| Counts of TMSIS Data Dictionary Data Elements | |||||
| as of 2012-11-12 | |||||
| File Type | Date Elements in 2012-Feb | Date Elements in 2012-Dec | Date Elements in 2012-Feb but not 2012-Dec | Date Elements in 2012-Dec but not 2012-Feb | Date Elements in both 2012-Feb & 2012-Dec |
| Eligibile File | 69 | 98 | 24 | 52 | 45 |
| TPL | 23 | 24 | 4 | 5 | 19 |
| Claim | 168 | 195 | 7 | 33 | 162 |
| Provider | 88 | 95 | 11 | 18 | 77 |
| Managed Care | 25 | 21 | 25 | 21 | 0 |
| All File Types | 373 | 433 | 71 | 129 | 303 |
| NOTE: These counts are approximations because some of the data elements' names changed, giving the impression that there were more drops and adds than there actually were. | |||||
| File-Id | Data-Element | In-Feb-DD | In-Dec-DD |
| ELIGIBLE FILE | DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: CHIP-CODE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: CITIZENSHIP-IND | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-BIRTH | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-DEATH | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-CITY | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-LAST-NAME | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-STATE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-GROUP | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-INSURANCE-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: HOUSEHOLD-SIZE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: INCOME-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MARITAL-STATUS | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MEDICARE-HIC-NUM | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-CASE-NUM | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: NEWBORN-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: PREGNANCY-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: RACE (1 - 14) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: SEX | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSDI-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATUS | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSN | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSN-VERIFICATION-FLAG | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: TANF-CASH-CODE | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-RECORD | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: VETERAN-IND | x | x |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID (1 - 4) | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE (1 - 4) | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4) | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: COVERAGE-TYPE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: GROUP-NUM | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3) | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-CITY | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAME | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-STATE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-ID | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-FIRST-NAME | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-LAST-NAME | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-MIDDLE-INIT | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES) | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EFF-DATE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EXP-DATE | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER | x | x |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-CODE | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-SSN | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND | x | |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUDICATION-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-HOUR | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-CHARGE-SRC | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFIT TYPE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NPI-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-SPECIALTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TAXONOMY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-UNIT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BMI-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BRAND-GENERIC-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: BORDER-STATE-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CHARGED-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CHECK-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR | x | |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-COUNT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-STATUS | x | |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DRUG-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: COPAY-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: COPAY-WAIVED-IND | x | |
| CLAIMS FILES | DATA ELEMENT NAME: CROSSOVER-INDICATOR | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DAILY-RATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED | x | |
| CLAIMS FILES | DATA ELEMENT NAME: DATE-PRESCRIBED | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DAYS-SUPPLY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DEDUCTIBLE-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-CITY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-STATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ZIP-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12) | x | |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-HOUR | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DISPENSE-FEE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-DESCRIPTION | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-OUTLIER-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-REL-WEIGHT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DRUG-UTILIZATION-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: DTL-METRIC-DEC-QTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: FIXED-PAYMENT-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: FORCED-CLAIM-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: FUNDING-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: FUNDING-SOURCE-STATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: HCBS-SERVICE-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME | x | |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ICF-MR-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ICN-ADJ | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ICN-ORIG | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION-TYPE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: LEAVE-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ADJ | x | |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ORIG | x | |
| CLAIMS FILES | DATA ELEMENT NAME: LTC-RCP-LIAB-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH | x | |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COINS-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COMB-DED-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-HIC-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-PAID-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-REIM-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: NATIONAL-DRUG-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: NEW-REFILL-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: NON-COV-CHARGES | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: NON-COV-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: NURSING-FACILITY-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OCCURRENCE-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM | x | |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-CITY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-STATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ZIP-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-COINS-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-INSURANCE-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-TPL-COLLECTION | x | |
| CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-CODE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-DAYS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-CONTROL-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-FIRST-NAME | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-LAST-NAME | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-MIDDLE-INIT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-STATUS | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PAYMENT-LEVEL-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PLACE-OF-SERVICE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PLAN-ID-NUMBER | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (1) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-DATE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: PROGRAM-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: PROVIDER-LOCATION-CODE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ACTUAL | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ALLOWED | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-OF-SERVICE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR | x | |
| CLAIMS FILES | DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED | x | |
| CLAIMS FILES | DATA ELEMENT NAME: RECORD-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-DATE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SELF-DIRECTION TYPE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-TYPE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SOURCE-LOCATION | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SPLIT-CLAIM-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: SUBMITTER-ID | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT | x | |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID | x | |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-NUM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-QUAD-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-SURFACE-IND | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-ALLOWED-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-CHARGED-AMOUNT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-COPAY-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-TPL-AMT | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: ME | x | |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-BILL | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-CLAIM | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-HOSPITAL | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-SERVICE | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CHARGE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CODE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-UNITS | x | |
| CLAIMS FILES | DATA ELEMENT NAME: UNITS-ACTUAL | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: UNITS-ALLOWED | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: WAIVER-ID | x | x |
| CLAIMS FILES | DATA ELEMENT NAME: WAIVER-TYPE | x | x |
| PROVIDER FILE | Data Element Name: APPL-DATE | x | x |
| PROVIDER FILE | Data Element Name: BED-ICF-MR-NUM | x | x |
| PROVIDER FILE | Data Element Name: BED-ICF-MR-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: BED-INPATIENT-NUM | x | x |
| PROVIDER FILE | Data Element Name: BED-INPATIENT-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: BED-NF-NUM | x | x |
| PROVIDER FILE | Data Element Name: BED-NF-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: BED-T18-SNF-NUM | x | x |
| PROVIDER FILE | Data Element Name: BED-T18-SNF-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: BENEFIT-TYPE(1) THRU (50) | x | |
| PROVIDER FILE | Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20) | x | |
| PROVIDER FILE | Data Element Name: BILLING-LOC-CITY (1) THRU (20) | x | |
| PROVIDER FILE | Data Element Name: BILL-LOC-COUNTY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BILL-LOC-EMAIL (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BILL-LOC-STATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: BORDER-STATE-IND | x | x |
| PROVIDER FILE | Data Element Name: BUSINESS-TYPE | x | x |
| PROVIDER FILE | Data Element Name: CLIA-EFF-DATE (1) THRU (12) | x | x |
| PROVIDER FILE | Data Element Name: CLIA-EXP-DATE (1) THRU (12) | x | x |
| PROVIDER FILE | Data Element Name: CLIA-NUM-1 through CLIA-NUM-12 | x | |
| PROVIDER FILE | Data Element Name: CLIA-TYPE (1) THRU (12) | x | x |
| PROVIDER FILE | Data Element Name:Core Based Statistical Area (CBSA) Code | x | |
| PROVIDER FILE | Data Element Name: DATE-OF-BIRTH | x | x |
| PROVIDER FILE | Data Element Name: DATE-OF-DEATH | x | x |
| PROVIDER FILE | Data Element Name: DEA-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: DEA-EXP-DATE | x | x |
| PROVIDER FILE | Data Element Name: DEA-NUM | x | x |
| PROVIDER FILE | Data Element Name: GENDER | x | x |
