Document
Data Elements List
ICR 201212-0938-001 · OMB 0938-0345 · Object 36504301.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Data Elements List |
| Author | JDC |
| Last Modified By | Calc |
| File Modified | 2012-11-12 |
| File Created | 2026-10-22 |
| Conversion State | complete |
Extracted Text
Counts of TMSIS Data Dictionary Data Elements as of 2012-11-12 File Type Eligibile File TPL Claim Provider Managed Care All File Types Date Date Date Elements in Date Elements in Date Elements in Elements in Elements in 2012-Feb but not 2012-Dec but not both 2012-Feb & 2012-Feb 2012-Dec 2012-Dec 2012-Feb 2012-Dec 69 98 24 52 45 23 24 4 5 19 168 195 7 33 162 88 95 11 18 77 25 21 25 21 0 373 433 71 129 303 NOTE: These counts are approximations because some of the data elements' names changed, giving the impression that there were more drops and adds than there actually were. file:///tmp/omb-doc-6ada7c4fe39963.48492777/input/source.xlsx source.xlsx Summary Page 1 of 90 10/22/2026 21:12:50 File-Id ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE Data-Element DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR DATA ELEMENT NAME: CHIP-CODE DATA ELEMENT NAME: CITIZENSHIP-IND DATA ELEMENT NAME: DATE-OF-BIRTH DATA ELEMENT NAME: DATE-OF-DEATH DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 DATA ELEMENT NAME: ELIGIBLE-CITY DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME DATA ELEMENT NAME: ELIGIBLE-LAST-NAME DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM DATA ELEMENT NAME: ELIGIBLE-STATE DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE DATA ELEMENT NAME: ELIGIBILITY-GROUP DATA ELEMENT NAME: ELIGIBILITY-STATUS DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4 DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4) DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4) DATA ELEMENT NAME: HEALTH-HOME-IND DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4) DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4) DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4) DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4) DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4) DATA ELEMENT NAME: HEALTH-INSURANCE-IND DATA ELEMENT NAME: HOUSEHOLD-SIZE DATA ELEMENT NAME: IMMIGRATION-STATUS DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE DATA ELEMENT NAME: INCOME-CODE DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12 DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4) DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4) DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4) DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4) DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4) DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4) DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4) DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4) DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4) DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4) DATA ELEMENT NAME: MARITAL-STATUS DATA ELEMENT NAME: MEDICARE-HIC-NUM DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2) DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4) DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2) DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2) DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4) DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2) DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2) DATA ELEMENT NAME: MSIS-CASE-NUM DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM DATA ELEMENT NAME: NEWBORN-IND DATA ELEMENT NAME: PREGNANCY-IND DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND DATA ELEMENT NAME: RACE (1 - 14) DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE DATA ELEMENT NAME: SEX DATA ELEMENT NAME: SSDI-IND DATA ELEMENT NAME: SSI-IND DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES DATA ELEMENT NAME: SSI-STATUS DATA ELEMENT NAME: SSN DATA ELEMENT NAME: SSN-VERIFICATION-FLAG DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5) DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5) DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5) DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP DATA ELEMENT NAME: TANF-CASH-CODE DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT DATA ELEMENT NAME: TYPE-OF-RECORD DATA ELEMENT NAME: VETERAN-IND DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4) DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4) DATA ELEMENT NAME: WAIVER-ID (1 - 4) DATA ELEMENT NAME: WAIVER-TYPE (1 - 4) DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4) DATA ELEMENT NAME: COVERAGE-TYPE DATA ELEMENT NAME: GROUP-NUM DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3) DATA ELEMENT NAME: INSURANCE-CARRIER-CITY DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE DATA ELEMENT NAME: INSURANCE-CARRIER-NAME DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM DATA ELEMENT NAME: INSURANCE-CARRIER-STATE DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE DATA ELEMENT NAME: MEMBER-ID DATA ELEMENT NAME: MEMBER-FIRST-NAME DATA ELEMENT NAME: MEMBER-LAST-NAME DATA ELEMENT NAME: MEMBER-MIDDLE-INIT DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES) DATA ELEMENT NAME: POLICY-EFF-DATE DATA ELEMENT NAME: POLICY-EXP-DATE DATA ELEMENT NAME: POLICY-OWNER DATA ELEMENT NAME: POLICY-OWNER-CODE DATA ELEMENT NAME: POLICY-OWNER-SSN DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND DATA ELEMENT NAME: ADJUDICATION-DATE DATA ELEMENT NAME: ADJUSTMENT-IND DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE DATA ELEMENT NAME: ADMISSION-DATE DATA ELEMENT NAME: ADMISSION-HOUR DATA ELEMENT NAME: ADMISSION-TYPE DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM DATA ELEMENT NAME: ADMITTING-PROV-NUM DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY DATA ELEMENT NAME: ADMITTING-PROV-TYPE DATA ELEMENT NAME: ALLOWED-AMT DATA ELEMENT NAME: ALLOWED-CHARGE-SRC DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID DATA ELEMENT NAME: BENEFIT TYPE DATA ELEMENT NAME: BILLING-PROV-NPI-NUM DATA ELEMENT NAME: BILLING-PROV-NUM DATA ELEMENT NAME: BILLING-PROV-SPECIALTY DATA ELEMENT NAME: BILLING-PROV-TAXONOMY DATA ELEMENT NAME: BILLING-PROV-TYPE DATA ELEMENT NAME: BILLING-UNIT DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS DATA ELEMENT NAME: BMI-CODE DATA ELEMENT NAME: BRAND-GENERIC-IND DATA ELEMENT NAME: BORDER-STATE-IND DATA ELEMENT NAME: CHARGED-AMT DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE DATA ELEMENT NAME: CHECK-NUM DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR DATA ELEMENT NAME: CLAIM-LINE-COUNT DATA ELEMENT NAME: CLAIM-LINE-STATUS DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 DATA ELEMENT NAME: CLAIM-STATUS DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM DATA ELEMENT NAME: COMPOUND-DRUG-IND DATA ELEMENT NAME: COPAY-AMT DATA ELEMENT NAME: COPAY-WAIVED-IND DATA ELEMENT NAME: CROSSOVER-INDICATOR DATA ELEMENT NAME: DAILY-RATE DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED DATA ELEMENT NAME: DATE-PRESCRIBED DATA ELEMENT NAME: DAYS-SUPPLY DATA ELEMENT NAME: DEDUCTIBLE-AMT DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 DATA ELEMENT NAME: DESTINATION-CITY DATA ELEMENT NAME: DESTINATION-STATE DATA ELEMENT NAME: DESTINATION-ZIP-CODE DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12) DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND DATA ELEMENT NAME: DISCHARGE-DATE DATA ELEMENT NAME: DISCHARGE-HOUR DATA ELEMENT NAME: DISPENSE-FEE DATA ELEMENT NAME: DRG-DESCRIPTION DATA ELEMENT NAME: DRG-OUTLIER-AMT DATA ELEMENT NAME: DRG-REL-WEIGHT DATA ELEMENT NAME: DRUG-UTILIZATION-CODE DATA ELEMENT NAME: DTL-METRIC-DEC-QTY DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE DATA ELEMENT NAME: FIXED-PAYMENT-IND DATA ELEMENT NAME: FORCED-CLAIM-IND DATA ELEMENT NAME: FUNDING-CODE DATA ELEMENT NAME: FUNDING-SOURCE-STATE DATA ELEMENT NAME: HCBS-SERVICE-IND DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND DATA ELEMENT NAME: ICF-MR-DAYS DATA ELEMENT NAME: ICN-ADJ DATA ELEMENT NAME: ICN-ORIG DATA ELEMENT NAME: IMMUNIZATION-TYPE DATA ELEMENT NAME: LEAVE-DAYS DATA ELEMENT NAME: LINE-NUM-ADJ DATA ELEMENT NAME: LINE-NUM-ORIG DATA ELEMENT NAME: LTC-RCP-LIAB-AMT DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT DATA ELEMENT NAME: MEDICAID-PAID-AMT DATA ELEMENT NAME: MEDICAID-PAID-DATE DATA ELEMENT NAME: MEDICARE-COINS-AMT DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT DATA ELEMENT NAME: MEDICARE-COMB-DED-IND DATA ELEMENT NAME: MEDICARE-HIC-NUM DATA ELEMENT NAME: MEDICARE-PAID-AMT DATA ELEMENT NAME: MEDICARE-REIM-TYPE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM DATA ELEMENT NAME: NATIONAL-DRUG-CODE DATA ELEMENT NAME: NEW-REFILL-IND DATA ELEMENT NAME: NON-COV-CHARGES DATA ELEMENT NAME: NON-COV-DAYS DATA ELEMENT NAME: NURSING-FACILITY-DAYS DATA ELEMENT NAME: OCCURRENCE-CODE DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 DATA ELEMENT NAME: ORIGINATION-CITY DATA ELEMENT NAME: ORIGINATION-STATE DATA ELEMENT NAME: ORIGINATION-ZIP-CODE DATA ELEMENT NAME: OTHER-COINS-AMT DATA ELEMENT NAME: OTHER-INSURANCE-IND DATA ELEMENT NAME: OTHER-TPL-COLLECTION DATA ELEMENT NAME: OUTLIER-CODE DATA ELEMENT NAME: OUTLIER-DAYS DATA ELEMENT NAME: PATIENT-CONTROL-NUM DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH DATA ELEMENT NAME: PATIENT-FIRST-NAME DATA ELEMENT NAME: PATIENT-LAST-NAME DATA ELEMENT NAME: PATIENT-MIDDLE-INIT DATA ELEMENT NAME: PATIENT-STATUS DATA ELEMENT NAME: PAYMENT-LEVEL-IND DATA ELEMENT NAME: PLACE-OF-SERVICE DATA ELEMENT NAME: PLAN-ID-NUMBER DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM DATA ELEMENT NAME: PRESCRIBING-PROV-NUM DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE DATA ELEMENT NAME: PRESCRIPTION-NUM DATA ELEMENT NAME: PROCEDURE-CODE (1) DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) DATA ELEMENT NAME: PROCEDURE-CODE- DATE DATA ELEMENT NAME: PROCEDURE-DATE DATA ELEMENT NAME: PROGRAM-TYPE DATA ELEMENT NAME: PROVIDER-LOCATION-CODE DATA ELEMENT NAME: QUANTITY-ACTUAL DATA ELEMENT NAME: QUANTITY-ALLOWED DATA ELEMENT NAME: QUANTITY-OF-SERVICE DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED DATA ELEMENT NAME: RECORD-TYPE DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM DATA ELEMENT NAME: REFERRING-PROV-NUM DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY DATA ELEMENT NAME: REFERRING-PROV-TYPE DATA ELEMENT NAME: REMITTANCE-DATE DATA ELEMENT NAME: REMITTANCE-NUM DATA ELEMENT NAME: SELF-DIRECTION TYPE DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM DATA ELEMENT NAME: SERVICING-PROV-NUM DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY DATA ELEMENT NAME: SERVICING-PROV-TYPE DATA ELEMENT NAME: SERVICE-TRACKING-TYPE DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT DATA ELEMENT NAME: SOURCE-LOCATION DATA ELEMENT NAME: SPLIT-CLAIM-IND DATA ELEMENT NAME: SUBMITTER-ID DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID DATA ELEMENT NAME: TOOTH-NUM DATA ELEMENT NAME: TOOTH-QUAD-IND DATA ELEMENT NAME: TOOTH-SURFACE-IND DATA ELEMENT NAME: TOT-ALLOWED-AMT DATA ELEMENT NAME: TOT-CHARGED-AMOUNT DATA ELEMENT NAME: TOT-COPAY-AMT DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT DATA ELEMENT NAME: TOT-TPL-AMT DATA ELEMENT NAME: ME DATA ELEMENT NAME: TYPE-OF-BILL DATA ELEMENT NAME: TYPE-OF-CLAIM DATA ELEMENT NAME: TYPE-OF-HOSPITAL DATA ELEMENT NAME: TYPE-OF-SERVICE DATA ELEMENT NAME: REVENUE-CHARGE DATA ELEMENT NAME: REVENUE-CODE DATA ELEMENT NAME: REVENUE-UNITS DATA ELEMENT NAME: UNITS-ACTUAL DATA ELEMENT NAME: UNITS-ALLOWED DATA ELEMENT NAME: WAIVER-ID DATA ELEMENT NAME: WAIVER-TYPE Data Element Name: APPL-DATE Data Element Name: BED-ICF-MR-NUM Data Element Name: BED-ICF-MR-EFF-DATE Data Element Name: BED-INPATIENT-NUM Data Element Name: BED-INPATIENT-EFF-DATE Data Element Name: BED-NF-NUM Data Element Name: BED-NF-EFF-DATE Data Element Name: BED-T18-SNF-NUM Data Element Name: BED-T18-SNF-EFF-DATE Data Element Name: BENEFIT-TYPE(1) THRU (50) Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20) Data Element Name: BILLING-LOC-CITY (1) THRU (20) Data Element Name: BILL-LOC-COUNTY (1) THRU (6) Data Element Name: BILL-LOC-EMAIL (1) THRU (6) Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) Data Element Name: BILL-LOC-STATE (1) THRU (6) Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) Data Element Name: BORDER-STATE-IND Data Element Name: BUSINESS-TYPE Data Element Name: CLIA-EFF-DATE (1) THRU (12) Data Element Name: CLIA-EXP-DATE (1) THRU (12) Data Element Name: CLIA-NUM-1 through CLIA-NUM-12 Data Element Name: CLIA-TYPE (1) THRU (12) Data Element Name:Core Based Statistical Area (CBSA) Code Data Element Name: DATE-OF-BIRTH Data Element Name: DATE-OF-DEATH Data Element Name: DEA-EFF-DATE Data Element Name: DEA-EXP-DATE Data Element Name: DEA-NUM Data Element Name: GENDER 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x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x RowNo 1 ELIGIBLE FILE 2 ELIGIBLE FILE 3 ELIGIBLE FILE 4 ELIGIBLE FILE 5 ELIGIBLE FILE 6 ELIGIBLE FILE 7 ELIGIBLE FILE 8 ELIGIBLE FILE 9 ELIGIBLE FILE 10 ELIGIBLE FILE 11 ELIGIBLE FILE 12 ELIGIBLE FILE 13 ELIGIBLE FILE 14 ELIGIBLE FILE 15 ELIGIBLE FILE 16 ELIGIBLE FILE 17 ELIGIBLE FILE 18 ELIGIBLE FILE 19 ELIGIBLE FILE 20 ELIGIBLE FILE 21 ELIGIBLE FILE 22 ELIGIBLE FILE 23 ELIGIBLE FILE 24 ELIGIBLE FILE 25 ELIGIBLE FILE 26 ELIGIBLE FILE 27 ELIGIBLE FILE 28 ELIGIBLE FILE 29 ELIGIBLE FILE 30 ELIGIBLE FILE 31 ELIGIBLE FILE 32 ELIGIBLE FILE 33 ELIGIBLE FILE 34 ELIGIBLE FILE 35 ELIGIBLE FILE 36 ELIGIBLE FILE 37 ELIGIBLE FILE 38 ELIGIBLE FILE 39 ELIGIBLE FILE 40 ELIGIBLE FILE 41 ELIGIBLE FILE 42 ELIGIBLE FILE 43 ELIGIBLE FILE 44 ELIGIBLE FILE 45 ELIGIBLE FILE 46 ELIGIBLE FILE 47 ELIGIBLE FILE FileId 48 ELIGIBLE FILE 49 ELIGIBLE FILE 50 ELIGIBLE FILE 51 ELIGIBLE FILE 52 ELIGIBLE FILE 53 ELIGIBLE FILE 54 ELIGIBLE FILE 55 ELIGIBLE FILE 56 ELIGIBLE FILE 57 ELIGIBLE FILE 58 ELIGIBLE FILE 59 ELIGIBLE FILE 60 ELIGIBLE FILE 61 ELIGIBLE FILE 62 ELIGIBLE FILE 63 ELIGIBLE FILE 64 ELIGIBLE FILE 65 ELIGIBLE FILE 66 ELIGIBLE FILE 67 ELIGIBLE FILE 68 ELIGIBLE FILE 69 ELIGIBLE FILE 70 ELIGIBLE FILE 71 ELIGIBLE FILE 72 ELIGIBLE FILE 73 ELIGIBLE FILE 74 ELIGIBLE FILE 75 ELIGIBLE FILE 76 ELIGIBLE FILE 77 ELIGIBLE FILE 78 ELIGIBLE FILE 79 ELIGIBLE FILE 80 ELIGIBLE FILE 81 ELIGIBLE FILE 82 ELIGIBLE FILE 83 ELIGIBLE FILE 84 ELIGIBLE FILE 85 ELIGIBLE FILE 86 ELIGIBLE FILE 87 ELIGIBLE FILE 88 ELIGIBLE FILE 89 ELIGIBLE FILE 90 ELIGIBLE FILE 91 ELIGIBLE FILE 92 ELIGIBLE FILE 93 ELIGIBLE FILE 94 ELIGIBLE FILE 95 ELIGIBLE FILE 96 ELIGIBLE FILE 97 ELIGIBLE FILE 98 THIRD PARTY LIABILITY (TPL) FILE 99 THIRD PARTY LIABILITY (TPL) FILE 100 THIRD PARTY LIABILITY (TPL) FILE 101 THIRD PARTY LIABILITY (TPL) FILE 102 THIRD PARTY LIABILITY (TPL) FILE 103 THIRD PARTY LIABILITY (TPL) FILE 104 THIRD PARTY LIABILITY (TPL) FILE 105 THIRD