4 - T-MSIS Record Layouts V2.4.0.xlsx

Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)

4 - T-MSIS Record Layouts V2.4.0.xlsx

OMB: 0938-0345

Document [xlsx]
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Overview

Cover Sheet
Record Layouts

Sheet 1: Cover Sheet




































Centers for Medicaid and CHIP Services (CMCS)









Transformed Medicaid Statistical Information System (T-MSIS)









Data Dictionary Record Layouts









Version: v2.4.0









Last Modified: 12/04/2020





















Sheet 2: Record Layouts
T-MSIS Record Layouts





DE_NO DATA_ELEMENT_NAME SIZE START POSITION STOP POSITION FILE NAME FILE SEGMENT (with RECORD-ID)
CIP001 RECORD-ID X(8) 1 8 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP002 DATA-DICTIONARY-VERSION X(10) 9 18 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP003 SUBMISSION-TRANSACTION-TYPE X(1) 19 19 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP004 FILE-ENCODING-SPECIFICATION X(3) 20 22 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP005 DATA-MAPPING-DOCUMENT-VERSION X(9) 23 31 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP006 FILE-NAME X(8) 32 39 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP007 SUBMITTING-STATE X(2) 40 41 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP008 DATE-FILE-CREATED 9(8) 42 49 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP009 START-OF-TIME-PERIOD 9(8) 50 57 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP010 END-OF-TIME-PERIOD 9(8) 58 65 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP011 FILE-STATUS-INDICATOR X(1) 66 66 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP012 SSN-INDICATOR X(1) 67 67 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP013 TOT-REC-CNT 9(11) 68 78 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP275 SEQUENCE-NUMBER X(4) 79 82 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP014 STATE-NOTATION X(500) 83 582 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP015 FILLER X(1518) 583 2100 CLAIMIP FILE-HEADER-RECORD-IP-CIP00001
CIP016 RECORD-ID X(8) 1 8 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP017 SUBMITTING-STATE X(2) 9 10 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP018 RECORD-NUMBER 9(11) 11 21 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP019 ICN-ORIG X(50) 22 71 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP020 ICN-ADJ X(50) 72 121 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP021 SUBMITTER-ID X(12) 122 133 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP022 MSIS-IDENTIFICATION-NUM X(20) 134 153 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP023 CROSSOVER-INDICATOR X(1) 154 154 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP024 TYPE-OF-HOSPITAL X(2) 155 156 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP025 1115A-DEMONSTRATION-IND X(1) 157 157 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP026 ADJUSTMENT-IND X(1) 158 158 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP027 ADJUSTMENT-REASON-CODE X(3) 159 161 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP028 ADMISSION-TYPE X(1) 162 162 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP029 DRG-DESCRIPTION X(20) 163 182 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP030 ADMITTING-DIAGNOSIS-CODE X(7) 183 189 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP031 ADMITTING-DIAGNOSIS-CODE-FLAG X(1) 190 190 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP032 DIAGNOSIS-CODE-1 X(7) 191 197 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP033 DIAGNOSIS-CODE-FLAG-1 X(1) 198 198 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP034 DIAGNOSIS-POA-FLAG-1 X(1) 199 199 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP035 DIAGNOSIS-CODE-2 X(7) 200 206 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP036 DIAGNOSIS-CODE-FLAG-2 X(1) 207 207 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP037 DIAGNOSIS-POA-FLAG-2 X(1) 208 208 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP038 DIAGNOSIS-CODE-3 X(7) 209 215 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP039 DIAGNOSIS-CODE-FLAG-3 X(1) 216 216 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP040 DIAGNOSIS-POA-FLAG-3 X(1) 217 217 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP041 DIAGNOSIS-CODE-4 X(7) 218 224 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP042 DIAGNOSIS-CODE-FLAG-4 X(1) 225 225 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP043 DIAGNOSIS-POA-FLAG-4 X(1) 226 226 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP044 DIAGNOSIS-CODE-5 X(7) 227 233 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP045 DIAGNOSIS-CODE-FLAG-5 X(1) 234 234 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP046 DIAGNOSIS-POA-FLAG-5 X(1) 235 235 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP047 DIAGNOSIS-CODE-6 X(7) 236 242 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP048 DIAGNOSIS-CODE-FLAG-6 X(1) 243 243 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP049 DIAGNOSIS-POA-FLAG-6 X(1) 244 244 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP050 DIAGNOSIS-CODE-7 X(7) 245 251 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP051 DIAGNOSIS-CODE-FLAG-7 X(1) 252 