| 1 |
BENE_ID |
Encrypted CCW Beneficiary Identifier |
| 2 |
MSIS_ID |
Encrypted State Assigned Beneficiary Unique Identifier |
| 3 |
STATE_CD |
Submitting State Alpha Abbreviation |
| 4 |
SUBMTG_STATE_CD |
Submitting State FIPS Code |
| 5 |
CLM_ID |
CCW Claim Identifier |
| 6 |
CLM_NUM_ORIG |
Original Claim Identifier |
| 7 |
CLM_NUM_ADJ |
Adjustment Claim Identifier |
| 8 |
CLM_TYPE_CD |
Claim Type Code (TAF) |
| 9 |
BILL_TYPE_CD |
Bill Type Code |
| 10 |
CROSSOVER_CLM_IND |
Code To Indicate if a Portion of Claim is Paid by Medicare |
| 11 |
ADJUST_CD |
Claim Adjustment Code |
| 12 |
ADJUST_RSN_CD |
Adjustment Reason Code |
| 13 |
ADJDCTN_DT |
Adjudication Date |
| 14 |
MDCD_PD_DT |
Medicaid Paid Date |
| 15 |
SPLIT_CLM_IND |
Split Claim Indicator |
| 16 |
CLL_CNT |
Claim Line Count - Original |
| 17 |
CLL_CNT_CALC |
Claim Line Count - Calculated |
| 18 |
PRSN_CLM_IND |
Indicator of a Claim for a Person |
| 19 |
SRVC_TRKNG_TYPE_CD |
Service Tracking Type Code |
| 20 |
FED_SRVC_CTGRY_CD |
Federally Assigned Service Category Code Added During TAF Production |
| 21 |
BIRTH_DT |
Date of Birth |
| 22 |
PTNT_DSCHRG_STUS_CD |
Patient Status at Ending Date of Service |
| 23 |
BIRTH_WT |
Birth Weight in Grams |
| 24 |
PGM_TYPE_CD |
Program Type Code |
| 25 |
MC_PLAN_ID |
Managed Care Plan Identification Number |
| 26 |
WVR_TYPE_CD |
Waiver Type Code |
| 27 |
WVR_ID |
Waiver Identification Number |
| 28 |
OTHR_INSRNC_IND |
Indicator Insured is Covered by Another Plan (Not Medicare or Medicaid) |
| 29 |
SECT_1115A_DEMO_IND |
1115(A) Demonstration Participation Indicator |
| 30 |
SRVC_BGN_DT |
Claim Beginning Date of Service |
| 31 |
SRVC_END_DT |
Claim Ending Date of Service |
| 32 |
SRVC_END_DT_CD |
Identifies the Date Field Used to Populate SRVC_END_DT |
| 33 |
HOSP_TYPE_CD |
Hospital Type Code |
| 34 |
ADMSN_TYPE_CD |
Admission Type Code |
| 35 |
ADMSM_DT |
Admission Date (TAF) |
| 36 |
ADMSN_HR |
Admission Hour |
| 37 |
DSCHRG_DT |
Discharge Date |
| 38 |
DSCHRG_HR |
Discharge Hour |
| 39 |
ADMTG_DGNS_CD |
Admitting Diagnosis Code |
| 40 |
ADMTG_DGNS_VRSN_CD |
Admitting Diagnosis Version Code (ICD-9 or ICD-10) |
| 41 |
DGNS_CD_1 |
Primary or Principal Diagnosis Code |
| 42 |
DGNS_VRSN_CD_1 |
Diagnosis Version Code 1 (ICD-9 or ICD-10) |
| 43 |
DGNS_POA_IND_1 |
Diagnosis Present on Admission Indicator 1 |
| 44 |
DGNS_1_CCSR_CTGRY_CD |
AHRQ Clinical Classifications Software Refined (CCSR) Diagnosis 1 Category Code |
| 45 |
DGNS_CD_2 |
Diagnosis Code 2 |
| 46 |
DGNS_VRSN_CD_2 |
Diagnosis Version Code 2 (ICD-9 or ICD-10) |
| 47 |
DGNS_POA_IND_2 |
Diagnosis Present on Admission Indicator 2 |
| 48 |
DGNS_CD_3 |
Diagnosis Code 3 |
| 49 |
DGNS_VRSN_CD_3 |
Diagnosis Version Code 3 (ICD-9 or ICD-10) |
| 50 |
DGNS_POA_IND_3 |
Diagnosis Present on Admission Indicator 3 |
| 51 |
DGNS_CD_4 |
Diagnosis Code 4 |
| 52 |
DGNS_VRSN_CD_4 |
Diagnosis Version Code 4 (ICD-9 or ICD-10) |
| 53 |
DGNS_POA_IND_4 |
Diagnosis Present on Admission Indicator 4 |
| 54 |
DGNS_CD_5 |
Diagnosis Code 5 |
| 55 |
DGNS_VRSN_CD_5 |
Diagnosis Version Code 5 (ICD-9 or ICD-10) |
