Data Elements List

Data Element Lists 2012-Dec and 2012-Feb as of 2012-11-12.xlsx

Medicaid Statistical Information System (MSIS) and the Transformed - Medicaid Statistical Information System (T-MSIS)

Data Elements List

OMB: 0938-0345

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Overview

Summary
Field Comparison
2012-Dec
2012-Feb
SuperSet

Sheet 1: Summary
Counts of TMSIS Data Dictionary Data Elements
as of 2012-11-12






File Type Date Elements in 2012-Feb Date Elements in 2012-Dec Date Elements in 2012-Feb but not 2012-Dec Date Elements in 2012-Dec but not 2012-Feb Date Elements in both 2012-Feb & 2012-Dec
Eligibile File 69 98 24 52 45
TPL 23 24 4 5 19
Claim 168 195 7 33 162
Provider 88 95 11 18 77
Managed Care 25 21 25 21 0
All File Types 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.

Sheet 2: Field Comparison
File-Id Data-Element In-Feb-DD In-Dec-DD
ELIGIBLE FILE DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY x x
ELIGIBLE FILE DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR
x
ELIGIBLE FILE DATA ELEMENT NAME: CHIP-CODE
x
ELIGIBLE FILE DATA ELEMENT NAME: CITIZENSHIP-IND
x
ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-BIRTH x x
ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-DEATH x x
ELIGIBLE FILE DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 x x
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 x x
ELIGIBLE FILE DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-CITY x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-LAST-NAME x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-STATE x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-GROUP x x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS
x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON
x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE
x
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE
x
ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4
x
ELIGIBLE FILE DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH x x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-INSURANCE-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: HOUSEHOLD-SIZE
x
ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS
x
ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE
x
ELIGIBLE FILE DATA ELEMENT NAME: INCOME-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS
x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 x x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12
x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12
x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 x x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4)
x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS x x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MARITAL-STATUS
x
ELIGIBLE FILE DATA ELEMENT NAME: MEDICARE-HIC-NUM x x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2)
x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2)
x
ELIGIBLE FILE DATA ELEMENT NAME: MSIS-CASE-NUM x x
ELIGIBLE FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM x x
ELIGIBLE FILE DATA ELEMENT NAME: NEWBORN-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: PREGNANCY-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: RACE (1 - 14)
x
ELIGIBLE FILE DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: SEX x x
ELIGIBLE FILE DATA ELEMENT NAME: SSDI-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: SSI-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES
x
ELIGIBLE FILE DATA ELEMENT NAME: SSI-STATUS
x
ELIGIBLE FILE DATA ELEMENT NAME: SSN
x
ELIGIBLE FILE DATA ELEMENT NAME: SSN-VERIFICATION-FLAG
x
ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5)
x
ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5)
x
ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5)
x
ELIGIBLE FILE DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP x x
ELIGIBLE FILE DATA ELEMENT NAME: TANF-CASH-CODE x x
ELIGIBLE FILE DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT
x
ELIGIBLE FILE DATA ELEMENT NAME: TYPE-OF-RECORD x x
ELIGIBLE FILE DATA ELEMENT NAME: VETERAN-IND x x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4)
x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ID (1 - 4)
x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-TYPE (1 - 4)
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4)
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: COVERAGE-TYPE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: GROUP-NUM x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3)
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-CITY x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAME x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-STATE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-ID x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-FIRST-NAME x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-LAST-NAME x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-MIDDLE-INIT x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES)
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EFF-DATE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EXP-DATE x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER x x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-CODE
x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-SSN x x
CLAIMS FILES DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND
x
CLAIMS FILES DATA ELEMENT NAME: ADJUDICATION-DATE x x
CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-IND x x
CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE x x
CLAIMS FILES DATA ELEMENT NAME: ADMISSION-DATE x x
CLAIMS FILES DATA ELEMENT NAME: ADMISSION-HOUR x x
CLAIMS FILES DATA ELEMENT NAME: ADMISSION-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NUM x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY x x
CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: ALLOWED-AMT x x
CLAIMS FILES DATA ELEMENT NAME: ALLOWED-CHARGE-SRC x x
CLAIMS FILES DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE x x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT
x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID
x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT
x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID
x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT
x
CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID
x
CLAIMS FILES DATA ELEMENT NAME: BENEFIT TYPE
x
CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NPI-NUM x x
CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NUM x x
CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-SPECIALTY x x
CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TAXONOMY x x
CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: BILLING-UNIT x x
CLAIMS FILES DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS x x
CLAIMS FILES DATA ELEMENT NAME: BMI-CODE x x
CLAIMS FILES DATA ELEMENT NAME: BRAND-GENERIC-IND x x
CLAIMS FILES DATA ELEMENT NAME: BORDER-STATE-IND x x
CLAIMS FILES DATA ELEMENT NAME: CHARGED-AMT x x
CLAIMS FILES DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE x x
CLAIMS FILES DATA ELEMENT NAME: CHECK-NUM x x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR
x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-LINE-COUNT x x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-LINE-STATUS
x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 x x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS x x
CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY x x
CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM x x
CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DRUG-IND x x
CLAIMS FILES DATA ELEMENT NAME: COPAY-AMT x x
CLAIMS FILES DATA ELEMENT NAME: COPAY-WAIVED-IND
x
CLAIMS FILES DATA ELEMENT NAME: CROSSOVER-INDICATOR x x
CLAIMS FILES DATA ELEMENT NAME: DAILY-RATE x x
CLAIMS FILES DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED
x
CLAIMS FILES DATA ELEMENT NAME: DATE-PRESCRIBED x x
CLAIMS FILES DATA ELEMENT NAME: DAYS-SUPPLY x x
CLAIMS FILES DATA ELEMENT NAME: DEDUCTIBLE-AMT x x
CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 x x
CLAIMS FILES DATA ELEMENT NAME: DESTINATION-CITY x x
CLAIMS FILES DATA ELEMENT NAME: DESTINATION-STATE x x
CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ZIP-CODE x x
CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) x x
CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) x x
CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12)
x
CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP x x
CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND x x
CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-DATE x x
CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-HOUR x x
CLAIMS FILES DATA ELEMENT NAME: DISPENSE-FEE x x
CLAIMS FILES DATA ELEMENT NAME: DRG-DESCRIPTION x x
CLAIMS FILES DATA ELEMENT NAME: DRG-OUTLIER-AMT x x
CLAIMS FILES DATA ELEMENT NAME: DRG-REL-WEIGHT x x
CLAIMS FILES DATA ELEMENT NAME: DRUG-UTILIZATION-CODE x x
CLAIMS FILES DATA ELEMENT NAME: DTL-METRIC-DEC-QTY x x
CLAIMS FILES DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE x x
CLAIMS FILES DATA ELEMENT NAME: FIXED-PAYMENT-IND x x
CLAIMS FILES DATA ELEMENT NAME: FORCED-CLAIM-IND x x
CLAIMS FILES DATA ELEMENT NAME: FUNDING-CODE x x
CLAIMS FILES DATA ELEMENT NAME: FUNDING-SOURCE-STATE x x
CLAIMS FILES DATA ELEMENT NAME: HCBS-SERVICE-IND x x
CLAIMS FILES DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND x x
CLAIMS FILES DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME
x
CLAIMS FILES DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND x x
CLAIMS FILES DATA ELEMENT NAME: ICF-MR-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: ICN-ADJ x x
CLAIMS FILES DATA ELEMENT NAME: ICN-ORIG x x
CLAIMS FILES DATA ELEMENT NAME: IMMUNIZATION-TYPE
x
CLAIMS FILES DATA ELEMENT NAME: LEAVE-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: LINE-NUM-ADJ
x
CLAIMS FILES DATA ELEMENT NAME: LINE-NUM-ORIG
x