252 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP052 DIAGNOSIS-POA-FLAG-7 X(1) 253 253 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP053 DIAGNOSIS-CODE-8 X(7) 254 260 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP054 DIAGNOSIS-CODE-FLAG-8 X(1) 261 261 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP055 DIAGNOSIS-POA-FLAG-8 X(1) 262 262 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP056 DIAGNOSIS-CODE-9 X(7) 263 269 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP057 DIAGNOSIS-CODE-FLAG-9 X(1) 270 270 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP058 DIAGNOSIS-POA-FLAG-9 X(1) 271 271 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP059 DIAGNOSIS-CODE-10 X(7) 272 278 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP060 DIAGNOSIS-CODE-FLAG-10 X(1) 279 279 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP061 DIAGNOSIS-POA-FLAG-10 X(1) 280 280 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP062 DIAGNOSIS-CODE-11 X(7) 281 287 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP063 DIAGNOSIS-CODE-FLAG-11 X(1) 288 288 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP064 DIAGNOSIS-POA-FLAG-11 X(1) 289 289 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP065 DIAGNOSIS-CODE-12 X(7) 290 296 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP066 DIAGNOSIS-CODE-FLAG-12 X(1) 297 297 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP067 DIAGNOSIS-POA-FLAG-12 X(1) 298 298 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP068 DIAGNOSIS-RELATED-GROUP X(4) 299 302 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP069 DIAGNOSIS-RELATED-GROUP-IND X(4) 303 306 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP070 PROCEDURE-CODE-1 X(8) 307 314 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP071 PROCEDURE-CODE-MOD-1 X(2) 315 316 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP072 PROCEDURE-CODE-FLAG-1 X(2) 317 318 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP073 PROCEDURE-CODE-DATE-1 9(8) 319 326 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP074 PROCEDURE-CODE-2 X(8) 327 334 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP075 PROCEDURE-CODE-MOD-2 X(2) 335 336 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP076 PROCEDURE-CODE-FLAG-2 X(2) 337 338 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP077 PROCEDURE-CODE-DATE-2 9(8) 339 346 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP078 PROCEDURE-CODE-3 X(8) 347 354 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP079 PROCEDURE-CODE-MOD-3 X(2) 355 356 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP080 PROCEDURE-CODE-FLAG-3 X(2) 357 358 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP081 PROCEDURE-CODE-DATE-3 9(8) 359 366 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP082 PROCEDURE-CODE-4 X(8) 367 374 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP083 PROCEDURE-CODE-MOD-4 X(2) 375 376 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP084 PROCEDURE-CODE-FLAG-4 X(2) 377 378 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP085 PROCEDURE-CODE-DATE-4 9(8) 379 386 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP086 PROCEDURE-CODE-5 X(8) 387 394 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP087 PROCEDURE-CODE-MOD-5 X(2) 395 396 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP088 PROCEDURE-CODE-FLAG-5 X(2) 397 398 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP089 PROCEDURE-CODE-DATE-5 9(8) 399 406 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP090 PROCEDURE-CODE-6 X(8) 407 414 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP091 PROCEDURE-CODE-MOD-6 X(2) 415 416 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP092 PROCEDURE-CODE-FLAG-6 X(2) 417 418 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP093 PROCEDURE-CODE-DATE-6 9(8) 419 426 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP094 ADMISSION-DATE 9(8) 427 434 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP095 ADMISSION-HOUR X(2) 435 436 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP096 DISCHARGE-DATE 9(8) 437 444 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP097 DISCHARGE-HOUR X(2) 445 446 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP098 ADJUDICATION-DATE 9(8) 447 454 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP099 MEDICAID-PAID-DATE 9(8) 455 462 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP100 TYPE-OF-CLAIM X(1) 463 463 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP101 TYPE-OF-BILL X(4) 464 467 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP102 CLAIM-STATUS X(3) 468 470 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP103 CLAIM-STATUS-CATEGORY X(3) 471 473 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP104 SOURCE-LOCATION X(2) 474 475 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP105 CHECK-NUM X(15) 476 490 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP106 CHECK-EFF-DATE 9(8) 491 498 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP107 ALLOWED-CHARGE-SRC X(1) 499 499 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP108 CLAIM-PYMT-REM-CODE-1 X(5) 500 504 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP109 CLAIM-PYMT-REM-CODE-2 X(5) 505 509 