|
1 |
BENE_ID |
Encrypted CCW Beneficiary ID |
| 2 |
CLM_ID |
Claim ID |
| 3 |
NCH_NEAR_LINE_REC_IDENT_CD |
NCH Near Line Record Identification Code (RIC) |
| 4 |
NCH_CLM_TYPE_CD |
NCH Claim Type Code |
| 5 |
CLM_FROM_DT |
Claim From Date (FFS) |
| 6 |
CLM_THRU_DT |
Claim Through Date (FFS) |
| 7 |
NCH_WKLY_PROC_DT |
NCH Weekly Claim Processing Date |
| 8 |
FI_CLM_PROC_DT |
FI Claim Process Date |
| 9 |
CLAIM_QUERY_CODE |
Claim Query Code |
| 10 |
PRVDR_NUM |
Provider Number |
| 11 |
PRVDR_FULL_CCN_NUM |
Full CMS Certification Number for Provider |
| 12 |
CLM_FAC_TYPE_CD |
Claim Facility Type Code (FFS) |
| 13 |
OWNG_PRVDR_TIN_NUM |
Owning Provider Tax Identification Number (TIN) |
| 14 |
CLM_SRVC_CLSFCTN_TYPE_CD |
Claim Service Classification Type Code (FFS) |
| 15 |
CLM_FREQ_CD |
Claim Frequency Code (FFS) |
| 16 |
FI_NUM |
FI or MAC Number |
| 17 |
CLM_MDCR_NON_PMT_RSN_CD |
Claim Medicare Non-Payment Reason Code |
| 18 |
CLM_PMT_AMT |
Claim (Medicare) Payment Amount |
| 19 |
NCH_PRMRY_PYR_CLM_PD_AMT |
NCH Primary Payer (if not Medicare) Claim Paid Amount |
| 20 |
NCH_PRMRY_PYR_CD |
NCH Primary Payer Code (if not Medicare) |
| 21 |
FI_CLM_ACTN_CD |
FI or MAC Claim Action Code |
| 22 |
PRVDR_STATE_CD |
NCH Provider SSA State Code |
| 23 |
ORG_NPI_NUM |
Organization (or group) NPI Number |
| 24 |
SRVC_LOC_NPI_NUM |
Claim Service Location NPI Number |
| 25 |
AT_PHYSN_UPIN |
Claim Attending Physician UPIN Number |
| 26 |
AT_PHYSN_NPI |
Claim Attending Physician NPI Number (FFS) |
| 27 |
AT_PHYSN_SPCLTY_CD |
Claim Attending Physician Specialty Code |
| 28 |
OP_PHYSN_UPIN |
Claim Operating Physician UPIN Number |
| 29 |
OP_PHYSN_NPI |
Claim Operating Physician NPI Number (FFS) |
| 30 |
OP_PHYSN_SPCLTY_CD |
Claim Operating Physician Specialty Code |
| 31 |
OT_PHYSN_UPIN |
Claim Other Physician UPIN Number |
| 32 |
OT_PHYSN_NPI |
Claim Other Physician NPI Number (FFS) |
| 33 |
OT_PHYSN_SPCLTY_CD |
Claim Other Physician Specialty Code |
| 34 |
RNDRNG_PHYSN_NPI |
Rendering Physician NPI (FFS) |
| 34 |
RNDRNG_PHYSN_SPCLTY_CD |
Claim or Revenue Center Rendering Physician Specialty Code |
| 35 |
RFR_PHYSN_NPI |
Claim Referring Physician NPI Number |
| 36 |
RFRG_SPCLTY_CD |
Claim Referring Physician Specialty Code |
| 37 |
CLM_MCO_PD_SW |
Claim MCO Paid Switch |
| 38 |
PTNT_DSCHRG_STUS_CD |
Patient Discharge Status Code (FFS) |
| 39 |
CLM_PPS_IND_CD |
Claim PPS Indicator Code |
| 38 |
CLM_TOT_CHRG_AMT |
Claim Total Charge Amount |
| 39 |
CLM_ADMSN_DT |
Claim Admission Date (FFS) |
| 40 |
CLM_IP_ADMSN_TYPE_CD |
Claim Inpatient Admission Type Code (FFS) |
| 41 |