PARTY LIABILITY (TPL) FILE 106 THIRD PARTY LIABILITY (TPL) FILE 107 THIRD PARTY LIABILITY (TPL) FILE 108 THIRD PARTY LIABILITY (TPL) FILE 109 THIRD PARTY LIABILITY (TPL) FILE 110 THIRD PARTY LIABILITY (TPL) FILE 111 THIRD PARTY LIABILITY (TPL) FILE 112 THIRD PARTY LIABILITY (TPL) FILE 113 THIRD PARTY LIABILITY (TPL) FILE 114 THIRD PARTY LIABILITY (TPL) FILE 115 THIRD PARTY LIABILITY (TPL) FILE 116 THIRD PARTY LIABILITY (TPL) FILE 117 THIRD PARTY LIABILITY (TPL) FILE 118 THIRD PARTY LIABILITY (TPL) FILE 119 THIRD PARTY LIABILITY (TPL) FILE 120 THIRD PARTY LIABILITY (TPL) FILE 121 THIRD PARTY LIABILITY (TPL) FILE 122 CLAIMS FILES 123 CLAIMS FILES 124 CLAIMS FILES 125 CLAIMS FILES 126 CLAIMS FILES 127 CLAIMS FILES 128 CLAIMS FILES 129 CLAIMS FILES 130 CLAIMS FILES 131 CLAIMS FILES 132 CLAIMS FILES 133 CLAIMS FILES 134 CLAIMS FILES 135 CLAIMS FILES 136 CLAIMS FILES 137 CLAIMS FILES 138 CLAIMS FILES 139 CLAIMS FILES 140 CLAIMS FILES 141 CLAIMS FILES 142 CLAIMS FILES 143 CLAIMS FILES 144 CLAIMS FILES 145 CLAIMS FILES 146 CLAIMS FILES 147 CLAIMS FILES 148 CLAIMS FILES 149 CLAIMS FILES 150 CLAIMS FILES 151 CLAIMS FILES 152 CLAIMS FILES 153 CLAIMS FILES 154 CLAIMS FILES 155 CLAIMS FILES 156 CLAIMS FILES 157 CLAIMS FILES 158 CLAIMS 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Element Name: MANAGED-CARE-SERVICE-AREA Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME Data Element Name: MANAGED-CARE-STATE Data Element Name: MANAGED-CARE-TELEPHONE Data Element Name: MANAGED-CARE-ZIP-CODE Data Element Name: OPERATING-AUTHORITY Data Element Name: PLAN-ID-NUM Data Element Name: REIMBURSEMENT-ARRANGEMENT Data Element Name: Core Based Statistical Area (CBSA) Code RowNo 1 ELIGIBLE FILE 2 ELIGIBLE FILE 3 ELIGIBLE FILE 4 ELIGIBLE FILE 5 ELIGIBLE FILE 6 ELIGIBLE FILE 7 ELIGIBLE FILE 8 ELIGIBLE FILE 9 ELIGIBLE FILE 10 ELIGIBLE FILE 11 ELIGIBLE FILE 12 ELIGIBLE FILE 13 ELIGIBLE FILE 14 ELIGIBLE FILE 15 ELIGIBLE FILE 16 ELIGIBLE FILE 17 ELIGIBLE FILE 18 ELIGIBLE FILE 19 ELIGIBLE FILE 20 ELIGIBLE FILE 21 ELIGIBLE FILE 22 ELIGIBLE FILE 23 ELIGIBLE FILE 24 ELIGIBLE FILE 25 ELIGIBLE FILE 26 ELIGIBLE FILE 27 ELIGIBLE FILE 28 ELIGIBLE FILE 29 ELIGIBLE FILE 30 ELIGIBLE FILE 31 ELIGIBLE FILE 32 ELIGIBLE FILE 33 ELIGIBLE FILE 34 ELIGIBLE FILE 35 ELIGIBLE FILE 36 ELIGIBLE FILE 37 ELIGIBLE FILE 38 ELIGIBLE FILE 39 ELIGIBLE FILE 40 ELIGIBLE FILE 41 ELIGIBLE FILE 42 ELIGIBLE FILE 43 ELIGIBLE FILE 44 ELIGIBLE FILE 45 ELIGIBLE FILE 46 ELIGIBLE FILE 47 ELIGIBLE FILE FileId 48 ELIGIBLE FILE 49 ELIGIBLE FILE 50 ELIGIBLE FILE 51 ELIGIBLE FILE 52 ELIGIBLE FILE 53 ELIGIBLE FILE 54 ELIGIBLE FILE 55 ELIGIBLE FILE 56 ELIGIBLE FILE 57 ELIGIBLE FILE 58 ELIGIBLE FILE 59 ELIGIBLE FILE 60 ELIGIBLE FILE 61 ELIGIBLE FILE 62 ELIGIBLE FILE 63 ELIGIBLE FILE 64 ELIGIBLE FILE 65 ELIGIBLE FILE 66 ELIGIBLE FILE 67 ELIGIBLE FILE 68 ELIGIBLE FILE 69 ELIGIBLE FILE 70 THIRD PARTY LIABILITY (TPL) FILE 71 THIRD PARTY LIABILITY (TPL) FILE 72 THIRD PARTY LIABILITY (TPL) FILE 73 THIRD PARTY LIABILITY (TPL) FILE 74 THIRD PARTY LIABILITY (TPL) FILE 75 THIRD PARTY LIABILITY (TPL) FILE 76 THIRD PARTY LIABILITY (TPL) FILE 77 THIRD PARTY LIABILITY (TPL) FILE 78 THIRD PARTY LIABILITY (TPL) FILE 79 THIRD PARTY LIABILITY (TPL) FILE 80 THIRD PARTY LIABILITY (TPL) FILE 81 THIRD PARTY LIABILITY (TPL) FILE 82 THIRD PARTY LIABILITY (TPL) FILE 83 THIRD PARTY LIABILITY (TPL) FILE 84 THIRD PARTY LIABILITY (TPL) FILE 85 THIRD PARTY LIABILITY (TPL) FILE 86 THIRD PARTY LIABILITY (TPL) FILE 87 THIRD PARTY LIABILITY (TPL) FILE 88 THIRD PARTY LIABILITY (TPL) FILE 89 THIRD PARTY LIABILITY (TPL) FILE 90 THIRD PARTY LIABILITY (TPL) FILE 91 THIRD PARTY LIABILITY (TPL) FILE 92 THIRD PARTY LIABILITY (TPL) FILE 93 CLAIMS FILES 94 CLAIMS FILES 