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP110 CLAIM-PYMT-REM-CODE-3 X(5) 510 514 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP111 CLAIM-PYMT-REM-CODE-4 X(5) 515 519 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP112 TOT-BILLED-AMT S9(11)V99 520 532 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP113 TOT-ALLOWED-AMT S9(11)V99 533 545 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP114 TOT-MEDICAID-PAID-AMT S9(11)V99 546 558 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP115 TOT-COPAY-AMT S9(11)V99 559 571 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP116 TOT-MEDICARE-DEDUCTIBLE-AMT S9(11)V99 572 584 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP117 TOT-MEDICARE-COINS-AMT S9(11)V99 585 597 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP118 TOT-TPL-AMT S9(11)V99 598 610 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP119 TOT-OTHER-INSURANCE-AMT S9(11)V99 611 623 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP121 OTHER-INSURANCE-IND X(1) 624 624 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP122 OTHER-TPL-COLLECTION X(3) 625 627 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP123 SERVICE-TRACKING-TYPE X(2) 628 629 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP124 SERVICE-TRACKING-PAYMENT-AMT S9(11)V99 630 642 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP125 FIXED-PAYMENT-IND X(1) 643 643 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP126 FUNDING-CODE X(2) 644 645 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP127 FUNDING-SOURCE-NONFEDERAL-SHARE X(2) 646 647 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP128 MEDICARE-COMB-DED-IND X(1) 648 648 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP129 PROGRAM-TYPE X(2) 649 650 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP130 PLAN-ID-NUMBER X(12) 651 662 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP131 NATIONAL-HEALTH-CARE-ENTITY-ID X(10) 663 672 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP132 PAYMENT-LEVEL-IND X(1) 673 673 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP133 MEDICARE-REIM-TYPE X(2) 674 675 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP134 NON-COV-DAYS S9(5) 676 680 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP135 NON-COV-CHARGES S9(11)V99 681 693 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP136 MEDICAID-COV-INPATIENT-DAYS S9(7) 694 700 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP137 CLAIM-LINE-COUNT 9(4) 701 704 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP138 FORCED-CLAIM-IND X(1) 705 705 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP139 HEALTH-CARE-ACQUIRED-CONDITION-IND X(1) 706 706 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP140 OCCURRENCE-CODE-01 X(2) 707 708 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP141 OCCURRENCE-CODE-02 X(2) 709 710 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP142 OCCURRENCE-CODE-03 X(2) 711 712 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP143 OCCURRENCE-CODE-04 X(2) 713 714 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP144 OCCURRENCE-CODE-05 X(2) 715 716 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP145 OCCURRENCE-CODE-06 X(2) 717 718 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP146 OCCURRENCE-CODE-07 X(2) 719 720 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP147 OCCURRENCE-CODE-08 X(2) 721 722 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP148 OCCURRENCE-CODE-09 X(2) 723 724 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP149 OCCURRENCE-CODE-10 X(2) 725 726 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP150 OCCURRENCE-CODE-EFF-DATE-01 9(8) 727 734 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP151 OCCURRENCE-CODE-EFF-DATE-02 9(8) 735 742 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP152 OCCURRENCE-CODE-EFF-DATE-03 9(8) 743 750 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP153 OCCURRENCE-CODE-EFF-DATE-04 9(8) 751 758 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP154 OCCURRENCE-CODE-EFF-DATE-05 9(8) 759 766 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP155 OCCURRENCE-CODE-EFF-DATE-06 9(8) 767 774 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP156 OCCURRENCE-CODE-EFF-DATE-07 9(8) 775 782 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP157 OCCURRENCE-CODE-EFF-DATE-08 9(8) 783 790 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP158 OCCURRENCE-CODE-EFF-DATE-09 9(8) 791 798 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP159 OCCURRENCE-CODE-EFF-DATE-10 9(8) 799 806 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP160 OCCURRENCE-CODE-END-DATE-01 9(8) 807 814 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP161 OCCURRENCE-CODE-END-DATE-02 9(8) 815 822 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP162 OCCURRENCE-CODE-END-DATE-03 9(8) 823 830 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP163 OCCURRENCE-CODE-END-DATE-04 9(8) 831 838 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP164 OCCURRENCE-CODE-END-DATE-05 9(8) 839 846 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP165 OCCURRENCE-CODE-END-DATE-06 9(8) 847 854 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP166 OCCURRENCE-CODE-END-DATE-07 