CLM_SRC_IP_ADMSN_CD |
Claim Source Inpatient Admission Code (FFS) |
| 42 |
NCH_PTNT_STUS_IND_CD |
NCH Patient Status Indicator Code |
| 43 |
CLM_PASS_THRU_PER_DIEM_AMT |
Claim Pass Thru Per Diem Amount |
| 44 |
NCH_BENE_IP_DDCTBL_AMT |
NCH Beneficiary Inpatient (or other Part A) Deductible Amount |
| 45 |
NCH_BENE_PTA_COINSRNC_LBLTY_AM |
NCH Beneficiary Part A Coinsurance Liability Amount |
| 46 |
NCH_BENE_BLOOD_DDCTBL_LBLTY_AM |
NCH Beneficiary Blood Deductible Liability Amount |
| 47 |
NCH_PROFNL_CMPNT_CHRG_AMT |
Professional Component Charge Amount |
| 48 |
NCH_IP_NCVRD_CHRG_AMT |
NCH Inpatient (or other Part A) Non-covered Charge Amount |
| 49 |
NCH_IP_TOT_DDCTN_AMT |
NCH Inpatient (or other Part A) Total Deductible/Coinsurance Amount |
| 50 |
CLM_TOT_PPS_CPTL_AMT |
Claim Total PPS Capital Amount |
| 51 |
CLM_PPS_CPTL_FSP_AMT |
Claim PPS Capital Federal Specific Portion (FSP) Amount |
| 52 |
CLM_PPS_CPTL_OUTLIER_AMT |
Claim PPS Capital Outlier Amount |
| 53 |
CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT |
Claim PPS Capital Disproportionate Share Amount |
| 54 |
CLM_PPS_CPTL_IME_AMT |
Claim PPS Capital Indirect Medical Education (IME) Amount |
| 55 |
CLM_PPS_CPTL_EXCPTN_AMT |
Claim PPS Capital Exception Amount |
| 56 |
CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT |
Claim PPS Old Capital Hold Harmless Amount |
| 57 |
CLM_PPS_CPTL_DRG_WT_NUM |
Claim PPS Capital DRG Weight Number |
| 58 |
CLM_UTLZTN_DAY_CNT |
Claim Medicare Utilization Day Count |
| 59 |
BENE_TOT_COINSRNC_DAYS_CNT |
Beneficiary Total Coinsurance Days Count |
| 60 |
BENE_LRD_USED_CNT |
Beneficiary Medicare Lifetime Reserve Days (LRD) Used Count |
| 61 |
CLM_NON_UTLZTN_DAYS_CNT |
Claim Medicare Non Utilization Days Count |
| 62 |
NCH_BLOOD_PNTS_FRNSHD_QTY |
NCH Blood Pints Furnished Quantity |
| 63 |
NCH_VRFD_NCVRD_STAY_FROM_DT |
NCH Verified Non-covered Stay From Date |
| 64 |
NCH_VRFD_NCVRD_STAY_THRU_DT |
NCH Verified Non-covered Stay Through Date |
| 65 |
NCH_ACTV_OR_CVRD_LVL_CARE_THRU |
NCH Active or Covered Level Care Thru Date |
| 66 |
NCH_BENE_MDCR_BNFTS_EXHTD_DT_I |
NCH Beneficiary Medicare Benefits Exhausted Date |
| 67 |
NCH_BENE_DSCHRG_DT |
NCH Beneficiary Discharge Date |
| 68 |
CLM_DRG_CD |
Claim Diagnosis Related Group Code (or MS-DRG Code) (FFS) |
| 69 |
MS_DRG_GRPR_VRSN_CD |
MS-DRG Grouper Version Code |
| 70 |
CLM_IP_INITL_MS_DRG_CD |
Claim Inpatient Initial MS DRG Code |
| 71 |
CLM_DRG_OUTLIER_STAY_CD |
Claim Diagnosis Related Group Outlier Stay Code |
| 72 |
NCH_DRG_OUTLIER_APRVD_PMT_AMT |
NCH DRG Outlier Approved Payment Amount |
| 73 |
ADMTG_DGNS_CD |
