Hospice Claims Data Dictionary - CCW Version 04/2007

If associated CCW data is read into a SAS version 6.x environment, the "SHORT NAMES" 
will be displayed in the output file.

If associated CCW data is read into a SAS version 8.x environment, the "LONG NAMES" 
will be displayed in the output file.

              NAME              TYPE   LENGTH
------------------------------------   ------
1.  Encrypted 723 Beneficiary	CHAR	  15
    ID

	A unique CCW beneficiary identifier field
	that is specific to the Chronic Condition Warehouse.  
	This field is encrypted prior to delivery to 
	researchers. The BENE_ID field is used to cross-
	reference data for each beneficiary across all claim	
	and assessment data files.
	
	SHORT NAME: BENE_ID
	LONG NAME: BENE_ID

	SOURCE:
	CCW

2.  Claim ID		     NUM	13             

	This number is assigned when a claim is 
	processed in the Chronic Condition Warehouse.
	It identifies lines that are submitted from
	the same claim.
 
	SHORT NAME: CLM_ID
	LONG NAME: CLM_ID

	SOURCE:
	CCW

3. NCH Near Line Record         CHAR     1
   Identification Code

     A code defining the type of claim record being processed.

     SHORT NAME: RIC_CD
     LONG NAME: NCH_NEAR_LINE_REC_IDENT_CD

     CODES:
     NCH Near-Line Record Identification Code Table
     ----------------------------------------------
     O = Part B physician/supplier claim
         record (processed by local carriers;
         can include DMEPOS services)
     V = Part A institutional claim record
         (inpatient (IP), skilled nursing
         facility (SNF), christian science
         (CS), home health agency (HHA), or
         hospice)
     W = Part B institutional claim record
         (outpatient (OP), HHA)
     U = Both Part A and B institutional home
         health agency (HHA) claim records --
         due to HHPPS and HHA A/B split.
         (effective 10/00)
     M = Part B DMEPOS claim record (processed
         by DME Regional Carrier) (effective 10/93)

     SOURCE:
     NCH

4. NCH Claim Type Code          CHAR      2

     The code used to identify the type of claim record being
     processed in NCH.


     NOTE1:  During the Version H conversion this field was
             populated with data through- out history (back to
             service year 1991).
     NOTE2:  During the Version I conversion this field was
             expanded to include inpatient 'full' encounter
             claims (for service dates after 6/30/97).
             Placeholders for Physician and Outpatient encounters
             (available in NMUD) have also been added.

     SHORT NAME: CLM_TYPE
     LONG NAME: NCH_CLM_TYPE_CD

     DERIVATION:
     FFS CLAIM TYPE CODES DERIVED FROM:
       NCH_NEAR_LINE_REC_IDENT_CD
       NCH PMT_EDIT_RIC_CD
       NCH CLM_TRANS_CD
       NCH PRVDR_NUM

     INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
       (Pre-HDC processing -- AVAILABLE IN NCH)
       CLM_MCO_PD_SW
       CLM_RLT_COND_CD
       MCO_CNTRCT_NUM
       MCO_OPTN_CD
       MCO_PRD_EFCTV_DT
       MCO_PRD_TRMNTN_DT

     INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
       (HDC processing -- AVAILABLE IN NMUD)
       FI_NUM

     INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
     FROM: (HDC processing -- AVAILABLE IN NMUD)
       FI_NUM
       CLM_FAC_TYPE_CD
       CLM_SRVC_CLSFCTN_TYPE_CD
       CLM_FREQ_CD
     NOTE:  From 7/1/97 to the start of HDC processing(?),
     abbreviated inpatient encounter claims are not
     available in NCH or NMUD.

     PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
       (AVAILABLE IN NMUD)
       CARR_NUM
       CLM_DEMO_ID_NUM

     OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
       (AVAILABLE IN NMUD)
       FI_NUM

     OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
     DERIVED FROM:  (AVAILABLE IN NMUD)
       FI_NUM
       CLM_FAC_TYPE_CD
       CLM_SRVC_CLSFCTN_TYPE_CD
       CLM_FREQ_CD

     DERIVATION RULES:

       SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
       FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
       2.   PMT_EDIT_RIC_CD EQUAL 'F'
       3.   CLM_TRANS_CD EQUAL '5'

       SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
       2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
       3.   CLM_TRANS_CD EQUAL '0' OR '4'
       4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
            OR 'Z'

       SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
       2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
       3.   CLM_TRANS_CD EQUAL '0' OR '4'
       4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
            OR 'Z'

       SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
       2.   PMT_EDIT_RIC_CD EQUAL 'D'
       3.   CLM_TRANS_CD EQUAL '6'

       SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
       ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
       THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
       2.   PMT_EDIT_RIC_CD EQUAL 'D'
       3.   CLM_TRANS_CD EQUAL '6'
       4.   FI_NUM = 80881

       SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
       ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
       1.   FI_NUM = 80881
       2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
            CLSFCTN_TYPE_CD = '2', '3' OR '4' &
            CLM_FREQ_CD = 'Z', 'Y' OR 'X'

       SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
       2.   PMT_EDIT_RIC_CD EQUAL 'I'
       3.   CLM_TRANS_CD EQUAL 'H'

       SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
       2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
       3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

       SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
       CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
       12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_MCO_PD_SW = '1'
       2.   CLM_RLT_COND_CD = '04'
       3.   MCO_CNTRCT_NUM
            MCO_OPTN_CD = 'C'
            CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
            MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
            ENROLLMENT PERIODS

       SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
       CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
       FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
       2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
       3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
       4.   FI_NUM = 80881

       SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
       ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
       THE FOLLOWING CONDITIONS ARE MET:
       1.   FI_NUM = 80881 AND
       2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
            TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

       SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
       2.   HCPCS_CD not on DMEPOS table

       SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
       2.   HCPCS_CD on DMEPOS table (NOTE: if one or
            more line item(s) match the HCPCS on the
            DMEPOS table).

       SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
       EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
       CONDITIONS ARE MET:
       1.   CARR_NUM = 80882 AND
       2.   CLM_DEMO_ID_NUM = 38

       SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
       CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
       2.   HCPCS_CD not on DMEPOS table

       SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
       WHERE THE FOLLOWING CONDITIONS ARE MET:
       1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
       2.   HCPCS_CD on DMEPOS table (NOTE: if one or
            more line item(s) match the HCPCS on the
            DMEPOS table).

     CODES:
     NCH Claim Type Table
     --------------------
     10 = HHA claim
     20 = Non swing bed SNF claim
     30 = Swing bed SNF claim
     40 = Outpatient claim
     41 = Outpatient 'Full-Encounter' claim
          (available in NMUD)
     42 = Outpatient 'Abbreviated-Encounter' claim
          (available in NMUD)
     50 = Hospice claim
     60 = Inpatient claim
     61 = Inpatient 'Full-Encounter' claim
     62 = Inpatient 'Abbreviated-Encounter claim
          (available in NMUD)
     71 = RIC O local carrier non-DMEPOS claim
     72 = RIC O local carrier DMEPOS claim
     73 = Physician 'Full-Encounter' claim
          (available in NMUD)
     81 = RIC M DMERC non-DMEPOS claim
     82 = RIC M DMERC DMEPOS claim

     SOURCE:
     NCH

              NAME              TYPE   LENGTH
------------------------------------   ------
5. Claim From Date              DATE      8

     The first day on the billing statement
     covering services rendered to the bene-
     ficiary (a.k.a. 'Statement Covers From Date').

        NOTE:  For Home Health PPS claims, the 'from'
        date and the 'thru' date on the RAP (initial
        claim) must always match.

        8 DIGITS UNSIGNED

        SHORT NAME: FROM_DT
        LONG NAME: CLM_FROM_DT

        EDIT-RULES:

        YYYYMMDD

        SOURCE:
        CWF

6. Claim Through Date           DATE     8

     The last day on the billing statement covering
     services rendered to the beneficiary (a.k.a
     'Statement Covers Thru Date').

        NOTE:  For Home Health PPS claims, the 'from'
        date and the 'thru' date on the RAP (initial
        claim) must always match.