9(8) 855 862 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP167 OCCURRENCE-CODE-END-DATE-08 9(8) 863 870 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP168 OCCURRENCE-CODE-END-DATE-09 9(8) 871 878 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP169 OCCURRENCE-CODE-END-DATE-10 9(8) 879 886 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP170 BIRTH-WEIGHT-GRAMS S9(6)V999 887 895 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP171 PATIENT-CONTROL-NUM X(20) 896 915 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP172 ELIGIBLE-LAST-NAME X(30) 916 945 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP173 ELIGIBLE-FIRST-NAME X(30) 946 975 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP174 ELIGIBLE-MIDDLE-INIT X(1) 976 976 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP175 DATE-OF-BIRTH 9(8) 977 984 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP176 HEALTH-HOME-PROV-IND X(1) 985 985 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP177 WAIVER-TYPE X(2) 986 987 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP178 WAIVER-ID X(20) 988 1007 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP179 BILLING-PROV-NUM X(30) 1008 1037 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP180 BILLING-PROV-NPI-NUM X(10) 1038 1047 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP181 BILLING-PROV-TAXONOMY X(12) 1048 1059 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP182 BILLING-PROV-TYPE X(2) 1060 1061 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP183 BILLING-PROV-SPECIALTY X(2) 1062 1063 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP184 ADMITTING-PROV-NPI-NUM X(10) 1064 1073 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP185 ADMITTING-PROV-NUM X(30) 1074 1103 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP186 ADMITTING-PROV-SPECIALTY X(2) 1104 1105 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP187 ADMITTING-PROV-TAXONOMY X(12) 1106 1117 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP188 ADMITTING-PROV-TYPE X(2) 1118 1119 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP189 REFERRING-PROV-NUM X(30) 1120 1149 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP190 REFERRING-PROV-NPI-NUM X(10) 1150 1159 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP191 REFERRING-PROV-TAXONOMY X(12) 1160 1171 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP192 REFERRING-PROV-TYPE X(2) 1172 1173 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP193 REFERRING-PROV-SPECIALTY X(2) 1174 1175 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP194 DRG-OUTLIER-AMT S9(11)V99 1176 1188 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP195 DRG-REL-WEIGHT X(8) 1189 1196 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP196 MEDICARE-HIC-NUM X(12) 1197 1208 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP197 OUTLIER-CODE X(2) 1209 1210 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP198 OUTLIER-DAYS S9(5) 1211 1215 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP199 PATIENT-STATUS X(2) 1216 1217 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP201 BMI S9(5)V9 1218 1223 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP202 REMITTANCE-NUM X(30) 1224 1253 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP203 SPLIT-CLAIM-IND X(1) 1254 1254 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP204 BORDER-STATE-IND X(1) 1255 1255 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP206 BENEFICIARY-COINSURANCE-AMOUNT S9(11)V99 1256 1268 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP207 BENEFICIARY-COINSURANCE-DATE-PAID 9(8) 1269 1276 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP208 BENEFICIARY-COPAYMENT-AMOUNT S9(11)V99 1277 1289 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP209 BENEFICIARY-COPAYMENT-DATE-PAID 9(8) 1290 1297 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP210 BENEFICIARY-DEDUCTIBLE-AMOUNT S9(11)V99 1298 1310 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP211 BENEFICIARY-DEDUCTIBLE-DATE-PAID 9(8) 1311 1318 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP212 CLAIM-DENIED-INDICATOR X(1) 1319 1319 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP213 COPAY-WAIVED-IND X(1) 1320 1320 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP214 HEALTH-HOME-ENTITY-NAME X(50) 1321 1370 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP216 THIRD-PARTY-COINSURANCE-AMOUNT-PAID S9(11)V99 1371 1383 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP217 THIRD-PARTY-COINSURANCE-DATE-PAID 9(8) 1384 1391 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP218 THIRD-PARTY-COPAYMENT-AMOUNT-PAID S9(11)V99 1392 1404 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP219 THIRD-PARTY-COPAYMENT-DATE-PAID 9(8) 1405 1412 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP220 MEDICAID-AMOUNT-PAID-DSH S9(11)V99 1413 1425 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP221 HEALTH-HOME-PROVIDER-NPI X(10) 1426 1435 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
CIP222 MEDICARE-BENEFICIARY-IDENTIFIER X(12) 1436 1447 CLAIMIP CLAIM-HEADER-RECORD-IP-CIP00002
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End of Sheet





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