Claim Admitting Diagnosis Code (FFS) |
| 74 |
PRNCPAL_DGNS_CD |
Claim Principal Diagnosis Code (FFS) |
| 75 |
ICD_DGNS_CD1 |
Claim Diagnosis Code I (FFS) |
| 76 |
CLM_POA_IND_SW1 |
Claim Diagnosis Code I Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 77 |
ICD_DGNS_CD2 |
Claim Diagnosis Code II (FFS) |
| 78 |
CLM_POA_IND_SW2 |
Claim Diagnosis Code II Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 79 |
ICD_DGNS_CD3 |
Claim Diagnosis Code III (FFS) |
| 80 |
CLM_POA_IND_SW3 |
Claim Diagnosis Code III Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 81 |
ICD_DGNS_CD4 |
Claim Diagnosis Code IV (FFS) |
| 82 |
CLM_POA_IND_SW4 |
Claim Diagnosis Code IV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 83 |
ICD_DGNS_CD5 |
Claim Diagnosis Code V (FFS) |
| 84 |
CLM_POA_IND_SW5 |
Claim Diagnosis Code V Diagnosis Present on Admission Indicator (POA) Code (FFS) |
| 85 |
ICD_DGNS_CD6 |
Claim Diagnosis Code VI (FFS) |
| 86 |
CLM_POA_IND_SW6 |
Claim Diagnosis Code VI Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 87 |
ICD_DGNS_CD7 |
Claim Diagnosis Code VII (FFS) |
| 88 |
CLM_POA_IND_SW7 |
Claim Diagnosis Code VII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 89 |
ICD_DGNS_CD8 |
Claim Diagnosis Code VIII (FFS) |
| 90 |
CLM_POA_IND_SW8 |
Claim Diagnosis Code VIII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 91 |
ICD_DGNS_CD9 |
Claim Diagnosis Code IX (FFS) |
| 92 |
CLM_POA_IND_SW9 |
Claim Diagnosis Code IX Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 93 |
ICD_DGNS_CD10 |
Claim Diagnosis Code X (FFS) |
| 94 |
CLM_POA_IND_SW10 |
Claim Diagnosis Code X Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 95 |
ICD_DGNS_CD11 |
Claim Diagnosis Code XI (FFS) |
| 96 |
CLM_POA_IND_SW11 |
Claim Diagnosis Code XI Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 97 |
ICD_DGNS_CD12 |
Claim Diagnosis Code XII (FFS) |
| 98 |
CLM_POA_IND_SW12 |
Claim Diagnosis Code XII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 99 |
ICD_DGNS_CD13 |
Claim Diagnosis Code XIII (FFS) |
| 100 |
CLM_POA_IND_SW13 |
Claim Diagnosis Code XIII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 101 |
ICD_DGNS_CD14 |
Claim Diagnosis Code XIV (FFS) |
| 102 |
CLM_POA_IND_SW14 |
Claim Diagnosis Code XIV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 103 |
ICD_DGNS_CD15 |
Claim Diagnosis Code XV (FFS) |
| 104 |
CLM_POA_IND_SW15 |
Claim Diagnosis Code XV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 105 |
ICD_DGNS_CD16 |
Claim Diagnosis Code XVI (FFS) |
| 106 |
CLM_POA_IND_SW16 |
Claim Diagnosis Code XVI Diagnosis Present on Admission (POA) Indicator Code |