	If the year of the original Claim Through
	Date (THRU_DT) was future to the year of
	the Weekly Processing Date (WKLY_DT), the
	CCW Claim Through Date (THRU_DT) has been
	changed to 12/31/YYYY with YYYY representing
	the year of the Weekly Processing Date
	(WKLY_DT).

        8 DIGITS UNSIGNED
  
        SHORT NAME: THRU_DT
        LONG NAME: CLM_THRU_DT

        EDIT-RULES:
        YYYYMMDD

        SOURCE:
        CWF
 
7. NCH Weekly Claim Processing  DATE      8
   Date

     The date the weekly NCH database load
     process cycle begins, during which the claim
     records are loaded into the Nearline file.
     This date will always be a Friday, although
     the claims will actually be appended to the
     database subsequent to the date.

        8 DIGITS UNSIGNED

        SHORT NAME: WKLY_DT
        LONG NAME: NCH_WKLY_PROC_DT

        EDIT-RULES:
        YYYYMMDD

        SOURCE:
        NCH

8. Filler

9. Provider Number               CHAR      6

	The identification number of the institutional provider
	certified by Medicare to provide services to the
	beneficiary.

	SHORT NAME: PROVIDER
	LONG NAME: PRVDR_NUM

	Provider Number Table
	---------------------
	-   First two positions are the GEO SSA State Code.
	     Exception: 55 = California
	                67 = Texas
	                68 = Florida

	-   Positions 3 and sometimes 4 are used as a
	    category identifier.  The remaining positions
	    are serial numbers.  The following blocks of numbers
	    are reserved for the facilities indicated (NOTE:
	    may have different meanings dependent on the Type
	    of Bill (TOB):

	    0001-0879   Short-term (general and specialty)
	                hospitals where TOB = 11X; ESRD
	                clinic where TOB = 72X
	    0880-0899   Reserved for hospitals participating
	                in ORD demonstration projects where
	                TOB = 11X; ESRD clinic where TOB =
	                72X
	    0900-0999   Multiple hospital component in a
	                medical complex (numbers retired)
	                where TOB = 11X; ESRD clinic where
	                TOB = 72X
	    1000-1199   Reserved for future use
	    1200-1224   Alcohol/drug hospitals (excluded
	                from PPS-numbers retired)
	                where TOB = 11X; ESRD clinic where
	                TOB = 72X
	    1225-1299   Medical assistance facilities
	                (Montana project); ESRD clinic where
	                TOB = 72X
	    1300-1399   Rural Primary Care Hospital (RCPH) -
	                eff. 10/97 changed to Critical Access
	                Hospitals (CAH)
	    1400-1499   Continuation of 4900-4999 series (CMHC)
	    1500-1799   Hospices
	    1800-1989   Federally Qualified Health Centers
	                (FQHC) where TOB = 73X; SNF (IP PTB)
	                where TOB = 22X; HHA where TOB = 32X,
	                33X, 34X
	    1990-1999   Christian Science Sanatoria
	                (hospital services)
	    2000-2299   Long-term hospitals (excluded from PPS)
	    2300-2499   Chronic renal disease facilities
	                (hospital based)
	    2500-2899   Non-hospital renal disease
	                treatment centers
	    2900-2999   Independent special purpose renal
	                dialysis facility (1)
	    3000-3024   Formerly tuberculosis hospitals
	                (numbers retired)
	    3025-3099   Rehabilitation hospitals (excluded
	                from PPS)
	    3100-3199   Continuation of Subunits of Nonprofit
	                and Proprietary Home Health Agencies
	                (7300-7399) Series (3) (eff. 4/96)
	    3200-3299   Continuation of 4800-4899 series (CORF)
	    3300-3399   Children's hospitals (excluded from PPS)
	                where TOB = 11X; ESRD clinic where TOB =
	                72X
	    3400-3499   Continuation of rural health clinics
	                (provider-based) (3975-3999)
	    3500-3699   Renal disease treatment centers
	                (hospital satellites)
	    3700-3799   Hospital based special purpose renal
	                dialysis facility (1)
	    3800-3974   Rural health clinics (free-standing)
	    3975-3999   Rural health clinics (provider-based)
	    4000-4499   Psychiatric hospitals (excluded
	                from PPS)
	    4500-4599   Comprehensive Outpatient
	                Rehabilitation Facilities (CORF)
	    4600-4799   Community Mental Health Centers (CMHC);
	                9/30/91 - 3/31/97 used for clinic OPT
	                where TOB = 74X
	    4800-4899   Continuation of 4500-4599 series (CORF)
	                 (eff. 10/95)
	    4900-4999   Continuation of 4600-4799 series (CMHC)
	                (eff. 10/95); 9/30/91 - 3/31/97 used for
	                clinic OPT where TOB = 74X
	    5000-6499   Skilled Nursing Facilities
	    6500-6989   CMHC / Outpatient physical therapy services
	                where TOB = 74X; CORF where TOB =
	                75X
	    6990-6999   Christian Science Sanatoria (skilled
	                nursing services)
	    7000-7299   Home Health Agencies (HHA) (2)
	    7300-7399   Subunits of 'nonprofit' and
	                'proprietary' Home Health Agencies (3)
	    7400-7799   Continuation of 7000-7299 series
	    7800-7999   Subunits of state and local governmental
	                Home Health Agencies (3)
	    8000-8499   Continuation of 7400-7799 series (HHA)
	    8500-8899   Continuation of rural health
	                center (provider based) (3400-3499)
	    8900-8999   Continuation of rural health
	                center (free-standing) (3800-3974)
	    9000-9499   Continuation of 8000-8499 series (HHA)
	                (eff. 10/95)
	    9500-9999   Reserved for future use (eff. 8/1/98)
	                NOTE: 10/95-7/98 this series was
	                assigned to HHA's but rescinded - no
	                HHA's were ever assigned a number
	                from this series.

 	   Exception:

	    P001-P999   Organ procurement organization

	(1) These facilities (SPRDFS) will be assigned
	    the same provider number whenever they
	    are recertified.

	(2) The 6400-6499 series of provider numbers
	    in Iowa (16), South Dakota (43) and Texas (45)
	    have been used in reducing acute care costs (RACC)
	    experiments.

	(3) In Virginia (49), the series 7100-7299 has
	    been reserved for statewide subunit components
	    of the Virginia state home health agencies.

	(4) Parent agency must have a number in the
	    7000-7299, 7400-7799 or 8000-8499 series.

	NOTE:
	  There is a special numbering system for units
	  of hospitals that are excluded from prospective
	  payment system (PPS) and hospitals with SNF
	  swing-bed designation.  An alpha character in
	  the third position of the provider number
	  identifies the type of unit or swing-bed
	  designation as follows:

	    S = Psychiatric unit (excluded from PPS)
	    T = Rehabilitation unit (excluded from PPS)
	    U = Short term/acute care swing-bed hospital
	    V = Alcohol drug unit (prior to 10/87 only)
	    W = Long term SNF swing-bed hospital
	        (eff 3/91)
	    Y = Rehab hospital swing-bed (eff 9/92)
	    Z = Rural primary care swing-bed hospital
	
	  There is also a special numbering system for
	  assigning emergency hospital identification
	  numbers (non participating hospitals).  The
	  sixth position of the provider number is as
	  follows:

	    E = Non-federal emergency hospital
	    F = Federal emergency hospital

	SOURCE:
	OSCAR

              NAME              TYPE   LENGTH
------------------------------------   ------
10. Claim Facility Type Code    CHAR      1

	The first digit of the type of bill submitted on an
	institutional claim used to identify the type of facility
	that provided care to the beneficiary.

	SHORT NAME: FAC_TYPE
	LONG NAME: CLM_FAC_TYPE_CD

	CODES:
	Claim Facility Type Table
	-------------------------
	1 = Hospital
	2 = Skilled nursing facility (SNF)
	3 = Home health agency (HHA)
	4 = Religious Nonmedical (Hospital)
	    (eff. 8/1/00); prior to 8/00 referenced Christian Science (CS)
	5 = Religious Nonmedical (Extended Care)
	    (eff. 8/1/00); prior to 8/00 referenced CS
	6 = Intermediate care
	7 = Clinic or hospital-based renal dialysis facility
	8 = Special facility or ASC surgery
	9 = Reserved

	SOURCE:
	CWF

11. Claim Service               CHAR      1
    Classification Type Code

	The second digit of the type of bill submitted on an
	institutional claim record to indicate the classification of
	the type of service provided to the beneficiary.

