Search Data Variables

These are fields to capture a modifier code associated with the LINE_PRCDR_CD field on the OT claim line. The first modifier is reported in LINE_PRCDR_MDFR_CD_1.  If more than one modifier is reported, the additional codes are in fields LINE_PRCDR_MDFR_CD_2 through LINE_PRCDR_MDFR_CD_4.

These are fields to capture a modifier code associated with the LINE_PRCDR_CD field on the OT claim line. The first modifier is reported in LINE_PRCDR_MDFR_CD_1.  If more than one modifier is reported, the additional codes are in fields LINE_PRCDR_MDFR_CD_2 through LINE_PRCDR_MDFR_CD_4.

A flag that identifies the coding system used for the procedure code on the line file (variable called LINE_PRCDR_CD).

The code on a non-institutional claim indicating to whom payment was made or if the claim was denied. 

Code indicating whether or not a provider is participating or accepting assignment for this line item service on the non-institutional claim.

The payment made by Medicare to the provider for the line item service on the noninstitutional claim. Additional payments may have been made to the provider - including beneficiary deductible and coinsurance amounts and/or other primary payer amounts.

The federal taxpayer identification number (TIN) that identifies the physician/practice/supplier to whom payment is made for the line item service.

This number may be an employer identification number (EIN) or social security number (SSN).

Line Provider Validation Type Code for Carrier claim lines

This field indicates whether Railroad Board (RRB) beneficiary durable medical equipment (DME) claim line should be excluded from Prior Authorization processing

Claim remittance advice remark code used to provide an additional explanation for an adjustment already described by a claim adjustment reason code (CARC) for a claim or claim line. It is also used to communicate information about remittance processing. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

This is not a comprehensive list of values; refer to website below for current values and descriptions:

The National Provider Identifier (NPI) assigned to the rendering provider.

Line Representative Payee (RP) Indicator Code

Line Residual Payment Indicator Code

The count of the total number of services processed for the line item on the noninstitutional claim.

The count of the total number of services processed for the line item on the non-institutional claim.

Switch indicating whether or not the line item service on the non-institutional claim is subject to a deductible.

The amount of submitted charges for the line item service on the non-institutional claim.

Providers' submitted charges often differ from the amount they were eventually paid - either from Medicare, the beneficiary (through deductible or coinsurance amounts) or third party payers.

Third Party Liability (TPL) refers to the legal obligation of third parties, i.e., certain individuals, entities, or programs, to pay all or part of the expenditures for medical assistance furnished under a state plan. This is the total amount denoted at the header claim level paid by the third party.

Effective with Version ‘L’ of the NCH layout, this line level field will be used to identify if the service (procedure code) was voluntary or required. 

'Flag indicating a beneficiary had any months of LIS in the rolling 12 month report period.

List of CMS Certification Numbers (facility numbers) for the practice.

List of National Provider Identifiers in the Practice

List of federal Taxpayer Identification Numbers (TINs) for the practice.

The charge amount (rounded to whole dollars) for lithotripsy services provided during the beneficiary's stay.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Liver Disease, Cirrhosis & Oth Liver Cond (excl Hepatitis). 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Liver Disease, Cirrhosis & Oth Liver Cond (excl Hepatitis). 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Liver Disease, Cirrhosis & Oth Liver Cond (excl Hepatitis). 

This variable indicates whether a beneficiary met the condition criteria for liver disease, cirrhosis and other liver conditions (excluding hepatitis) as of the end of the calendar year.

This variable shows the date when the beneficiary first met the criteria for the liver disease, cirrhosis and other liver conditions (excluding hepatitis) indicator. The variable will be blank for beneficiaries that have never had the condition.

Liver Disease, Cirrhosis, and Other Liver Conditions (Excluding Hepatitis) - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

Liver Disease, Cirrhosis, and Other Liver Conditions (Excluding Hepatitis) - Medicaid Only Claims, First Ever Occurrence Date

Lung Cancer - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

Lung Cancer - Medicaid Only Claims, First Ever Occurrence Date

The lock-in date for the HHA assessment.

A flag to indicate whether the beneficiary had an active lock-in period with a healthcare service/provider in the calendar year.

A unique identification number assigned by the state to a provider furnishing locked-in healthcare services to a beneficiary; most recent in the calendar year.

The type(s) of service that are locked-in; most recent in the calendar year.

A unique identification number assigned by the state to a provider furnishing locked-in healthcare services to a beneficiary; most recent in the calendar year.

The type(s) of service that are locked-in; most recent in the calendar year.

A unique identification number assigned by the state to a provider furnishing locked-in healthcare services to a beneficiary; most recent in the calendar year.

The type(s) of service that are locked-in; most recent in the calendar year.

Indicates whether the provider’s taxonomy value maps to the other non-individual service provider category; ever in the calendar year.

This variable indicates if the beneficiary was a long-term care (LTC) facility resident

For long-term care facility claims, the accommodation rate is captured here.

The sum of the CLM_LTCH_DSCHRG_PMT_PCT_AMT reported on the claims that comprised the stay.

Number of months the beneficiary was enrolled in a Long-Term Care (LTC) Prepaid Inpatient Health Plan (PIHP) Managed Care Plan in the calendar year.

This field represents the year and month of the reporting period.

A unique identification number assigned by the state to the long term care facility furnishing healthcare services to the beneficiary; most recent in the calendar year.

The level of care provided to the beneficiary by the first of up to three long term care facilities, most recent in the calendar year.