| 107 |
ICD_DGNS_CD17 |
Claim Diagnosis Code XVII (FFS) |
| 108 |
CLM_POA_IND_SW17 |
Claim Diagnosis Code XVII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 109 |
ICD_DGNS_CD18 |
Claim Diagnosis Code XVIII (FFS) |
| 110 |
CLM_POA_IND_SW18 |
Claim Diagnosis Code XVIII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 111 |
ICD_DGNS_CD19 |
Claim Diagnosis Code XIX (FFS) |
| 112 |
CLM_POA_IND_SW19 |
Claim Diagnosis Code XIX Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 113 |
ICD_DGNS_CD20 |
Claim Diagnosis Code XX (FFS) |
| 114 |
CLM_POA_IND_SW20 |
Claim Diagnosis Code XX Diagnosis Present on Admission (POA) Indicator Code |
| 115 |
ICD_DGNS_CD21 |
Claim Diagnosis Code XXI (FFS) |
| 116 |
CLM_POA_IND_SW21 |
Claim Diagnosis Code XXI Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 117 |
ICD_DGNS_CD22 |
Claim Diagnosis Code XXII (FFS) |
| 118 |
CLM_POA_IND_SW22 |
Claim Diagnosis Code XXII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 119 |
ICD_DGNS_CD23 |
Claim Diagnosis Code XXIII (FFS) |
| 120 |
CLM_POA_IND_SW23 |
Claim Diagnosis Code XXIII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 121 |
ICD_DGNS_CD24 |
Claim Diagnosis Code XXIV (FFS) |
| 122 |
CLM_POA_IND_SW24 |
Claim Diagnosis Code XXIV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 123 |
ICD_DGNS_CD25 |
Claim Diagnosis Code XXV (FFS) |
| 124 |
CLM_POA_IND_SW25 |
Claim Diagnosis Code XXV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 125 |
FST_DGNS_E_CD |
First Claim Diagnosis E Code (FFS) |
| 126 |
ICD_DGNS_E_CD1 |
Claim Diagnosis E Code I (FFS) |
| 127 |
CLM_E_POA_IND_SW1 |
Claim Diagnosis E Code I Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 128 |
ICD_DGNS_E_CD2 |
Claim Diagnosis E Code II (FFS) |
| 129 |
CLM_E_POA_IND_SW2 |
Claim Diagnosis E Code II Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 130 |
ICD_DGNS_E_CD3 |
Claim Diagnosis E Code III (FFS) |
| 131 |
CLM_E_POA_IND_SW3 |
Claim Diagnosis E Code III Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 132 |
ICD_DGNS_E_CD4 |
Claim Diagnosis E Code IV (FFS) |
| 133 |
CLM_E_POA_IND_SW4 |
Claim Diagnosis E Code IV Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 134 |
ICD_DGNS_E_CD5 |
Claim Diagnosis E Code V (FFS) |
| 135 |
CLM_E_POA_IND_SW5 |
Claim Diagnosis E Code V Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 136 |
ICD_DGNS_E_CD6 |
Claim Diagnosis E Code VI (FFS) |
| 137 |
CLM_E_POA_IND_SW6 |
Claim Diagnosis E Code VI Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 138 |
ICD_DGNS_E_CD7 |
Claim Diagnosis E Code VII (FFS) |
| 139 |