| PROVIDER FILE | Data Element Name: LIC-EFF-DATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: LIC-EXP-DATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: LIC-NUM (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MAILING-CITY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MAILING-COUNTY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MAILING-STATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MAILING-ZIP-CODE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: MEDICAID-PROV-NUM | x | x |
| PROVIDER FILE | Data Element Name: MEDICARE-PROV-NUM | x | x |
| PROVIDER FILE | Data Element Name: NCPDP-EFF-DATE | x | x |
| PROVIDER FILE | Data Element Name: NCPDP-EXP-DATE | x | x |
| PROVIDER FILE | Data Element Name: NCPDP-NUM | x | x |
| PROVIDER FILE | Data Element Name: OUT-OF-STATE-IND | x | x |
| PROVIDER FILE | Data Element Name: OWNERSHIP-CODE | x | x |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-ICF-MR | x | x |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-INPATIENT | x | x |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-NF | x | x |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-T18-SNF | x | x |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW> | x | x |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW> | x | x |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW> | x | x |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW> | x | x |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW> | x | x |
| PROVIDER FILE | Data Element Name: PREV-MEDICAID-PROV-NUM | x | x |
| PROVIDER FILE | Data Element Name: PREV-MEDICARE-PROV-NUM | x | x |
| PROVIDER FILE | Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS | x | |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-EFF-DATE (1) THRU (12) | x | |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-END-DATE (1) THRU (12) | x | |
| PROVIDER FILE | Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100) | x | x |
| PROVIDER FILE | Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100) | x | x |
| PROVIDER FILE | Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100) | x | x |
| PROVIDER FILE | Data Element Name: PROV-GRP-NUM (1) THRU (100) | x | x |
| PROVIDER FILE | Data Element Name: PROV-STATUS-CODE (1) THRU (100) | x | |
| PROVIDER FILE | Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) | x | x |
| PROVIDER FILE | Data Element Name: PROV-FIRST-NAME | x | |
| PROVIDER FILE | Data Element Name: PROV-MIDDLE-INITIAL | x | |
| PROVIDER FILE | Data Element Name: PROV-LAST-NAME | x | |
| PROVIDER FILE | Data Element Name: PROV-LEGAL-NAME | x | |
| PROVIDER FILE | Data Element Name: PROV-DOING-BUSINESS-AS-NAME | x | |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-IND | x | |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-START-DATE | x | |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-END-DATE | x | |
| PROVIDER FILE | Data Element Name: PROV-NPI-NUM (1) THRU (10) | x | x |
| PROVIDER FILE | Data Element Name: PROV-SPECIALTY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: PROV-TAX-ID-CURRENT | x | x |
| PROVIDER FILE | Data Element Name: PROV-TAX-ID-PREVIOUS | x | x |
| PROVIDER FILE | Data Element Name: PROV-TAXONOMY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: PROV-TYPE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-CITY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-STATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) | x | x |
| PROVIDER FILE | Data Element Name: SSN | x | |
| PROVIDER FILE | Data Element Name: TEACHING-IND | x | x |
| PROVIDER FILE | Data Element Name: TERMINATION-DATE | x | x |
| PROVIDER FILE | Data Element Name: TERMINATION-REASON-CODE | x | x |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: APPL-DATE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BORDER-STATE-IND | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BUSINESS-TYPE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-CITY | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EMAIL | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-END-DATE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-NAME | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-POPULATIONS | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-RECORD-TYPE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-STATE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-TELEPHONE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ZIP-CODE | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: OPERATING-AUTHORITY | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: PLAN-ID-NUM | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT | x | |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: Core Based Statistical Area (CBSA) Code | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: CHIP- CODE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-BEGIN-DATE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: RACE | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4 | x | |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4 | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3 | x | |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-IND | x | |
| CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION TYPE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ADJ | x | |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ORIG | x | |
| CLAIMS FILES | DATA ELEMENT NAME: TPL-AMT | x | |
| CLAIMS FILES | DATA ELEMENT NAME: UB-REV-CHARGE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: UB REV-CODE | x | |
| CLAIMS FILES | DATA ELEMENT NAME: UB-REV-UNITS | x | |
| PROVIDER FILE | Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6) | x | |
| PROVIDER FILE | Data Element Name: BILL-LOC-CITY (1) THRU (6) | x | |
| PROVIDER FILE | Data Element Name: CLIA-NUM | x | |
| PROVIDER FILE | Data Element Name: DBA-NAME | x | |
| PROVIDER FILE | Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100) | x | |
| PROVIDER FILE | Data Element Name: PROV-NAME | x | |
| PROVIDER FILE | Data Element Name: REASON-CODE (1) THRU (12) | x | |
| PROVIDER FILE | Data Element Name: REASON-EFF-DATE (1) THRU (12) | x | |
| PROVIDER FILE | Data Element Name: REASON-EXP-DATE (1) THRU (12) | x | |
| PROVIDER FILE | Data Element Name: SOCIAL-SECURITY-NUMBER | x | |
| PROVIDER FILE | Data Element Name: URBAN-RURAL-IND | x | |
| MANAGED CARE PLAN FILE | Data Element Name: APPL-DATE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: BORDER-STATE-IND | x | |
| MANAGED CARE PLAN FILE | Data Element Name: BUSINESS-TYPE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-CITY | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-COUNTY | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EMAIL | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-END-DATE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-FAX-NUM | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-NAME | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-STATE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-TELEPHONE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ZIP-CODE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-DUAL-ELIGIBLES | x | |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-ENROLLMENT | x | |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-PROVIDERS | x | |
| MANAGED CARE PLAN FILE | Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) | x | |
| MANAGED CARE PLAN FILE | Data Element Name: OUT-OF-STATE-IND | x | |
| MANAGED CARE PLAN FILE | Data Element Name: OWNERSHIP-CODE | x | |
| MANAGED CARE PLAN FILE | Data Element Name: PLAN-ID-NUM | x | |
| MANAGED CARE PLAN FILE | Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 | x | |
| MANAGED CARE PLAN FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT | x | |
| MANAGED CARE PLAN FILE | Data Element Name: URBAN-RURAL-IND | x |
| RowNo | FileId | DataElement |
| 1 | ELIGIBLE FILE | DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY |
| 2 | ELIGIBLE FILE | DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR |
| 3 | ELIGIBLE FILE | DATA ELEMENT NAME: CHIP-CODE |
| 4 | ELIGIBLE FILE | DATA ELEMENT NAME: CITIZENSHIP-IND |
| 5 | ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-BIRTH |
| 6 | ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-DEATH |
| 7 | ELIGIBLE FILE | DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY |
| 8 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 |
| 9 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 |
| 10 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 |
| 11 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 |
| 12 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 |
| 13 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 |
| 14 | ELIGIBLE FILE | DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE |
| 15 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE |
| 16 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 |
| 17 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-CITY |
| 18 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE |
| 19 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME |
| 20 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME |
| 21 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-LAST-NAME |
| 22 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT |
| 23 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM |
| 24 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-STATE |
| 25 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE |
| 26 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-GROUP |
| 27 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS |
| 28 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON |
| 29 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE |
| 30 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE |
| 31 | ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4 |
| 32 | ELIGIBLE FILE | DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH |
| 33 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4) |
| 34 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4) |
| 35 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-IND |
| 36 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4) |
| 37 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4) |
| 38 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4) |
| 39 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4) |
| 40 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4) |
| 41 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-INSURANCE-IND |
| 42 | ELIGIBLE FILE | DATA ELEMENT NAME: HOUSEHOLD-SIZE |
| 43 | ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS |
| 44 | ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE |
| 45 | ELIGIBLE FILE | DATA ELEMENT NAME: INCOME-CODE |
| 46 | ELIGIBLE FILE | DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS |
| 47 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 |
| 48 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12 |
| 49 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 |
| 50 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 |
| 51 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4) |
| 52 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4) |
| 53 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4) |
| 54 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4) |
| 55 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4) |
| 56 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4) |
| 57 | ELIGIBLE FILE | DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS |
| 58 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4) |
| 59 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4) |
| 60 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4) |
| 61 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4) |
| 62 | ELIGIBLE FILE | DATA ELEMENT NAME: MARITAL-STATUS |
| 63 | ELIGIBLE FILE | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| 64 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2) |
| 65 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4) |
| 66 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2) |
| 67 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2) |
| 68 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4) |
| 69 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2) |
| 70 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2) |
| 71 | ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-CASE-NUM |
| 72 | ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 73 | ELIGIBLE FILE | DATA ELEMENT NAME: NEWBORN-IND |
| 74 | ELIGIBLE FILE | DATA ELEMENT NAME: PREGNANCY-IND |
| 75 | ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND |
| 76 | ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND |
| 77 | ELIGIBLE FILE | DATA ELEMENT NAME: RACE (1 - 14) |
| 78 | ELIGIBLE FILE | DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE |
| 79 | ELIGIBLE FILE | DATA ELEMENT NAME: SEX |
| 80 | ELIGIBLE FILE | DATA ELEMENT NAME: SSDI-IND |
| 81 | ELIGIBLE FILE | DATA ELEMENT NAME: SSI-IND |
| 82 | ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES |
| 83 | ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATUS |
| 84 | ELIGIBLE FILE | DATA ELEMENT NAME: SSN |
| 85 | ELIGIBLE FILE | DATA ELEMENT NAME: SSN-VERIFICATION-FLAG |
| 86 | ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5) |
| 87 | ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5) |
| 88 | ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5) |
| 89 | ELIGIBLE FILE | DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP |
| 90 | ELIGIBLE FILE | DATA ELEMENT NAME: TANF-CASH-CODE |
| 91 | ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT |
| 92 | ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-RECORD |
| 93 | ELIGIBLE FILE | DATA ELEMENT NAME: VETERAN-IND |
| 94 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4) |
| 95 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4) |
| 96 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID (1 - 4) |
| 97 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE (1 - 4) |
| 98 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4) |
| 99 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: COVERAGE-TYPE |
| 100 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: GROUP-NUM |
| 101 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID |
| 102 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE |
| 103 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3) |
| 104 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-CITY |
| 105 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM |
| 106 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE |
| 107 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAME |
| 108 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM |
| 109 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-STATE |
| 110 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE |
| 111 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-ID |
| 112 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-FIRST-NAME |
| 113 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-LAST-NAME |
| 114 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-MIDDLE-INIT |
| 115 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 116 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES) |
| 117 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EFF-DATE |
| 118 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EXP-DATE |
| 119 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER |
| 120 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-CODE |
| 121 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-SSN |
| 122 | CLAIMS FILES | DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND |
| 123 | CLAIMS FILES | DATA ELEMENT NAME: ADJUDICATION-DATE |
| 124 | CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-IND |
| 125 | CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE |
| 126 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-DATE |
| 127 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-HOUR |
| 128 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-TYPE |
| 129 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE |
| 130 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG |
| 131 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM |
| 132 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NUM |
| 133 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY |
| 134 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY |
| 135 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TYPE |
| 136 | CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-AMT |
| 137 | CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-CHARGE-SRC |
| 138 | CLAIMS FILES | DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE |
| 139 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT |
| 140 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID |
| 141 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT |
| 142 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID |
| 143 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT |
| 144 | CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID |
| 145 | CLAIMS FILES | DATA ELEMENT NAME: BENEFIT TYPE |
| 146 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NPI-NUM |
| 147 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NUM |
| 148 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-SPECIALTY |
| 149 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TAXONOMY |
| 150 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TYPE |
| 151 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-UNIT |
| 152 | CLAIMS FILES | DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS |
| 153 | CLAIMS FILES | DATA ELEMENT NAME: BMI-CODE |
| 154 | CLAIMS FILES | DATA ELEMENT NAME: BRAND-GENERIC-IND |
| 155 | CLAIMS FILES | DATA ELEMENT NAME: BORDER-STATE-IND |
| 156 | CLAIMS FILES | DATA ELEMENT NAME: CHARGED-AMT |
| 157 | CLAIMS FILES | DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE |
| 158 | CLAIMS FILES | DATA ELEMENT NAME: CHECK-NUM |
| 159 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR |
| 160 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-COUNT |
| 161 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-STATUS |
| 162 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 |
| 163 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS |
| 164 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY |
| 165 | CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM |
| 166 | CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DRUG-IND |
| 167 | CLAIMS FILES | DATA ELEMENT NAME: COPAY-AMT |
| 168 | CLAIMS FILES | DATA ELEMENT NAME: COPAY-WAIVED-IND |
| 169 | CLAIMS FILES | DATA ELEMENT NAME: CROSSOVER-INDICATOR |
| 170 | CLAIMS FILES | DATA ELEMENT NAME: DAILY-RATE |
| 171 | CLAIMS FILES | DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED |
| 172 | CLAIMS FILES | DATA ELEMENT NAME: DATE-PRESCRIBED |
| 173 | CLAIMS FILES | DATA ELEMENT NAME: DAYS-SUPPLY |
| 174 | CLAIMS FILES | DATA ELEMENT NAME: DEDUCTIBLE-AMT |
| 175 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 |
| 176 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-CITY |
| 177 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-STATE |
| 178 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ZIP-CODE |
| 179 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) |
| 180 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) |
| 181 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12) |
| 182 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP |
| 183 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND |
| 184 | CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-DATE |
| 185 | CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-HOUR |
| 186 | CLAIMS FILES | DATA ELEMENT NAME: DISPENSE-FEE |
| 187 | CLAIMS FILES | DATA ELEMENT NAME: DRG-DESCRIPTION |
| 188 | CLAIMS FILES | DATA ELEMENT NAME: DRG-OUTLIER-AMT |
| 189 | CLAIMS FILES | DATA ELEMENT NAME: DRG-REL-WEIGHT |
| 190 | CLAIMS FILES | DATA ELEMENT NAME: DRUG-UTILIZATION-CODE |
| 191 | CLAIMS FILES | DATA ELEMENT NAME: DTL-METRIC-DEC-QTY |
| 192 | CLAIMS FILES | DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE |
| 193 | CLAIMS FILES | DATA ELEMENT NAME: FIXED-PAYMENT-IND |
| 194 | CLAIMS FILES | DATA ELEMENT NAME: FORCED-CLAIM-IND |
| 195 | CLAIMS FILES | DATA ELEMENT NAME: FUNDING-CODE |
| 196 | CLAIMS FILES | DATA ELEMENT NAME: FUNDING-SOURCE-STATE |
| 197 | CLAIMS FILES | DATA ELEMENT NAME: HCBS-SERVICE-IND |
| 198 | CLAIMS FILES | DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND |
| 199 | CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME |
| 200 | CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND |
| 201 | CLAIMS FILES | DATA ELEMENT NAME: ICF-MR-DAYS |
| 202 | CLAIMS FILES | DATA ELEMENT NAME: ICN-ADJ |
| 203 | CLAIMS FILES | DATA ELEMENT NAME: ICN-ORIG |
| 204 | CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION-TYPE |
| 205 | CLAIMS FILES | DATA ELEMENT NAME: LEAVE-DAYS |
| 206 | CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ADJ |
| 207 | CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ORIG |
| 208 | CLAIMS FILES | DATA ELEMENT NAME: LTC-RCP-LIAB-AMT |
| 209 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH |
| 210 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS |
| 211 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT |
| 212 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-AMT |
| 213 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-DATE |
| 214 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COINS-AMT |
| 215 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT |
| 216 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COMB-DED-IND |
| 217 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| 218 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-PAID-AMT |
| 219 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-REIM-TYPE |
| 220 | CLAIMS FILES | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 221 | CLAIMS FILES | DATA ELEMENT NAME: NATIONAL-DRUG-CODE |
| 222 | CLAIMS FILES | DATA ELEMENT NAME: NEW-REFILL-IND |
| 223 | CLAIMS FILES | DATA ELEMENT NAME: NON-COV-CHARGES |
| 224 | CLAIMS FILES | DATA ELEMENT NAME: NON-COV-DAYS |
| 225 | CLAIMS FILES | DATA ELEMENT NAME: NURSING-FACILITY-DAYS |
| 226 | CLAIMS FILES | DATA ELEMENT NAME: OCCURRENCE-CODE |
| 227 | CLAIMS FILES | DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM |
| 228 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 |
| 229 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-CITY |
| 230 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-STATE |
| 231 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ZIP-CODE |
| 232 | CLAIMS FILES | DATA ELEMENT NAME: OTHER-COINS-AMT |
| 233 | CLAIMS FILES | DATA ELEMENT NAME: OTHER-INSURANCE-IND |
| 234 | CLAIMS FILES | DATA ELEMENT NAME: OTHER-TPL-COLLECTION |
| 235 | CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-CODE |
| 236 | CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-DAYS |
| 237 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-CONTROL-NUM |
| 238 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH |
| 239 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-FIRST-NAME |
| 240 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-LAST-NAME |
| 241 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-MIDDLE-INIT |
| 242 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-STATUS |
| 243 | CLAIMS FILES | DATA ELEMENT NAME: PAYMENT-LEVEL-IND |
| 244 | CLAIMS FILES | DATA ELEMENT NAME: PLACE-OF-SERVICE |
| 245 | CLAIMS FILES | DATA ELEMENT NAME: PLAN-ID-NUMBER |
| 246 | CLAIMS FILES | DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM |
| 247 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM |
| 248 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NUM |
| 249 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY |
| 250 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY |
| 251 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE |
| 252 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE |
| 253 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-NUM |
| 254 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (1) |
| 255 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) |
| 256 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) |
| 257 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) |
| 258 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) |
| 259 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) |
| 260 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) |
| 261 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE |
| 262 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-DATE |
| 263 | CLAIMS FILES | DATA ELEMENT NAME: PROGRAM-TYPE |
| 264 | CLAIMS FILES | DATA ELEMENT NAME: PROVIDER-LOCATION-CODE |
| 265 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ACTUAL |
| 266 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ALLOWED |
| 267 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-OF-SERVICE |
| 268 | CLAIMS FILES | DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR |
| 269 | CLAIMS FILES | DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED |
| 270 | CLAIMS FILES | DATA ELEMENT NAME: RECORD-TYPE |
| 271 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM |
| 272 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NUM |
| 273 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY |
| 274 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY |
| 275 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TYPE |
| 276 | CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-DATE |
| 277 | CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-NUM |
| 278 | CLAIMS FILES | DATA ELEMENT NAME: SELF-DIRECTION TYPE |
| 279 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) |
| 280 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM |
| 281 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NUM |
| 282 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY |
| 283 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY |
| 284 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TYPE |
| 285 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-TYPE |
| 286 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT |
| 287 | CLAIMS FILES | DATA ELEMENT NAME: SOURCE-LOCATION |
| 288 | CLAIMS FILES | DATA ELEMENT NAME: SPLIT-CLAIM-IND |
| 289 | CLAIMS FILES | DATA ELEMENT NAME: SUBMITTER-ID |
| 290 | CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID |
| 291 | CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID |
| 292 | CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT |
| 293 | CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID |
| 294 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-NUM |
| 295 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-QUAD-IND |
| 296 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-SURFACE-IND |
| 297 | CLAIMS FILES | DATA ELEMENT NAME: TOT-ALLOWED-AMT |
| 298 | CLAIMS FILES | DATA ELEMENT NAME: TOT-CHARGED-AMOUNT |
| 299 | CLAIMS FILES | DATA ELEMENT NAME: TOT-COPAY-AMT |
| 300 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT |
| 301 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT |
| 302 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT |
| 303 | CLAIMS FILES | DATA ELEMENT NAME: TOT-TPL-AMT |
| 304 | CLAIMS FILES | DATA ELEMENT NAME: ME |
| 305 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-BILL |
| 306 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-CLAIM |
| 307 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-HOSPITAL |
| 308 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-SERVICE |
| 309 | CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CHARGE |
| 310 | CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CODE |
| 311 | CLAIMS FILES | DATA ELEMENT NAME: REVENUE-UNITS |
| 312 | CLAIMS FILES | DATA ELEMENT NAME: UNITS-ACTUAL |
| 313 | CLAIMS FILES | DATA ELEMENT NAME: UNITS-ALLOWED |
| 314 | CLAIMS FILES | DATA ELEMENT NAME: WAIVER-ID |
| 315 | CLAIMS FILES | DATA ELEMENT NAME: WAIVER-TYPE |
| 316 | PROVIDER FILE | Data Element Name: APPL-DATE |
| 317 | PROVIDER FILE | Data Element Name: BED-ICF-MR-NUM |
| 318 | PROVIDER FILE | Data Element Name: BED-ICF-MR-EFF-DATE |
| 319 | PROVIDER FILE | Data Element Name: BED-INPATIENT-NUM |
| 320 | PROVIDER FILE | Data Element Name: BED-INPATIENT-EFF-DATE |
| 321 | PROVIDER FILE | Data Element Name: BED-NF-NUM |
| 322 | PROVIDER FILE | Data Element Name: BED-NF-EFF-DATE |
| 323 | PROVIDER FILE | Data Element Name: BED-T18-SNF-NUM |
| 324 | PROVIDER FILE | Data Element Name: BED-T18-SNF-EFF-DATE |
| 325 | PROVIDER FILE | Data Element Name: BENEFIT-TYPE(1) THRU (50) |
| 326 | PROVIDER FILE | Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20) |
| 327 | PROVIDER FILE | Data Element Name: BILLING-LOC-CITY (1) THRU (20) |
| 328 | PROVIDER FILE | Data Element Name: BILL-LOC-COUNTY (1) THRU (6) |
| 329 | PROVIDER FILE | Data Element Name: BILL-LOC-EMAIL (1) THRU (6) |
| 330 | PROVIDER FILE | Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) |
| 331 | PROVIDER FILE | Data Element Name: BILL-LOC-STATE (1) THRU (6) |
| 332 | PROVIDER FILE | Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) |
| 333 | PROVIDER FILE | Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) |
| 334 | PROVIDER FILE | Data Element Name: BORDER-STATE-IND |
| 335 | PROVIDER FILE | Data Element Name: BUSINESS-TYPE |
| 336 | PROVIDER FILE | Data Element Name: CLIA-EFF-DATE (1) THRU (12) |
| 337 | PROVIDER FILE | Data Element Name: CLIA-EXP-DATE (1) THRU (12) |
| 338 | PROVIDER FILE | Data Element Name: CLIA-NUM-1 through CLIA-NUM-12 |
| 339 | PROVIDER FILE | Data Element Name: CLIA-TYPE (1) THRU (12) |
| 340 | PROVIDER FILE | Data Element Name:Core Based Statistical Area (CBSA) Code |
| 341 | PROVIDER FILE | Data Element Name: DATE-OF-BIRTH |
| 342 | PROVIDER FILE | Data Element Name: DATE-OF-DEATH |
| 343 | PROVIDER FILE | Data Element Name: DEA-EFF-DATE |
| 344 | PROVIDER FILE | Data Element Name: DEA-EXP-DATE |
| 345 | PROVIDER FILE | Data Element Name: DEA-NUM |
| 346 | PROVIDER FILE | Data Element Name: GENDER |
| 347 | PROVIDER FILE | Data Element Name: LIC-EFF-DATE (1) THRU (6) |
| 348 | PROVIDER FILE | Data Element Name: LIC-EXP-DATE (1) THRU (6) |
| 349 | PROVIDER FILE | Data Element Name: LIC-NUM (1) THRU (6) |
| 350 | PROVIDER FILE | Data Element Name: MAILING-CITY (1) THRU (6) |
| 351 | PROVIDER FILE | Data Element Name: MAILING-COUNTY (1) THRU (6) |
| 352 | PROVIDER FILE | Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) |
| 353 | PROVIDER FILE | Data Element Name: MAILING-STATE (1) THRU (6) |
| 354 | PROVIDER FILE | Data Element Name: MAILING-ZIP-CODE (1) THRU (6) |
| 355 | PROVIDER FILE | Data Element Name: MEDICAID-PROV-NUM |
| 356 | PROVIDER FILE | Data Element Name: MEDICARE-PROV-NUM |
| 357 | PROVIDER FILE | Data Element Name: NCPDP-EFF-DATE |
| 358 | PROVIDER FILE | Data Element Name: NCPDP-EXP-DATE |
| 359 | PROVIDER FILE | Data Element Name: NCPDP-NUM |
| 360 | PROVIDER FILE | Data Element Name: OUT-OF-STATE-IND |
| 361 | PROVIDER FILE | Data Element Name: OWNERSHIP-CODE |
| 362 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-ICF-MR |
| 363 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-INPATIENT |
| 364 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-NF |
| 365 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-T18-SNF |
| 366 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW> |
| 367 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW> |
| 368 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW> |
| 369 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW> |
| 370 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW> |
| 371 | PROVIDER FILE | Data Element Name: PREV-MEDICAID-PROV-NUM |
| 372 | PROVIDER FILE | Data Element Name: PREV-MEDICARE-PROV-NUM |
| 373 | PROVIDER FILE | Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6) |
| 374 | PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS |
| 375 | PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-EFF-DATE (1) THRU (12) |
| 376 | PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-END-DATE (1) THRU (12) |
| 377 | PROVIDER FILE | Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100) |
| 378 | PROVIDER FILE | Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100) |
| 379 | PROVIDER FILE | Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100) |
| 380 | PROVIDER FILE | Data Element Name: PROV-GRP-NUM (1) THRU (100) |
| 381 | PROVIDER FILE | Data Element Name: PROV-STATUS-CODE (1) THRU (100) |
| 382 | PROVIDER FILE | Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) |
| 383 | PROVIDER FILE | Data Element Name: PROV-FIRST-NAME |
| 384 | PROVIDER FILE | Data Element Name: PROV-MIDDLE-INITIAL |
| 385 | PROVIDER FILE | Data Element Name: PROV-LAST-NAME |
| 386 | PROVIDER FILE | Data Element Name: PROV-LEGAL-NAME |
| 387 | PROVIDER FILE | Data Element Name: PROV-DOING-BUSINESS-AS-NAME |
| 388 | PROVIDER FILE | Data Element Name: PROV-INACTIVE-IND |
| 389 | PROVIDER FILE | Data Element Name: PROV-INACTIVE-START-DATE |
| 390 | PROVIDER FILE | Data Element Name: PROV-INACTIVE-END-DATE |
| 391 | PROVIDER FILE | Data Element Name: PROV-NPI-NUM (1) THRU (10) |
| 392 | PROVIDER FILE | Data Element Name: PROV-SPECIALTY (1) THRU (6) |
| 393 | PROVIDER FILE | Data Element Name: PROV-TAX-ID-CURRENT |
| 394 | PROVIDER FILE | Data Element Name: PROV-TAX-ID-PREVIOUS |
| 395 | PROVIDER FILE | Data Element Name: PROV-TAXONOMY (1) THRU (6) |
| 396 | PROVIDER FILE | Data Element Name: PROV-TYPE (1) THRU (6) |
| 397 | PROVIDER FILE | Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) |
| 398 | PROVIDER FILE | Data Element Name: SERVICE-LOC-CITY (1) THRU (6) |
| 399 | PROVIDER FILE | Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) |
| 400 | PROVIDER FILE | Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) |
| 401 | PROVIDER FILE | Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) |
| 402 | PROVIDER FILE | Data Element Name: SERVICE-LOC-STATE (1) THRU (6) |
| 403 | PROVIDER FILE | Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) |
| 404 | PROVIDER FILE | Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) |
| 405 | PROVIDER FILE | Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) |
| 406 | PROVIDER FILE | Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) |
| 407 | PROVIDER FILE | Data Element Name: SSN |
| 408 | PROVIDER FILE | Data Element Name: TEACHING-IND |
| 409 | PROVIDER FILE | Data Element Name: TERMINATION-DATE |
| 410 | PROVIDER FILE | Data Element Name: TERMINATION-REASON-CODE |
| 411 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: APPL-DATE |
| 412 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BORDER-STATE-IND |
| 413 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BUSINESS-TYPE |
| 414 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 |
| 415 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-CITY |
| 416 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE |
| 417 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EMAIL |
| 418 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-END-DATE |
| 419 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-NAME |
| 420 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE |
| 421 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-POPULATIONS |
| 422 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-RECORD-TYPE |
| 423 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA |
| 424 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME |
| 425 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-STATE |
| 426 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-TELEPHONE |
| 427 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ZIP-CODE |
| 428 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: OPERATING-AUTHORITY |
| 429 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: PLAN-ID-NUM |
| 430 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT |
| 431 | MANAGED CARE PLAN INFORMATION FILE | Data Element Name: Core Based Statistical Area (CBSA) Code |
| RowNo | FileId | DataElement |
| 1 | ELIGIBLE FILE | DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY |
| 2 | ELIGIBLE FILE | DATA ELEMENT NAME: CHIP- CODE |
| 3 | ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-BIRTH |
| 4 | ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-DEATH |
| 5 | ELIGIBLE FILE | DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY |
| 6 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 |
| 7 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 |
| 8 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 |
| 9 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 |
| 10 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 |
| 11 | ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 |
| 12 | ELIGIBLE FILE | DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE |
| 13 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE |
| 14 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 |
| 15 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-CITY |
| 16 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE |
| 17 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME |
| 18 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-GROUP |
| 19 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME |
| 20 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-LAST-NAME |
| 21 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT |
| 22 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM |
| 23 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-STATE |
| 24 | ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE |
| 25 | ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE |
| 26 | ELIGIBLE FILE | DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH |
| 27 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-IND |
| 28 | ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-INSURANCE-IND |
| 29 | ELIGIBLE FILE | DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND |
| 30 | ELIGIBLE FILE | DATA ELEMENT NAME: INCOME-CODE |
| 31 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 |
| 32 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1 |
| 33 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 |
| 34 | ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 |
| 35 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-BEGIN-DATE |
| 36 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4 |
| 37 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4 |
| 38 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4 |
| 39 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4 |
| 40 | ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4 |