	SHORT NAME: TYPESRVC
	LONG NAME: CLM_SRVC_CLSFCTN_TYPE_CD

	CODES:
	Claim Service Classification Type Table
	---------------------------------------
	   For facility type code 1 thru 6, and 9

	1 = Inpatient (including Part A)
	2 = Hospital based or Inpatient (Part B only)
	    or home health visits under Part B
	3 = Outpatient (HHA-A also)
	4 = Other (Part B)
	5 = Intermediate care - level I
	6 = Intermediate care - level II
	7 = Subacute Inpatient
	    (formerly Intermediate care - level III)
	8 = Swing beds (used to indicate billing for
	    SNF level of care in a hospital with an
	    approved swing bed agreement)
	9 = Reserved for national assignment

	  For facility type code 7

	1 = Rural health
	2 = Hospital based or independent renal
	    dialysis facility
	3 = Free-standing provider based federally
	    qualified health center (eff 10/91)
	4 = Other Rehabilitation Facility (ORF) and
	    Community Mental Health Center (CMHC)
	    (eff 10/91 - 3/97); ORF only (eff. 4/97)
	5 = Comprehensive Rehabilitation Center
	    (CORF)
	6 = Community Mental Health Center (CMHC) (eff 4/97)
	7-8 = Reserved for national assignment
	9 = Other

	  For facility type code 8

	1 = Hospice (non-hospital based)
	2 = Hospice (hospital based)
	3 = Ambulatory surgical center in hospital
	    outpatient department
	4 = Freestanding birthing center
	5 = Critical Access Hospital (eff. 10/99)
	    formerly Rural primary care hospital
	    (eff. 10/94)
	6-8 = Reserved for national use
	9 = Other

	SOURCE:
	CWF

12. Claim Frequency Code        CHAR      1

	The third digit of the type of bill (TOB3) submitted on an
	institutional claim record to indicate the sequence of a
	claim in the beneficiary's current episode of care.

	SHORT NAME: FREQ_CD
	LONG NAME: CLM_FREQ_CD

	CODES:
	Claim Frequency Table
	---------------------
	0 = Non-payment/zero claims
	1 = Admit thru discharge claim
	2 = Interim - first claim
	3 = Interim - continuing claim
	4 = Interim - last claim
	5 = Late charge(s) only claim
	6 = Adjustment of prior claim
	7 = Replacement of prior claim; eff 10/93, provider debit
	8 = Void/cancel prior claim. eff 10/93, provider cancel
	9 = Final claim -- used in an HH PPS
	    episode to indicate the claim
	    should be processed like debit/
	    credit adjustment to RAP (initial
	    claim) (eff. 10/00)
	A = Admission notice - used when hospice is submitting the
	    HCFA-1450 as an admission notice - hospice NOE only
	B = Hospice termination/revocation notice - hospice NOE only
	    (eff 9/93)
	C = Hospice change of provider notice - hospice NOE only
	    (eff 9/93)
	D = Hospice election void/cancel - hospice NOE only  (eff 9/93)
	E = Hospice change of ownership - hospice NOE only  (eff 1/97)
	F = Beneficiary initiated adjustment (eff 10/93)
	G = CWF generated adjustment (eff 10/93)
	H = HCFA generated adjustment (eff 10/93)
	I = Misc adjustment claim (other than PRO
	    or provider) - used to identify a
	    debit adjustment initiated by HCFA or
	    an intermediary - eff 10/93, used to
	    identify intermediary initiated
	    adjustment only
	J = Other adjustment request (eff 10/93)
	K = OIG initiated adjustment (eff 10/93)
	M = MSP adjustment (eff 10/93)
	P = Adjustment required by peer review organization (PRO)
	X = Special adjustment processing - used for QA editing (eff 8/92)
	Z = Hospital Encounter Data alternate sub-
	    mission (TOB '11Z') used for MCO enrollee
	    hospital discharges 7/1/97-12/31/98; not
	    stored in NCH.  Exception:  Problem in
	    startup months may have resulted in this
	    abbreviated UB-92 being erroneously
	    stored in NCH.

	SOURCE:
	CWF

13. FI Number                   CHAR      5

	The identification number assigned by HCFA to a fiscal
	intermediary authorized to process institutional claim
	records.

	SHORT NAME: FI_NUM
	LONG NAME: FI_NUM

	CODES:
	Fiscal Intermediary Number Table
	--------------------------------
	00010 = Alabama BC
	00020 = Arkansas BC
	00030 = Arizona BC
	00040 = California BC (term. 12/00)
	00050 = New Mexico BC/CO
	00060 = Connecticut BC
	00070 = Delaware BC - terminated 2/98
	00080 = Florida BC
	00090 = Florida BC
	00101 = Georgia BC
	00121 = Illinois - HCSC
	00123 = Michigan - HCSC
	00130 = Indiana BC/Administar Federal
	00131 = Illinois - Administar
	00140 = Iowa - Wellmark (term. 6/2000)
	00150 = Kansas BC
	00160 = Kentucky/Administar
	00180 = Maine BC
	00181 = Maine BC - Massachusetts
	00190 = Maryland BC
	00200 = Massachusetts BC - terminated 7/97
	00210 = Michigan BC - terminated 9/94
	00220 = Minnesota BC
	00230 = Mississippi BC
	00231 = Mississippi BC/LA
	00232 = Mississippi BC
	00241 = Missouri BC - terminated 9/92
	00250 = Montana BC
	00260 = Nebraska BC
	00270 = New Hampshire/VT BC
	00280 = New Jersey BC (term. 8/2000)
	00290 = New Mexico BC - terminated 11/95
	00308 = Empire BC
	00310 = North Carolina BC
	00320 = North Dakota BC
	00332 = Community Mutual Ins Co; Ohio-Administar
	00340 = Oklahoma BC
	00350 = Oregon BC
	00351 = Oregon BC/ID.
	00355 = Oregon-CWF
	00362 = Independence BC - terminated 8/97
	00363 = Veritus, Inc (PITTS)
	00370 = Rhode Island BC
	00380 = South Carolina BC
	00390 = Tennessee BC
	00400 = Texas BC
	00410 = Utah BC
	00423 = Virginia BC; Trigon
	00430 = Washington/Alaska BC
	00450 = Wisconsin BC
	00452 = Michigan - Wisconsin BC
	00454 = United Government Services -
	        Wisconsin BC (eff. 12/00)
	00460 = Wyoming BC
	00468 = N Carolina BC/CPRTIVA
	00993 = BC/BS Assoc.
	17120 = Hawaii Medical Service
	50333 = Travelers; Connecticut United Healthcare
	        (terminated - date unknown)
	51051 = Aetna California - terminated 6/97
	51070 = Aetna Connecticut - terminated 6/97
	51100 = Aetna Florida - terminated 6/97
	51140 = Aetna Illinois - terminated 6/97
	51390 = Aetna Pennsylvania - terminated 6/97
	52280 = Mutual of Omaha
	57400 = Cooperative, San Juan, PR
	61000 = Aetna

	SOURCE:
	CWF

              NAME              TYPE   LENGTH
------------------------------------   ------
14. Claim Medicare Non Payment  CHAR      1
    Reason Code

	The reason that no Medicare payment is made for
	services on an institutional claim.

	NOTE:  Effective with Version I, this field was
	       put on all institutional claim types.
	       Prior to Version I, this field was present
	       only on inpatient/SNF claims.

