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Variables : Claim Files

Institutional Claim Types | Non-Institutional Claim Types

Short SAS Name
Long SAS Name
Short Description
Type
 Length I/P O/P SNF Hospice HHA
Base Claim Files  
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
RIC_CD NCH_NEAR_LINE_REC_IDENT_CD NCH Near Line Record Identification Code CHAR
1
3
3
3
3
3
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
4
4
4
4
4
FROM_DT CLM_FROM_DT Claim From Date DATE
8
5
5
5
5
5
THRU_DT CLM_THRU_DT Claim Through Date DATE
8
6
6
6
6
6
WKLY_DT NCH_WKLY_PROC_DT NCH Weekly Claim Processing Date DATE
8
7
7
7
7
7
QUERY_CD CLAIM_QUERY_CODE Claim Query Code CHAR
1
8
8
8
-
-
PROVIDER PRVDR_NUM Provider Number CHAR
6
9
9
9
8
8
FAC_TYPE CLM_FAC_TYPE_CD Claim Facility Type Code CHAR
1
10
10
10
9
9
TYPESRVC CLM_SRVC_CLSFCTN_TYPE_CD Claim Service classification Type Code CHAR
1
11
11
11
10
10
FREQ_CD CLM_FREQ_CD Claim Frequency Code CHAR
1
12
12
12
11
11
FI_NUM FI_NUM FI Number CHAR
5
13
13
13
12
12
NOPAY_CD CLM_MDCR_NON_PMT_RSN_CD Claim Medicare Non Payment Reason Code CHAR
1
14
14
14
13
13
PMT_AMT CLM_PMT_AMT Claim Payment Amount NUM
12
15
15
15
14
14
PRPAYAMT NCH_PRMRY_PYR_CLM_PD_AMT NCH Primary Payer Claim Paid Amount* NUM
12
16
16
16
15
15
PRPAY_CD NCH_PRMRY_PYR_CD NCH Primary Payer Code CHAR
1
17
17
17
16
16
ACTIONCD FI_CLM_ACTN_CD FI Claim Action Code CHAR
1
18
-
18
-
-
PRSTATE PRVDR_STATE_CD NCH Provider State Code CHAR
2
19
18
19
17
17
ORGNPINM ORG_NPI_NUM Organization NPI Number CHAR
10
20
19
20
18
18
AT_UPIN AT_PHYSN_UPIN Claim Attending Physician UPIN Number CHAR
6
21
20
21
19
19
AT_NPI AT_PHYSN_NPI Claim Attending Physician NPI Number CHAR
10
22
21
22
20
20
OP_UPIN OP_PHYSN_UPIN Claim Operating Physician UPIN Number CHAR
6
23
22
23
-
-
OP_NPI OP_PHYSN_NPI Claim Operating Physician NPI Number CHAR
10
24
23
24
-
-
OT_UPIN OT_PHYSN_UPIN Claim Other Physician UPIN Number CHAR
6
25
24
25
-
-
OT_NPI OT_PHYSN_NPI Claim Other Physician NPI Number CHAR
10
26
25
26
-
-
MCOPDSW CLM_MCO_PD_SW Claim MCO Paid Switch CHAR
1
27
26
27
-
-
STUS_CD PTNT_DSCHRG_STUS_CD Patient Discharge Status Code CHAR
2
28
27
28
21
21
PPS_IND CLM_PPS_IND_CD Claim PPS Indicator Code CHAR
1
29
-
29
-
22
TOT_CHRG CLM_TOT_CHRG_AMT Claim Total Charge Amount NUM
12
30
28
30
22
23
ADMSN_DT CLM_ADMSN_DT Claim Admission Date DATE
8
31
-
31
-
-
TYPE_ADM CLM_IP_ADMSN_TYPE_CD Claim Inpatient Admission Type Code CHAR
1
32
-
32
-
-
SRC_ADMS CLM_SRC_IP_ADMSN_CD Claim Source Inpatient Admission Code CHAR
1
33
-
33
-
-
AD_DGNS ADMTNG_ICD9_DGNS_CD Claim Admitting Diagnosis Code CHAR
5
34
57
34
-
-
PTNTSTUS NCH_PTNT_STATUS_IND_CD NCH Patient Status Indicator Code CHAR
1
35
-
35
23
-