| 41 | ELIGIBLE FILE | DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS |
| 42 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4 |
| 43 | ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4 |
| 44 | ELIGIBLE FILE | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| 45 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2 |
| 46 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2 |
| 47 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2 |
| 48 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2 |
| 49 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2 |
| 50 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2 |
| 51 | ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2 |
| 52 | ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-CASE-NUM |
| 53 | ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 54 | ELIGIBLE FILE | DATA ELEMENT NAME: NEWBORN-IND |
| 55 | ELIGIBLE FILE | DATA ELEMENT NAME: PREGNANCY-IND |
| 56 | ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND |
| 57 | ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND |
| 58 | ELIGIBLE FILE | DATA ELEMENT NAME: RACE |
| 59 | ELIGIBLE FILE | DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE |
| 60 | ELIGIBLE FILE | DATA ELEMENT NAME: SEX |
| 61 | ELIGIBLE FILE | DATA ELEMENT NAME: SSDI-IND |
| 62 | ELIGIBLE FILE | DATA ELEMENT NAME: SSI-IND |
| 63 | ELIGIBLE FILE | DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER |
| 64 | ELIGIBLE FILE | DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP |
| 65 | ELIGIBLE FILE | DATA ELEMENT NAME: TANF-CASH-CODE |
| 66 | ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-RECORD |
| 67 | ELIGIBLE FILE | DATA ELEMENT NAME: VETERAN-IND |
| 68 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4 |
| 69 | ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4 |
| 70 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT |
| 71 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: COVERAGE-TYPE |
| 72 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: GROUP-NUM |
| 73 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID |
| 74 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE |
| 75 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3 |
| 76 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-CITY |
| 77 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM |
| 78 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE |
| 79 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAME |
| 80 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM |
| 81 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-STATE |
| 82 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE |
| 83 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-ID |
| 84 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-FIRST-NAME |
| 85 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-LAST-NAME |
| 86 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-MIDDLE-INIT |
| 87 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 88 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EFF-DATE |
| 89 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EXP-DATE |
| 90 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER |
| 91 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-IND |
| 92 | THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-SSN |
| 93 | CLAIMS FILES | DATA ELEMENT NAME: ADJUDICATION-DATE |
| 94 | CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-IND |
| 95 | CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE |
| 96 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-DATE |
| 97 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-HOUR |
| 98 | CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-TYPE |
| 99 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE |
| 100 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG |
| 101 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM |
| 102 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NUM |
| 103 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY |
| 104 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY |
| 105 | CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TYPE |
| 106 | CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-AMT |
| 107 | CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-CHARGE-SRC |
| 108 | CLAIMS FILES | DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE |
| 109 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NPI-NUM |
| 110 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NUM |
| 111 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-SPECIALTY |
| 112 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TAXONOMY |
| 113 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TYPE |
| 114 | CLAIMS FILES | DATA ELEMENT NAME: BILLING-UNIT |
| 115 | CLAIMS FILES | DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS |
| 116 | CLAIMS FILES | DATA ELEMENT NAME: BMI-CODE |
| 117 | CLAIMS FILES | DATA ELEMENT NAME: BRAND-GENERIC-IND |
| 118 | CLAIMS FILES | DATA ELEMENT NAME: BORDER-STATE-IND |
| 119 | CLAIMS FILES | DATA ELEMENT NAME: CHARGED-AMT |
| 120 | CLAIMS FILES | DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE |
| 121 | CLAIMS FILES | DATA ELEMENT NAME: CHECK-NUM |
| 122 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-COUNT |
| 123 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 |
| 124 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS |
| 125 | CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY |
| 126 | CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM |
| 127 | CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DRUG-IND |
| 128 | CLAIMS FILES | DATA ELEMENT NAME: COPAY-AMT |
| 129 | CLAIMS FILES | DATA ELEMENT NAME: CROSSOVER-INDICATOR |
| 130 | CLAIMS FILES | DATA ELEMENT NAME: DAILY-RATE |
| 131 | CLAIMS FILES | DATA ELEMENT NAME: DATE-PRESCRIBED |
| 132 | CLAIMS FILES | DATA ELEMENT NAME: DAYS-SUPPLY |
| 133 | CLAIMS FILES | DATA ELEMENT NAME: DEDUCTIBLE-AMT |
| 134 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 |
| 135 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-CITY |
| 136 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-STATE |
| 137 | CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ZIP-CODE |
| 138 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) |
| 139 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) |
| 140 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP |
| 141 | CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND |
| 142 | CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-DATE |
| 143 | CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-HOUR |
| 144 | CLAIMS FILES | DATA ELEMENT NAME: DISPENSE-FEE |
| 145 | CLAIMS FILES | DATA ELEMENT NAME: DRG-DESCRIPTION |
| 146 | CLAIMS FILES | DATA ELEMENT NAME: DRG-OUTLIER-AMT |
| 147 | CLAIMS FILES | DATA ELEMENT NAME: DRG-REL-WEIGHT |
| 148 | CLAIMS FILES | DATA ELEMENT NAME: DRUG-UTILIZATION-CODE |
| 149 | CLAIMS FILES | DATA ELEMENT NAME: DTL-METRIC-DEC-QTY |
| 150 | CLAIMS FILES | DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE |
| 151 | CLAIMS FILES | DATA ELEMENT NAME: FIXED-PAYMENT-IND |
| 152 | CLAIMS FILES | DATA ELEMENT NAME: FORCED-CLAIM-IND |
| 153 | CLAIMS FILES | DATA ELEMENT NAME: FUNDING-CODE |
| 154 | CLAIMS FILES | DATA ELEMENT NAME: FUNDING-SOURCE-STATE |
| 155 | CLAIMS FILES | DATA ELEMENT NAME: HCBS-SERVICE-IND |
| 156 | CLAIMS FILES | DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND |
| 157 | CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND |
| 158 | CLAIMS FILES | DATA ELEMENT NAME: ICF-MR-DAYS |
| 159 | CLAIMS FILES | DATA ELEMENT NAME: ICN-ADJ |
| 160 | CLAIMS FILES | DATA ELEMENT NAME: ICN-ORIG |
| 161 | CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION TYPE |
| 162 | CLAIMS FILES | DATA ELEMENT NAME: LEAVE-DAYS |
| 163 | CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ADJ |
| 164 | CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ORIG |
| 165 | CLAIMS FILES | DATA ELEMENT NAME: LTC-RCP-LIAB-AMT |
| 166 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS |
| 167 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT |
| 168 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-AMT |
| 169 | CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-DATE |
| 170 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COINS-AMT |
| 171 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT |
| 172 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COMB-DED-IND |
| 173 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| 174 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-PAID-AMT |
| 175 | CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-REIM-TYPE |
| 176 | CLAIMS FILES | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| 177 | CLAIMS FILES | DATA ELEMENT NAME: NATIONAL-DRUG-CODE |
| 178 | CLAIMS FILES | DATA ELEMENT NAME: NEW-REFILL-IND |
| 179 | CLAIMS FILES | DATA ELEMENT NAME: NON-COV-CHARGES |
| 180 | CLAIMS FILES | DATA ELEMENT NAME: NON-COV-DAYS |
| 181 | CLAIMS FILES | DATA ELEMENT NAME: NURSING-FACILITY-DAYS |
| 182 | CLAIMS FILES | DATA ELEMENT NAME: OCCURRENCE-CODE |
| 183 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 |
| 184 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-CITY |
| 185 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-STATE |
| 186 | CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ZIP-CODE |
| 187 | CLAIMS FILES | DATA ELEMENT NAME: OTHER-COINS-AMT |
| 188 | CLAIMS FILES | DATA ELEMENT NAME: OTHER-INSURANCE-IND |
| 189 | CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-CODE |
| 190 | CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-DAYS |
| 191 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-CONTROL-NUM |
| 192 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH |
| 193 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-FIRST-NAME |
| 194 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-LAST-NAME |
| 195 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-MIDDLE-INIT |
| 196 | CLAIMS FILES | DATA ELEMENT NAME: PATIENT-STATUS |
| 197 | CLAIMS FILES | DATA ELEMENT NAME: PAYMENT-LEVEL-IND |
| 198 | CLAIMS FILES | DATA ELEMENT NAME: PLACE-OF-SERVICE |
| 199 | CLAIMS FILES | DATA ELEMENT NAME: PLAN-ID-NUMBER |
| 200 | CLAIMS FILES | DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM |
| 201 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM |
| 202 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NUM |
| 203 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY |
| 204 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY |
| 205 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE |
| 206 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE |
| 207 | CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-NUM |
| 208 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (1) |
| 209 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) |
| 210 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) |
| 211 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) |
| 212 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) |
| 213 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) |
| 214 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) |
| 215 | CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE |
| 216 | CLAIMS FILES | DATA ELEMENT NAME: PROGRAM-TYPE |
| 217 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ACTUAL |
| 218 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ALLOWED |
| 219 | CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-OF-SERVICE |
| 220 | CLAIMS FILES | DATA ELEMENT NAME: RECORD-TYPE |
| 221 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM |
| 222 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NUM |
| 223 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY |
| 224 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY |
| 225 | CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TYPE |
| 226 | CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-DATE |
| 227 | CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-NUM |
| 228 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) |
| 229 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM |
| 230 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NUM |
| 231 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY |
| 232 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY |
| 233 | CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TYPE |
| 234 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-TYPE |
| 235 | CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT |
| 236 | CLAIMS FILES | DATA ELEMENT NAME: SOURCE-LOCATION |
| 237 | CLAIMS FILES | DATA ELEMENT NAME: SPLIT-CLAIM-IND |
| 238 | CLAIMS FILES | DATA ELEMENT NAME: SUBMITTER-ID |
| 239 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-NUM |
| 240 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-QUAD-IND |
| 241 | CLAIMS FILES | DATA ELEMENT NAME: TOOTH-SURFACE-IND |