CLAIMS FILES DATA ELEMENT NAME: LTC-RCP-LIAB-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH
x
CLAIMS FILES DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-DATE x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COINS-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COMB-DED-IND x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-HIC-NUM x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-PAID-AMT x x
CLAIMS FILES DATA ELEMENT NAME: MEDICARE-REIM-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM x x
CLAIMS FILES DATA ELEMENT NAME: NATIONAL-DRUG-CODE x x
CLAIMS FILES DATA ELEMENT NAME: NEW-REFILL-IND x x
CLAIMS FILES DATA ELEMENT NAME: NON-COV-CHARGES x x
CLAIMS FILES DATA ELEMENT NAME: NON-COV-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: NURSING-FACILITY-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: OCCURRENCE-CODE x x
CLAIMS FILES DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM
x
CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 x x
CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-CITY x x
CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-STATE x x
CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ZIP-CODE x x
CLAIMS FILES DATA ELEMENT NAME: OTHER-COINS-AMT x x
CLAIMS FILES DATA ELEMENT NAME: OTHER-INSURANCE-IND x x
CLAIMS FILES DATA ELEMENT NAME: OTHER-TPL-COLLECTION
x
CLAIMS FILES DATA ELEMENT NAME: OUTLIER-CODE x x
CLAIMS FILES DATA ELEMENT NAME: OUTLIER-DAYS x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-CONTROL-NUM x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-FIRST-NAME x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-LAST-NAME x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-MIDDLE-INIT x x
CLAIMS FILES DATA ELEMENT NAME: PATIENT-STATUS x x
CLAIMS FILES DATA ELEMENT NAME: PAYMENT-LEVEL-IND x x
CLAIMS FILES DATA ELEMENT NAME: PLACE-OF-SERVICE x x
CLAIMS FILES DATA ELEMENT NAME: PLAN-ID-NUMBER x x
CLAIMS FILES DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NUM x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE x x
CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-NUM x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (1) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE x x
CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-DATE
x
CLAIMS FILES DATA ELEMENT NAME: PROGRAM-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: PROVIDER-LOCATION-CODE
x
CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ACTUAL x x
CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ALLOWED x x
CLAIMS FILES DATA ELEMENT NAME: QUANTITY-OF-SERVICE x x
CLAIMS FILES DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR
x
CLAIMS FILES DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED
x
CLAIMS FILES DATA ELEMENT NAME: RECORD-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM x x
CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NUM x x
CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY x x
CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY x x
CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-DATE x x
CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-NUM x x
CLAIMS FILES DATA ELEMENT NAME: SELF-DIRECTION TYPE
x
CLAIMS FILES DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) x x
CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM x x
CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NUM x x
CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY x x
CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY x x
CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-TYPE x x
CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT x x
CLAIMS FILES DATA ELEMENT NAME: SOURCE-LOCATION x x
CLAIMS FILES DATA ELEMENT NAME: SPLIT-CLAIM-IND x x
CLAIMS FILES DATA ELEMENT NAME: SUBMITTER-ID x x
CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID
x
CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID
x
CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT
x
CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID
x
CLAIMS FILES DATA ELEMENT NAME: TOOTH-NUM x x
CLAIMS FILES DATA ELEMENT NAME: TOOTH-QUAD-IND x x
CLAIMS FILES DATA ELEMENT NAME: TOOTH-SURFACE-IND x x
CLAIMS FILES DATA ELEMENT NAME: TOT-ALLOWED-AMT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-CHARGED-AMOUNT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-COPAY-AMT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT x x
CLAIMS FILES DATA ELEMENT NAME: TOT-TPL-AMT x x
CLAIMS FILES DATA ELEMENT NAME: ME
x
CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-BILL x x
CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-CLAIM x x
CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-HOSPITAL x x
CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-SERVICE x x
CLAIMS FILES DATA ELEMENT NAME: REVENUE-CHARGE
x
CLAIMS FILES DATA ELEMENT NAME: REVENUE-CODE
x
CLAIMS FILES DATA ELEMENT NAME: REVENUE-UNITS
x
CLAIMS FILES DATA ELEMENT NAME: UNITS-ACTUAL x x
CLAIMS FILES DATA ELEMENT NAME: UNITS-ALLOWED x x
CLAIMS FILES DATA ELEMENT NAME: WAIVER-ID x x
CLAIMS FILES DATA ELEMENT NAME: WAIVER-TYPE x x
PROVIDER FILE Data Element Name: APPL-DATE x x
PROVIDER FILE Data Element Name: BED-ICF-MR-NUM x x
PROVIDER FILE Data Element Name: BED-ICF-MR-EFF-DATE x x
PROVIDER FILE Data Element Name: BED-INPATIENT-NUM x x
PROVIDER FILE Data Element Name: BED-INPATIENT-EFF-DATE x x
PROVIDER FILE Data Element Name: BED-NF-NUM x x
PROVIDER FILE Data Element Name: BED-NF-EFF-DATE x x
PROVIDER FILE Data Element Name: BED-T18-SNF-NUM x x
PROVIDER FILE Data Element Name: BED-T18-SNF-EFF-DATE x x
PROVIDER FILE Data Element Name: BENEFIT-TYPE(1) THRU (50)
x
PROVIDER FILE Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20)
x
PROVIDER FILE Data Element Name: BILLING-LOC-CITY (1) THRU (20)
x
PROVIDER FILE Data Element Name: BILL-LOC-COUNTY (1) THRU (6) x x
PROVIDER FILE Data Element Name: BILL-LOC-EMAIL (1) THRU (6) x x
PROVIDER FILE Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) x x
PROVIDER FILE Data Element Name: BILL-LOC-STATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) x x
PROVIDER FILE Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) x x
PROVIDER FILE Data Element Name: BORDER-STATE-IND x x
PROVIDER FILE Data Element Name: BUSINESS-TYPE x x
PROVIDER FILE Data Element Name: CLIA-EFF-DATE (1) THRU (12) x x
PROVIDER FILE Data Element Name: CLIA-EXP-DATE (1) THRU (12) x x
PROVIDER FILE Data Element Name: CLIA-NUM-1 through CLIA-NUM-12
x
PROVIDER FILE Data Element Name: CLIA-TYPE (1) THRU (12) x x
PROVIDER FILE Data Element Name:Core Based Statistical Area (CBSA) Code
x
PROVIDER FILE Data Element Name: DATE-OF-BIRTH x x
PROVIDER FILE Data Element Name: DATE-OF-DEATH x x
PROVIDER FILE Data Element Name: DEA-EFF-DATE x x
PROVIDER FILE Data Element Name: DEA-EXP-DATE x x
PROVIDER FILE Data Element Name: DEA-NUM x x
PROVIDER FILE Data Element Name: GENDER x x
PROVIDER FILE Data Element Name: LIC-EFF-DATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: LIC-EXP-DATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: LIC-NUM (1) THRU (6) x x
PROVIDER FILE Data Element Name: MAILING-CITY (1) THRU (6) x x
PROVIDER FILE Data Element Name: MAILING-COUNTY (1) THRU (6) x x
PROVIDER FILE Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) x x
PROVIDER FILE Data Element Name: MAILING-STATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: MAILING-ZIP-CODE (1) THRU (6) x x
PROVIDER FILE Data Element Name: MEDICAID-PROV-NUM x x
PROVIDER FILE Data Element Name: MEDICARE-PROV-NUM x x
PROVIDER FILE Data Element Name: NCPDP-EFF-DATE x x
PROVIDER FILE Data Element Name: NCPDP-EXP-DATE x x
PROVIDER FILE Data Element Name: NCPDP-NUM x x
PROVIDER FILE Data Element Name: OUT-OF-STATE-IND x x
PROVIDER FILE Data Element Name: OWNERSHIP-CODE x x
PROVIDER FILE Data Element Name: PER-DIEM-AMT-ICF-MR x x
PROVIDER FILE Data Element Name: PER-DIEM-AMT-INPATIENT x x
PROVIDER FILE Data Element Name: PER-DIEM-AMT-NF x x
PROVIDER FILE Data Element Name: PER-DIEM-AMT-T18-SNF x x
PROVIDER FILE Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW> x x
PROVIDER FILE Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW> x x
PROVIDER FILE Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW> x x
PROVIDER FILE Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW> x x
PROVIDER FILE Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW> x x
PROVIDER FILE Data Element Name: PREV-MEDICAID-PROV-NUM x x
PROVIDER FILE Data Element Name: PREV-MEDICARE-PROV-NUM x x
PROVIDER FILE Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6) x x
PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS
x
PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS-EFF-DATE (1) THRU (12)
x
PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS-END-DATE (1) THRU (12)
x
PROVIDER FILE Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100) x x
PROVIDER FILE Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100) x x
PROVIDER FILE Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100) x x
PROVIDER FILE Data Element Name: PROV-GRP-NUM (1) THRU (100) x x
PROVIDER FILE Data Element Name: PROV-STATUS-CODE (1) THRU (100)
x
PROVIDER FILE Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) x x
PROVIDER FILE Data Element Name: PROV-FIRST-NAME
x
PROVIDER FILE Data Element Name: PROV-MIDDLE-INITIAL
x
PROVIDER FILE Data Element Name: PROV-LAST-NAME
x
PROVIDER FILE Data Element Name: PROV-LEGAL-NAME
x
PROVIDER FILE Data Element Name: PROV-DOING-BUSINESS-AS-NAME
x
PROVIDER FILE Data Element Name: PROV-INACTIVE-IND
x
PROVIDER FILE Data Element Name: PROV-INACTIVE-START-DATE
x
PROVIDER FILE Data Element Name: PROV-INACTIVE-END-DATE
x
PROVIDER FILE Data Element Name: PROV-NPI-NUM (1) THRU (10) x x
PROVIDER FILE Data Element Name: PROV-SPECIALTY (1) THRU (6) x x
PROVIDER FILE Data Element Name: PROV-TAX-ID-CURRENT x x
PROVIDER FILE Data Element Name: PROV-TAX-ID-PREVIOUS x x
PROVIDER FILE Data Element Name: PROV-TAXONOMY (1) THRU (6) x x
