|
1 |
BENE_ID |
Encrypted 723 CCW Beneficiary ID |
| 2 |
MSIS_ID |
Encrypted MSIS Identification Number |
| 3 |
STATE_CD |
State |
| 4 |
YR_NUM |
Year of MAX Record |
| 5 |
EL_DOB |
Birth date |
| 6 |
EL_SEX_CD |
Sex (MAX) |
| 7 |
EL_RACE_ETHNCY_CD |
Race/ethnicity (from MSIS) |
| 8 |
RACE_CODE_1 |
Race - White (from MSIS) |
| 9 |
RACE_CODE_2 |
Race - Black (from MSIS) |
| 10 |
RACE_CODE_3 |
Race - Am Indian/Alaskan (from MSIS) |
| 11 |
RACE_CODE_4 |
Race - Asian (from MSIS) |
| 12 |
RACE_CODE_5 |
Race - Hawaiian/Pac Islands (from MSIS) |
| 13 |
ETHNICITY_CODE |
Ethnicity - Hispanic (from MSIS) |
| 14 |
EL_SS_ELGBLTY_CD_LTST |
State specific eligibility - most recent |
| 15 |
EL_SS_ELGBLTY_CD_MO |
State specific eligibility - mo of svc |
| 16 |
EL_MAX_ELGBLTY_CD_LTST |
MAX eligibility - most recent |
| 17 |
EL_MAX_ELGBLTY_CD_MO |
MAX eligibility - mo of svc |
| 18 |
EL_MDCR_ANN_XOVR_OLD |
Medicare Crossover code (Annual) old values |
| 19 |
MSNG_ELG_DATA |
Missing eligibility data |
| 20 |
EL_MDCR_XOVR_CLM_BSD_CD |
Crossover code (from claims only) |
| 21 |
EL_MDCR_ANN_XOVR_99 |
Crossover code (Annual) |
| 22 |
MSIS_TOS |
MSIS Type of Service (TOS) |
| 23 |
MSIS_TOP |
MSIS Type of Program (TOP) |
| 24 |
MAX_TOS |
MAX Type of Service (TOS) |
| 25 |
PRVDR_ID_NMBR |
Billing provider identification number (MAX) |
| 26 |
NPI |
National Provider Identifier (MAX) |
| 27 |
TAXONOMY |
Provider Taxonomy |
| 28 |
TYPE_CLM_CD |
Type of claim |
| 29 |
ADJUST_CD |
Adjustment code |
| 30 |
PHP_TYPE |
Managed care type of plan code |
| 31 |
PHP_ID |
Managed care plan identification code |
| 32 |
MDCD_PYMT_AMT |
Medicaid payment amount |
| 33 |
TP_PYMT_AMT |
Third party payment amount |
| 34 |
PYMT_DT |
Payment/adjudication date |
| 35 |
CHRG_AMT |
Charge amount |
| 36 |
PHP_VAL |
Prepaid plan value |
| 37 |
MDCR_COINSUR_PYMT_AMT |
Medicare coinsurance payment amount |
| 38 |
MDCR_DED_PYMT_AMT |
Medicare deductible payment amount |
| 39 |
ADMSN_DT |
Admission date (MAX) |
| 40 |
SRVC_BGN_DT |
Beginning date of service |
| 41 |
SRVC_END_DT |
Ending date of service |
| 42 |
DIAG_CD_1 |
Principle Diagnosis code |
| 43 |
ICD_DGNS_VRSN_CD1 |
Claim Diagnosis Code 1 Diagnosis Version Code (ICD-9 or ICD-10) (Encounter) |
| 44 |
DIAG_CD_2 |
Diagnosis codes (2nd diagnosis) |
| 45 |
DIAG_CD_3 |
Diagnosis codes (3rd diagnosis) |
| 46 |
DIAG_CD_4 |
Diagnosis codes (4th diagnosis) |
| 47 |
DIAG_CD_5 |
Diagnosis codes (5th diagnosis) |
| 48 |
DIAG_CD_6 |
Diagnosis codes (6th diagnosis) |
| 49 |
DIAG_CD_7 |
Diagnosis codes (7th diagnosis) |
| 50 |
DIAG_CD_8 |
Diagnosis codes (8th diagnosis) |
| 51 |
DIAG_CD_9 |
Diagnosis codes (9th diagnosis) |