CLM_E_POA_IND_SW7 |
Claim Diagnosis E Code VII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 140 |
ICD_DGNS_E_CD8 |
Claim Diagnosis E Code VIII (FFS) |
| 141 |
CLM_E_POA_IND_SW8 |
Claim Diagnosis E Code VIII Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 142 |
ICD_DGNS_E_CD9 |
Claim Diagnosis E Code IX (FFS) |
| 143 |
CLM_E_POA_IND_SW9 |
Claim Diagnosis E Code IX Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 144 |
ICD_DGNS_E_CD10 |
Claim Diagnosis E Code X (FFS) |
| 145 |
CLM_E_POA_IND_SW10 |
Claim Diagnosis E Code X Diagnosis Present on Admission (POA) Indicator Code (FFS) |
| 146 |
ICD_DGNS_E_CD11 |
Claim Diagnosis E Code XI |
| 147 |
CLM_E_POA_IND_SW11 |
Claim Diagnosis E Code XI Diagnosis Present on Admission (POA) Indicator Code |
| 148 |
ICD_DGNS_E_CD12 |
Claim Diagnosis E Code XII |
| 149 |
CLM_E_POA_IND_SW12 |
Claim Diagnosis E Code XII Diagnosis Present on Admission (POA) Indicator Code |
| 150 |
ICD_PRCDR_CD1 |
Claim Procedure Code I (FFS) |
| 151 |
PRCDR_DT1 |
Claim Procedure Code I Date (FFS) |
| 152 |
ICD_PRCDR_CD2 |
Claim Procedure Code II (FFS) |
| 153 |
PRCDR_DT2 |
Claim Procedure Code II Date (FFS) |
| 154 |
ICD_PRCDR_CD3 |
Claim Procedure Code III (FFS) |
| 155 |
PRCDR_DT3 |
Claim Procedure Code III Date (FFS) |
| 156 |
ICD_PRCDR_CD4 |
Claim Procedure Code IV (FFS) |
| 157 |
PRCDR_DT4 |
Claim Procedure Code IV Date (FFS) |
| 158 |
ICD_PRCDR_CD5 |
Claim Procedure Code V (FFS) |
| 159 |
PRCDR_DT5 |
Claim Procedure Code V Date (FFS) |
| 160 |
ICD_PRCDR_CD6 |
Claim Procedure Code VI (FFS) |
| 161 |
PRCDR_DT6 |
Claim Procedure Code VI Date (FFS) |
| 162 |
ICD_PRCDR_CD7 |
Claim Procedure Code VII (FFS) |
| 163 |
PRCDR_DT7 |
Claim Procedure Code VII Date (FFS) |
| 164 |
ICD_PRCDR_CD8 |
Claim Procedure Code VIII (FFS) |
| 165 |
PRCDR_DT8 |
Claim Procedure Code VIII Date (FFS) |
| 166 |
ICD_PRCDR_CD9 |
Claim Procedure Code IX (FFS) |
| 167 |
PRCDR_DT9 |
Claim Procedure Code IX Date (FFS) |
| 168 |
ICD_PRCDR_CD10 |
Claim Procedure Code X (FFS) |
| 169 |
PRCDR_DT10 |
Claim Procedure Code X Date (FFS) |
| 170 |
ICD_PRCDR_CD11 |
Claim Procedure Code XI (FFS) |
| 171 |
PRCDR_DT11 |
Claim Procedure Code XI Date (FFS) |
| 172 |
ICD_PRCDR_CD12 |
Claim Procedure Code XII (FFS) |
| 173 |
PRCDR_DT12 |
Claim Procedure Code XII Date (FFS) |
| 174 |
ICD_PRCDR_CD13 |
Claim Procedure Code XIII (FFS) |
| 175 |
PRCDR_DT13 |
Claim Procedure Code XIII Date (FFS) |
| 176 |
ICD_PRCDR_CD14 |
Claim Procedure Code XIV |
| 177 |
PRCDR_DT14 |
Claim Procedure Code XIV Date |
| 178 |
ICD_PRCDR_CD15 |
Claim Procedure Code XV |
| 179 |
PRCDR_DT15 |