	SHORT NAME: NOPAY_CD
	LONG NAME: CLM_MDCR_NON_PMT_RSN_CD

	EDIT-RULES:
	OPTIONAL

	CODES:
	Claim Medicare Non-Payment Reason Table
	---------------------------------------
	A = Covered worker's compensation (Obsolete)
	B = Benefit exhausted
	C = Custodial care - noncovered care
	    (includes all 'beneficiary at fault'
	    waiver cases) (Obsolete)
	E = HMO out-of-plan services not emergency
	    or urgently needed (Obsolete)
	E = MSP cost avoided - IRS/SSA/HCFA Data
	    Match (eff. 7/00)
	F = MSP cost avoid HMO Rate Cell (eff. 7/00)
	G = MSP cost avoided Litigation Settlement
	    (eff. 7/00)
	H = MSP cost avoided Employer Voluntary
	    Reporting (eff. 7/00)
	J = MSP cost avoid Insurer Voluntary
	    Reporting (eff. 7/00)
	K = MSP cost avoid Initial Enrollment
	    Questionnaire (eff. 7/00)
	N = All other reasons for nonpayment
	P = Payment requested
	Q = MSP cost avoided Voluntary Agreement
	    (eff. 7/00)
	R = Benefits refused, or evidence not
	    submitted
	T = MSP cost avoided - IEQ contractor
	    (eff. 9/76) (obsolete 6/30/00)
	U = MSP cost avoided - HMO rate cell
	    adjustment (eff. 9/76) (Obsolete 6/30/00)
	V = MSP cost avoided - litigation
	    settlement (eff. 9/76) (Obsolete 6/30/00)
	W = Worker's compensation (Obsolete)
	X = MSP cost avoided - generic
	Y = MSP cost avoided - IRS/SSA data
	    match project (obsolete 6/30/00)
	Z = Zero reimbursement RAPs -- zero reimbursement
	    made due to medical review intervention or
	    where provider specific zero payment has been
	    determined. (effective with HHPPS - 10/00)

	SOURCE:
	CWF

15. Claim Payment Amount     NUM     12   

	Amount of payment made from the Medicare trust fund for the
	services covered by the claim record.  Generally, the amount
	is calculated by the FI or carrier; and represents what was
	paid to the institutional provider, physician, or supplier,
	with the exceptions noted below.  **NOTE:  In some
	situations, a negative claim payment amount may be pre-
	sent; e.g., (1) when a beneficiary is charged the full
	deductible during a short stay and the deductible exceeded
	the amount Medicare pays; or (2) when a beneficiary is
	charged a coinsurance amount during a long stay and the
	coinsurance amount exceeds the amount Medicare pays (most
	prevalent situation involves psych hospitals who are paid a
	daily per diem rate no matter what the charges are.)

	Under IP PPS, inpatient hospital services are paid based on
	a predetermined rate per discharge, using the DRG patient
	classification system and the PRICER program.   On the IP
	PPS claim, the payment amount includes the DRG outlier
	approved payment amount, disproportionate share (since
	5/1/86), indirect medical education (since 10/1/88), total
	PPS capital (since 10/1/91).  It does NOT include the pass
	thru amounts (i.e., capital-related costs, direct medical
	education costs, kidney acquisition costs, bad debts); or
	any beneficiary-paid amounts (i.e., deductibles and
	coinsurance); or any other payer reimbursement.

	Under SNF PPS, SNFs will classify beneficiaries using the
	patient classification system known as RUGS III.  For the
	SNF PPS claim, the SNF PRICER will calculate/return the rate
	for each revenue center line item with revenue center code =
	'0022'; multiply the rate times the units count; and then
	sum the amount payable for all lines with revenue center
	code '0022' to determine the total claim payment amount.

	Under Outpatient PPS, the national ambulatory payment
	classification (APC) rate that is calculated for each APC
	group is the basis for determining the total payment.  The
	Medicare payment amount takes into account the wage index
	adjustment and the beneficiary deductible and coinsurance
	amounts.  NOTE: There is no CWF edit check to validate that
	the revenue center Medicare payment amount equals the claim
	level Medicare payment amount.

	Under Home Health PPS, beneficiaries will be classified into
	an appropriate case mix category known as the Home Health
	Resource Group.  A HIPPS code is then generated
	corresponding to the case mix category (HHRG).

	For the RAP, the PRICER will determine the payment amount
	appropriate to the HIPPS code by computing 60% (for first
	episode) or 50% (for subsequent episodes) of the case mix
	episode payment.  The payment is then wage index adjusted.

	For the final claim, PRICER calculates 100% of the amount
	due, because the final claim is processed as an adjustment
	to the RAP, reversing the RAP payment in full.  Although
	final claim will show 100% payment amount, the provider will
	actually receive the 40% or 50% payment.

	Exceptions:  For claims involving demos and BBA encounter
	data, the amount reported in this field may not just
	represent the actual provider payment.

	    For demo Ids '01','02','03','04' -- claims contain
	    amount paid to the provider, except that special
	    'differentials' paid outside the normal payment system
	    are not included.

	    For demo Ids '05','15' -- encounter data 'claims'
	    contain amount Medicare would have paid under FFS,
	    instead of the actual payment to the MCO.

	    For demo Ids '06','07','08' -- claims contain actual
	    provider payment but represent a special negotiated
	    bundled payment for both Part A and Part B services.
	    To identify what the conventional provider Part A
	    payment would have been, check value code = 'Y4'.   The
	    related noninstitutional (physician/supplier) claims
	    contain what would have been paid had there been no
	    demo.

	    For BBA encounter data (non-demo) -- 'claims' contain
	    amount Medicare would have paid under FFS, instead of
	    the actual payment to the BBA plan.


	9.2 DIGITS SIGNED

	SHORT NAME: PMT_AMT
	LONG NAME: CLM_PMT_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	CWF

	LIMITATIONS:
	Prior to 4/6/93, on inpatient, outpatient, and
	physician/supplier claims containing a
	CLM_DISP_CD of '02', the amount shown as the Medicare
	reimbursement does not take into consideration
	any CWF automatic adjustments (involving erroneous
	deductibles in most cases).  In as many as 30% of
	the claims (30% IP, 15% OP, 5% PART B), the
	reimbursement reported on the claims may be over
	or under the actual Medicare payment amount.

16. NCH Primary Payer Claim   NUM     12   
    Paid Amount

	The amount of a payment made on behalf of a Medicare
	beneficiary by a primary payer other than Medicare, 
	that the provider is applying to covered Medicare 
	charges on an institutional, carrier, or DMERC claim.

	9.2 DIGITS SIGNED

	SHORT NAME: PRPAYAMT
	LONG NAME: NCH_PRMRY_PYR_CLM_PD_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	NCH

17. NCH Primary Payer Code        CHAR      1

	The code, on an institutional claim, specifying a federal
	non-Medicare program or other source that has primary
	responsibility for the payment of the Medicare beneficiary's
	health insurance bills.

	SHORT NAME: PRPAY_CD
	LONG NAME: NCH_PRMRY_PYR_CD

	DERIVATION:
	DERIVED FROM:
	   CLM_VAL_CD
	   CLM_VAL_AMT

	DERIVATION RULES

	  SET NCH_PRMRY_PYR_CD TO 'A' WHERE THE
	  CLM_VAL_CD = '12'

	  SET NCH_PRMRY_PYR_CD TO 'B' WHERE THE
	  CLM_VAL_CD = '13'

	  SET NCH_PRMRY_PYR_CD TO 'C' WHERE THE
	  CLM_VAL_CD = '16' and CLM_VAL_AMT is zeroes

	  SET NCH_PRMRY_PYR_CD TO 'D' WHERE THE
	  CLM_VAL_CD = '14'

	  SET NCH_PRMRY_PYR_CD TO 'E' WHERE THE
	  CLM_VAL_CD = '15'

	  SET NCH_PRMRY_PYR_CD TO 'F' WHERE THE
	  CLM_VAL_CD = '16' (CLM_VAL_AMT not
	  equal to zeroes)

	  SET NCH_PRMRY_PYR_CD TO 'G' WHERE THE
	  CLM_VAL_CD = '43'

	  SET NCH_PRMRY_PYR_CD TO 'H' WHERE THE
	  CLM_VAL_CD = '41'

	  SET NCH_PRMRY_PYR_CD TO 'I' WHERE THE
	  CLM_VAL_CD = '42'

	  SET NCH_PRMRY_PYR_CD TO 'L' (or prior to 4/97
	  set code to 'J') WHERE THE CLM_VAL_CD = '47'