| 52 |
PRNCPL_PRCDR_DT |
Principle procedure date |
| 53 |
PRCDR_CD_SYS_1 |
Procedure code system- principal |
| 54 |
PRCDR_CD_1 |
Principle procedure code |
| 55 |
PRCDR_CD_SYS_2 |
Procedure code system (2nd procedure) |
| 56 |
PRCDR_CD_2 |
Procedure code (2nd procedure) |
| 57 |
PRCDR_CD_SYS_3 |
Procedure code system (3rd procedure) |
| 58 |
PRCDR_CD_3 |
Procedure code (3rd procedure) |
| 59 |
PRCDR_CD_SYS_4 |
Procedure code system (4th procedure) |
| 60 |
PRCDR_CD_4 |
Procedure code (4th procedure) |
| 61 |
PRCDR_CD_SYS_5 |
Procedure code system (5th procedure) |
| 62 |
PRCDR_CD_5 |
Procedure code (5th procedure) |
| 63 |
PRCDR_CD_SYS_6 |
Procedure code system (6th procedure) |
| 64 |
PRCDR_CD_6 |
Procedure code (6th procedure) |
| 65 |
RCPNT_DLVRY_CD |
Delivery code (MAX IP) |
| 66 |
MDCD_CVRD_IP_DAYS |
Medicaid covered inpatient days |
| 67 |
PATIENT_STATUS_CD |
Patient status |
| 68 |
DRG_REL_GROUP_IND |
Diagnosis Related Group (DRG) indicator |
| 69 |
DRG_REL_GROUP |
Diagnosis Related Group (DRG) |
| 70 |
UB_92_REV_CD_GP_1 |
UB-92 revenue code (1st) |
| 71 |
UB_92_REV_CD_CHGS_1 |
UB-92 revenue code charge (1st) |
| 72 |
UB_92_REV_CD_UNITS_1 |
UB-92 revenue code units (1st) |
| 73 |
UB_92_REV_CD_GP_2 |
UB-92 revenue code (2nd) |
| 74 |
UB_92_REV_CD_CHGS_2 |
UB-92 revenue code charge (2nd) |
| 75 |
UB_92_REV_CD_UNITS_2 |
UB-92 revenue code units (2nd) |
| 76 |
UB_92_REV_CD_GP_3 |
UB-92 revenue code (3rd) |
| 77 |
UB_92_REV_CD_CHGS_3 |
UB-92 revenue code charge (3rd) |
| 78 |
UB_92_REV_CD_UNITS_3 |
UB-92 revenue code units (3rd) |
| 79 |
UB_92_REV_CD_GP_4 |
UB-92 revenue code (4th) |
| 80 |
UB_92_REV_CD_CHGS_4 |
UB-92 revenue code charge (4th) |
| 81 |
UB_92_REV_CD_UNITS_4 |
UB-92 revenue code units (4th) |
| 82 |
UB_92_REV_CD_GP_5 |
UB-92 revenue code (5th) |
| 83 |
UB_92_REV_CD_CHGS_5 |
UB-92 revenue code charge (5th) |
| 84 |
UB_92_REV_CD_UNITS_5 |
UB-92 revenue code units (5th) |
| 85 |
UB_92_REV_CD_GP_6 |
UB-92 revenue code (6th) |
| 86 |
UB_92_REV_CD_CHGS_6 |
UB-92 revenue code charge (6th) |
| 87 |
UB_92_REV_CD_UNITS_6 |
UB-92 revenue code units (6th) |
| 88 |
UB_92_REV_CD_GP_7 |
UB-92 revenue code (7th) |
| 89 |
UB_92_REV_CD_CHGS_7 |
UB-92 revenue code charge (7th) |
| 90 |
UB_92_REV_CD_UNITS_7 |
UB-92 revenue code units (7th) |
| 91 |
UB_92_REV_CD_GP_8 |
UB-92 revenue code (8th) |
| 92 |
UB_92_REV_CD_CHGS_8 |
UB-92 revenue code charge (8th) |
| 93 |
UB_92_REV_CD_UNITS_8 |
UB-92 revenue code units (8th) |
| 94 |
UB_92_REV_CD_GP_9 |
UB-92 revenue code (9th) |
| 95 |
UB_92_REV_CD_CHGS_9 |
UB-92 revenue code charge (9th) |
| 96 |
UB_92_REV_CD_UNITS_9 |
UB-92 revenue code units (9th) |
| 97 |
UB_92_REV_CD_GP_10 |