| 242 | CLAIMS FILES | DATA ELEMENT NAME: TOT-ALLOWED-AMT |
| 243 | CLAIMS FILES | DATA ELEMENT NAME: TOT-CHARGED-AMOUNT |
| 244 | CLAIMS FILES | DATA ELEMENT NAME: TOT-COPAY-AMT |
| 245 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT |
| 246 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT |
| 247 | CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT |
| 248 | CLAIMS FILES | DATA ELEMENT NAME: TOT-TPL-AMT |
| 249 | CLAIMS FILES | DATA ELEMENT NAME: TPL-AMT |
| 250 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-BILL |
| 251 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-CLAIM |
| 252 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-HOSPITAL |
| 253 | CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-SERVICE |
| 254 | CLAIMS FILES | DATA ELEMENT NAME: UB-REV-CHARGE |
| 255 | CLAIMS FILES | DATA ELEMENT NAME: UB REV-CODE |
| 256 | CLAIMS FILES | DATA ELEMENT NAME: UB-REV-UNITS |
| 257 | CLAIMS FILES | DATA ELEMENT NAME: UNITS-ACTUAL |
| 258 | CLAIMS FILES | DATA ELEMENT NAME: UNITS-ALLOWED |
| 259 | CLAIMS FILES | DATA ELEMENT NAME: WAIVER-ID |
| 260 | CLAIMS FILES | DATA ELEMENT NAME: WAIVER-TYPE |
| 261 | PROVIDER FILE | Data Element Name: APPL-DATE |
| 262 | PROVIDER FILE | Data Element Name: BED-ICF-MR-NUM |
| 263 | PROVIDER FILE | Data Element Name: BED-ICF-MR-EFF-DATE |
| 264 | PROVIDER FILE | Data Element Name: BED-INPATIENT-NUM |
| 265 | PROVIDER FILE | Data Element Name: BED-INPATIENT-EFF-DATE |
| 266 | PROVIDER FILE | Data Element Name: BED-NF-NUM |
| 267 | PROVIDER FILE | Data Element Name: BED-NF-EFF-DATE |
| 268 | PROVIDER FILE | Data Element Name: BED-T18-SNF-NUM |
| 269 | PROVIDER FILE | Data Element Name: BED-T18-SNF-EFF-DATE |
| 270 | PROVIDER FILE | Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6) |
| 271 | PROVIDER FILE | Data Element Name: BILL-LOC-CITY (1) THRU (6) |
| 272 | PROVIDER FILE | Data Element Name: BILL-LOC-COUNTY (1) THRU (6) |
| 273 | PROVIDER FILE | Data Element Name: BILL-LOC-EMAIL (1) THRU (6) |
| 274 | PROVIDER FILE | Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) |
| 275 | PROVIDER FILE | Data Element Name: BILL-LOC-STATE (1) THRU (6) |
| 276 | PROVIDER FILE | Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) |
| 277 | PROVIDER FILE | Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) |
| 278 | PROVIDER FILE | Data Element Name: BORDER-STATE-IND |
| 279 | PROVIDER FILE | Data Element Name: BUSINESS-TYPE |
| 280 | PROVIDER FILE | Data Element Name: CLIA-EFF-DATE (1) THRU (12) |
| 281 | PROVIDER FILE | Data Element Name: CLIA-EXP-DATE (1) THRU (12) |
| 282 | PROVIDER FILE | Data Element Name: CLIA-NUM |
| 283 | PROVIDER FILE | Data Element Name: CLIA-TYPE (1) THRU (12) |
| 284 | PROVIDER FILE | Data Element Name: DATE-OF-BIRTH |
| 285 | PROVIDER FILE | Data Element Name: DATE-OF-DEATH |
| 286 | PROVIDER FILE | Data Element Name: DBA-NAME |
| 287 | PROVIDER FILE | Data Element Name: DEA-EFF-DATE |
| 288 | PROVIDER FILE | Data Element Name: DEA-EXP-DATE |
| 289 | PROVIDER FILE | Data Element Name: DEA-NUM |
| 290 | PROVIDER FILE | Data Element Name: GENDER |
| 291 | PROVIDER FILE | Data Element Name: LIC-EFF-DATE (1) THRU (6) |
| 292 | PROVIDER FILE | Data Element Name: LIC-EXP-DATE (1) THRU (6) |
| 293 | PROVIDER FILE | Data Element Name: LIC-NUM (1) THRU (6) |
| 294 | PROVIDER FILE | Data Element Name: MAILING-CITY (1) THRU (6) |
| 295 | PROVIDER FILE | Data Element Name: MAILING-COUNTY (1) THRU (6) |
| 296 | PROVIDER FILE | Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) |
| 297 | PROVIDER FILE | Data Element Name: MAILING-STATE (1) THRU (6) |
| 298 | PROVIDER FILE | Data Element Name: MAILING-ZIP-CODE (1) THRU (6) |
| 299 | PROVIDER FILE | Data Element Name: MEDICAID-PROV-NUM |
| 300 | PROVIDER FILE | Data Element Name: MEDICARE-PROV-NUM |
| 301 | PROVIDER FILE | Data Element Name: NCPDP-EFF-DATE |
| 302 | PROVIDER FILE | Data Element Name: NCPDP-EXP-DATE |
| 303 | PROVIDER FILE | Data Element Name: NCPDP-NUM |
| 304 | PROVIDER FILE | Data Element Name: OUT-OF-STATE-IND |
| 305 | PROVIDER FILE | Data Element Name: OWNERSHIP-CODE |
| 306 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-ICF-MR |
| 307 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-INPATIENT |
| 308 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-NF |
| 309 | PROVIDER FILE | Data Element Name: PER-DIEM-AMT-T18-SNF |
| 310 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW> |
| 311 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW> |
| 312 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW> |
| 313 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW> |
| 314 | PROVIDER FILE | Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW> |
| 315 | PROVIDER FILE | Data Element Name: PREV-MEDICAID-PROV-NUM |
| 316 | PROVIDER FILE | Data Element Name: PREV-MEDICARE-PROV-NUM |
| 317 | PROVIDER FILE | Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6) |
| 318 | PROVIDER FILE | Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100) |
| 319 | PROVIDER FILE | Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100) |
| 320 | PROVIDER FILE | Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100) |
| 321 | PROVIDER FILE | Data Element Name: PROV-GRP-NUM (1) THRU (100) |
| 322 | PROVIDER FILE | Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100) |
| 323 | PROVIDER FILE | Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) |
| 324 | PROVIDER FILE | Data Element Name: PROV-NAME |
| 325 | PROVIDER FILE | Data Element Name: PROV-NPI-NUM (1) THRU (10) |
| 326 | PROVIDER FILE | Data Element Name: PROV-SPECIALTY (1) THRU (6) |
| 327 | PROVIDER FILE | Data Element Name: PROV-TAX-ID-CURRENT |
| 328 | PROVIDER FILE | Data Element Name: PROV-TAX-ID-PREVIOUS |
| 329 | PROVIDER FILE | Data Element Name: PROV-TAXONOMY (1) THRU (6) |
| 330 | PROVIDER FILE | Data Element Name: PROV-TYPE (1) THRU (6) |
| 331 | PROVIDER FILE | Data Element Name: REASON-CODE (1) THRU (12) |
| 332 | PROVIDER FILE | Data Element Name: REASON-EFF-DATE (1) THRU (12) |
| 333 | PROVIDER FILE | Data Element Name: REASON-EXP-DATE (1) THRU (12) |
| 334 | PROVIDER FILE | Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) |
| 335 | PROVIDER FILE | Data Element Name: SERVICE-LOC-CITY (1) THRU (6) |
| 336 | PROVIDER FILE | Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) |
| 337 | PROVIDER FILE | Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) |
| 338 | PROVIDER FILE | Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) |
| 339 | PROVIDER FILE | Data Element Name: SERVICE-LOC-STATE (1) THRU (6) |
| 340 | PROVIDER FILE | Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) |
| 341 | PROVIDER FILE | Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) |
| 342 | PROVIDER FILE | Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) |
| 343 | PROVIDER FILE | Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) |
| 344 | PROVIDER FILE | Data Element Name: SOCIAL-SECURITY-NUMBER |
| 345 | PROVIDER FILE | Data Element Name: TEACHING-IND |
| 346 | PROVIDER FILE | Data Element Name: TERMINATION-DATE |
| 347 | PROVIDER FILE | Data Element Name: TERMINATION-REASON-CODE |
| 348 | PROVIDER FILE | Data Element Name: URBAN-RURAL-IND |
| 349 | MANAGED CARE PLAN FILE | Data Element Name: APPL-DATE |
| 350 | MANAGED CARE PLAN FILE | Data Element Name: BORDER-STATE-IND |
| 351 | MANAGED CARE PLAN FILE | Data Element Name: BUSINESS-TYPE |
| 352 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 |
| 353 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-CITY |
| 354 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-COUNTY |
| 355 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE |
| 356 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EMAIL |
| 357 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-END-DATE |
| 358 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-FAX-NUM |
| 359 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-NAME |
| 360 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE |
| 361 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-STATE |
| 362 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-TELEPHONE |
| 363 | MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ZIP-CODE |
| 364 | MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-DUAL-ELIGIBLES |
| 365 | MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-ENROLLMENT |
| 366 | MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-PROVIDERS |
| 367 | MANAGED CARE PLAN FILE | Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) |
| 368 | MANAGED CARE PLAN FILE | Data Element Name: OUT-OF-STATE-IND |
| 369 | MANAGED CARE PLAN FILE | Data Element Name: OWNERSHIP-CODE |
| 370 | MANAGED CARE PLAN FILE | Data Element Name: PLAN-ID-NUM |
| 371 | MANAGED CARE PLAN FILE | Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 |
| 372 | MANAGED CARE PLAN FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT |
| 373 | MANAGED CARE PLAN FILE | Data Element Name: URBAN-RURAL-IND |
| FileId | DataElement |
| ELIGIBLE FILE | DATA ELEMENT NAME: BASIS-OF-ELIGIBILITY |
| ELIGIBLE FILE | DATA ELEMENT NAME: CERTIFIED-AMERICAN-INDIAN/ALASKAN-NATIVE-INDICATOR |
| ELIGIBLE FILE | DATA ELEMENT NAME: CHIP-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: CITIZENSHIP-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-BIRTH |
| ELIGIBLE FILE | DATA ELEMENT NAME: DATE-OF-DEATH |
| ELIGIBLE FILE | DATA ELEMENT NAME: DAYS-OF-ELIGIBILITY |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-1 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-3 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-5 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DISABILITY-STATUS-IND-6 |
| ELIGIBLE FILE | DATA ELEMENT NAME: DUAL-ELIGIBLE-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-BEGIN-DATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ADDR-LN1 - ELIGIBLE-ADDR-LN3 |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-CITY |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-COUNTY-NAME |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-FIRST-NAME |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-LAST-NAME |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-MIDDLE-INIT |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-PHONE-NUM |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-STATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBLE-ZIP-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-GROUP |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-CHANGE-REASON |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-EFFECTIVE-DATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ELIGIBILITY-STATUS-END-DATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE 1 - 4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: FEDERAL-FISCAL-YEAR-MONTH |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NPI-NUM (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-PROV-NUM (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-ID (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-SPA-START-DATE (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-HOME-START-DATE (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: HEALTH-INSURANCE-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: HOUSEHOLD-SIZE |
| ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: INCOME-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: LEVEL-OF-CARE-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-BEGIN-DATE1 - LOCKIN-BEGIN-DATE12 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE12 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NUM1 - LOCKIN-PROV-NUM12 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-BEGIN-DATE (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIGIBILITY-END-DATE (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE (1 -4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MAINTENANCE-ASSISTANCE-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-END-DATES (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ENROLLMENT-START-DATES (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MARITAL-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE (1- 2) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED (1 -2) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON (1 -2) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION (1- 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE (1 - 2) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY (1 - 2) |
| ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-CASE-NUM |
| ELIGIBLE FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| ELIGIBLE FILE | DATA ELEMENT NAME: NEWBORN-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: PREGNANCY-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: PRIMARY-LANGUAGE-ENGL-PROF-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: RACE (1 - 14) |