PROVIDER FILE Data Element Name: PROV-TYPE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-CITY (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-STATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) x x
PROVIDER FILE Data Element Name: SSN
x
PROVIDER FILE Data Element Name: TEACHING-IND x x
PROVIDER FILE Data Element Name: TERMINATION-DATE x x
PROVIDER FILE Data Element Name: TERMINATION-REASON-CODE x x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: APPL-DATE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: BORDER-STATE-IND
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: BUSINESS-TYPE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-CITY
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EMAIL
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-END-DATE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-NAME
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-TYPE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-POPULATIONS
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-RECORD-TYPE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-STATE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-TELEPHONE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ZIP-CODE
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: OPERATING-AUTHORITY
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: PLAN-ID-NUM
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT
x
MANAGED CARE PLAN INFORMATION FILE Data Element Name: Core Based Statistical Area (CBSA) Code
x
ELIGIBLE FILE DATA ELEMENT NAME: CHIP- CODE x
ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE x
ELIGIBLE FILE DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1 x
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-BEGIN-DATE x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4 x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4 x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4 x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4 x
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4 x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4 x
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2 x
ELIGIBLE FILE DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2 x
ELIGIBLE FILE DATA ELEMENT NAME: RACE x
ELIGIBLE FILE DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4 x
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4 x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3 x
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-IND x
CLAIMS FILES DATA ELEMENT NAME: IMMUNIZATION TYPE x
CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ADJ x
CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ORIG x
CLAIMS FILES DATA ELEMENT NAME: TPL-AMT x
CLAIMS FILES DATA ELEMENT NAME: UB-REV-CHARGE x
CLAIMS FILES DATA ELEMENT NAME: UB REV-CODE x
CLAIMS FILES DATA ELEMENT NAME: UB-REV-UNITS x
PROVIDER FILE Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6) x
PROVIDER FILE Data Element Name: BILL-LOC-CITY (1) THRU (6) x
PROVIDER FILE Data Element Name: CLIA-NUM x
PROVIDER FILE Data Element Name: DBA-NAME x
PROVIDER FILE Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100) x
PROVIDER FILE Data Element Name: PROV-NAME x
PROVIDER FILE Data Element Name: REASON-CODE (1) THRU (12) x
PROVIDER FILE Data Element Name: REASON-EFF-DATE (1) THRU (12) x
PROVIDER FILE Data Element Name: REASON-EXP-DATE (1) THRU (12) x
PROVIDER FILE Data Element Name: SOCIAL-SECURITY-NUMBER x
PROVIDER FILE Data Element Name: URBAN-RURAL-IND x
MANAGED CARE PLAN FILE Data Element Name: APPL-DATE x
MANAGED CARE PLAN FILE Data Element Name: BORDER-STATE-IND x
MANAGED CARE PLAN FILE Data Element Name: BUSINESS-TYPE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-CITY x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-COUNTY x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EMAIL x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-END-DATE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-FAX-NUM x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-NAME x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-PLAN-TYPE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-STATE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-TELEPHONE x
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ZIP-CODE x
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-DUAL-ELIGIBLES x
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-ENROLLMENT x
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-PROVIDERS x
MANAGED CARE PLAN FILE Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) x
MANAGED CARE PLAN FILE Data Element Name: OUT-OF-STATE-IND x
MANAGED CARE PLAN FILE Data Element Name: OWNERSHIP-CODE x
MANAGED CARE PLAN FILE Data Element Name: PLAN-ID-NUM x
MANAGED CARE PLAN FILE Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 x
MANAGED CARE PLAN FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT x
MANAGED CARE PLAN FILE Data Element Name: URBAN-RURAL-IND x

Sheet 3: 2012-Dec
RowNo FileId DataElement
1 ELIGIBLE FILE DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY
2 ELIGIBLE FILE DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR
3 ELIGIBLE FILE DATA ELEMENT NAME: CHIP-CODE
4 ELIGIBLE FILE DATA ELEMENT NAME: CITIZENSHIP-IND
5 ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-BIRTH
6 ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-DEATH
7 ELIGIBLE FILE DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY
8 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-1
9 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-2
10 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-3
11 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-4
12 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-5
13 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-6
14 ELIGIBLE FILE DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE
15 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE
16 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3
17 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-CITY
18 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE
19 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME
20 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME
21 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-LAST-NAME
22 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT
23 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM
24 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-STATE
25 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE
26 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-GROUP
27 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS
28 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON
29 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE
30 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE
31 ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4
32 ELIGIBLE FILE DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH
33 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4)
34 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4)
35 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-IND
36 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4)
37 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4)
38 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4)
39 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4)
40 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4)
41 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-INSURANCE-IND
42 ELIGIBLE FILE DATA ELEMENT NAME: HOUSEHOLD-SIZE
43 ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS
44 ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE
45 ELIGIBLE FILE DATA ELEMENT NAME: INCOME-CODE
46 ELIGIBLE FILE DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS
47 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12
48 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12
49 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12
50 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12
51 ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4)
52 ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4)
53 ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4)
54 ELIGIBLE FILE DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4)
55 ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4)
56 ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4)
57 ELIGIBLE FILE DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS
58 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4)
59 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4)
60 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4)
61 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4)
62 ELIGIBLE FILE DATA ELEMENT NAME: MARITAL-STATUS
63 ELIGIBLE FILE DATA ELEMENT NAME: MEDICARE-HIC-NUM
64 ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2)
65 ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4)
66 ELIGIBLE FILE DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2)
67 ELIGIBLE FILE DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2)
68 ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4)
69 ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2)
70 ELIGIBLE FILE DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2)
71 ELIGIBLE FILE DATA ELEMENT NAME: MSIS-CASE-NUM
72 ELIGIBLE FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
73 ELIGIBLE FILE DATA ELEMENT NAME: NEWBORN-IND
74 ELIGIBLE FILE DATA ELEMENT NAME: PREGNANCY-IND
75 ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND
76 ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND
77 ELIGIBLE FILE DATA ELEMENT NAME: RACE (1 - 14)
78 ELIGIBLE FILE DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE
79 ELIGIBLE FILE DATA ELEMENT NAME: SEX
80 ELIGIBLE FILE DATA ELEMENT NAME: SSDI-IND
81 ELIGIBLE FILE DATA ELEMENT NAME: SSI-IND
82 ELIGIBLE FILE DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES
83 ELIGIBLE FILE DATA ELEMENT NAME: SSI-STATUS
84 ELIGIBLE FILE DATA ELEMENT NAME: SSN
