| 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 |
PGM_TYPE_CD |
Program Type Code |
| 24 |
MC_PLAN_ID |
Managed Care Plan Identification Number |
| 25 |
WVR_TYPE_CD |
Waiver Type Code |
| 26 |
WVR_ID |
Waiver Identification Number |
| 27 |
OTHR_INSRNC_IND |
Indicator Insured is Covered by Another Plan (Not Medicare or Medicaid) |
| 28 |
SECT_1115A_DEMO_IND |
1115(A) Demonstration Participation Indicator |
| 29 |
SRVC_BGN_DT |
Claim Beginning Date of Service |
| 30 |
SRVC_END_DT |
Claim Ending Date of Service |
| 31 |
SRVC_END_DT_CD |
Identifies the Date Field Used to Populate SRVC_END_DT |
| 32 |
ADMSM_DT |
Admission Date (TAF) |
| 33 |
ADMSN_HR |
Admission Hour |
| 34 |
DSCHRG_DT |
Discharge Date |
| 35 |
DSCHRG_HR |
Discharge Hour |
| 36 |
ADMTG_DGNS_CD |
Admitting Diagnosis Code |
| 37 |
ADMTG_DGNS_VRSN_CD |
Admitting Diagnosis Version Code (ICD-9 or ICD-10) |
| 38 |
DGNS_CD_1 |
Primary or Principal Diagnosis Code |
| 39 |
DGNS_VRSN_CD_1 |
Diagnosis Version Code 1 (ICD-9 or ICD-10) |
| 40 |
DGNS_POA_IND_1 |
Diagnosis Present on Admission Indicator 1 |
| 41 |
DGNS_1_CCSR_CTGRY_CD |
AHRQ Clinical Classifications Software Refined (CCSR) Diagnosis 1 Category Code |
| 42 |
DGNS_CD_2 |
Diagnosis Code 2 |
| 43 |
DGNS_VRSN_CD_2 |
Diagnosis Version Code 2 (ICD-9 or ICD-10) |
| 44 |
DGNS_POA_IND_2 |
Diagnosis Present on Admission Indicator 2 |
| 45 |
DGNS_CD_3 |
Diagnosis Code 3 |
| 46 |
DGNS_VRSN_CD_3 |
Diagnosis Version Code 3 (ICD-9 or ICD-10) |
| 47 |
DGNS_POA_IND_3 |
Diagnosis Present on Admission Indicator 3 |
| 48 |
DGNS_CD_4 |
Diagnosis Code 4 |
| 49 |
DGNS_VRSN_CD_4 |
Diagnosis Version Code 4 (ICD-9 or ICD-10) |
| 50 |
DGNS_POA_IND_4 |
Diagnosis Present on Admission Indicator 4 |
| 51 |
DGNS_CD_5 |
Diagnosis Code 5 |
| 52 |
DGNS_VRSN_CD_5 |
Diagnosis Version Code 5 (ICD-9 or ICD-10) |
| 53 |
DGNS_POA_IND_5 |
Diagnosis Present on Admission Indicator 5 |
| 54 |
HAC_IND |
Health Care Acquired Condition (HAC) Indicator |
| 55 |
IP_MH_DGNS_IND |
Mental Health Diagnosis Indicator |
| 56 |
IP_SUD_DGNS_IND |
Substance Use Disorder Diagnosis Indicator |
| 57 |
ADMTG_PRVDR_ID |
Admitting Provider Identification Number |
| 58 |
ADMTG_PRVDR_NPI |
Admitting Provider NPI |
| 59 |
ADMTG_PRVDR_TXNMY_CD |
Admitting Provider Taxonomy Code |
| 60 |
ADMTG_PRVDR_TYPE_CD |
Admitting Provider Type Code |
| 61 |
ADMTG_PRVDR_SPCLTY_CD |
Admitting Provider Specialty Code |
| 62 |
BLG_PRVDR_ID |
Billing Provider Identification Number (TAF) |
| 63 |
BLG_PRVDR_NPI |
Billing Provider NPI |
| 64 |
BLG_PRVDR_TXNMY_CD |
Billing Provider Taxonomy Code |
| 65 |
BLG_PRVDR_NPPES_TXNMY_CD |
Billing Provider NPPES Taxonomy Code |
| 66 |
BLG_PRVDR_TYPE_CD |
Billing Provider Type Code |
| 67 |
BLG_PRVDR_SPCLTY_CD |
Billing Provider Specialty Code |
| 68 |
RFRG_PRVDR_ID |
Referring Provider Identification Number |
| 69 |
RFRG_PRVDR_NPI |
Referring Provider NPI |
| 70 |
RFRG_PRVDR_TYPE_CD |
Referring Provider Type Code |
| 71 |
RFRG_PRVDR_SPCLTY_CD |
Referring Provider Specialty Code |
| 72 |
PRVDR_LCTN_CD |