| 56 |
DGNS_POA_IND_5 |
Diagnosis Present on Admission Indicator 5 |
| 57 |
DGNS_CD_6 |
Diagnosis Code 6 |
| 58 |
DGNS_VRSN_CD_6 |
Diagnosis Version Code 6 (ICD-9 or ICD-10) |
| 59 |
DGNS_POA_IND_6 |
Diagnosis Present on Admission Indicator 6 |
| 60 |
DGNS_CD_7 |
Diagnosis Code 7 |
| 61 |
DGNS_VRSN_CD_7 |
Diagnosis Version Code 7 (ICD-9 or ICD-10) |
| 62 |
DGNS_POA_IND_7 |
Diagnosis Present on Admission Indicator 7 |
| 63 |
DGNS_CD_8 |
Diagnosis Code 8 |
| 64 |
DGNS_VRSN_CD_8 |
Diagnosis Version Code 8 (ICD-9 or ICD-10) |
| 65 |
DGNS_POA_IND_8 |
Diagnosis Present on Admission Indicator 8 |
| 66 |
DGNS_CD_9 |
Diagnosis Code 9 |
| 67 |
DGNS_VRSN_CD_9 |
Diagnosis Version Code 9 (ICD-9 or ICD-10) |
| 68 |
DGNS_POA_IND_9 |
Diagnosis Present on Admission Indicator 9 |
| 69 |
DGNS_CD_10 |
Diagnosis Code 10 |
| 70 |
DGNS_VRSN_CD_10 |
Diagnosis Version Code 10 (ICD-9 or ICD-10) |
| 71 |
DGNS_POA_IND_10 |
Diagnosis Present on Admission Indicator 10 |
| 72 |
DGNS_CD_11 |
Diagnosis Code 11 |
| 73 |
DGNS_VRSN_CD_11 |
Diagnosis Version Code 11 (ICD-9 or ICD-10) |
| 74 |
DGNS_POA_IND_11 |
Diagnosis Present on Admission Indicator 11 |
| 75 |
DGNS_CD_12 |
Diagnosis Code 12 |
| 76 |
DGNS_VRSN_CD_12 |
Diagnosis Version Code 12 (ICD-9 or ICD-10) |
| 77 |
DGNS_POA_IND_12 |
Diagnosis Present on Admission Indicator 12 |
| 78 |
HAC_IND |
Health Care Acquired Condition (HAC) Indicator |
| 79 |
IP_MH_DGNS_IND |
Mental Health Diagnosis Indicator |
| 80 |
IP_SUD_DGNS_IND |
Substance Use Disorder Diagnosis Indicator |
| 81 |
DRG_CD |
Diagnosis Related Group (DRG) Code |
| 82 |
DRG_CD_SYS |
DRG Code System/Nomenclature |
| 83 |
DRG_DESC |
Description of DRG Code |
| 84 |
MDC_CD |
Major Diagnostic Category (MDC) Code |
| 85 |
PRCDR_CD_DT_1 |
Date Procedures 1 Performed |
| 86 |
PRCDR_CD_1 |
Procedure Code 1 |
| 87 |
PRCDR_CD_SYS_1 |
Procedure Code 1 System/Nomenclature |
| 88 |
PRCDR_CD_DT_2 |
Date Procedures 2 Performed |
| 89 |
PRCDR_CD_2 |
Procedure Code 2 |
| 90 |
PRCDR_CD_SYS_2 |
Procedure Code 2 System/Nomenclature |
| 91 |
PRCDR_CD_DT_3 |
Date Procedures 3 Performed |
| 92 |
PRCDR_CD_3 |
Procedure Code 3 |
| 93 |
PRCDR_CD_SYS_3 |
Procedure Code 3 System/Nomenclature |
| 94 |
PRCDR_CD_DT_4 |
Date Procedures 4 Performed |
| 95 |
PRCDR_CD_4 |
Procedure Code 4 |
| 96 |
PRCDR_CD_SYS_4 |
Procedure Code 4 System/Nomenclature |
| 97 |
PRCDR_CD_DT_5 |
Date Procedures 5 Performed |
| 98 |
PRCDR_CD_5 |
Procedure Code 5 |
| 99 |
PRCDR_CD_SYS_5 |
Procedure Code 5 System/Nomenclature |
| 100 |
PRCDR_CD_DT_6 |
Date Procedures 6 Performed |
| 101 |
PRCDR_CD_6 |
Procedure Code 6 |
| 102 |
PRCDR_CD_SYS_6 |
Procedure Code 6 System/Nomenclature |
| 103 |
ADMTG_PRVDR_ID |
Admitting Provider Identification Number |
| 104 |
ADMTG_PRVDR_NPI |
Admitting Provider NPI |
| 105 |
ADMTG_PRVDR_TXNMY_CD |
Admitting Provider Taxonomy Code |
| 106 |
ADMTG_PRVDR_TYPE_CD |
Admitting Provider Type Code |
| 107 |
ADMTG_PRVDR_SPCLTY_CD |
Admitting Provider Specialty Code |
| 108 |
BLG_PRVDR_ID |
Billing Provider Identification Number (TAF) |
| 109 |
BLG_PRVDR_NPI |
Billing Provider NPI |
| 110 |
BLG_PRVDR_TXNMY_CD |
Billing Provider Taxonomy Code |
| 111 |
BLG_PRVDR_NPPES_TXNMY_CD |
Billing Provider NPPES Taxonomy Code |
| 112 |
BLG_PRVDR_TYPE_CD |
Billing Provider Type Code |
| 113 |
BLG_PRVDR_SPCLTY_CD |
Billing Provider Specialty Code |
| 114 |
RFRG_PRVDR_ID |
Referring Provider Identification Number |
| 115 |
RFRG_PRVDR_NPI |
Referring Provider NPI |
| 116 |
RFRG_PRVDR_TYPE_CD |
Referring Provider Type Code |
| 117 |
RFRG_PRVDR_SPCLTY_CD |
Referring Provider Specialty Code |
| 118 |
PRVDR_LCTN_CD |
Provider Location Code |
| 119 |
BRDR_STATE_IND |
Border State Indicator |
| 120 |
IP_MH_TXNMY_IND |
Mental Health Provider Taxonomy Indicator |
| 121 |
IP_SUD_TXNMY_IND |
Substance Use Disorder Provider Taxonomy Indicator |
| 122 |
NCVRD_DAYS |
Medicaid Non-covered Days Count |
| 123 |
CVRD_DAYS |
Medicaid Covered Inpatient Days Count |
| 124 |
OUTLIER_DAYS |
Outlier Days Count |
| 125 |
OUTLIER_TYPE_CD |
Outlier Type Code |
| 126 |
DRG_OUTLIER_AMT |
DRG Outlier Additional Payment Amount |
| 127 |
FIXD_PYMT_IND |
Fixed Payment Indicator |
| 128 |
SRVC_TRKNG_PYMT_AMT |
Service Tracking Payment Amount |
| 129 |
DRG_RLTV_WT |
DRG Relative Weight |
| 130 |
PYMT_LVL_IND |
Payment Level Indicator - Header or Line |
| 131 |
BILLED_AMT |
Total Claim Billed Amount |
| 132 |
NCVRD_CHRG_AMT |
Non-covered Charges Amount |
| 133 |
MDCD_ALOWD_AMT |
Total Medicaid Allowed Amount |
| 134 |
MDCD_PD_AMT |
Total Amount Paid By Medicaid |
| 135 |
MDCD_COPAY_AMT |
Total Copay Amount Paid by Beneficiary |
| 136 |
MDCD_DSH_PD_AMT |
Medicaid Amount Paid Disproportionate Share Hospital (DSH) |
| 137 |
MDCR_PD_AMT |
Medicare Paid Amount |
| 138 |
MDCR_DDCTBL_PD_AMT |
Total Medicare Deductible Amount |
| 139 |
MDCR_COINSRNC_PD_AMT |
Total Medicare Coinsurance Amount |
| 140 |
MDCR_CMBND_DDCTBL_IND |
Medicare Combined Deductible and Coinsurance Indicator |
| 141 |
MDCR_REIMBRSMT_TYPE_CD |
Medicare Reimbursement Type Code |
| 142 |
COINSRNC_AMT |
Beneficiary Coinsurance Amount |
| 143 |
COPAY_AMT |
Beneficiary Copayment Amount |
| 144 |
DDCTBL_AMT |
Beneficiary Deductible Amount |
| 145 |
COPAY_WVD_IND |
Indicator Signifying Copay was Waived by Provider |
| 146 |
TP_PD_AMT |
Total Third Party Liability Paid Amount |
| 147 |
TP_COINSRNC_PD_AMT |
Third Party Coinsurance Paid Amount |
| 148 |
TP_COPAY_PD_AMT |
Third Party Copayment Paid Amount |
| 149 |
OTHR_INSRNC_PD_AMT |
Total Other Than Medicare or Medicaid -Insurance Paid Amount |
| 150 |
OTHR_TP_CLCTN_CD |
Other Third Party Collection Code |
| 151 |
FUNDNG_CD |
Code To Indicate Source of Non-Federal Funding |
| 152 |
FUNDNG_SRC_NON_FED_SHR_CD |
Funding Source Non-Federal Share Code |
| 153 |
DA_RUN_ID |
TAF Production Run Identifier (unique for each TAF run) |
| 154 |
TMSIS_RUN_ID |
TMSIS State Data Processing Run Identifier |
| 155 |
IP_VRSN |
Inpatient Version Representing the Iteration of the File |
| 156 |
IP_FIL_DT |
Inpatient File Date - Represents the Year and Month of the Reporting Period |
| 157 |
CCW_LD_DT |
CCW Load Date |