85 ELIGIBLE FILE DATA ELEMENT NAME: SSN-VERIFICATION-FLAG
86 ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5)
87 ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5)
88 ELIGIBLE FILE DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5)
89 ELIGIBLE FILE DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP
90 ELIGIBLE FILE DATA ELEMENT NAME: TANF-CASH-CODE
91 ELIGIBLE FILE DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT
92 ELIGIBLE FILE DATA ELEMENT NAME: TYPE-OF-RECORD
93 ELIGIBLE FILE DATA ELEMENT NAME: VETERAN-IND
94 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4)
95 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4)
96 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ID (1 - 4)
97 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-TYPE (1 - 4)
98 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4)
99 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: COVERAGE-TYPE
100 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: GROUP-NUM
101 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID
102 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE
103 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3)
104 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-CITY
105 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM
106 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE
107 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAME
108 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM
109 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-STATE
110 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE
111 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-ID
112 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-FIRST-NAME
113 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-LAST-NAME
114 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-MIDDLE-INIT
115 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
116 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES)
117 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EFF-DATE
118 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EXP-DATE
119 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER
120 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-CODE
121 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-SSN
122 CLAIMS FILES DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND
123 CLAIMS FILES DATA ELEMENT NAME: ADJUDICATION-DATE
124 CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-IND
125 CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE
126 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-DATE
127 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-HOUR
128 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-TYPE
129 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE
130 CLAIMS FILES DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG
131 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM
132 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NUM
133 CLAIMS FILES DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY
134 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY
135 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TYPE
136 CLAIMS FILES DATA ELEMENT NAME: ALLOWED-AMT
137 CLAIMS FILES DATA ELEMENT NAME: ALLOWED-CHARGE-SRC
138 CLAIMS FILES DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE
139 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT
140 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID
141 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT
142 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID
143 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT
144 CLAIMS FILES DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID
145 CLAIMS FILES DATA ELEMENT NAME: BENEFIT TYPE
146 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NPI-NUM
147 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NUM
148 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-SPECIALTY
149 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TAXONOMY
150 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TYPE
151 CLAIMS FILES DATA ELEMENT NAME: BILLING-UNIT
152 CLAIMS FILES DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS
153 CLAIMS FILES DATA ELEMENT NAME: BMI-CODE
154 CLAIMS FILES DATA ELEMENT NAME: BRAND-GENERIC-IND
155 CLAIMS FILES DATA ELEMENT NAME: BORDER-STATE-IND
156 CLAIMS FILES DATA ELEMENT NAME: CHARGED-AMT
157 CLAIMS FILES DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE
158 CLAIMS FILES DATA ELEMENT NAME: CHECK-NUM
159 CLAIMS FILES DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR
160 CLAIMS FILES DATA ELEMENT NAME: CLAIM-LINE-COUNT
161 CLAIMS FILES DATA ELEMENT NAME: CLAIM-LINE-STATUS
162 CLAIMS FILES DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4
163 CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS
164 CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY
165 CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM
166 CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DRUG-IND
167 CLAIMS FILES DATA ELEMENT NAME: COPAY-AMT
168 CLAIMS FILES DATA ELEMENT NAME: COPAY-WAIVED-IND
169 CLAIMS FILES DATA ELEMENT NAME: CROSSOVER-INDICATOR
170 CLAIMS FILES DATA ELEMENT NAME: DAILY-RATE
171 CLAIMS FILES DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED
172 CLAIMS FILES DATA ELEMENT NAME: DATE-PRESCRIBED
173 CLAIMS FILES DATA ELEMENT NAME: DAYS-SUPPLY
174 CLAIMS FILES DATA ELEMENT NAME: DEDUCTIBLE-AMT
175 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2
176 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-CITY
177 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-STATE
178 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ZIP-CODE
179 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12)
180 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12)
181 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12)
182 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP
183 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND
184 CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-DATE
185 CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-HOUR
186 CLAIMS FILES DATA ELEMENT NAME: DISPENSE-FEE
187 CLAIMS FILES DATA ELEMENT NAME: DRG-DESCRIPTION
188 CLAIMS FILES DATA ELEMENT NAME: DRG-OUTLIER-AMT
189 CLAIMS FILES DATA ELEMENT NAME: DRG-REL-WEIGHT
190 CLAIMS FILES DATA ELEMENT NAME: DRUG-UTILIZATION-CODE
191 CLAIMS FILES DATA ELEMENT NAME: DTL-METRIC-DEC-QTY
192 CLAIMS FILES DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE
193 CLAIMS FILES DATA ELEMENT NAME: FIXED-PAYMENT-IND
194 CLAIMS FILES DATA ELEMENT NAME: FORCED-CLAIM-IND
195 CLAIMS FILES DATA ELEMENT NAME: FUNDING-CODE
196 CLAIMS FILES DATA ELEMENT NAME: FUNDING-SOURCE-STATE
197 CLAIMS FILES DATA ELEMENT NAME: HCBS-SERVICE-IND
198 CLAIMS FILES DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND
199 CLAIMS FILES DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME
200 CLAIMS FILES DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND
201 CLAIMS FILES DATA ELEMENT NAME: ICF-MR-DAYS
202 CLAIMS FILES DATA ELEMENT NAME: ICN-ADJ
203 CLAIMS FILES DATA ELEMENT NAME: ICN-ORIG
204 CLAIMS FILES DATA ELEMENT NAME: IMMUNIZATION-TYPE
205 CLAIMS FILES DATA ELEMENT NAME: LEAVE-DAYS
206 CLAIMS FILES DATA ELEMENT NAME: LINE-NUM-ADJ
207 CLAIMS FILES DATA ELEMENT NAME: LINE-NUM-ORIG
208 CLAIMS FILES DATA ELEMENT NAME: LTC-RCP-LIAB-AMT
209 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH
210 CLAIMS FILES DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS
211 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT
212 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-AMT
213 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-DATE
214 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COINS-AMT
215 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT
216 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COMB-DED-IND
217 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-HIC-NUM
218 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-PAID-AMT
219 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-REIM-TYPE
220 CLAIMS FILES DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
221 CLAIMS FILES DATA ELEMENT NAME: NATIONAL-DRUG-CODE
222 CLAIMS FILES DATA ELEMENT NAME: NEW-REFILL-IND
223 CLAIMS FILES DATA ELEMENT NAME: NON-COV-CHARGES
224 CLAIMS FILES DATA ELEMENT NAME: NON-COV-DAYS
225 CLAIMS FILES DATA ELEMENT NAME: NURSING-FACILITY-DAYS
226 CLAIMS FILES DATA ELEMENT NAME: OCCURRENCE-CODE
227 CLAIMS FILES DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM
228 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2
229 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-CITY
230 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-STATE
231 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ZIP-CODE
232 CLAIMS FILES DATA ELEMENT NAME: OTHER-COINS-AMT
233 CLAIMS FILES DATA ELEMENT NAME: OTHER-INSURANCE-IND
234 CLAIMS FILES DATA ELEMENT NAME: OTHER-TPL-COLLECTION
235 CLAIMS FILES DATA ELEMENT NAME: OUTLIER-CODE
236 CLAIMS FILES DATA ELEMENT NAME: OUTLIER-DAYS
237 CLAIMS FILES DATA ELEMENT NAME: PATIENT-CONTROL-NUM
238 CLAIMS FILES DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH
239 CLAIMS FILES DATA ELEMENT NAME: PATIENT-FIRST-NAME
240 CLAIMS FILES DATA ELEMENT NAME: PATIENT-LAST-NAME
241 CLAIMS FILES DATA ELEMENT NAME: PATIENT-MIDDLE-INIT
242 CLAIMS FILES DATA ELEMENT NAME: PATIENT-STATUS
243 CLAIMS FILES DATA ELEMENT NAME: PAYMENT-LEVEL-IND
244 CLAIMS FILES DATA ELEMENT NAME: PLACE-OF-SERVICE
245 CLAIMS FILES DATA ELEMENT NAME: PLAN-ID-NUMBER
246 CLAIMS FILES DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM
247 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM
248 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NUM
249 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY
250 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY
251 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE
252 CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE
253 CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-NUM
254 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (1)
255 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6)
256 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1)
257 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6)
258 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1)
259 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6)
260 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1)
261 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE
262 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-DATE
263 CLAIMS FILES DATA ELEMENT NAME: PROGRAM-TYPE
264 CLAIMS FILES DATA ELEMENT NAME: PROVIDER-LOCATION-CODE
265 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ACTUAL
266 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ALLOWED
267 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-OF-SERVICE
268 CLAIMS FILES DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR
269 CLAIMS FILES DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED
270 CLAIMS FILES DATA ELEMENT NAME: RECORD-TYPE
271 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM
272 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NUM
273 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY
274 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY
275 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TYPE
276 CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-DATE
277 CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-NUM
278 CLAIMS FILES DATA ELEMENT NAME: SELF-DIRECTION TYPE
279 CLAIMS FILES DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE)
280 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM
281 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NUM
282 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY
283 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY
284 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TYPE
285 CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-TYPE
286 CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT
287 CLAIMS FILES DATA ELEMENT NAME: SOURCE-LOCATION
288 CLAIMS FILES DATA ELEMENT NAME: SPLIT-CLAIM-IND
289 CLAIMS FILES DATA ELEMENT NAME: SUBMITTER-ID
290 CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID
291 CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID
292 CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT
293 CLAIMS FILES DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID
294 CLAIMS FILES DATA ELEMENT NAME: TOOTH-NUM
295 CLAIMS FILES DATA ELEMENT NAME: TOOTH-QUAD-IND
296 CLAIMS FILES DATA ELEMENT NAME: TOOTH-SURFACE-IND
297 CLAIMS FILES DATA ELEMENT NAME: TOT-ALLOWED-AMT
298 CLAIMS FILES DATA ELEMENT NAME: TOT-CHARGED-AMOUNT
299 CLAIMS FILES DATA ELEMENT NAME: TOT-COPAY-AMT
300 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT
301 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT
302 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT
303 CLAIMS FILES DATA ELEMENT NAME: TOT-TPL-AMT
304 CLAIMS FILES DATA ELEMENT NAME: ME
305 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-BILL
306 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-CLAIM
307 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-HOSPITAL
308 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-SERVICE
309 CLAIMS FILES DATA ELEMENT NAME: REVENUE-CHARGE
310 CLAIMS FILES DATA ELEMENT NAME: REVENUE-CODE
311 CLAIMS FILES DATA ELEMENT NAME: REVENUE-UNITS
312 CLAIMS FILES DATA ELEMENT NAME: UNITS-ACTUAL
313 CLAIMS FILES DATA ELEMENT NAME: UNITS-ALLOWED
314 CLAIMS FILES DATA ELEMENT NAME: WAIVER-ID
315 CLAIMS FILES DATA ELEMENT NAME: WAIVER-TYPE
316 PROVIDER FILE Data Element Name: APPL-DATE
317 PROVIDER FILE Data Element Name: BED-ICF-MR-NUM
318 PROVIDER FILE Data Element Name: BED-ICF-MR-EFF-DATE
319 PROVIDER FILE Data Element Name: BED-INPATIENT-NUM
320 PROVIDER FILE Data Element Name: BED-INPATIENT-EFF-DATE
321 PROVIDER FILE Data Element Name: BED-NF-NUM
322 PROVIDER FILE Data Element Name: BED-NF-EFF-DATE
323 PROVIDER FILE Data Element Name: BED-T18-SNF-NUM
324 PROVIDER FILE Data Element Name: BED-T18-SNF-EFF-DATE
325 PROVIDER FILE Data Element Name: BENEFIT-TYPE(1) THRU (50)
326 PROVIDER FILE Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20)
327 PROVIDER FILE Data Element Name: BILLING-LOC-CITY (1) THRU (20)
328 PROVIDER FILE Data Element Name: BILL-LOC-COUNTY (1) THRU (6)
329 PROVIDER FILE Data Element Name: BILL-LOC-EMAIL (1) THRU (6)
330 PROVIDER FILE Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6)
331 PROVIDER FILE Data Element Name: BILL-LOC-STATE (1) THRU (6)
332 PROVIDER FILE Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6)
333 PROVIDER FILE Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6)
334 PROVIDER FILE Data Element Name: BORDER-STATE-IND
335 PROVIDER FILE Data Element Name: BUSINESS-TYPE
336 PROVIDER FILE Data Element Name: CLIA-EFF-DATE (1) THRU (12)
337 PROVIDER FILE Data Element Name: CLIA-EXP-DATE (1) THRU (12)
338 PROVIDER FILE Data Element Name: CLIA-NUM-1 through CLIA-NUM-12
339 PROVIDER FILE Data Element Name: CLIA-TYPE (1) THRU (12)
340 PROVIDER FILE Data Element Name:Core Based Statistical Area (CBSA) Code
341 PROVIDER FILE Data Element Name: DATE-OF-BIRTH
342 PROVIDER FILE Data Element Name: DATE-OF-DEATH
343 PROVIDER FILE Data Element Name: DEA-EFF-DATE
344 PROVIDER FILE Data Element Name: DEA-EXP-DATE
345 PROVIDER FILE Data Element Name: DEA-NUM
346 PROVIDER FILE Data Element Name: GENDER
347 PROVIDER FILE Data Element Name: LIC-EFF-DATE (1) THRU (6)
348 PROVIDER FILE Data Element Name: LIC-EXP-DATE (1) THRU (6)
349 PROVIDER FILE Data Element Name: LIC-NUM (1) THRU (6)
350 PROVIDER FILE Data Element Name: MAILING-CITY (1) THRU (6)
351 PROVIDER FILE Data Element Name: MAILING-COUNTY (1) THRU (6)
352 PROVIDER FILE Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6)
353 PROVIDER FILE Data Element Name: MAILING-STATE (1) THRU (6)
354 PROVIDER FILE Data Element Name: MAILING-ZIP-CODE (1) THRU (6)
355 PROVIDER FILE Data Element Name: MEDICAID-PROV-NUM
356 PROVIDER FILE Data Element Name: MEDICARE-PROV-NUM
357 PROVIDER FILE Data Element Name: NCPDP-EFF-DATE
358 PROVIDER FILE Data Element Name: NCPDP-EXP-DATE
359 PROVIDER FILE Data Element Name: NCPDP-NUM
360 PROVIDER FILE Data Element Name: OUT-OF-STATE-IND
361 PROVIDER FILE Data Element Name: OWNERSHIP-CODE
362 PROVIDER FILE Data Element Name: PER-DIEM-AMT-ICF-MR
363 PROVIDER FILE Data Element Name: PER-DIEM-AMT-INPATIENT
364 PROVIDER FILE Data Element Name: PER-DIEM-AMT-NF
365 PROVIDER FILE Data Element Name: PER-DIEM-AMT-T18-SNF
366 PROVIDER FILE Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW>
367 PROVIDER FILE Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW>
368 PROVIDER FILE Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW>
369 PROVIDER FILE Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW>
370 PROVIDER FILE Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW>
371 PROVIDER FILE Data Element Name: PREV-MEDICAID-PROV-NUM
372 PROVIDER FILE Data Element Name: PREV-MEDICARE-PROV-NUM
373 PROVIDER FILE Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6)
374 PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS
375 PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS-EFF-DATE (1) THRU (12)
376 PROVIDER FILE Data Element Name: PROV-ENROLLMENT-STATUS-END-DATE (1) THRU (12)
377 PROVIDER FILE Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100)
378 PROVIDER FILE Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100)
379 PROVIDER FILE Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100)
380 PROVIDER FILE Data Element Name: PROV-GRP-NUM (1) THRU (100)
381 PROVIDER FILE Data Element Name: PROV-STATUS-CODE (1) THRU (100)
382 PROVIDER FILE Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100)
383 PROVIDER FILE Data Element Name: PROV-FIRST-NAME
384 PROVIDER FILE Data Element Name: PROV-MIDDLE-INITIAL
385 PROVIDER FILE Data Element Name: PROV-LAST-NAME
386 PROVIDER FILE Data Element Name: PROV-LEGAL-NAME
387 PROVIDER FILE Data Element Name: PROV-DOING-BUSINESS-AS-NAME
388 PROVIDER FILE Data Element Name: PROV-INACTIVE-IND
389 PROVIDER FILE Data Element Name: PROV-INACTIVE-START-DATE
390 PROVIDER FILE Data Element Name: PROV-INACTIVE-END-DATE
391 PROVIDER FILE Data Element Name: PROV-NPI-NUM (1) THRU (10)
392 PROVIDER FILE Data Element Name: PROV-SPECIALTY (1) THRU (6)
393 PROVIDER FILE Data Element Name: PROV-TAX-ID-CURRENT
394 PROVIDER FILE Data Element Name: PROV-TAX-ID-PREVIOUS
395 PROVIDER FILE Data Element Name: PROV-TAXONOMY (1) THRU (6)
396 PROVIDER FILE Data Element Name: PROV-TYPE (1) THRU (6)
397 PROVIDER FILE Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6)
398 PROVIDER FILE Data Element Name: SERVICE-LOC-CITY (1) THRU (6)
399 PROVIDER FILE Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6)
400 PROVIDER FILE Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6)
401 PROVIDER FILE Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6)
402 PROVIDER FILE Data Element Name: SERVICE-LOC-STATE (1) THRU (6)
403 PROVIDER FILE Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6)
404 PROVIDER FILE Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6)
405 PROVIDER FILE Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6)
406 PROVIDER FILE Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6)
407 PROVIDER FILE Data Element Name: SSN
408 PROVIDER FILE Data Element Name: TEACHING-IND
409 PROVIDER FILE Data Element Name: TERMINATION-DATE
410 PROVIDER FILE Data Element Name: TERMINATION-REASON-CODE
411 MANAGED CARE PLAN INFORMATION FILE Data Element Name: APPL-DATE
412 MANAGED CARE PLAN INFORMATION FILE Data Element Name: BORDER-STATE-IND
413 MANAGED CARE PLAN INFORMATION FILE Data Element Name: BUSINESS-TYPE
414 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3
415 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-CITY
416 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE
417 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EMAIL
418 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-END-DATE
419 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-NAME
420 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-TYPE
421 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-POPULATIONS
422 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-RECORD-TYPE
423 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA
424 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME
425 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-STATE
426 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-TELEPHONE
427 MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ZIP-CODE
428 MANAGED CARE PLAN INFORMATION FILE Data Element Name: OPERATING-AUTHORITY
429 MANAGED CARE PLAN INFORMATION FILE Data Element Name: PLAN-ID-NUM
430 MANAGED CARE PLAN INFORMATION FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT
431 MANAGED CARE PLAN INFORMATION FILE Data Element Name: Core Based Statistical Area (CBSA) Code

Sheet 4: 2012-Feb
RowNo FileId DataElement
1 ELIGIBLE FILE DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY
2 ELIGIBLE FILE DATA ELEMENT NAME: CHIP- CODE
3 ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-BIRTH
4 ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-DEATH
5 ELIGIBLE FILE DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY
6 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-1
7 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-2
8 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-3
9 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-4
10 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-5
11 ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-6
12 ELIGIBLE FILE DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE
13 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE
14 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3
15 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-CITY
16 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE
17 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME
18 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-GROUP
19 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME
20 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-LAST-NAME
21 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT
22 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM
23 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-STATE
24 ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE
25 ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE
26 ELIGIBLE FILE DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH
27 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-IND
28 ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-INSURANCE-IND
29 ELIGIBLE FILE DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND
30 ELIGIBLE FILE DATA ELEMENT NAME: INCOME-CODE
31 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12
32 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1
33 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12
34 ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12
35 ELIGIBLE FILE DATA ELEMENT NAME: LTC-BEGIN-DATE
36 ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4
37 ELIGIBLE FILE DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4
38 ELIGIBLE FILE DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4
39 ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4
40 ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4
41 ELIGIBLE FILE DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS
42 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4
43 ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4
44 ELIGIBLE FILE DATA ELEMENT NAME: MEDICARE-HIC-NUM
45 ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2
46 ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2
47 ELIGIBLE FILE DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2
48 ELIGIBLE FILE DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2
49 ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2
50 ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2
51 ELIGIBLE FILE DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2
52 ELIGIBLE FILE DATA ELEMENT NAME: MSIS-CASE-NUM
53 ELIGIBLE FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
54 ELIGIBLE FILE DATA ELEMENT NAME: NEWBORN-IND
55 ELIGIBLE FILE DATA ELEMENT NAME: PREGNANCY-IND
56 ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND
57 ELIGIBLE FILE DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND
58 ELIGIBLE FILE DATA ELEMENT NAME: RACE
59 ELIGIBLE FILE DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE
60 ELIGIBLE FILE DATA ELEMENT NAME: SEX
61 ELIGIBLE FILE DATA ELEMENT NAME: SSDI-IND
62 ELIGIBLE FILE DATA ELEMENT NAME: SSI-IND
63 ELIGIBLE FILE DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER
64 ELIGIBLE FILE DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP
65 ELIGIBLE FILE DATA ELEMENT NAME: TANF-CASH-CODE
66 ELIGIBLE FILE DATA ELEMENT NAME: TYPE-OF-RECORD
67 ELIGIBLE FILE DATA ELEMENT NAME: VETERAN-IND
68 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4
69 ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4
70 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT
71 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: COVERAGE-TYPE
72 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: GROUP-NUM
73 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID
74 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE
75 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3
76 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-CITY
77 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM
78 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE
79 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-NAME
80 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM
81 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-STATE
82 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE
83 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-ID
84 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-FIRST-NAME
85 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-LAST-NAME
86 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MEMBER-MIDDLE-INIT
87 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
88 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EFF-DATE
89 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-EXP-DATE
90 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER
91 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-IND
92 THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-SSN
93 CLAIMS FILES DATA ELEMENT NAME: ADJUDICATION-DATE
94 CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-IND
95 CLAIMS FILES DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE
96 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-DATE
97 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-HOUR
98 CLAIMS FILES DATA ELEMENT NAME: ADMISSION-TYPE
99 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE
100 CLAIMS FILES DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG
101 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM
102 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-NUM
103 CLAIMS FILES DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY
104 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY
105 CLAIMS FILES DATA ELEMENT NAME: ADMITTING-PROV-TYPE
106 CLAIMS FILES DATA ELEMENT NAME: ALLOWED-AMT
107 CLAIMS FILES DATA ELEMENT NAME: ALLOWED-CHARGE-SRC
108 CLAIMS FILES DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE
109 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NPI-NUM
110 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-NUM
111 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-SPECIALTY
112 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TAXONOMY
113 CLAIMS FILES DATA ELEMENT NAME: BILLING-PROV-TYPE
114 CLAIMS FILES DATA ELEMENT NAME: BILLING-UNIT
115 CLAIMS FILES DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS
116 CLAIMS FILES DATA ELEMENT NAME: BMI-CODE
117 CLAIMS FILES DATA ELEMENT NAME: BRAND-GENERIC-IND
118 CLAIMS FILES DATA ELEMENT NAME: BORDER-STATE-IND
119 CLAIMS FILES DATA ELEMENT NAME: CHARGED-AMT
120 CLAIMS FILES DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE
121 CLAIMS FILES DATA ELEMENT NAME: CHECK-NUM
122 CLAIMS FILES DATA ELEMENT NAME: CLAIM-LINE-COUNT
123 CLAIMS FILES DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4
124 CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS
125 CLAIMS FILES DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY
126 CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM
127 CLAIMS FILES DATA ELEMENT NAME: COMPOUND-DRUG-IND
128 CLAIMS FILES DATA ELEMENT NAME: COPAY-AMT
129 CLAIMS FILES DATA ELEMENT NAME: CROSSOVER-INDICATOR
130 CLAIMS FILES DATA ELEMENT NAME: DAILY-RATE
131 CLAIMS FILES DATA ELEMENT NAME: DATE-PRESCRIBED
132 CLAIMS FILES DATA ELEMENT NAME: DAYS-SUPPLY
133 CLAIMS FILES DATA ELEMENT NAME: DEDUCTIBLE-AMT
134 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2
135 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-CITY
136 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-STATE
137 CLAIMS FILES DATA ELEMENT NAME: DESTINATION-ZIP-CODE
138 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12)
139 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12)
140 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP
141 CLAIMS FILES DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND
142 CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-DATE
143 CLAIMS FILES DATA ELEMENT NAME: DISCHARGE-HOUR
144 CLAIMS FILES DATA ELEMENT NAME: DISPENSE-FEE
145 CLAIMS FILES DATA ELEMENT NAME: DRG-DESCRIPTION
146 CLAIMS FILES DATA ELEMENT NAME: DRG-OUTLIER-AMT
147 CLAIMS FILES DATA ELEMENT NAME: DRG-REL-WEIGHT
148 CLAIMS FILES DATA ELEMENT NAME: DRUG-UTILIZATION-CODE
149 CLAIMS FILES DATA ELEMENT NAME: DTL-METRIC-DEC-QTY
150 CLAIMS FILES DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE
151 CLAIMS FILES DATA ELEMENT NAME: FIXED-PAYMENT-IND
152 CLAIMS FILES DATA ELEMENT NAME: FORCED-CLAIM-IND
153 CLAIMS FILES DATA ELEMENT NAME: FUNDING-CODE
154 CLAIMS FILES DATA ELEMENT NAME: FUNDING-SOURCE-STATE
155 CLAIMS FILES DATA ELEMENT NAME: HCBS-SERVICE-IND
156 CLAIMS FILES DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND
157 CLAIMS FILES DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND
158 CLAIMS FILES DATA ELEMENT NAME: ICF-MR-DAYS
159 CLAIMS FILES DATA ELEMENT NAME: ICN-ADJ
160 CLAIMS FILES DATA ELEMENT NAME: ICN-ORIG
161 CLAIMS FILES DATA ELEMENT NAME: IMMUNIZATION TYPE
162 CLAIMS FILES DATA ELEMENT NAME: LEAVE-DAYS
163 CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ADJ
164 CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ORIG
165 CLAIMS FILES DATA ELEMENT NAME: LTC-RCP-LIAB-AMT
166 CLAIMS FILES DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS
167 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT
168 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-AMT
169 CLAIMS FILES DATA ELEMENT NAME: MEDICAID-PAID-DATE
170 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COINS-AMT
171 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT
172 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-COMB-DED-IND
173 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-HIC-NUM
174 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-PAID-AMT
175 CLAIMS FILES DATA ELEMENT NAME: MEDICARE-REIM-TYPE
176 CLAIMS FILES DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM
177 CLAIMS FILES DATA ELEMENT NAME: NATIONAL-DRUG-CODE
178 CLAIMS FILES DATA ELEMENT NAME: NEW-REFILL-IND
179 CLAIMS FILES DATA ELEMENT NAME: NON-COV-CHARGES
180 CLAIMS FILES DATA ELEMENT NAME: NON-COV-DAYS
181 CLAIMS FILES DATA ELEMENT NAME: NURSING-FACILITY-DAYS
182 CLAIMS FILES DATA ELEMENT NAME: OCCURRENCE-CODE
183 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2
184 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-CITY
185 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-STATE
186 CLAIMS FILES DATA ELEMENT NAME: ORIGINATION-ZIP-CODE
187 CLAIMS FILES DATA ELEMENT NAME: OTHER-COINS-AMT
188 CLAIMS FILES DATA ELEMENT NAME: OTHER-INSURANCE-IND
189 CLAIMS FILES DATA ELEMENT NAME: OUTLIER-CODE
190 CLAIMS FILES DATA ELEMENT NAME: OUTLIER-DAYS
191 CLAIMS FILES DATA ELEMENT NAME: PATIENT-CONTROL-NUM
192 CLAIMS FILES DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH
193 CLAIMS FILES DATA ELEMENT NAME: PATIENT-FIRST-NAME
194 CLAIMS FILES DATA ELEMENT NAME: PATIENT-LAST-NAME
195 CLAIMS FILES DATA ELEMENT NAME: PATIENT-MIDDLE-INIT
196 CLAIMS FILES DATA ELEMENT NAME: PATIENT-STATUS
197 CLAIMS FILES DATA ELEMENT NAME: PAYMENT-LEVEL-IND
198 CLAIMS FILES DATA ELEMENT NAME: PLACE-OF-SERVICE
199 CLAIMS FILES DATA ELEMENT NAME: PLAN-ID-NUMBER
200 CLAIMS FILES DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM
201 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM
202 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-NUM
203 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY
204 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY
205 CLAIMS FILES DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE
206 CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE
207 CLAIMS FILES DATA ELEMENT NAME: PRESCRIPTION-NUM
208 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (1)
209 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6)
210 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1)
211 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6)
212 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1)
213 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6)
214 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1)
215 CLAIMS FILES DATA ELEMENT NAME: PROCEDURE-CODE- DATE
216 CLAIMS FILES DATA ELEMENT NAME: PROGRAM-TYPE
217 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ACTUAL
218 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-ALLOWED
219 CLAIMS FILES DATA ELEMENT NAME: QUANTITY-OF-SERVICE
220 CLAIMS FILES DATA ELEMENT NAME: RECORD-TYPE
221 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM
222 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-NUM
223 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY
224 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY
225 CLAIMS FILES DATA ELEMENT NAME: REFERRING-PROV-TYPE
226 CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-DATE
227 CLAIMS FILES DATA ELEMENT NAME: REMITTANCE-NUM
228 CLAIMS FILES DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE)
229 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM
230 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-NUM
231 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY
232 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY
233 CLAIMS FILES DATA ELEMENT NAME: SERVICING-PROV-TYPE
234 CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-TYPE
235 CLAIMS FILES DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT
236 CLAIMS FILES DATA ELEMENT NAME: SOURCE-LOCATION
237 CLAIMS FILES DATA ELEMENT NAME: SPLIT-CLAIM-IND
238 CLAIMS FILES DATA ELEMENT NAME: SUBMITTER-ID
239 CLAIMS FILES DATA ELEMENT NAME: TOOTH-NUM
240 CLAIMS FILES DATA ELEMENT NAME: TOOTH-QUAD-IND
241 CLAIMS FILES DATA ELEMENT NAME: TOOTH-SURFACE-IND
242 CLAIMS FILES DATA ELEMENT NAME: TOT-ALLOWED-AMT
243 CLAIMS FILES DATA ELEMENT NAME: TOT-CHARGED-AMOUNT
244 CLAIMS FILES DATA ELEMENT NAME: TOT-COPAY-AMT
245 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT
246 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT
247 CLAIMS FILES DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT
248 CLAIMS FILES DATA ELEMENT NAME: TOT-TPL-AMT
249 CLAIMS FILES DATA ELEMENT NAME: TPL-AMT
250 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-BILL
251 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-CLAIM
252 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-HOSPITAL
253 CLAIMS FILES DATA ELEMENT NAME: TYPE-OF-SERVICE
254 CLAIMS FILES DATA ELEMENT NAME: UB-REV-CHARGE
255 CLAIMS FILES DATA ELEMENT NAME: UB REV-CODE
256 CLAIMS FILES DATA ELEMENT NAME: UB-REV-UNITS
257 CLAIMS FILES DATA ELEMENT NAME: UNITS-ACTUAL
258 CLAIMS FILES DATA ELEMENT NAME: UNITS-ALLOWED
259 CLAIMS FILES DATA ELEMENT NAME: WAIVER-ID
260 CLAIMS FILES DATA ELEMENT NAME: WAIVER-TYPE
261 PROVIDER FILE Data Element Name: APPL-DATE
262 PROVIDER FILE Data Element Name: BED-ICF-MR-NUM
263 PROVIDER FILE Data Element Name: BED-ICF-MR-EFF-DATE
264 PROVIDER FILE Data Element Name: BED-INPATIENT-NUM
265 PROVIDER FILE Data Element Name: BED-INPATIENT-EFF-DATE
266 PROVIDER FILE Data Element Name: BED-NF-NUM
267 PROVIDER FILE Data Element Name: BED-NF-EFF-DATE
268 PROVIDER FILE Data Element Name: BED-T18-SNF-NUM
269 PROVIDER FILE Data Element Name: BED-T18-SNF-EFF-DATE
270 PROVIDER FILE Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6)
271 PROVIDER FILE Data Element Name: BILL-LOC-CITY (1) THRU (6)
272 PROVIDER FILE Data Element Name: BILL-LOC-COUNTY (1) THRU (6)
273 PROVIDER FILE Data Element Name: BILL-LOC-EMAIL (1) THRU (6)
274 PROVIDER FILE Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6)
275 PROVIDER FILE Data Element Name: BILL-LOC-STATE (1) THRU (6)
276 PROVIDER FILE Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6)
277 PROVIDER FILE Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6)
278 PROVIDER FILE Data Element Name: BORDER-STATE-IND
279 PROVIDER FILE Data Element Name: BUSINESS-TYPE
280 PROVIDER FILE Data Element Name: CLIA-EFF-DATE (1) THRU (12)
281 PROVIDER FILE Data Element Name: CLIA-EXP-DATE (1) THRU (12)
282 PROVIDER FILE Data Element Name: CLIA-NUM
283 PROVIDER FILE Data Element Name: CLIA-TYPE (1) THRU (12)
284 PROVIDER FILE Data Element Name: DATE-OF-BIRTH
285 PROVIDER FILE Data Element Name: DATE-OF-DEATH
286 PROVIDER FILE Data Element Name: DBA-NAME
287 PROVIDER FILE Data Element Name: DEA-EFF-DATE
288 PROVIDER FILE Data Element Name: DEA-EXP-DATE
289 PROVIDER FILE Data Element Name: DEA-NUM
290 PROVIDER FILE Data Element Name: GENDER
291 PROVIDER FILE Data Element Name: LIC-EFF-DATE (1) THRU (6)
292 PROVIDER FILE Data Element Name: LIC-EXP-DATE (1) THRU (6)
293 PROVIDER FILE Data Element Name: LIC-NUM (1) THRU (6)
294 PROVIDER FILE Data Element Name: MAILING-CITY (1) THRU (6)
295 PROVIDER FILE Data Element Name: MAILING-COUNTY (1) THRU (6)
296 PROVIDER FILE Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6)
297 PROVIDER FILE Data Element Name: MAILING-STATE (1) THRU (6)
298 PROVIDER FILE Data Element Name: MAILING-ZIP-CODE (1) THRU (6)
299 PROVIDER FILE Data Element Name: MEDICAID-PROV-NUM
300 PROVIDER FILE Data Element Name: MEDICARE-PROV-NUM
301 PROVIDER FILE Data Element Name: NCPDP-EFF-DATE
302 PROVIDER FILE Data Element Name: NCPDP-EXP-DATE
303 PROVIDER FILE Data Element Name: NCPDP-NUM
304 PROVIDER FILE Data Element Name: OUT-OF-STATE-IND
305 PROVIDER FILE Data Element Name: OWNERSHIP-CODE
306 PROVIDER FILE Data Element Name: PER-DIEM-AMT-ICF-MR
307 PROVIDER FILE Data Element Name: PER-DIEM-AMT-INPATIENT
308 PROVIDER FILE Data Element Name: PER-DIEM-AMT-NF
309 PROVIDER FILE Data Element Name: PER-DIEM-AMT-T18-SNF
310 PROVIDER FILE Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW>
311 PROVIDER FILE Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW>
312 PROVIDER FILE Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW>
313 PROVIDER FILE Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW>
314 PROVIDER FILE Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW>
315 PROVIDER FILE Data Element Name: PREV-MEDICAID-PROV-NUM
316 PROVIDER FILE Data Element Name: PREV-MEDICARE-PROV-NUM
317 PROVIDER FILE Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6)
318 PROVIDER FILE Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100)
319 PROVIDER FILE Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100)
320 PROVIDER FILE Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100)
321 PROVIDER FILE Data Element Name: PROV-GRP-NUM (1) THRU (100)
322 PROVIDER FILE Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100)
323 PROVIDER FILE Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100)
324 PROVIDER FILE Data Element Name: PROV-NAME
325 PROVIDER FILE Data Element Name: PROV-NPI-NUM (1) THRU (10)
326 PROVIDER FILE Data Element Name: PROV-SPECIALTY (1) THRU (6)
327 PROVIDER FILE Data Element Name: PROV-TAX-ID-CURRENT
328 PROVIDER FILE Data Element Name: PROV-TAX-ID-PREVIOUS
329 PROVIDER FILE Data Element Name: PROV-TAXONOMY (1) THRU (6)
330 PROVIDER FILE Data Element Name: PROV-TYPE (1) THRU (6)
331 PROVIDER FILE Data Element Name: REASON-CODE (1) THRU (12)
332 PROVIDER FILE Data Element Name: REASON-EFF-DATE (1) THRU (12)
333 PROVIDER FILE Data Element Name: REASON-EXP-DATE (1) THRU (12)
334 PROVIDER FILE Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6)
335 PROVIDER FILE Data Element Name: SERVICE-LOC-CITY (1) THRU (6)
336 PROVIDER FILE Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6)
337 PROVIDER FILE Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6)
338 PROVIDER FILE Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6)
339 PROVIDER FILE Data Element Name: SERVICE-LOC-STATE (1) THRU (6)
340 PROVIDER FILE Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6)
341 PROVIDER FILE Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6)
342 PROVIDER FILE Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6)
343 PROVIDER FILE Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6)
344 PROVIDER FILE Data Element Name: SOCIAL-SECURITY-NUMBER
345 PROVIDER FILE Data Element Name: TEACHING-IND
346 PROVIDER FILE Data Element Name: TERMINATION-DATE
347 PROVIDER FILE Data Element Name: TERMINATION-REASON-CODE
348 PROVIDER FILE Data Element Name: URBAN-RURAL-IND
349 MANAGED CARE PLAN FILE Data Element Name: APPL-DATE
350 MANAGED CARE PLAN FILE Data Element Name: BORDER-STATE-IND
351 MANAGED CARE PLAN FILE Data Element Name: BUSINESS-TYPE
352 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3
353 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-CITY
354 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-COUNTY
355 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE
356 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EMAIL
357 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-END-DATE
358 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-FAX-NUM
359 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-NAME
360 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-PLAN-TYPE
361 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-STATE
362 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-TELEPHONE
363 MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ZIP-CODE
364 MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-DUAL-ELIGIBLES
365 MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-ENROLLMENT
366 MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-PROVIDERS
367 MANAGED CARE PLAN FILE Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE)
368 MANAGED CARE PLAN FILE Data Element Name: OUT-OF-STATE-IND
369 MANAGED CARE PLAN FILE Data Element Name: OWNERSHIP-CODE
370 MANAGED CARE PLAN FILE Data Element Name: PLAN-ID-NUM
371 MANAGED CARE PLAN FILE Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20
372 MANAGED CARE PLAN FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT
373 MANAGED CARE PLAN FILE Data Element Name: URBAN-RURAL-IND

Sheet 5: SuperSet
FileId DataElement
ELIGIBLE FILE DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY
ELIGIBLE FILE DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR
ELIGIBLE FILE DATA ELEMENT NAME: CHIP-CODE
ELIGIBLE FILE DATA ELEMENT NAME: CITIZENSHIP-IND
ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-BIRTH
ELIGIBLE FILE DATA ELEMENT NAME: DATE-OF-DEATH
ELIGIBLE FILE DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-1
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-2
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-3
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-4
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-5
ELIGIBLE FILE DATA ELEMENT NAME: DISABILITY-STATUS-IND-6
ELIGIBLE FILE DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-CITY
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-LAST-NAME
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-STATE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-GROUP
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE
ELIGIBLE FILE DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE
ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4
ELIGIBLE FILE DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-IND
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4)
ELIGIBLE FILE DATA ELEMENT NAME: HEALTH-INSURANCE-IND
ELIGIBLE FILE DATA ELEMENT NAME: HOUSEHOLD-SIZE
ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS
ELIGIBLE FILE DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE
ELIGIBLE FILE DATA ELEMENT NAME: INCOME-CODE
ELIGIBLE FILE DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS
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ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12
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PROVIDER FILE Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6)
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MANAGED CARE PLAN INFORMATION FILE Data Element Name: BORDER-STATE-IND
MANAGED CARE PLAN INFORMATION FILE Data Element Name: BUSINESS-TYPE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-CITY
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-EMAIL
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-END-DATE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-NAME
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-TYPE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-PLAN-POPULATIONS
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-RECORD-TYPE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-STATE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-TELEPHONE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: MANAGED-CARE-ZIP-CODE
MANAGED CARE PLAN INFORMATION FILE Data Element Name: OPERATING-AUTHORITY
MANAGED CARE PLAN INFORMATION FILE Data Element Name: PLAN-ID-NUM
MANAGED CARE PLAN INFORMATION FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT
MANAGED CARE PLAN INFORMATION FILE Data Element Name: Core Based Statistical Area (CBSA) Code
ELIGIBLE FILE DATA ELEMENT NAME: CHIP- CODE
ELIGIBLE FILE DATA ELEMENT NAME: ETHNICITY-CODE
ELIGIBLE FILE DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1
ELIGIBLE FILE DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12
ELIGIBLE FILE DATA ELEMENT NAME: LTC-BEGIN-DATE
ELIGIBLE FILE DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4
ELIGIBLE FILE DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4
ELIGIBLE FILE DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4
ELIGIBLE FILE DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4
ELIGIBLE FILE DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2
ELIGIBLE FILE DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2
ELIGIBLE FILE DATA ELEMENT NAME: RACE
ELIGIBLE FILE DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4
ELIGIBLE FILE DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3
THIRD PARTY LIABILITY (TPL) FILE DATA ELEMENT NAME: POLICY-OWNER-IND
CLAIMS FILES DATA ELEMENT NAME: IMMUNIZATION TYPE
CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ADJ
CLAIMS FILES DATA ELEMENT NAME: LINE-NUMBER-ORIG
CLAIMS FILES DATA ELEMENT NAME: TPL-AMT
CLAIMS FILES DATA ELEMENT NAME: UB-REV-CHARGE
CLAIMS FILES DATA ELEMENT NAME: UB REV-CODE
CLAIMS FILES DATA ELEMENT NAME: UB-REV-UNITS
PROVIDER FILE Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6)
PROVIDER FILE Data Element Name: BILL-LOC-CITY (1) THRU (6)
PROVIDER FILE Data Element Name: CLIA-NUM
PROVIDER FILE Data Element Name: DBA-NAME
PROVIDER FILE Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100)
PROVIDER FILE Data Element Name: PROV-NAME
PROVIDER FILE Data Element Name: REASON-CODE (1) THRU (12)
PROVIDER FILE Data Element Name: REASON-EFF-DATE (1) THRU (12)
PROVIDER FILE Data Element Name: REASON-EXP-DATE (1) THRU (12)
PROVIDER FILE Data Element Name: SOCIAL-SECURITY-NUMBER
PROVIDER FILE Data Element Name: URBAN-RURAL-IND
MANAGED CARE PLAN FILE Data Element Name: APPL-DATE
MANAGED CARE PLAN FILE Data Element Name: BORDER-STATE-IND
MANAGED CARE PLAN FILE Data Element Name: BUSINESS-TYPE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-CITY
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-COUNTY
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EFFECTIVE-DATE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-EMAIL
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-END-DATE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-FAX-NUM
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-NAME
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-PLAN-TYPE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-STATE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-TELEPHONE
MANAGED CARE PLAN FILE Data Element Name: MANAGED-CARE-ZIP-CODE
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-DUAL-ELIGIBLES
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-ENROLLMENT
MANAGED CARE PLAN FILE Data Element Name: NUMBER-OF-PROVIDERS
MANAGED CARE PLAN FILE Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE)
MANAGED CARE PLAN FILE Data Element Name: OUT-OF-STATE-IND
MANAGED CARE PLAN FILE Data Element Name: OWNERSHIP-CODE
MANAGED CARE PLAN FILE Data Element Name: PLAN-ID-NUM
MANAGED CARE PLAN FILE Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20
MANAGED CARE PLAN FILE Data Element Name: REIMBURSEMENT-ARRANGEMENT
MANAGED CARE PLAN FILE Data Element Name: URBAN-RURAL-IND
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00
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