95 CLAIMS FILES 96 CLAIMS FILES 97 CLAIMS FILES 98 CLAIMS FILES 99 CLAIMS FILES 100 CLAIMS FILES 101 CLAIMS FILES 102 CLAIMS FILES 103 CLAIMS FILES 104 CLAIMS FILES 105 CLAIMS FILES 106 CLAIMS FILES 107 CLAIMS FILES 108 CLAIMS FILES 109 CLAIMS FILES 110 CLAIMS FILES 111 CLAIMS FILES 112 CLAIMS FILES 113 CLAIMS FILES 114 CLAIMS FILES 115 CLAIMS FILES 116 CLAIMS FILES 117 CLAIMS FILES 118 CLAIMS FILES 119 CLAIMS FILES 120 CLAIMS FILES 121 CLAIMS FILES 122 CLAIMS FILES 123 CLAIMS FILES 124 CLAIMS FILES 125 CLAIMS FILES 126 CLAIMS FILES 127 CLAIMS FILES 128 CLAIMS FILES 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CLAIMS FILES 247 CLAIMS FILES 248 CLAIMS FILES 249 CLAIMS FILES 250 CLAIMS FILES 251 CLAIMS FILES 252 CLAIMS FILES 253 CLAIMS FILES 254 CLAIMS FILES 255 CLAIMS FILES 256 CLAIMS FILES 257 CLAIMS FILES 258 CLAIMS FILES 259 CLAIMS FILES 260 CLAIMS FILES 261 PROVIDER FILE 262 PROVIDER FILE 263 PROVIDER FILE 264 PROVIDER FILE 265 PROVIDER FILE 266 PROVIDER FILE 267 PROVIDER FILE 268 PROVIDER FILE 269 PROVIDER FILE 270 PROVIDER FILE 271 PROVIDER FILE 272 PROVIDER FILE 273 PROVIDER FILE 274 PROVIDER FILE 275 PROVIDER FILE 276 PROVIDER FILE 277 PROVIDER FILE 278 PROVIDER FILE 279 PROVIDER FILE 280 PROVIDER FILE 281 PROVIDER FILE 282 PROVIDER FILE 283 PROVIDER FILE 284 PROVIDER FILE 285 PROVIDER FILE 286 PROVIDER FILE 287 PROVIDER FILE 288 PROVIDER FILE 289 PROVIDER FILE 290 PROVIDER FILE 291 PROVIDER FILE 292 PROVIDER FILE 293 PROVIDER FILE 294 PROVIDER FILE 295 PROVIDER FILE 296 PROVIDER FILE 297 PROVIDER FILE 298 PROVIDER FILE 299 PROVIDER FILE 300 PROVIDER FILE 301 PROVIDER FILE 302 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FILE 355 MANAGED CARE PLAN FILE 356 MANAGED CARE PLAN FILE 357 MANAGED CARE PLAN FILE 358 MANAGED CARE PLAN FILE 359 MANAGED CARE PLAN FILE 360 MANAGED CARE PLAN FILE 361 MANAGED CARE PLAN FILE 362 MANAGED CARE PLAN FILE 363 MANAGED CARE PLAN FILE 364 MANAGED CARE PLAN FILE 365 MANAGED CARE PLAN FILE 366 MANAGED CARE PLAN FILE 367 MANAGED CARE PLAN FILE 368 MANAGED CARE PLAN FILE 369 MANAGED CARE PLAN FILE 370 MANAGED CARE PLAN FILE 371 MANAGED CARE PLAN FILE 372 MANAGED CARE PLAN FILE 373 MANAGED CARE PLAN FILE DataElement DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY DATA ELEMENT NAME: CHIP- CODE DATA ELEMENT NAME: DATE-OF-BIRTH DATA ELEMENT NAME: DATE-OF-DEATH DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE 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Name: CLIA-EXP-DATE (1) THRU (12) Data Element Name: CLIA-NUM Data Element Name: CLIA-TYPE (1) THRU (12) Data Element Name: DATE-OF-BIRTH Data Element Name: DATE-OF-DEATH Data Element Name: DBA-NAME Data Element Name: DEA-EFF-DATE Data Element Name: DEA-EXP-DATE Data Element Name: DEA-NUM Data Element Name: GENDER Data Element Name: LIC-EFF-DATE (1) THRU (6) Data Element Name: LIC-EXP-DATE (1) THRU (6) Data Element Name: LIC-NUM (1) THRU (6) Data Element Name: MAILING-CITY (1) THRU (6) Data Element Name: MAILING-COUNTY (1) THRU (6) Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) Data Element Name: MAILING-STATE (1) THRU (6) Data Element Name: MAILING-ZIP-CODE (1) THRU (6) Data Element Name: MEDICAID-PROV-NUM Data Element Name: MEDICARE-PROV-NUM Data Element Name: NCPDP-EFF-DATE Data Element Name: NCPDP-EXP-DATE Data Element Name: NCPDP-NUM Data Element Name: OUT-OF-STATE-IND Data Element Name: OWNERSHIP-CODE Data Element Name: PER-DIEM-AMT-ICF-MR Data 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PROV-SPECIALTY (1) THRU (6) Data Element Name: PROV-TAX-ID-CURRENT Data Element Name: PROV-TAX-ID-PREVIOUS Data Element Name: PROV-TAXONOMY (1) THRU (6) Data Element Name: PROV-TYPE (1) THRU (6) Data Element Name: REASON-CODE (1) THRU (12) Data Element Name: REASON-EFF-DATE (1) THRU (12) Data Element Name: REASON-EXP-DATE (1) THRU (12) Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) Data Element Name: SERVICE-LOC-CITY (1) THRU (6) Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) Data Element Name: SERVICE-LOC-STATE (1) THRU (6) Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) Data Element Name: SOCIAL-SECURITY-NUMBER Data Element Name: TEACHING-IND Data Element Name: TERMINATION-DATE Data Element Name: TERMINATION-REASON-CODE Data Element Name: URBAN-RURAL-IND Data Element Name: APPL-DATE Data Element Name: BORDER-STATE-IND Data Element Name: BUSINESS-TYPE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 Data Element Name: MANAGED-CARE-CITY Data Element Name: MANAGED-CARE-COUNTY Data Element Name: MANAGED-CARE-EFFECTIVE-DATE Data Element Name: MANAGED-CARE-EMAIL Data Element Name: MANAGED-CARE-END-DATE Data Element Name: MANAGED-CARE-FAX-NUM Data Element Name: MANAGED-CARE-NAME Data Element Name: MANAGED-CARE-PLAN-TYPE Data Element Name: MANAGED-CARE-STATE Data Element Name: MANAGED-CARE-TELEPHONE Data Element Name: MANAGED-CARE-ZIP-CODE Data Element Name: NUMBER-OF-DUAL-ELIGIBLES Data Element Name: NUMBER-OF-ENROLLMENT Data Element Name: NUMBER-OF-PROVIDERS Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) Data Element Name: OUT-OF-STATE-IND Data Element Name: OWNERSHIP-CODE Data Element Name: PLAN-ID-NUM Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 Data Element Name: REIMBURSEMENT-ARRANGEMENT Data Element Name: URBAN-RURAL-IND FileId ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE 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PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE MANAGED CARE PLAN INFORMATION FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE ELIGIBLE FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE THIRD PARTY LIABILITY (TPL) FILE CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES CLAIMS FILES PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE PROVIDER FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE MANAGED CARE PLAN FILE DataElement DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR DATA ELEMENT NAME: CHIP-CODE DATA ELEMENT NAME: CITIZENSHIP-IND DATA ELEMENT NAME: DATE-OF-BIRTH DATA ELEMENT NAME: DATE-OF-DEATH DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 DATA ELEMENT NAME: ELIGIBLE-CITY DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME DATA ELEMENT NAME: 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PROV-GRP-NUM (1) THRU (100) Data Element Name: PROV-STATUS-CODE (1) THRU (100) Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) Data Element Name: PROV-FIRST-NAME Data Element Name: PROV-MIDDLE-INITIAL Data Element Name: PROV-LAST-NAME Data Element Name: PROV-LEGAL-NAME Data Element Name: PROV-DOING-BUSINESS-AS-NAME Data Element Name: PROV-INACTIVE-IND Data Element Name: PROV-INACTIVE-START-DATE Data Element Name: PROV-INACTIVE-END-DATE Data Element Name: PROV-NPI-NUM (1) THRU (10) Data Element Name: PROV-SPECIALTY (1) THRU (6) Data Element Name: PROV-TAX-ID-CURRENT Data Element Name: PROV-TAX-ID-PREVIOUS Data Element Name: PROV-TAXONOMY (1) THRU (6) Data Element Name: PROV-TYPE (1) THRU (6) Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) Data Element Name: SERVICE-LOC-CITY (1) THRU (6) Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) Data Element Name: SERVICE-LOC-STATE (1) THRU (6) Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) Data Element Name: SSN Data Element Name: TEACHING-IND Data Element Name: TERMINATION-DATE Data Element Name: TERMINATION-REASON-CODE Data Element Name: APPL-DATE Data Element Name: BORDER-STATE-IND Data Element