PER_DIEM CLM_PASS_THRU_PER_DIEM_AMT Claim Pass Thru Per Diem Amount NUM
12
36
-
-
-
-
DED_AMT NCH_BENE_IP_DDCTBL_AMT NCH Beneficiary Inpatient Deductible Amount NUM
12
37
-
36
-
-
COIN_AMT NCH_BENE_PTA_COINSRNC_LBLTY_AM NCH Beneficiary Part A Coinsurance Liability Amount NUM
12
38
-
37
-
-
BLDDEDAM NCH_BENE_BLOOD_DDCTBL_LBLTY_AM NCH Beneficiary Blood Deductible Liability Amount NUM
12
39
29
38
-
-
PCCHGAMT NCH_PROFNL_CMPNT_CHRG_AMT NCH Professional Component Charge Amount NUM
12
40
30
-
-
-
NCCHGAMT NCH_IP_NCVRD_CHRG_AMT NCH Inpatient Noncovered Charge Amount NUM
12
41
-
39
-
-
TDEDAMT NCH_IP_TOT_DDCTN_AMT NCH Inpatient Total Deduction Amount NUM
12
42
-
40
-
-
PPS_CPTL CLM_TOT_PPS_CPTL_AMT Claim Total PPS Capital Amount NUM
12
43
-
-
-
-
CPTL_FSP CLM_PPS_CPTL_FSP_AMT Claim PPS Capital FSP Amount NUM
12
44
-
41
-
-
CPTLOUTL CLM_PPS_CPTL_OUTLIER_AMT Claim PPS Capital Outlier Amount NUM
12
45
-
42
-
-
DISP_SHR CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT Claim PPS Capital Disproportionate Share Amount NUM
12
46
-
43
-
-
IME_AMT CLM_PPS_CPTL_IME_AMT Claim PPS Capital IME Amount NUM
12
47
-
44
-
-
CPTL_EXP CLM_PPS_CPTL_EXCPTN_AMT Claim PPS Capital Exception Amount NUM
12
48
-
45
-
-
HLDHRMLS CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT Claim PPS Old Capital Hold Harmless Amount NUM
12
49
-
46
-
-
DRGWTAMT CLM_PPS_CPTL_DRG_WT_NUM Claim PPS Capital DRG Weight Number NUM
8
50
-
-
-
-
UTIL_DAY CLM_UTLZTN_DAY_CNT Claim Utilization Day Count NUM
3
51
-
47
24
-
COIN_DAY BENE_TOT_COINSRNC_DAYS_CNT Beneficiary Total Coinsurance Days Count NUM
3
52
-
48
-
-
LRD_USE BENE_LRD_USED_CNT Beneficiary LRD Used Count NUM
3
53
-
-
-
-
NUTILDAY CLM_NON_UTLZTN_DAYS_CNT Claim Non Utilization Days Count NUM
5
54
-
49
-
-
BLDFRNSH NCH_BLOOD_PNTS_FRNSHD_QTY NCH Blood Pints Furnished Quantity NUM
3
55
-
50
-
-
QLFYFROM NCH_QLFYD_STAY_FROM_DT NCH Qualified Stay From Date DATE
8
-
-
51
-
-
QLFYTHRU NCH_QLFYD_STAY_THRU_DT NCH Qualify Stay Through Date DATE
8
-
-
52
-
-
NCOVFROM NCH_VRFD_NCVRD_STAY_FROM_DT NCH Verified Noncovered Stay From Date DATE
8
56
-
53
-
-
NCOVTHRU NCH_VRFD_NCVRD_STAY_THRU_DT NCH Verified Noncovered Stay Through Date DATE
8
57
-
54
-
-
CARETHRU NCH_ACTV_OR_CVRD_LVL_CARE_THRU NCH Active or Covered Level Care Thru Date DATE
8
58
-
55
-
-
EXHST_DT NCH_BENE_MDCR_BNFTS_EXHTD_DT_I NCH Beneficiary Medicare Benefits Exhausted Date DATE
8
59
-
56
-
-
DSCHRGDT NCH_BENE_DSCHRG_DT NCH Beneficiary Discharge Date DATE
8
60
-
57
25
-
DRG_CD CLM_DRG_CD Claim Diagnosis Related Group Code CHAR
3
61
-
58
-
-
OUTLR_CD CLM_DRG_OUTLIER_STAY_CD Claim Diagnosis Related Group Outlier Stay Code CHAR
1
62
-
-
-
-
OUTLRPMT NCH_DRG_OUTLIER_APRVD_PMT_AMT NCH DRG Outlier Approved Payment Amount NUM
12
63
-
-