| ELIGIBLE FILE | DATA ELEMENT NAME: RESTRICTED-BENEFITS-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: SEX |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSDI-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATE-SUPPLEMENT-STATUS-CODES |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSI-STATUS |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSN |
| ELIGIBLE FILE | DATA ELEMENT NAME: SSN-VERIFICATION-FLAG |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-END-DATE (1-5) |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-START-DATE (1-5) |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-PLAN-OPTION-TYPE (1-5) |
| ELIGIBLE FILE | DATA ELEMENT NAME: STATE-SPEC-ELIG-GROUP |
| ELIGIBLE FILE | DATA ELEMENT NAME: TANF-CASH-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-LIVING-ARRANGEMENT |
| ELIGIBLE FILE | DATA ELEMENT NAME: TYPE-OF-RECORD |
| ELIGIBLE FILE | DATA ELEMENT NAME: VETERAN-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-END-DATE (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ENROLLMENT-START-DATE (1-4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID (1 - 4) |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE (1 - 4) |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT (1 - 4) |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: COVERAGE-TYPE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: GROUP-NUM |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-ID |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: HEALTH-INSURANCE-BENEFIT-PLAN-TYPE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN (1 - 3) |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-CITY |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ID-NUM |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAIC-CODE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-NAME |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-PHONE-NUM |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-STATE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ZIP-CODE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-ID |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-FIRST-NAME |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-LAST-NAME |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MEMBER-MIDDLE-INIT |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: OTHER-THIRD-PARTY-LIABILITY (OCCURS 4 TIMES) |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EFF-DATE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-EXP-DATE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-CODE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-SSN |
| CLAIMS FILES | DATA ELEMENT NAME: 1115A-DEMONSTRATION-IND |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUDICATION-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-IND |
| CLAIMS FILES | DATA ELEMENT NAME: ADJUSTMENT-REASON-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-HOUR |
| CLAIMS FILES | DATA ELEMENT NAME: ADMISSION-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-DIAGNOSIS-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -DIAGNOSIS-FLAG |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING -PROV-SPECIALTY |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TAXONOMY |
| CLAIMS FILES | DATA ELEMENT NAME: ADMITTING-PROV-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: ALLOWED-CHARGE-SRC |
| CLAIMS FILES | DATA ELEMENT NAME: BEGINNING-DATE-OF-SERVICE |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-AMOUNT |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COINSURANCE-DATE-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-AMOUNT |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-COPAYMENT-DATE-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-AMOUNT |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFICIARY-DEDUCTIBLE-DATE-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: BENEFIT TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-SPECIALTY |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TAXONOMY |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-PROV-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: BILLING-UNIT |
| CLAIMS FILES | DATA ELEMENT NAME: BIRTH-WEIGHT-GRAMS |
| CLAIMS FILES | DATA ELEMENT NAME: BMI-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: BRAND-GENERIC-IND |
| CLAIMS FILES | DATA ELEMENT NAME: BORDER-STATE-IND |
| CLAIMS FILES | DATA ELEMENT NAME: CHARGED-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: CHECK-EFFECTIVE-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: CHECK-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-DENIED-INDICATOR |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-COUNT |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-LINE-STATUS |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-PYMT-REM-CODE-1 THRU CLAIM-PYMT-REM-CODE-4 |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS |
| CLAIMS FILES | DATA ELEMENT NAME: CLAIM-STATUS-CATEGORY |
| CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DOSAGE-FORM |
| CLAIMS FILES | DATA ELEMENT NAME: COMPOUND-DRUG-IND |
| CLAIMS FILES | DATA ELEMENT NAME: COPAY-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: COPAY-WAIVED-IND |
| CLAIMS FILES | DATA ELEMENT NAME: CROSSOVER-INDICATOR |
| CLAIMS FILES | DATA ELEMENT NAME: DAILY-RATE |
| CLAIMS FILES | DATA ELEMENT NAME: DATE-CAPITATED-AMOUNT-REQUESTED |
| CLAIMS FILES | DATA ELEMENT NAME: DATE-PRESCRIBED |
| CLAIMS FILES | DATA ELEMENT NAME: DAYS-SUPPLY |
| CLAIMS FILES | DATA ELEMENT NAME: DEDUCTIBLE-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ADDR-LN1, LN2 |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-CITY |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-STATE |
| CLAIMS FILES | DATA ELEMENT NAME: DESTINATION-ZIP-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE (1 ) THRU DIAGNOSIS-CODE (12) |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-CODE-FLAG (1 ) THRU DIAGNOSIS-CODE-FLAG (12) |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-POA-FLAG (1 ) THRU DIAGNOSIS-POA-FLAG (12) |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP |
| CLAIMS FILES | DATA ELEMENT NAME: DIAGNOSIS-RELATED-GROUP-IND |
| CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: DISCHARGE-HOUR |
| CLAIMS FILES | DATA ELEMENT NAME: DISPENSE-FEE |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-DESCRIPTION |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-OUTLIER-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: DRG-REL-WEIGHT |
| CLAIMS FILES | DATA ELEMENT NAME: DRUG-UTILIZATION-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: DTL-METRIC-DEC-QTY |
| CLAIMS FILES | DATA ELEMENT NAME: ENDING-DATE-OF-SERVICE |
| CLAIMS FILES | DATA ELEMENT NAME: FIXED-PAYMENT-IND |
| CLAIMS FILES | DATA ELEMENT NAME: FORCED-CLAIM-IND |
| CLAIMS FILES | DATA ELEMENT NAME: FUNDING-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: FUNDING-SOURCE-STATE |
| CLAIMS FILES | DATA ELEMENT NAME: HCBS-SERVICE-IND |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-CARE-ACQUIRED-CONDITION-IND |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-ENTITY-NAME |
| CLAIMS FILES | DATA ELEMENT NAME: HEALTH-HOME-PROVIDER-IND |
| CLAIMS FILES | DATA ELEMENT NAME: ICF-MR-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: ICN-ADJ |
| CLAIMS FILES | DATA ELEMENT NAME: ICN-ORIG |
| CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: LEAVE-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ADJ |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUM-ORIG |
| CLAIMS FILES | DATA ELEMENT NAME: LTC-RCP-LIAB-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-AMOUNT-PAID-DSH |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID COV-INPATIENT-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-FFS-EQUIVALENT-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICAID-PAID-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COINS-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-DEDUCTIBLE-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-COMB-DED-IND |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-HIC-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-PAID-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: MEDICARE-REIM-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: MSIS-IDENTIFICATION-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: NATIONAL-DRUG-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: NEW-REFILL-IND |
| CLAIMS FILES | DATA ELEMENT NAME: NON-COV-CHARGES |
| CLAIMS FILES | DATA ELEMENT NAME: NON-COV-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: NURSING-FACILITY-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: OCCURRENCE-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: OPERATING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ADDR-LN1, LN2 |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-CITY |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-STATE |
| CLAIMS FILES | DATA ELEMENT NAME: ORIGINATION-ZIP-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-COINS-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-INSURANCE-IND |
| CLAIMS FILES | DATA ELEMENT NAME: OTHER-TPL-COLLECTION |
| CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: OUTLIER-DAYS |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-CONTROL-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-DATE-OF-BIRTH |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-FIRST-NAME |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-LAST-NAME |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-MIDDLE-INIT |
| CLAIMS FILES | DATA ELEMENT NAME: PATIENT-STATUS |
| CLAIMS FILES | DATA ELEMENT NAME: PAYMENT-LEVEL-IND |
| CLAIMS FILES | DATA ELEMENT NAME: PLACE-OF-SERVICE |
| CLAIMS FILES | DATA ELEMENT NAME: PLAN-ID-NUMBER |
| CLAIMS FILES | DATA ELEMENT NAME: PRE-AUTHORIZATION-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-SPECIALTY |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TAXONOMY |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIBING-PROV-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-FILL-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: PRESCRIPTION-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (1) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE (2) THRU PROCEDURE-CODE (6) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (1) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-FLAG (2) THRU PROCEDURE-CODE-FLAG (6) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (1) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE-MOD (2) THRU PROCEDURE-CODE-MOD (6) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE(1) |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-CODE- DATE |
| CLAIMS FILES | DATA ELEMENT NAME: PROCEDURE-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: PROGRAM-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: PROVIDER-LOCATION-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ACTUAL |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-ALLOWED |
| CLAIMS FILES | DATA ELEMENT NAME: QUANTITY-OF-SERVICE |
| CLAIMS FILES | DATA ELEMENT NAME: REBATE-ELIGIBLE-INDICATOR |
| CLAIMS FILES | DATA ELEMENT NAME: REBATE-UNITS-REIMBURSED |
| CLAIMS FILES | DATA ELEMENT NAME: RECORD-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-SPECIALTY |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TAXONOMY |
| CLAIMS FILES | DATA ELEMENT NAME: REFERRING-PROV-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-DATE |
| CLAIMS FILES | DATA ELEMENT NAME: REMITTANCE-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: SELF-DIRECTION TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-SUBCATEGORY (FUTURE) |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NPI-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-SPECIALTY |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TAXONOMY |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICING-PROV-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: SERVICE-TRACKING-PAYMENT-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: SOURCE-LOCATION |
| CLAIMS FILES | DATA ELEMENT NAME: SPLIT-CLAIM-IND |
| CLAIMS FILES | DATA ELEMENT NAME: SUBMITTER-ID |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-AMOUNT-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COINSURANCE-DATE-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-AMOUNT |
| CLAIMS FILES | DATA ELEMENT NAME: THIRD-PARTY-COPAYMENT-DATE-PAID |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-NUM |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-QUAD-IND |
| CLAIMS FILES | DATA ELEMENT NAME: TOOTH-SURFACE-IND |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-ALLOWED-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-CHARGED-AMOUNT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-COPAY-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICAID-PAID-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-COINS-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-MEDICARE-DEDUCTIBLE-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: TOT-TPL-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: ME |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-BILL |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-CLAIM |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-HOSPITAL |