Provider Location Code |
| 73 |
BRDR_STATE_IND |
Border State Indicator |
| 74 |
IP_MH_TXNMY_IND |
Mental Health Provider Taxonomy Indicator |
| 75 |
IP_SUD_TXNMY_IND |
Substance Use Disorder Provider Taxonomy Indicator |
| 76 |
NCVRD_DAYS |
Medicaid Non-covered Days Count |
| 77 |
CVRD_DAYS_ICF_IID |
Count of Medicaid Covered Days in ICF for Patients with Intellectual Disability |
| 78 |
CVRD_DAYS_NF |
Count of Medicaid Covered Days in a Nursing Facility |
| 79 |
CVRD_DAYS_IP_PSYCH |
Count of Medicaid Covered Days in an Inpatient Psychiatric Facility (IPF) |
| 80 |
CVRD_DAYS_IP_PSYCH_OVER_65 |
Count of Medicaid Covered Days in an IPF (Beneficiary Over 65 Years) |
| 81 |
CVRD_DAYS_IP_PSYCH_UNDER_21 |
Count of Medicaid Covered Days in an IPF (Beneficiary Under 21 Years) |
| 82 |
LEAVE_DAYS |
Count of Days During Medicaid Coverage Period Patient was not Residing in LTC |
| 83 |
FIXD_PYMT_IND |
Fixed Payment Indicator |
| 84 |
SRVC_TRKNG_PYMT_AMT |
Service Tracking Payment Amount |
| 85 |
PYMT_LVL_IND |
Payment Level Indicator - Header or Line |
| 86 |
BILLED_AMT |
Total Claim Billed Amount |
| 87 |
NCVRD_CHRG_AMT |
Non-covered Charges Amount |
| 88 |
MDCD_ALOWD_AMT |
Total Medicaid Allowed Amount |
| 89 |
MDCD_PD_AMT |
Total Amount Paid By Medicaid |
| 90 |
DAILY_RATE |
Daily Rate that a Policy will Pay for a Covered Service |
| 91 |
MDCD_ACMDTN_PD_AMT |
Medicaid Amount Paid for All Accommodation (Room and Board) Revenue Lines |
| 92 |
MDCD_ANCLRY_PD_AMT |
Medicaid Amount Paid for All Ancillary (Non-Room & Board) Revenue Lines |
| 93 |
MDCR_PD_AMT |
Medicare Paid Amount |
| 94 |
MDCR_DDCTBL_PD_AMT |
Total Medicare Deductible Amount |
| 95 |
MDCR_COINSRNC_PD_AMT |
Total Medicare Coinsurance Amount |
| 96 |
MDCR_CMBND_DDCTBL_IND |
Medicare Combined Deductible and Coinsurance Indicator |
| 97 |
MDCR_REIMBRSMT_TYPE_CD |
Medicare Reimbursement Type Code |
| 98 |
BENE_LIABILITY_AMT |
Total Beneficiary Long-Term Care Liability Amount |
| 99 |
COINSRNC_AMT |
Beneficiary Coinsurance Amount |
| 100 |
COPAY_AMT |
Beneficiary Copayment Amount |
| 101 |
DDCTBL_AMT |
Beneficiary Deductible Amount |
| 102 |
COPAY_WVD_IND |
Indicator Signifying Copay was Waived by Provider |
| 103 |
TP_PD_AMT |
Total Third Party Liability Paid Amount |
| 104 |
TP_COINSRNC_PD_AMT |
Third Party Coinsurance Paid Amount |
| 105 |
TP_COPAY_PD_AMT |
Third Party Copayment Paid Amount |
| 106 |
OTHR_INSRNC_PD_AMT |
Total Other Than Medicare or Medicaid -Insurance Paid Amount |
| 107 |
OTHR_TP_CLCTN_CD |
Other Third Party Collection Code |
| 108 |
FUNDNG_CD |
Code To Indicate Source of Non-Federal Funding |
| 109 |
FUNDNG_SRC_NON_FED_SHR_CD |
Funding Source Non-Federal Share Code |
| 110 |
DA_RUN_ID |
TAF Production Run Identifier (unique for each TAF run) |
| 111 |
TMSIS_RUN_ID |
TMSIS State Data Processing Run Identifier |
| 112 |
LT_VRSN |
Long-Term Version Representing the Iteration of the File |
| 113 |
LT_FIL_DT |
Long-Term File Date - Represents the Year and Month of the Reporting Period |
| 114 |
CCW_LD_DT |
CCW Load Date (Claims) |
