail
Description: The CMS standard revenue code from the UB facility claim.

Room and Board Flag Code (Room_and_Board_Flag_Code)

Data type: Char
Found in: Facility Header
Description: The code for the flag indicating the type of room and board services on a facility claim.

Rx Count (Rx_Count)

Data type: Num
Found in: Drug
Description: The count of prescriptions for the drug claim.

Security Flag Claim (Security_Flag_Claim)

Data type: Char
Found in: Drug
Description: Indicates Claims associated with specific programs.

State Code (State_Code)

Data type: Char
Found in: Eligibility
Description: The state abbreviation for the residence of the person, for the most recent month of eligibility.

Third Party Amount (Third_Party_Amount)

Data type: Num
Found in: Drug, Professional, Facility Header
Description: The amount paid by Third Party Insurance.This is a claim header amount.

Third Party Amount Detail (Third_Party_Amount_Detail)

Data type: Num
Found in: Professional, Facility Detail
Description: The dollar amount for the claim line representing the amount paid by another insurance coverage other than Medicare.

Third Party Coinsurance Dtl Amount (Third_Party_Coinsurance_Dtl_Amou)

Data type: Num
Found in: Facility Detail
Description: The claim line item record dollar amount applied to the Third Party Coinsurance Amount.

Third Party Coinsurance Hdr Amount (Third_Party_Coinsurance_Hdr_Amou)

Data type: Num
Found in: Facility Header
Description: The claim header record total dollar amount applied to the the Third Party Coinsurance Amount.

Third Party Deductible Dtl Amount (Third_Party_Deductible_Dtl_Amoun)

Data type: Num
Found in: Facility Detail
Description: The claim line item record dollar amount applied to the TPL Deductible Amount.

Third Party Deductible Hdr Amount (Third_Party_Deductible_Hdr_Amoun)

Data type: Num
Found in: Facility Header
Description: The claim header record total dollar amount applied to the the Third Party Deductible Amount.

Tobacco Cessation Education Indicator (Tobacco_Cessation_Education_Indi)

Data type: Char
Found in: Eligibility
Description: An indicator for Tobacco Cessation Education based on Member Attribute table.

UB Rev Cd (UB_Rev_Cd)

Data type: Char
Found in: Facility Detail

Units of Service (Units_of_Service)

Data type: Num
Found in: Professional, Facility Detail

Units of Service Billed (Units_of_Service_Billed)

Data type: Num
Found in: Professional, Facility Detail
Description: The Units of Service the provider billed at the claim detail line.

Units of Service Paid (Units_of_Service_Paid)

Data type: Num
Found in: Professional, Facility Detail
Description: The Units of Service paid at the claim detail line

Zip code (Zip_code)

Data type: Char
Found in: Eligibility
Description: The 5-digit zip code of the person, based on the time of service or the month of eligibility.