	CODES:
	Beneficiary Primary Payer Table
	-------------------------------
	A = Working aged bene/spouse with employer group health plan (EGHP)
	B = End stage renal disease (ESRD) beneficiary in the 18 month
	    coordination period with an employer group health plan
	C = Conditional payment by Medicare; future reimbursement expected
	D = Automobile no-fault (eff. 4/97; Prior to 3/94, also included
	    any liability insurance)
	E = Workers' compensation
	F = Public Health Service or other federal agency (other than Dept.
	    of Veterans Affairs)
	G = Working disabled bene (under age 65 with LGHP)
	H = Black Lung
	I = Dept. of Veterans Affairs
	J = Any liability insurance (eff. 3/94 - 3/97)
	L = Any liability insurance (eff. 4/97) (eff. 12/90 for carrier claims
	    and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
	M = Override code:  EGHP services involved (eff. 12/90 for carrier
	    claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
	N = Override code:  non-EGHP services involved (eff. 12/90 for carrier
	    claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)

	BLANK = Medicare is primary payer (not sure of effective date:
	        in use 1/91, if not earlier)

	T = MSP cost avoided - IEQ contractor (eff. 7/96 carrier claims only)
	U = MSP cost avoided - HMO rate cell adjust- ment contractor (eff.
	    7/96 carrier claims only)
	V = MSP cost avoided - litigation settlement contractor (eff. 7/96
	    carrier claims only)
	X = MSP cost avoided override code (eff. 12/90 for carrier claims
	    and 10/93 for FI claims; obsoleted for all claim types 7/1/96)

             ***Prior to 12/90***

	Y = Other secondary payer investigation shows Medicare as primary payer
	Z = Medicare is primary payer

	NOTE:  Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer.
	       (values Z and Y were used prior to 12/90.  BLANK was suppose to be
 	      effective after 12/90, but may have been used prior to that date.)

	SOURCE:
	NCH
	
              NAME              TYPE   LENGTH
------------------------------------   ------
18. Filler

19. NCH Provider State Code       CHAR      2

	Effective with Version H, the two position postal abbreviation
	state code where provider facility is located.

	NOTE:  During the Version H conversion this field was
	populated with data throughout history (back to service year
	1991).

	SHORT NAME: PRSTATE
	LONG NAME: PRVDR_STATE_CD

	SOURCE:
	NCH

20. Organization NPI Number       CHAR     10

	A placeholder field (effective with Version H) for storing
	the NPI assigned to the institutional provider.

	SHORT NAME: ORGNPINM
	LONG NAME: ORG_NPI_NUM

	SOURCE:
	CWF

21. Claim Attending Physician     CHAR      6
    UPIN Number

	On an institutional claim, the unique physician
	identification number (UPIN) of the physician
	who would normally be expected to certify and
	recertify the medical necessity of the services
	rendered and/or who has primary responsibility for
	the beneficiary's medical care and treatment
	(attending physician).

	SHORT NAME: AT_UPIN
	LONG NAME: AT_PHSYN_UPIN

	SOURCE:
	CWF

22. Claim Attending Physician   CHAR     10
    NPI Number

	A placeholder field (effective with Version H)
	for storing the NPI assigned to the attending
	physician.

	SHORT NAME: AT_NPI
	LONG NAME: AT_PHYSN_NPI

	SOURCE:
	CWF

              NAME              TYPE   LENGTH
------------------------------------   ------
23. Filler

24. Filler

25. Filler

26. Filler

27. Filler

28. Patient Discharge Status    CHAR      2
    Code

	The code used to identify the status of the
	patient as of the CLM_THRU_DT.

	SHORT NAME: STUS_CD
	LONG NAME: PTNT_DSCHRG_STUS_CD

	CODES:
	Patient Discharge Status Table
	------------------------------
	01 = Discharged to home/self care (routine
	     charge).
	02 = Discharged/transferred to other short term
	     general hospital for inpatient care.
	03 = Discharged/transferred to skilled
	     nursing facility (SNF) - (For hospitals
	     with an approved swing bed arrangement,
	     use Code 61 - swing bed.  For reporting
	     discharges/transfers to a non-certified
 	     SNF, the hospital must use Code 04 - ICF.
	04 = Discharged/transferred to intermediate
	     care facility (ICF).
	05 = Discharged/transferred to another type
	     of institution for inpatient care (including
	     distinct parts).
	06 = Discharged/transferred to home care of
	     organized home health service organization.
	07 = Left against medical advice or discontinued
	     care.
	08 = Discharged/transferred to home under
	     care of a home IV drug therapy provider.
	09 = Admitted as an inpatient to this
	     hospital (effective 3/1/91).  In situa-
	     tions  where a patient is admitted before
	     midnight of the third day following the
	     day of an outpatient service, the out-
	     patient services are considered inpatient.
	20 = Expired (did not recover - Christian
	     Science patient).
	30 = Still patient.
	40 = Expired at home (hospice claims only)
	41 = Expired in a medical facility such as
	     hospital, SNF, ICF, or freestanding
	     hospice. (Hospice claims only)
	42 = Expired - place unknown (Hospice claims
	     only)
	50 = Hospice - home (eff. 10/96)
	51 = Hospice - medical facility (eff. 10/96)
	61 = Discharged/transferred within this insti-
	     tution to a hospital-based Medicare
	     approved swing bed (to be implemented in
	     1999)
	71 = Discharged/transferred/referred to another
	     institution for outpatient services as
	     specified by the discharge plan of care (to
	     be implemented in 1999).
	72 = Discharged/transferred/referred to this
	     institution for outpatient services as
	     specified by the discharge plan of care
	     (to be implemented in 1999).

	SOURCE:
	CWF

29. Filler

30. Claim Total Charge Amount   NUM      12

	Effective with Version G, the total charges for
	all services included on the institutional claim.
	This field is redundant with revenue center
	code 0001/total charges.

	9.2 DIGITS SIGNED

	SHORT NAME: TOT_CHRG
	LONG NAME: CLM_TOT_CHRG_AMT

	SOURCE:
	CWF

31. Filler

32. Filler

33. Filler

34. Filler

35. NCH Patient Status        CHAR      1
    Indicator Code

	Effective with Version H, the code on an
	inpatient/SNF and Hospice claim, indicating
	whether the beneficiary was discharged, died
	or still a patient (used for internal CWFMQA
	editing purposes.)

	NOTE:  During the Version H conversion this
	field was populated throughout history (back to
	service year 1991).

	SHORT NAME: PTNTSTUS
	LONG NAME: NCH_PTNT_STATUS_IND_CD

	DERIVATION:
	DERIVED FROM:
	  NCH PTNT_DSCHRG_STUS_CD

	DERIVATION RULES:

	  SET NCH_PTNT_STUS_IND_CD TO 'A' WHERE THE
	  PTNT_DSCHRG_STUS_CD NOT EQUAL TO '20'- '30'
	  OR '40' - '42'.

	  SET NCH_PTNT_STUS_IND_CD TO 'B' WHERE THE
	  PTNT_DSCHRG_STUS_CD EQUAL TO '20'- '29'
	  OR '40' - '42'.

	  SET NCH_PTNT_STUS_IND_CD TO 'C' WHERE THE
	  PTNT_DSCHRG_STUS_CD EQUAL TO '30'

	CODES:
	A = Discharged
	B = Died
	C = Still patient

	SOURCE:
	NCH QA Process

36. Filler

37. Filler

              NAME              TYPE   LENGTH
------------------------------------   ------
38. Filler

39. Filler

40. Filler
  
41. Filler
  
42. Filler

43. Filler

44. Filler

45. Filler

46. Filler

47. Filler

48. Filler

49. Filler

50. Filler

51. Claim Utilization Day Count  NUM      3

	On an institutional claim, the number of
	covered days of care that are chargeable
	to Medicare facility utilization that
	includes full days, coinsurance days, and
	lifetime reserve days.
	