UB-92 revenue code (10th) |
| 98 |
UB_92_REV_CD_CHGS_10 |
UB-92 revenue code charge (10th) |
| 99 |
UB_92_REV_CD_UNITS_10 |
UB-92 revenue code units (10th) |
| 100 |
UB_92_REV_CD_GP_11 |
UB-92 revenue code (11th) |
| 101 |
UB_92_REV_CD_CHGS_11 |
UB-92 revenue code charge (11th) |
| 102 |
UB_92_REV_CD_UNITS_11 |
UB-92 revenue code units (11th) |
| 103 |
UB_92_REV_CD_GP_12 |
UB-92 revenue code (12th) |
| 104 |
UB_92_REV_CD_CHGS_12 |
UB-92 revenue code charge (12th) |
| 105 |
UB_92_REV_CD_UNITS_12 |
UB-92 revenue code units (12th) |
| 106 |
UB_92_REV_CD_GP_13 |
UB-92 revenue code (13th) |
| 107 |
UB_92_REV_CD_CHGS_13 |
UB-92 revenue code charge (13th) |
| 108 |
UB_92_REV_CD_UNITS_13 |
UB-92 revenue code units (13th) |
| 109 |
UB_92_REV_CD_GP_14 |
UB-92 revenue code (14th) |
| 110 |
UB_92_REV_CD_CHGS_14 |
UB-92 revenue code charge (14th) |
| 111 |
UB_92_REV_CD_UNITS_14 |
UB-92 revenue code units (14th) |
| 112 |
UB_92_REV_CD_GP_15 |
UB-92 revenue code (15th) |
| 113 |
UB_92_REV_CD_CHGS_15 |
UB-92 revenue code charge (15th) |
| 114 |
UB_92_REV_CD_UNITS_15 |
UB-92 revenue code units (15th) |
| 115 |
UB_92_REV_CD_GP_16 |
UB-92 revenue code (16th) |
| 116 |
UB_92_REV_CD_CHGS_16 |
UB-92 revenue code charge (16th) |
| 117 |
UB_92_REV_CD_UNITS_16 |
UB-92 revenue code units (16th) |
| 118 |
UB_92_REV_CD_GP_17 |
UB-92 revenue code (17th) |
| 119 |
UB_92_REV_CD_CHGS_17 |
UB-92 revenue code charge (17th) |
| 120 |
UB_92_REV_CD_UNITS_17 |
UB-92 revenue code units (17th) |
| 121 |
UB_92_REV_CD_GP_18 |
UB-92 revenue code (18th) |
| 122 |
UB_92_REV_CD_CHGS_18 |
UB-92 revenue code charge (18th) |
| 123 |
UB_92_REV_CD_UNITS_18 |
UB-92 revenue code units (18th) |
| 124 |
UB_92_REV_CD_GP_19 |
UB-92 revenue code (19th) |
| 125 |
UB_92_REV_CD_CHGS_19 |
UB-92 revenue code charge (19th) |
| 126 |
UB_92_REV_CD_UNITS_19 |
UB-92 revenue code units (19th) |
| 127 |
UB_92_REV_CD_GP_20 |
UB-92 revenue code (20th) |
| 128 |
UB_92_REV_CD_CHGS_20 |
UB-92 revenue code charge (20th) |
| 129 |
UB_92_REV_CD_UNITS_20 |
UB-92 revenue code units (20th) |
| 130 |
UB_92_REV_CD_GP_21 |
UB-92 revenue code (21st) |
| 131 |
UB_92_REV_CD_CHGS_21 |
UB-92 revenue code charge (21st) |
| 132 |
UB_92_REV_CD_UNITS_21 |
UB-92 revenue code units (21st) |
| 133 |
UB_92_REV_CD_GP_22 |
UB-92 revenue code (22nd) |
| 134 |
UB_92_REV_CD_CHGS_22 |
UB-92 revenue code charge (22nd) |
| 135 |
UB_92_REV_CD_UNITS_22 |
UB-92 revenue code units (22nd) |
| 136 |
UB_92_REV_CD_GP_23 |
UB-92 revenue code (23rd) |
| 137 |
UB_92_REV_CD_CHGS_23 |
UB-92 revenue code charge (23rd) |
| 138 |
UB_92_REV_CD_UNITS_23 |
UB-92 revenue code units (23rd) |
| 139 |
UPDT_DT |
MAX File Update Date |