Name: BUSINESS-TYPE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 Data Element Name: MANAGED-CARE-CITY Data Element Name: MANAGED-CARE-EFFECTIVE-DATE Data Element Name: MANAGED-CARE-EMAIL Data Element Name: MANAGED-CARE-END-DATE Data Element Name: MANAGED-CARE-NAME Data Element Name: MANAGED-CARE-PLAN-TYPE Data Element Name: MANAGED-CARE-PLAN-POPULATIONS Data Element Name: MANAGED-CARE-RECORD-TYPE Data Element Name: MANAGED-CARE-SERVICE-AREA Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME Data Element Name: MANAGED-CARE-STATE Data Element Name: MANAGED-CARE-TELEPHONE Data Element Name: MANAGED-CARE-ZIP-CODE Data Element Name: OPERATING-AUTHORITY Data Element Name: PLAN-ID-NUM Data Element Name: REIMBURSEMENT-ARRANGEMENT Data Element Name: Core Based Statistical Area (CBSA) Code DATA ELEMENT NAME: CHIP- CODE DATA ELEMENT NAME: ETHNICITY-CODE DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1 DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 DATA ELEMENT NAME: LTC-BEGIN-DATE DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4 DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4 DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4 DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4 DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4 DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4 DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4 DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2 DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2 DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2 DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2 DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2 DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2 DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2 DATA ELEMENT NAME: RACE DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4 DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4 DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3 DATA ELEMENT NAME: POLICY-OWNER-IND DATA ELEMENT NAME: IMMUNIZATION TYPE DATA ELEMENT NAME: LINE-NUMBER-ADJ DATA ELEMENT NAME: LINE-NUMBER-ORIG DATA ELEMENT NAME: TPL-AMT DATA ELEMENT NAME: UB-REV-CHARGE DATA ELEMENT NAME: UB REV-CODE DATA ELEMENT NAME: UB-REV-UNITS Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6) Data Element Name: BILL-LOC-CITY (1) THRU (6) Data Element Name: CLIA-NUM Data Element Name: DBA-NAME Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100) Data Element Name: PROV-NAME Data Element Name: REASON-CODE (1) THRU (12) Data Element Name: REASON-EFF-DATE (1) THRU (12) Data Element Name: REASON-EXP-DATE (1) THRU (12) Data Element Name: SOCIAL-SECURITY-NUMBER Data Element Name: URBAN-RURAL-IND Data Element Name: APPL-DATE Data Element Name: BORDER-STATE-IND Data Element Name: BUSINESS-TYPE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 Data Element Name: MANAGED-CARE-CITY Data Element Name: MANAGED-CARE-COUNTY Data Element Name: MANAGED-CARE-EFFECTIVE-DATE Data Element Name: MANAGED-CARE-EMAIL Data Element Name: MANAGED-CARE-END-DATE Data Element Name: MANAGED-CARE-FAX-NUM Data Element Name: MANAGED-CARE-NAME Data Element Name: MANAGED-CARE-PLAN-TYPE Data Element Name: MANAGED-CARE-STATE Data Element Name: MANAGED-CARE-TELEPHONE Data Element Name: MANAGED-CARE-ZIP-CODE Data Element Name: NUMBER-OF-DUAL-ELIGIBLES Data Element Name: NUMBER-OF-ENROLLMENT Data Element Name: NUMBER-OF-PROVIDERS Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) Data Element Name: OUT-OF-STATE-IND Data Element Name: OWNERSHIP-CODE Data Element Name: PLAN-ID-NUM Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 Data Element Name: REIMBURSEMENT-ARRANGEMENT Data Element Name: URBAN-RURAL-IND