	3 DIGITS SIGNED

	SHORT NAME: UTIL_DAY
	LONG NAME: CLM_UTLZTN_DAY_CNT

	SOURCE:
	CWF

52. Filler

53. Filler

54. Filler

55. Filler

56. Filler

57. Filler

58. Filler

59. Filler

60. Filler

              NAME              TYPE   LENGTH
------------------------------------   ------
61. Filler

62. NCH Beneficiary Discharge    DATE      8
    Date

	Effective with Version H, on an inpatient and
	HHA claim, the date the beneficiary was discharged
	from the facility or died (used for internal CWFMQA
	editing purposes.)

	NOTE:  During the Version H conversion this field
	was populated with data throughout history (back to
	service year 1991.)

	8 DIGITS UNSIGNED

	SHORT NAME: DSCHRGDT
	LONG NAME: NCH_BENE_DSCHRG_DT

	EDIT-RULES:
	YYYYMMDD

	DERIVATION:
	DERIVED FROM:
	  NCH_PTNT_STATUS_IND_CD
	  CLM_THRU_DT

	DERIVATION RULES:
	Based on the presence of patient discharge status
	code not equal to 30 (still patient), move the claim
	thru date to the NCH_BENE_DSCHRG_DT.

	SOURCE:
	NCH QA Process

63. Filler

64. Filler

65. Filler

66. Primary Claim Diagnosis Code   CHAR      5

	The ICD-9-CM based code identifying the
	beneficiary's principal diagnosis.

	SHORT NAME: DGNSCD1
	LONG NAME: ICD9_DGNS_CD1

	EDIT-RULES:
	ICD-9-CM

67. Claim Diagnosis Code II	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's second diagnosis.

	SHORT NAME: DGNSCD2
	LONG NAME: ICD9_DGNS_CD2

	EDIT-RULES:
	ICD-9-CM

68. Claim Diagnosis Code III	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's third diagnosis.

	SHORT NAME: DGNSCD3
	LONG NAME: ICD9_DGNS_CD3

	EDIT-RULES:
	ICD-9-CM


69. Claim Diagnosis Code IV	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's fourth diagnosis.

	SHORT NAME: DGNSCD4
	LONG NAME: ICD9_DGNS_CD4

	EDIT-RULES:
	ICD-9-CM

70. Claim Diagnosis Code V	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's fifth diagnosis.

	SHORT NAME: DGNSCD5
	LONG NAME: ICD9_DGNS_CD5

	EDIT-RULES:
	ICD-9-CM

71. Claim Diagnosis Code VI	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's sixth diagnosis.

	SHORT NAME: DGNSCD6
	LONG NAME: ICD9_DGNS_CD6

	EDIT-RULES:
	ICD-9-CM

72.  Claim Diagnosis Code VII	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's seventh diagnosis.

	SHORT NAME: DGNSCD7
	LONG NAME: ICD9_DGNS_CD7

	EDIT-RULES:
	ICD-9-CM

73.  Claim Diagnosis Code VIII	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's eighth diagnosis.

	SHORT NAME: DGNSCD8
	LONG NAME: ICD9_DGNS_CD8

	EDIT-RULES:
	ICD-9-CM

74.  Claim Diagnosis Code IX	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's ninth diagnosis.

	SHORT NAME: DGNSCD9
	LONG NAME: ICD9_DGNS_CD9

	EDIT-RULES:
	ICD-9-CM

75.  Claim Diagnosis Code X	 CHAR	  5

	The ICD-9-CM based code identifying the
	beneficiary's tenth diagnosis.

	SHORT NAME: DGNSCD10
	LONG NAME: ICD9_DGNS_CD10

	EDIT-RULES:
	ICD-9-CM

76. Filler

77. Filler

78. Filler

79. Filler

80. Filler

81. Filler

82. Filler

83. Filler

84. Filler

85. Filler

86. Filler

87. Filler

88. Filler

89. Filler

90. Filler

91. Filler

92. Filler

93. Filler

94. Filler

              NAME              TYPE   LENGTH
------------------------------------   ------
95. Filler

96. Claim Hospice Start Date      DATE      8

	On an institutional claim, the date the beneficiary
	was admitted to the hospice.

	8 DIGITS UNSIGNED

	SHORT NAME: HSPCSTRT
	LONG NAME: CLM_HOSPC_STRT_DT

	EDIT-RULES:
	YYYYMMDD

	SOURCE:
	CWF

97. Beneficiary's Hospice        NUM       1
    Period Count

	The count of the number of hospice period trailers
	present for the beneficiary's record.  Prior to BBA
	a beneficiary was entitled to a maximum of 4 hospice
	benefit periods that may be elected in lieu of
	standard Part A hospital benefits.  The BBA changed
	the hospice benefit to the following:  2 initial 90
	day periods followed by an unlimited number of 60 day
	periods (effective 8/5/97).

	1 DIGIT UNSIGNED

	SHORT NAME: HOSPCPRD
	LONG NAME: BENE_HOSPC_PRD_CNT

	EDIT-RULES:
	RANGE: 1 THRU 3: 1 = 1st 90-day period; 2 = 2nd 90
	day period and 3 = 60-day period (3 or greater
	periods)

	SOURCE:
	CWF

98. Filler

99. Filler

100. Claim Related Condition   CHAR	2             
     Code Sequence

	This number identifies the position of the
	related condition code in the event that 
	multiple related condition codes are 
	recorded.
 
	SHORT NAME: RLTCNDSQ
	LONG NAME: RLT_COND_CD_SEQ

	SOURCE:
	CCW

101. Claim Related Condition      CHAR      2
     Code

	The code that indicates a condition relating to
	an institutional claim that may affect payer
	processing.

	SHORT NAME: RLT_COND
	LONG NAME: RLTD_COND_CD

	CODES:
	01 THRU 16 = Insurance related
	17 THRU 30 = Special condition
	31 THRU 35 = Student status codes which are required
	             when a patient is a dependent child
	             over 18 years old
	36 THRU 45 = Accommodation
	46 THRU 54 = CHAMPUS information
	55 THRU 59 = Skilled nursing facility
	60 THRU 70 = Prospective payment
	71 THRU 99 = Renal dialysis setting
	A0 THRU B9 = Special program codes
	C0 THRU C9 = PRO approval services
	D0 THRU W0 = Change conditions

	SOURCE:
	CWF

              NAME              TYPE   LENGTH
------------------------------------   ------
102. Claim Related Occurrence    CHAR	 2             
     Code Sequence

	This number identifies the position of the
	related occurrence code in the event that 
	multiple related occurrence codes are 
	recorded.
 
	SHORT NAME: RLTOCRSQ
	LONG NAME: RLT_OCRNC_CD_SEQ

	SOURCE:
	CCW

103. Claim Related Occurrence     CHAR      2
     Code

	The code that identifies a significant event
	relating to an institutional claim that may
	affect payer processing.  These codes are
	claim-related occurrences that are related
	to a specific date.

	SHORT NAME: OCRNC_CD
	LONG NAME: RLTD_OCRNC_CD

	CODES:
	01 THRU 09 = Accident
	10 THRU 19 = Medical condition
	20 THRU 39 = Insurance related
	40 THRU 69 = Service related
	A1-A3 = Miscellaneous

	SOURCE:
	CWF

104. Claim Related Occurrence     DATE       8
     Date

	The date associated with a significant event
	related to an institutional claim that may
	affect payer processing.

	8 DIGITS UNSIGNED

	SHORT NAME: OCRNCDT
	LONG NAME: RLTD_OCRNC_DT

	EDIT-RULES:
	YYYYMMDD

	SOURCE:
	CWF

105. Claim Related Span Code    CHAR	 2             
     Sequence

	This number identifies the position of the
	related span code in the event that 
	multiple related span codes are recorded.
 
	SHORT NAME: RLTSPNSQ
	LONG NAME: RLT_SPAN_CD_SEQ

	SOURCE:
	CCW

106. Claim Occurrence Span Code   CHAR      2

	The code that identifies a significant event
	relating to an institutional claim that may
	affect payer processing. These codes are
	claim-related occurrences that are related
	to a time period (span of dates).