Claim Procedure Code XV Date |
| 180 |
ICD_PRCDR_CD16 |
Claim Procedure Code XVI |
| 181 |
PRCDR_DT16 |
Claim Procedure Code XVI Date |
| 182 |
ICD_PRCDR_CD17 |
Claim Procedure Code XVII |
| 183 |
PRCDR_DT17 |
Claim Procedure Code XVII Date |
| 184 |
ICD_PRCDR_CD18 |
Claim Procedure Code XVIII |
| 185 |
PRCDR_DT18 |
Claim Procedure Code XVIII Date |
| 186 |
ICD_PRCDR_CD19 |
Claim Procedure Code XIX |
| 187 |
PRCDR_DT19 |
Claim Procedure Code XIX Date |
| 188 |
ICD_PRCDR_CD20 |
Claim Procedure Code XX |
| 189 |
PRCDR_DT20 |
Claim Procedure Code XX Date |
| 190 |
ICD_PRCDR_CD21 |
Claim Procedure Code XXI |
| 191 |
PRCDR_DT21 |
Claim Procedure Code XXI Date |
| 192 |
ICD_PRCDR_CD22 |
Claim Procedure Code XXII |
| 193 |
PRCDR_DT22 |
Claim Procedure Code XXII Date |
| 194 |
ICD_PRCDR_CD23 |
Claim Procedure Code XXIII |
| 195 |
PRCDR_DT23 |
Claim Procedure Code XXIII Date |
| 196 |
ICD_PRCDR_CD24 |
Claim Procedure Code XXIV |
| 197 |
PRCDR_DT24 |
Claim Procedure Code XXIV Date |
| 198 |
ICD_PRCDR_CD25 |
Claim Procedure Code XXV |
| 196 |
PRCDR_DT25 |
Claim Procedure Code XXV Date |
| 200 |
IME_OP_CLM_VAL_AMT |
Operating Indirect Medical Education (IME) Amount |
| 201 |
DSH_OP_CLM_VAL_AMT |
Operating Disproportionate Share (DSH) Amount |
| 202 |
DOB_DT |
Date of Birth from Claim |
| 204 |
BENE_RACE_CD |
Beneficiary Race Code (FFS) |
| 205 |
BENE_CNTY_CD |
County Code from Claim (SSA) |
| 206 |
BENE_STATE_CD |
Beneficiary Residence (SSA) State Code (FFS) |
| 207 |
BENE_MLG_CNTCT_ZIP_CD |
Zip Code of Residence from Claim |
| 208 |
CLM_MDCL_REC |
Claim Medical Record Number (FFS) |
| 209 |
CLM_TRTMT_AUTHRZTN_NUM |
Claim Treatment Authorization Number |
| 210 |
CLM_PRCR_RTRN_CD |
Claim Pricer Return Code |
| 211 |
CLM_PRCR_VRSN_CD |
Claim Pricer Version Code |
| 212 |
CLM_SRVC_FAC_ZIP_CD |
Claim service facility ZIP code (where service was provided) |
| 213 |
CLM_IP_LOW_VOL_PMT_AMT |
Claim Inpatient Low Volume Payment Amount |
| 214 |
CLM_CARE_IMPRVMT_MODEL_CD1 |
Claim Care Improvement Model 1 Code (bundled payment) |
| 215 |
CLM_CARE_IMPRVMT_MODEL_CD2 |
Claim Care Improvement Model 2 Code |
| 216 |
CLM_CARE_IMPRVMT_MODEL_CD3 |
Claim Care Improvement Model 3 Code |
| 217 |
CLM_CARE_IMPRVMT_MODEL_CD4 |
Claim Care Improvement Model 4 Code |
| 218 |
CLM_BNDLD_MODEL_1_DSCNT_PCT |
Claim Bundled Model 1 Discount Percent |
| 219 |
CLM_BASE_OPRTG_DRG_AMT |
Claim Base Operating DRG Amount |
| 220 |
CLM_VBP_PRTCPNT_IND_CD |
Claim Value-Based Purchasing (VBP) Participant Indicator Code |
| 221 |
CLM_VBP_ADJSTMT_PCT |
Claim VBP Adjustment Percent |
| 222 |
CLM_HRR_PRTCPNT_IND_CD |
