| 1 |
BENE_ID |
Encrypted CCW Beneficiary ID |
| 2 |
SAMPLE_GROUP |
CCW Beneficiary Random Sample Group |
| 3 |
ENC_JOIN_KEY |
Unique Encounter Join Key |
| 4 |
CLM_TYPE_CD |
Claim Type Code |
| 5 |
CLM_FROM_DT |
Claim From Date (Encounter) |
| 6 |
CLM_THRU_DT |
Claim Through Date (Encounter) |
| 7 |
SRVC_MONTH |
Service Month |
| 8 |
CLM_CHRT_RVW_SW |
Claim Chart Review Switch |
| 9 |
CLM_CNTL_NUM |
Claim Control Number |
| 10 |
CLM_ORIG_CNTL_NUM |
Claim Original Control Number |
| 11 |
CLM_FINL_ACTN_IND |
Claim Final Action Indicator |
| 12 |
CLM_LTST_CLM_IND |
Latest Claim Indicator |
| 13 |
EDPS_CREATE_DT |
Encounter Data Processing System (EDPS) Create Date |
| 14 |
CLM_RCPT_DT |
Claim Receipt Date |
| 15 |
CLM_FAC_TYPE_CD |
Claim Facility Type Code (Encounter) |
| 16 |
CLM_SRVC_CLSFCTN_TYPE_CD |
Claim Service Classification Type Code (Encounter) |
| 17 |
CLM_FREQ_CD |
Claim Frequency Code (Encounter) |
| 18 |
CNTRCT_NUM |
Medicare Part C Contract Number |
| 19 |
CNTRCT_PBP_NUM |
Medicare Part C Plan Benefit Package (PBP) Number |
| 20 |
CLM_MDCL_REC |
Claim Medical Record Number (Encounter) |
| 21 |
ORG_NPI |
Organization NPI Number (Encounter) |
| 22 |
ORG_TXNMY_CD |
Organization Taxonomy Code |
| 23 |
RNDRNG_PHYSN_NPI |
Rendering Physician NPI (Encounter) |
| 24 |
RFRG_PHYSN_NPI |
Carrier/DME Referring Physician NPI Number |
| 25 |
AT_PHYSN_NPI |
Claim Attending Physician NPI Number (Encounter) |
| 26 |
AT_PHYSN_TXNMY_CD |
Claim Attending Physician Taxonomy Code |
| 27 |
OP_PHYSN_NPI |
Claim Operating Physician NPI Number (Encounter) |
| 28 |
OT_PHYSN_NPI |
Claim Other Physician NPI Number (Encounter) |
| 29 |
PTNT_DSCHRG_STUS_CD |
Patient Discharge Status Code (Encounter) |
| 30 |
PRNCPAL_DGNS_CD |
Claim Principal Diagnosis Code (Encounter) |
| 31 |
ICD_DGNS_CD1 |
Claim Diagnosis Code 1 (Encounter) |
| 32 |
ICD_DGNS_CD2 |
Claim Diagnosis Code 2 (Encounter) |
| 33 |
ICD_DGNS_CD3 |
Claim Diagnosis Code 3 (Encounter) |
| 34 |
ICD_DGNS_CD4 |
Claim Diagnosis Code 4 (Encounter) |
| 35 |
ICD_DGNS_CD5 |
Claim Diagnosis Code 5 (Encounter) |
| 36 |
ICD_DGNS_CD6 |
Claim Diagnosis Code 6 (Encounter) |
| 37 |
ICD_DGNS_CD7 |
Claim Diagnosis Code 7 (Encounter) |
| 38 |
ICD_DGNS_CD8 |
Claim Diagnosis Code 8 (Encounter) |
| 39 |
ICD_DGNS_CD9 |
Claim Diagnosis Code 9 (Encounter) |
| 40 |
ICD_DGNS_CD10 |
Claim Diagnosis Code 10 (Encounter) |
| 41 |
ICD_DGNS_CD11 |
Claim Diagnosis Code 11 (Encounter) |
| 42 |
ICD_DGNS_CD12 |
Claim Diagnosis Code 12 (Encounter) |
| 43 |
ICD_DGNS_CD13 |
Claim Diagnosis Code 13 (Encounter) |
| 44 |
ICD_DGNS_CD14 |
Claim Diagnosis Code 14 (Encounter) |
| 45 |
ICD_DGNS_CD15 |
Claim Diagnosis Code 15 (Encounter) |
| 46 |
ICD_DGNS_CD16 |
Claim Diagnosis Code 16 (Encounter) |
| 47 |
ICD_DGNS_CD17 |
Claim Diagnosis Code 17 (Encounter) |
| 48 |
ICD_DGNS_CD18 |
Claim Diagnosis Code 18 (Encounter) |
| 49 |
ICD_DGNS_CD19 |
Claim Diagnosis Code 19 (Encounter) |
| 50 |
ICD_DGNS_CD20 |
Claim Diagnosis Code 20 (Encounter) |
| 51 |
ICD_DGNS_CD21 |
Claim Diagnosis Code 21 (Encounter) |
| 52 |
ICD_DGNS_CD22 |
Claim Diagnosis Code 22 (Encounter) |
| 53 |
ICD_DGNS_CD23 |
Claim Diagnosis Code 23 (Encounter) |
| 54 |
ICD_DGNS_CD24 |
Claim Diagnosis Code 24 (Encounter) |
| 55 |
ICD_DGNS_CD25 |
Claim Diagnosis Code 25 (Encounter) |
| 56 |
CLM_1ST_DGNS_E_CD |
First Claim Diagnosis E Code (Encounter) |
| 57 |
ICD_DGNS_E_CD1 |