	SHORT NAME: SPAN_CD
	LONG NAME: SPAN_CD

	CODES:
	Claim Occurrence Span Table
	---------------------------
	70 = Eff 10/93, payer use only, the
	     nonutilization from/thru dates
	     for PPS-inlier stay where bene had
	     exhausted all full/coinsurance days, but
	     covered on cost report.
	     SNF qualifying hospital stay from/thru dates
	71 = Hospital prior stay dates - the from/
	     thru dates of any hospital stay that
	     ended within 60 days of this hospital
	     or SNF admission.
	72 = First/last visit - the dates of the
	     first and last visits occurring in this
	     billing period if the dates are different
	     from those in the statement covers period.
	73 = Benefit eligibility period - the
	     inclusive dates during which CHAMPUS
	     medical benefits are available to a
	     sponsor's bene as shown on the
	     bene's ID card.
	74 = Non-covered level of care - The from/
	     thru dates of a period at a noncovered
	     level of care in an otherwise
	     covered stay, excluding any period
	     reported with occurrence span code 76,
	     77, or 79.
	75 = The from/thru dates of SNF level of care
	     during IP hospital stay.  Shows PRO approval
	     of patient remaining in hospital
	     because SNF bed not available.
	     not applicable to swing bed
	     cases. PPS hospitals use in day
	     outlier cases only.
	76 = Patient liability - From/thru
	     dates of period of noncovered care
	     for which hospital may charge
	     bene. The FI or PRO must have
	     approved such charges in advance.
	     patient must be notified in writing
	     3 days prior to noncovered period
	77 = Provider liability - The from/thru
	     dates of period of noncovered care
	     for which the provider is liable.
	     Eff 3/92, applies to provider liability
	     where bene is charged with utilization
	     and is liable for deductible/coinsurance
	78 = SNF prior stay dates - The from/
	     thru dates of any SNF stay that
	     ended within 60 days of this hospital
 	     or SNF admission.
	79 = (Payer code) -
	     Eff 3/92, from/thru dates of
	     period of noncovered care where
	     bene is not charged with utilization,
	     deductible, or coinsurance.
	     and provider is liable.
	     Eff 9/93, noncovered period of care
	     due to lack of medical necessity.
	80 - 99 = Reserved for state assignment
	M0 = PRO/UR approved stay dates - Eff 10/93,
	     the first and last days that were
	     approved where not all of the stay was
	     approved.

	SOURCE:
	CWF

              NAME              TYPE   LENGTH
------------------------------------   ------
107. Claim Occurrence Span From  DATE      8
     Date

	The from date of a period associated with
	an occurrence of a specific event relating to
	an institutional claim that may affect payer
	processing.

	8 DIGITS UNSIGNED

	SHORT NAME: SPANFROM
	LONG NAME: SPAN_FROM_DT

	EDIT-RULES:
	YYYYMMDD

	SOURCE:
	CWF

108. Claim Occurrence Span        DATE     8
     Through Date

	The thru date of a period associated with an
	occurrence of a specific event relating to an
	institutional claim that may affect payer
	processing.

	8 DIGITS UNSIGNED

	SHORT NAME: SPANTHRU
	LONG NAME: SPAN_TO_DT

	EDIT-RULES:
	YYYYMMDD

	SOURCE:
	CWF

109. Claim Related Value Code  CHAR	2             
     Sequence

	This number identifies the position of the
	related value code in the event that 
	multiple related value codes are recorded.
	 
	SHORT NAME: RLTVALSQ
	LONG NAME: RLT_VAL_CD_SEQ

	SOURCE:
	CCW

110. Claim Value Code             CHAR      2

	The code indicating the value of a monetary
	condition which was used by the intermediary
	to process an institutional claim.

	SHORT NAME: VAL_CD
	LONG NAME: VAL_CD

	SOURCE:
	CWF

111. Claim Value Amount           NUM     12

	The amount related to the condition identified
	in the CLM_VAL_CD which was used by the
	intermediary to process the institutional
	claim.

	9.2 DIGITS SIGNED

	SHORT NAME: VAL_AMT
	LONG NAME: VAL_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	CWF

              NAME              TYPE   LENGTH
------------------------------------   ------
112. Claim Line Number	         NUM	13             

	This number identifies the line number of 
	the claim.
 
	SHORT NAME: CLM_LN
	LONG NAME: CLM_LINE_NUM

	SOURCE:
	CCW

113. Revenue Center Code          CHAR      4

	The provider-assigned revenue code for each cost center for
	which a separate charge is billed (type of accommodation or
	ancillary).  A cost center is a division or unit within a
	hospital (e.g., radiology, emergency room, pathology).
	EXCEPTION:  Revenue center code 0001 represents the total of
	all revenue centers included on the claim.

	SHORT NAME: REV_CNTR
	LONG NAME: REV_CNTR

	SOURCE:
	CWF

114. Revenue Center Date          DATE      8

	Effective with Version H, the date applicable
	to the service represented by the revenue center
	code.   This field may be present on any of the
	institutional claim types.  For home health claims
	the service date should be present on all bills
	with from date greater than 3/31/98.  With the
	implementation of outpatient PPS, hospitals will
	be required to enter line item dates of service
	for all outpatient services which require a HCPCS.

	NOTE1:  Beginning with NCH weekly process date
	10/3/97 this field was populated with data.
	Claims processed prior to 10/3/97 will contain
	zeroes in this field.

	NOTE2:  When revenue center code equals '0022'
	(SNF PPS) and revenue center HCPCS code not equal
	to 'AAA00' (default for no assessment), date re-
	presents the MDS RAI assessment reference date.

	NOTE3:  When revenue center code equals '0023'
	(HHPPS), the  date on the initial claim (RAP) must
	represent the first date of service in the episode.
	The final claim will match the '0023' information
	submitted on the initial claim.  The SCIC
	(significant change in condition) claims may show
	additional '0023' revenue lines in which the
	date represents the date of the first service
	under the revised plan of treatment.

	8 DIGITS UNSIGNED

	SHORT NAME: REV_DT
	LONG NAME: REV_CNTR_DT

	EDIT-RULES:
	YYYYMMDD

	SOURCE:
	CWF

115. Filler

116. Filler

              NAME              TYPE   LENGTH
------------------------------------   ------
117. Filler

118. Filler

119. Filler

120. Line HCPCS Code              CHAR      5

	The Health Care Financing Administration (HCFA)
	Common Procedure Coding System (HCPCS) is a
	collection of codes that represent procedures,
	supplies, products and services which may be
	provided to Medicare beneficiaries and to
	individuals enrolled in private health
	insurance programs.  The codes are divided
	into three levels, or groups, as described
	below:

	SHORT NAME: HCPCS_CD
	LONG NAME: HCPCS_CD

	COMMENT:
	Prior to Version H this line item field was
	named: HCPCS_CD.  With Version H, a prefix
	was added to denote the location of this field
	on each claim type (institutional: REV_CNTR and
	noninstitutional: LINE).

	Level I
	   Codes and descriptors copyrighted by the American
	   Medical Association's Current Procedural
	   Terminology, Fourth Edition (CPT-4).  These are
	   5 position numeric codes representing physician
	   and nonphysician services.

	   **** Note: ****
	   CPT-4 codes including both long and short
	   descriptions shall be used in accordance with the
	   HCFA/AMA agreement.  Any other use violates the
	   AMA copyright.

	Level II
	   Includes codes and descriptors copyrighted by
	   the American Dental Association's Current Dental
	   Terminology, Second Edition (CDT-2).  These are
	   5 position alpha-numeric codes comprising
	   the D series.  All other level II codes and
	   descriptors are approved and maintained jointly
	   by the alpha-numeric editorial panel (consisting
	   of HCFA, the Health Insurance Association of
	   America, and the Blue Cross and Blue Shield
	   Association).  These are 5 position alpha-
	   numeric codes representing primarily items and
	   nonphysician services that are not
	   represented in the level I codes.

	Level III
	   Codes and descriptors developed by Medicare
	   carriers for use at the local (carrier) level.
	   These are 5 position alpha-numeric codes in the
	   W, X, Y or Z series representing physician
	   and nonphysician services that are not
	   represented in the level I or level II codes.

121. Line HCPCS Initial Modifier  CHAR      2
     Code

	A first modifier to the HCPCS procedure code
	to enable a more specific procedure
	identification for the line item service
	on the noninstitutional claim.