Claim Hospital Readmission Reduction (HRR) Participant Indicator Code |
| 223 |
CLM_HRR_ADJSTMT_PCT |
Claim HRR Adjustment Percent |
| 224 |
CLM_MODEL_4_READMSN_IND_CD |
Claim Model 4 Readmission Indicator Code |
| 225 |
CLM_UNCOMPD_CARE_PMT_AMT |
Claim Uncompensated Care Payment Amount |
| 226 |
CLM_BNDLD_ADJSTMT_PMT_AMT |
Claim Bundled Adjustment Payment Amount |
| 227 |
CLM_VBP_ADJSTMT_PMT_AMT |
Claim Value-Based Purchasing Adjustment Payment Amount |
| 228 |
CLM_HRR_ADJSTMT_PMT_AMT |
Claim Hospital Readmission Reduction (HRR) Adjustment Payment Amount |
| 229 |
EHR_PYMT_ADJSTMT_AMT |
Claim Electronic Health Record (EHR) Payment Adjustment Amount |
| 230 |
PPS_STD_VAL_PYMT_AMT |
Standard Payment Amount |
| 231 |
FINL_STD_AMT |
Claim Final Standard Payment Amount |
| 232 |
CLM_FULL_STD_PYMT_AMT |
Claim Full Standard Payment Amount |
| 233 |
CLM_SS_OUTLIER_STD_PYMT_AMT |
Claim Short Stay Outlier (SSO) Standard Payment Amount |
| 234 |
HAC_PGM_RDCTN_IND_SW |
Claim Hospital Acquired Condition (HAC) Program Reduction Indicator Switch |
| 235 |
EHR_PGM_RDCTN_IND_SW |
Claim Electronic Health Records (EHR) Program Reduction Indicator Switch |
| 236 |
CLM_SITE_NTRL_PYMT_CST_AMT |
Claim Site Neutral Payment Based on Cost Amount |
| 237 |
CLM_SITE_NTRL_PYMT_IPPS_AMT |
Claim Site Neutral Payment Based on Inpatient Prospective Payment System (IPPS) Amounts |
| 238 |
CLM_NEXT_GNRTN_ACO_IND_CD1 |
Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population-Based Payment (PBP) |
| 239 |
CLM_NEXT_GNRTN_ACO_IND_CD2 |
Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth |
| 240 |
CLM_NEXT_GNRTN_ACO_IND_CD3 |
Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits |
| 241 |
CLM_NEXT_GNRTN_ACO_IND_CD4 |
Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3-day SNF waiver |
| 242 |
CLM_NEXT_GNRTN_ACO_IND_CD5 |
Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation |
| 243 |
ACO_ID_NUM |
Claim Accountable Care Organization (ACO) Identification Number |
| 244 |
CLM_BENE_ID_TYPE_CD |
Claim Beneficiary Identifier Type Code |
| 245 |
CLM_RSDL_PYMT_IND_CD |
Claim Residual Payment Indicator Code |
| 246 |
CLM_RP_IND_CD |
Claim Representative Payee (RP) Indicator Code |
| 247 |
PRVDR_VLDTN_TYPE_CD |
Provider Validation Type Code |
| 248 |
RR_BRD_EXCLSN_IND_SW |
Railroad Board Exclusion Indicator Switch |
| 250 |
CLM_MODEL_REIMBRSMT_AMT |
Claim Model Reimbursement Amount |
| 251 |
LTCH_DSCHRG_PYMT_ADJSTMT_AMT |
LTCH Discharge Payment Adjustment Amount |
| 251 |
CLM_ADJUST_GRP_CD |
Claim Adjustment Group Code |
| 252 |
CLM_ADJUST_RSN_CD |
Claim Adjustment Reason Code |