Claim Diagnosis E Code 1 (Encounter) |
| 58 |
ICD_DGNS_E_CD2 |
Claim Diagnosis E Code 2 (Encounter) |
| 59 |
ICD_DGNS_E_CD3 |
Claim Diagnosis E Code 3 (Encounter) |
| 60 |
ICD_DGNS_E_CD4 |
Claim Diagnosis E Code 4 (Encounter) |
| 61 |
ICD_DGNS_E_CD5 |
Claim Diagnosis E Code 5 (Encounter) |
| 62 |
ICD_DGNS_E_CD6 |
Claim Diagnosis E Code 6 (Encounter) |
| 63 |
ICD_DGNS_E_CD7 |
Claim Diagnosis E Code 7 (Encounter) |
| 64 |
ICD_DGNS_E_CD8 |
Claim Diagnosis E Code 8 (Encounter) |
| 65 |
ICD_DGNS_E_CD9 |
Claim Diagnosis E Code 9 (Encounter) |
| 66 |
ICD_DGNS_E_CD10 |
Claim Diagnosis E Code 10 (Encounter) |
| 67 |
RSN_VISIT_CD1 |
Reason for Visit Diagnosis Code 1 (Encounter) |
| 68 |
RSN_VISIT_CD2 |
Reason for Visit Diagnosis Code 2 (Encounter) |
| 69 |
RSN_VISIT_CD3 |
Reason for Visit Diagnosis Code 3 (Encounter) |
| 70 |
ICD_PRCDR_CD1 |
Claim Procedure Code 1 (Encounter) |
| 71 |
ICD_PRCDR_CD2 |
Claim Procedure Code 2 (Encounter) |
| 72 |
ICD_PRCDR_CD3 |
Claim Procedure Code 3 (Encounter) |
| 73 |
ICD_PRCDR_CD4 |
Claim Procedure Code 4 (Encounter) |
| 74 |
ICD_PRCDR_CD5 |
Claim Procedure Code 5 (Encounter) |
| 75 |
ICD_PRCDR_CD6 |
Claim Procedure Code 6 (Encounter) |
| 76 |
ICD_PRCDR_CD7 |
Claim Procedure Code 7 (Encounter) |
| 77 |
ICD_PRCDR_CD8 |
Claim Procedure Code 8 (Encounter) |
| 78 |
ICD_PRCDR_CD9 |
Claim Procedure Code 9 (Encounter) |
| 79 |
ICD_PRCDR_CD10 |
Claim Procedure Code 10 (Encounter) |
| 80 |
ICD_PRCDR_CD11 |
Claim Procedure Code 11 (Encounter) |
| 81 |
ICD_PRCDR_CD12 |
Claim Procedure Code 12 (Encounter) |
| 82 |
ICD_PRCDR_CD13 |
Claim Procedure Code 13 (Encounter) |
| 83 |
PRCDR_DT1 |
Claim Procedure Code 1 Date (Encounter) |
| 84 |
PRCDR_DT2 |
Claim Procedure Code 2 Date (Encounter) |
| 85 |
PRCDR_DT3 |
Claim Procedure Code 3 Date (Encounter) |
| 86 |
PRCDR_DT4 |
Claim Procedure Code 4 Date (Encounter) |
| 87 |
PRCDR_DT5 |
Claim Procedure Code 5 Date (Encounter) |
| 88 |
PRCDR_DT6 |
Claim Procedure Code 6 Date (Encounter) |
| 89 |
PRCDR_DT7 |
Claim Procedure Code 7 Date (Encounter) |
| 90 |
PRCDR_DT8 |
Claim Procedure Code 8 Date (Encounter) |
| 91 |
PRCDR_DT9 |
Claim Procedure Code 9 Date (Encounter) |
| 92 |
PRCDR_DT10 |
Claim Procedure Code 10 Date (Encounter) |
| 93 |
PRCDR_DT11 |
Claim Procedure Code 11 Date (Encounter) |
| 94 |
PRCDR_DT12 |
Claim Procedure Code 12 Date (Encounter) |
| 95 |
PRCDR_DT13 |
Claim Procedure Code 13 Date (Encounter) |
| 96 |
CLM_OBSLT_DT |
Claim Obsolete Date |
| 97 |
CLM_BPRVDR_CITY_NAME |
Billing Provider Address - City |
| 98 |
CLM_BPRVDR_USPS_STATE_CD |
Billing Provider Address - USPS State Code |
| 99 |
CLM_BPRVDR_ADR_ZIP_CD |
Billing Provider Zip Code |
| 100 |
CLM_SUBSCR_CITY_NAME |
Medicare Subscriber Address - City |
| 101 |
CLM_SUBSCR_USPS_STATE_CD |
Medicare Subscriber Address - USPS State Code |
| 102 |
CLM_SUBSCR_ADR_ZIP_CD |
Medicare Subscriber Address - ZIP Code |
| 103 |
BENE_CNTY_CD |
Beneficiary County Code from Claim (SSA) |
| 104 |
BENE_STATE_CD |
Beneficiary Residence (SSA) State Code (Encounter) |
| 105 |
BENE_MLG_CNTCT_ZIP_CD |
Beneficiary ZIP Code of Residence from Claim |
| 107 |
BENE_RACE_CD |
Beneficiary Race Code (Encounter) |
| 108 |
DOB_DT |
Date of Birth from Encounter |
| 109 |
BENE_MDCR_STUS_CD |
Beneficiary Medicare Status Code |
| 110 |
TAX_NUM |
Provider Tax Number |
| 111 |
BENE_STATE |
State of beneficiary (postal abbreviation) |