	SHORT NAME: MDFR_CD1
	LONG NAME: HCPCS_1ST_MDFR_CD

	EDIT-RULES:
	CARRIER INFORMATION FILE

	SOURCE:
	CWF

              NAME               TYPE   LENGTH
-------------------------------------   ------
122. Line HCPCS Second Modifier  CHAR      2
     Code

	A second modifier to the HCPCS procedure code to
	make it more specific than the first modifier
	code to identify the line item procedures for
	this claim.

	SHORT NAME: MDFR_CD2
	LONG NAME: HCPCS_2ND_MDFR_CD

	EDIT-RULES:
	CARRIER INFORMATION FILE

	SOURCE:
	CWF

123. Filler

124. Filler
              NAME              TYPE   LENGTH
------------------------------------   ------
125. Filler

126. Filler

127. Filler

128. Filler

129. Revenue Center Unit Count   NUM      8

	A quantitative measure (unit) of the number of times the
	service or procedure being reported was performed according
	to the revenue center/HCPCS code definition as described on
	an institutional claim.

	Depending on type of service, units are measured by number
	of covered days in a particular accommodation, pints of
	blood, emergency room visits, clinic visits, dialysis
	treatments (sessions or days), outpatient therapy visits,
	and outpatient clinical diagnostic laboratory tests.

	NOTE1:  When revenue center code = '0022' (SNF PPS) the unit
	count will reflect the number of covered days for each HIPPS
	code and, if applicable, the number of visits for each rehab
	therapy code.

	7 DIGITS SIGNED

	SHORT NAME: REV_UNIT
	LONG NAME: REV_CNTR_UNIT_CNT

	SOURCE:
	CWF


              NAME              TYPE   LENGTH
------------------------------------   ------
130. Revenue Center Rate Amount  NUM     12

	Charges relating to unit cost associated with
	the revenue center code.  Exception (encounter
	data only):  If plan (e.g. MCO) does not know
	the actual rate for the accommodations, $1 will
	be reported in the field.

	NOTE1:  For SNF PPS claims (when revenue center
	code equals '0022'), HCFA has developed a SNF
	PRICER to compute the rate based on the provider
	supplied coding for the MDS RUGS III group and
	assessment type (HIPPS code, stored in revenue
	center HCPCS code field).

	NOTE2:  For OP PPS claims, HCFA has developed a
	PRICER to compute the rate based on the Ambulatory
	Payment Classification (APC), discount factor,
	units of service and the wage index.

	NOTE3:  Under HH PPS (when revenue center
	code equals '0023'), HCFA has developed a HHA
	PRICER to compute the rate.  On the RAP, the rate is
	determined using the case mix weight associated with
	the HIPPS code, adjusting it for the wage index
	for the beneficiary's site of service, then
	multiplying the result by 60% or 50%, depending on
	whether or not the RAP is for a first episode.

	On the final claim, the HIPPS code could change the
	payment if the therapy threshold is not met, or
	partial episode payment (PEP) adjustment or a
	significant change in condition (SCIC) adjustment.
	In cases of SCICs, there will be more than one
	'0023' revenue center line, each representing the
	payment made at each case-mix level.

	9.2 DIGITS SIGNED

	SHORT NAME: REV_RATE
	LONG NAME: REV_CNTR_RATE_AMT

	EFFECTIVE-DATE: 10/01/1993

	SOURCE:
	CWF

131. Filler

132. Filler

133. Filler

134. Filler
             
135. Filler

136. Filler

137. Revenue Center Provider       NUM    12
     Payment Amount

	Effective with Version 'I', the amount paid
	to the provider for the services reported
	on the line item.

	NOTE:  Beginning with NCH weekly process date
	7/7/00, this field will be populated with data.
	Claims processed prior to 7/7/00 will contain
	spaces in this field.

	9.2 DIGITS SIGNED

	SHORT NAME: RPRVDPMT
	LONG NAME: REV_CNTR_PRVDR_PMT_AMT

	SOURCE:
	CWF

138. Revenue Center Beneficiary   NUM     12
     Payment Amount

	Effective with Version I, the amount paid
	to the beneficiary for the services reported
	on the line item.

	NOTE:  Beginning with NCH weekly process date
	7/7/00, this field will be populated with data.
	Claims processed prior to 7/7/00 will contain
	spaces in this field.

	9.2 DIGITS SIGNED

	SHORT NAME: RBENEPMT
	LONG NAME: REV_CNTR_BENE_PMT_AMT

	SOURCE:
	CWF

139. Filler

              NAME              TYPE   LENGTH
------------------------------------   ------
140. Revenue Center Payment      NUM    12
     Amount

	Effective with Version 'I', the line item
	Medicare payment amount for the specific
	revenue center.

	Under OP PPS, PRICER will compute the
	standard OPPS payment for a line item based
	on the payment APC.

	Under HH PPS, PRICER will compute/return
	a line item payment amount for the case-mixed,
	wage-index adjusted HIPPS code assigned to
	the '0023' revenue center line.  The HIPPS
	code will be stored in the Revenue Center
	HCPCS code field.

	9.2 DIGITS SIGNED

	SHORT NAME: REVPMT
	LONG NAME: REV_CNTR_PMT_AMT_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	CWF

141. Revenue Center Total Charge  NUM     12
     Amount

	The total charges (covered and non-covered) for all
	accommodations and services (related to the revenue code)
	for a billing period before reduction for the deductible and
	coinsurance amounts and before an adjustment for the cost of
	services provided.  NOTE: For accommodation revenue center
	total charges must equal the rate times units (days).

	EXCEPTIONS:
	(1)  For SNF RUGS demo claims only (9000 series revenue
	center codes), this field contains SNF customary
	accommodation charge, (ie., charges related to the
	accommodation revenue center code that would have been
	applicable if the provider had not been participating in the
	demo).

	(2)  For SNF PPS (non demo claims), when revenue center code
	= '0022', the total charges will be zero.

	(3)  For Home Health PPS (RAPs), when revenue center code =
	'0023', the total charges will equal the dollar amount for
	the '0023' line.

	(4) For Home Health PPS (final claim), when revenue center
	code = '0023', the total charges will be the sum of the
	revenue center code lines (other than '0023').

	(5)  For encounter data, if the plan (e.g. MCO) does not
	know the actual charges for the accommodations the total
	charges will be $1 (rate) times units (days).

	9.2 DIGITS SIGNED

	SHORT NAME: REV_CHRG
	LONG NAME: REV_CNTR_TOT_CHRG_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	CWF

142. Revenue Center Non-Covered   NUM     12
     Charge Amount

	The charge amount related to a revenue center code for
	services that are not covered by Medicare.

	NOTE:  Prior to Version H the field size was S9(7)V99 and
	the element was only present on the Inpatient/SNF format.
	As of NCH weekly process date 10/3/97 this field was added
	to all institutional claim types.
	
	9.2 DIGITS SIGNED

	SHORT NAME: REV_NCVR
	LONG NAME: REV_CNTR_NCVRD_CHRG_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	SOURCE:
	CWF

143. Revenue Center Deductible    CHAR      1
     Coinsurance Code

	Code indicating whether the revenue center charges
	are subject to deductible and/or coinsurance.

	SHORT NAME: REVDEDCD
	LONG NAME: REV_CNTR_DDCTBL_COINSRNC_CD

	CODES:
	Revenue Center Deductible Coinsurance Code
	------------------------------------------
	0 = Charges are subject to deductible
	    and coinsurance
	1 = Charges are not subject to deductible
	2 = Charges are not subject to coinsurance
	3 = Charges are not subject to deductible
	    or coinsurance
	4 = No charge or units associated with this
	    revenue center code.  (For multiple
	    HCPCS per single revenue center code)

	For revenue center code 0001, the following
	MSP override values may be present:

	M = Override code; EGHP services involved
	    (eff 12/90 for non-institutional claims;
	    10/93 for institutional claims)
	N = Override code; non-EGHP services involved
	    (eff 12/90 for non-institutional claims;
	    10/93 for institutional claims)
	X = Override code: MSP cost avoided
	    (eff 12/90 for non-institutional claims;
	    10/93 for institutional claims)

	SOURCE:
	CWF

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