| CLAIMS FILES | DATA ELEMENT NAME: TYPE-OF-SERVICE |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CHARGE |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: REVENUE-UNITS |
| CLAIMS FILES | DATA ELEMENT NAME: UNITS-ACTUAL |
| CLAIMS FILES | DATA ELEMENT NAME: UNITS-ALLOWED |
| CLAIMS FILES | DATA ELEMENT NAME: WAIVER-ID |
| CLAIMS FILES | DATA ELEMENT NAME: WAIVER-TYPE |
| PROVIDER FILE | Data Element Name: APPL-DATE |
| PROVIDER FILE | Data Element Name: BED-ICF-MR-NUM |
| PROVIDER FILE | Data Element Name: BED-ICF-MR-EFF-DATE |
| PROVIDER FILE | Data Element Name: BED-INPATIENT-NUM |
| PROVIDER FILE | Data Element Name: BED-INPATIENT-EFF-DATE |
| PROVIDER FILE | Data Element Name: BED-NF-NUM |
| PROVIDER FILE | Data Element Name: BED-NF-EFF-DATE |
| PROVIDER FILE | Data Element Name: BED-T18-SNF-NUM |
| PROVIDER FILE | Data Element Name: BED-T18-SNF-EFF-DATE |
| PROVIDER FILE | Data Element Name: BENEFIT-TYPE(1) THRU (50) |
| PROVIDER FILE | Data Element Name: BILLING-LOC-ADDR-LN1 THRU BILLING-LOC-ADDR-LN3 (1) THRU (20) |
| PROVIDER FILE | Data Element Name: BILLING-LOC-CITY (1) THRU (20) |
| PROVIDER FILE | Data Element Name: BILL-LOC-COUNTY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-EMAIL (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-FAX-NUM (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-STATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-TELEPHONE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-ZIP-CODE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BORDER-STATE-IND |
| PROVIDER FILE | Data Element Name: BUSINESS-TYPE |
| PROVIDER FILE | Data Element Name: CLIA-EFF-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: CLIA-EXP-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: CLIA-NUM-1 through CLIA-NUM-12 |
| PROVIDER FILE | Data Element Name: CLIA-TYPE (1) THRU (12) |
| PROVIDER FILE | Data Element Name:Core Based Statistical Area (CBSA) Code |
| PROVIDER FILE | Data Element Name: DATE-OF-BIRTH |
| PROVIDER FILE | Data Element Name: DATE-OF-DEATH |
| PROVIDER FILE | Data Element Name: DEA-EFF-DATE |
| PROVIDER FILE | Data Element Name: DEA-EXP-DATE |
| PROVIDER FILE | Data Element Name: DEA-NUM |
| PROVIDER FILE | Data Element Name: GENDER |
| PROVIDER FILE | Data Element Name: LIC-EFF-DATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: LIC-EXP-DATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: LIC-NUM (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MAILING-CITY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MAILING-COUNTY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MAILING-LOC-ADDR-LN1 THRU MAILING-LOC-ADDR-LN3 (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MAILING-STATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MAILING-ZIP-CODE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: MEDICAID-PROV-NUM |
| PROVIDER FILE | Data Element Name: MEDICARE-PROV-NUM |
| PROVIDER FILE | Data Element Name: NCPDP-EFF-DATE |
| PROVIDER FILE | Data Element Name: NCPDP-EXP-DATE |
| PROVIDER FILE | Data Element Name: NCPDP-NUM |
| PROVIDER FILE | Data Element Name: OUT-OF-STATE-IND |
| PROVIDER FILE | Data Element Name: OWNERSHIP-CODE |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-ICF-MR |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-INPATIENT |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-NF |
| PROVIDER FILE | Data Element Name: PER-DIEM-AMT-T18-SNF |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-ADDR-LN1 THRU PRACTICE-LOC-ADDR-LN3 (1) THRU (3) <NEW> |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-CITY (1) THRU (3) <NEW> |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-COUNTY (1) THRU (3) <NEW> |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-STATE (1) THRU (3) <NEW> |
| PROVIDER FILE | Data Element Name: PRACTICE-LOC-ZIP-CODE (1) THRU (3) <NEW> |
| PROVIDER FILE | Data Element Name: PREV-MEDICAID-PROV-NUM |
| PROVIDER FILE | Data Element Name: PREV-MEDICARE-PROV-NUM |
| PROVIDER FILE | Data Element Name: PROV-CATEGORY-OF-SERVICE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-EFF-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: PROV-ENROLLMENT-STATUS-END-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: PROV-GRP-EFFECTIVE-DATE (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-GRP-EXPIRATION-DATE (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-GRP-NPI-NUM (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-GRP-NUM (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-STATUS-CODE (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-GRP-TAXONOMY (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-FIRST-NAME |
| PROVIDER FILE | Data Element Name: PROV-MIDDLE-INITIAL |
| PROVIDER FILE | Data Element Name: PROV-LAST-NAME |
| PROVIDER FILE | Data Element Name: PROV-LEGAL-NAME |
| PROVIDER FILE | Data Element Name: PROV-DOING-BUSINESS-AS-NAME |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-IND |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-START-DATE |
| PROVIDER FILE | Data Element Name: PROV-INACTIVE-END-DATE |
| PROVIDER FILE | Data Element Name: PROV-NPI-NUM (1) THRU (10) |
| PROVIDER FILE | Data Element Name: PROV-SPECIALTY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: PROV-TAX-ID-CURRENT |
| PROVIDER FILE | Data Element Name: PROV-TAX-ID-PREVIOUS |
| PROVIDER FILE | Data Element Name: PROV-TAXONOMY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: PROV-TYPE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-ADDR-LN1 THRU SERVICE-LOC-ADDR-LN3 (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-CITY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-COUNTY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-EMAIL (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-FAX-NUM (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-STATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-TELEPHONE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SERVICE-LOC-ZIP-CODE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SPEC-CERT-EFF-DATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SPEC-CERT-EXP-DATE (1) THRU (6) |
| PROVIDER FILE | Data Element Name: SSN |
| PROVIDER FILE | Data Element Name: TEACHING-IND |
| PROVIDER FILE | Data Element Name: TERMINATION-DATE |
| PROVIDER FILE | Data Element Name: TERMINATION-REASON-CODE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: APPL-DATE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BORDER-STATE-IND |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: BUSINESS-TYPE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-CITY |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-EMAIL |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-END-DATE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-NAME |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-PLAN-POPULATIONS |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-RECORD-TYPE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-SERVICE-AREA-NAME |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-STATE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-TELEPHONE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: MANAGED-CARE-ZIP-CODE |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: OPERATING-AUTHORITY |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: PLAN-ID-NUM |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT |
| MANAGED CARE PLAN INFORMATION FILE | Data Element Name: Core Based Statistical Area (CBSA) Code |
| ELIGIBLE FILE | DATA ELEMENT NAME: CHIP- CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: ETHNICITY-CODE |
| ELIGIBLE FILE | DATA ELEMENT NAME: HISPANIC-ETHINICITY-IND |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-END-DATE1 - LOCKIN-END-DATE1 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LOCKIN-PROV-NPI-NUM1 - LOCKIN-PROV-NPI-NUM12 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-BEGIN-DATE |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-ELIG-IND1 - LTC-ELIG-IND4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-END-DATE1 - LTC-END-DATE4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-LEVEL-CARE1 - LTC-LEVEL-CARE4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NPI-NUM1 - LTC-PROV-NPI-NUM4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: LTC-PROV-NUM1 - LTC-PROV-NUM4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-ID1 - MANAGED-CARE-PLAN-ID4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MANAGED-CARE-PLAN-TYPE1 - MANAGED-CARE-PLAN-TYPE4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-START-DATE1 - MFP-ENROLLMENT-START-DATE2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-ENROLLMENT-END-DATE1 - MFP-ENROLLMENT-END-DATE2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REASON-PARTICIPATION-ENDED1 - MFP-REASON-PARTICIPATION-ENDED2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-REINSTITUTIONALIZED-REASON1 - MFP-REINSTITUTIONALIZED-REASON2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-INSTITUTION1 - MFP-QUALIFIED-INSTITUTION2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-QUALIFIED-RESIDENCE1 - MFP-QUALIFIED-RESIDENCE2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: MFP-LIVES-WITH-FAMILY1 - MFP-LIVES-WITH-FAMILY2 |
| ELIGIBLE FILE | DATA ELEMENT NAME: RACE |
| ELIGIBLE FILE | DATA ELEMENT NAME: SOCIAL-SECURITY-NUMBER |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-ID1 THROUGH WAIVER-ID4 |
| ELIGIBLE FILE | DATA ELEMENT NAME: WAIVER-TYPE1 THROUGH WAIVER-TYPE4 |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: ANNUAL-DEDUCTIBLE-AMT |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAMES: INSURANCE-BENEFIT-PLAN-TYPE |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: INSURANCE-CARRIER-ADDR-LN1 THRU INSURANCE-CARRIER-ADDR-LN3 |
| THIRD PARTY LIABILITY (TPL) FILE | DATA ELEMENT NAME: POLICY-OWNER-IND |
| CLAIMS FILES | DATA ELEMENT NAME: IMMUNIZATION TYPE |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ADJ |
| CLAIMS FILES | DATA ELEMENT NAME: LINE-NUMBER-ORIG |
| CLAIMS FILES | DATA ELEMENT NAME: TPL-AMT |
| CLAIMS FILES | DATA ELEMENT NAME: UB-REV-CHARGE |
| CLAIMS FILES | DATA ELEMENT NAME: UB REV-CODE |
| CLAIMS FILES | DATA ELEMENT NAME: UB-REV-UNITS |
| PROVIDER FILE | Data Element Name: BILL-LOC-ADDR-LN1 THRU BILL-LOC-ADDR-LN3 (1) THRU (6) |
| PROVIDER FILE | Data Element Name: BILL-LOC-CITY (1) THRU (6) |
| PROVIDER FILE | Data Element Name: CLIA-NUM |
| PROVIDER FILE | Data Element Name: DBA-NAME |
| PROVIDER FILE | Data Element Name: PROV-GRP-STATUS-CODE (1) THRU (100) |
| PROVIDER FILE | Data Element Name: PROV-NAME |
| PROVIDER FILE | Data Element Name: REASON-CODE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: REASON-EFF-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: REASON-EXP-DATE (1) THRU (12) |
| PROVIDER FILE | Data Element Name: SOCIAL-SECURITY-NUMBER |
| PROVIDER FILE | Data Element Name: URBAN-RURAL-IND |
| MANAGED CARE PLAN FILE | Data Element Name: APPL-DATE |
| MANAGED CARE PLAN FILE | Data Element Name: BORDER-STATE-IND |
| MANAGED CARE PLAN FILE | Data Element Name: BUSINESS-TYPE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ADDR-LN1 THRU MANAGED-CARE-ADDR-LN3 |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-CITY |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-COUNTY |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EFFECTIVE-DATE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-EMAIL |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-END-DATE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-FAX-NUM |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-NAME |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-PLAN-TYPE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-STATE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-TELEPHONE |
| MANAGED CARE PLAN FILE | Data Element Name: MANAGED-CARE-ZIP-CODE |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-DUAL-ELIGIBLES |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-ENROLLMENT |
| MANAGED CARE PLAN FILE | Data Element Name: NUMBER-OF-PROVIDERS |
| MANAGED CARE PLAN FILE | Data Element Name: OPERATING-AUTHORITY (WAIVER TYPE) |
| MANAGED CARE PLAN FILE | Data Element Name: OUT-OF-STATE-IND |
| MANAGED CARE PLAN FILE | Data Element Name: OWNERSHIP-CODE |
| MANAGED CARE PLAN FILE | Data Element Name: PLAN-ID-NUM |
| MANAGED CARE PLAN FILE | Data Element Name: POPULATION-COVERED1 - POPULATION-COVERED20 |
| MANAGED CARE PLAN FILE | Data Element Name: REIMBURSEMENT-ARRANGEMENT |
| MANAGED CARE PLAN FILE | Data Element Name: URBAN-RURAL-IND |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |