Raps Inbound Record Layout

RAPS INBOUND RECORD
LAYOUT

OMB No. 0938-0878
(Expires: 03/31/2020)

AAA RECORD
FIELD NO
1
2
3

FIELD NAME
RECORD-ID
SUBMITTER-ID
FILE-ID

POSITION
1–3
4–9
10 – 19

PICTURE
X(3)
X(6)
X(10)

VALUE
‘AAA’
‘Shnnnn’

4
5

TRANSACTION-DATE
PROD-TEST-IND

20 – 27
28 – 31

9(8)
X(4)

‘CCYYMMDD’
‘PROD’ Or ‘TEST’ Or ‘CERT’

6
7

FILE-DIAG-TYPE
FILLER

32 – 36
37 – 512

X(5)
X(476)

‘ICD9’ Or ‘ICD10’
SPACES

PICTURE
X(3)
9(7)
X(5)
X(497)

VALUE
‘BBB’
Must begin with ‘0000001’
‘Hnnnn’
SPACES

BBB RECORD
FIELD NO.
1
2
3
4

FIELD NAME
RECORD-ID
SEQ-NO
PLAN-NO
FILLER

Revision Date: 08/19/2020

POSITION
1–3
4 – 10
11 – 15
16 – 512

CCC RECORD
FIELD NO.
1
2

FIELD NAME
RECORD-ID
SEQ-NO

POSITION
1–3
4 – 10

PICTURE
X(3)
9(7)

3
4
5

SEQ-ERROR-CODE
PATIENT-CONTROL-NO
MEMBER ID

11 – 13
14 – 53
54 – 78

X(3)
X(40)
X(25)

SPACES
Optional

6
7
8

MEMBER ID-ERROR-CODE
PATIENT-DOB
DOB-ERROR-CODE

79 – 81
82 – 89
90 – 92

X(3)
X(8)
X(3)

SPACES
‘CCYYMMDD’
SPACES

9 – 15

DIAGNOSIS-CLUSTER (10
OCCURRENCES)
PROVIDER-TYPE

93 – 412
X(2)

9(8)
9(8)
X(1)
X(7)
X(3)
X(3)
X(25)

HOSPITAL IP PRINCIPAL = 01
HOSPITAL IP OTHER = 02
HOSPITAL OP = 10
PHYSICIAN = 20
‘CCYYMMDD’
‘CCYYMMDD’
SPACE or ‘D’
ICD-9 or ICD-10
SPACES
SPACES
SPACES

X(1)
X(3)
X(35)

‘A’, ‘B’, or ‘C’
SPACES
SPACES

9.0

9.1
9.2
9.3
9.4
9.5
9.6
16
17 – 18
17.0
17.1
19

FROM-DATE
THRU-DATE
DELETE-IND
DIAGNOSIS-CODE
DIAG-CLSTR-ERROR-1
DIAG-CLSTR-ERROR-2
CORRECTED-MEDICARE ID
RISK ASSESSMENT-CODE-CLUSTER
(10 OCCURRENCES)
RISK ASSESSMENT-CODE
RISK ASSESSMENT-CODE-ERROR
FILLER

Revision Date: 08/19/2020

413 – 437
438 – 477

478 - 512

VALUE
‘CCC’
Must begin with ‘0000001’

YYY RECORD
FIELD NO.
1
2

FIELD NAME
RECORD-ID
SEQ-NO

POSITION
1–3
4 – 10

PICTURE
X(3)
9(7)

3
4
5

PLAN-NO
CCC-RECORD-TOTAL
FILLER

11 – 15
16 – 22
23 – 512

X(5)
9(7)
X(490)

VALUE
‘YYY’
Must begin with ‘0000001’
‘Hnnnn’
SPACES

ZZZ RECORD
FIELD NO.
1
2
3
4
5

FIELD NAME
RECORD-ID
SUBMITTER-ID
FILE-ID
BBB-RECORD-TOTAL
FILLER

Revision Date: 08/19/2020

POSITION
1–3
4–9
10 – 19
20 – 26
27 – 512

PICTURE
X(3)
X(6)
X(10)
9(7)
X(486)

VALUE
‘ZZZ’
‘SHnnnn’

SPACES

Revision History
Revision Date
12/21/18
12/21/18
08/12/2020
08/19/2020

Comments
In the CCC record; Field 5 changed from “MEDICARE ID” to “MEMBER ID”
In the CCC record; Field 6 changed from “MEDICARE ID -ERROR-CODE” to
“MEMBER ID-ERROR-CODE”
Added the OMB#/expiration date and PRA language, CMS#/expiration date
Updated the OMB# expiration date to 03/31/2020 per CMS request.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0878. The time
required to complete this information collection is estimated to average 5 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed, and complete and review the information
collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this
form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.
CMS-10062(03/2020)

Revision Date: 08/19/2020