-
-
DGNSCD1 ICD9_DGNS_CD1 Primary Claim Diagnosis Code CHAR
5
64
31
59
26
24
DGNSCD2 ICD9_DGNS_CD2 Claim Diagnosis Code II CHAR
5
65
32
60
27
25
DGNSCD3 ICD9_DGNS_CD3 Claim Diagnosis Code III CHAR
5
66
33
61
28
26
DGNSCD4 ICD9_DGNS_CD4 Claim Diagnosis Code IV CHAR
5
67
34
62
29
27
DGNSCD5 ICD9_DGNS_CD5 Claim Diagnosis Code V CHAR
5
68
35
63
30
28
DGNSCD6 ICD9_DGNS_CD6 Claim Diagnosis Code VI CHAR
5
69
36
64
-
-
DGNSCD7 ICD9_DGNS_CD7 Claim Diagnosis Code VII CHAR
5
70
37
65
-
-
DGNSCD8 ICD9_DGNS_CD8 Claim Diagnosis Code VIII CHAR
5
71
38
66
-
-
DGNSCD9 ICD9_DGNS_CD9 Claim Diagnosis Code IX CHAR
5
72
39
67
-
-
DGNSCD10 ICD9_DGNS_CD10 Claim Diagnosis Code X CHAR
5
73
40
68
-
-
PRCDRCD1 ICD9_PRCDR_CD1 Primary Claim Procedure Code CHAR
5
74
41
69
-
-
PRCDRCD2 ICD9_PRCDR_CD2 Claim Procedure Code II CHAR
5
75
42
70
-
-
PRCDRCD3 ICD9_PRCDR_CD3 Claim Procedure Code III CHAR
5
76
43
71
-
-
PRCDRCD4 ICD9_PRCDR_CD4 Claim Procedure Code IV CHAR
5
77
44
72
-
-
PRCDRCD5 ICD9_PRCDR_CD5 Claim Procedure Code V CHAR
5
78
45
73
-
-
PRCDRCD6 ICD9_PRCDR_CD6 Claim Procedure Code VI CHAR
5
79
46
74
-
-
PRCDRDT1 PRCDR_DT1 Primary Claim Procedure Performed Date DATE
8
80
47
75
-
-
PRCDRDT2 PRCDR_DT2 Claim Procedure Performed Date II DATE
8
81
48
76
-
-
PRCDRDT3 PRCDR_DT3 Claim Procedure Performed Date III DATE
8
82
49
77
-
-
PRCDRDT4 PRCDR_DT4 Claim Procedure Performed Date IV DATE
8
83
50
78
-
-
PRCDRDT5 PRCDR_DT5 Claim Procedure Performed Date V DATE
8
84
51
79
-
-
PRCDRDT6 PRCDR_DT6 Claim Procedure Performed Date VI DATE
8
85
52
80
-
-
PTB_DED NCH_BENE_PTB_DDCTBL_AMT NCH Beneficiary Part B Deductible Amount NUM
12
-
53
-
-
-
PTB_COIN NCH_BENE_PTB_COINSRNC_AMT NCH Beneficiary Part B Coinsurance Amount NUM
12
-
54
-
-
-
PRVDRPMT CLM_OP_PRVDR_PMT_AMT Claim Outpatient Provider Payment Amount NUM
12
-
55
-
-
-
BENEPMT CLM_OP_BENE_PMT_AMT Claim Outpatient Beneficiary Payment Amount NUM
12
-
56
-
-
-
LUPAIND CLM_HHA_LUPA_IND_CD Claim HHA Low Utilization Payment Adjustment (LUPA) Indicator Code CHAR
1
-
-
-
-
34
HHA_RFRL CLM_HHA_RFRL_CD Claim HHA Referral Code CHAR
1
-
-
-
-
35
VISITCNT CLM_HHA_TOT_VISIT_CNT Claim HHA Total Visit Count NUM
3
-
-
-
-
36
HHSTRTDT CLM_ADMSN_DT Claim HHA Care Start Date DATE
8
-
-
-
-
37
HSPCSTRT CLM_HOSPC_START_DT_ID Claim Hospice Start Date DATE
8
-
-
-
36
-
HOSPCPRD BENE_HOSPC_PRD_CNT Beneficiary's Hospice Period Count NUM
1
-
-
-
37
-
IME_OP IME_OP_CLM_VAL_AMT Operating Indirect Medical Education (IME) Amount * NUM
12
86
-
-
-
-
DSH_OP DSH_OP_CLM_VAL_AMT Operating Disproportionate Share Amount* NUM
12
87
-
-
-
-

Condition Code File
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
3
3
3
3
3
RLTCNDSQ RLT_COND_CD_SEQ Claim Related Condition Code Sequence CHAR
2
4
4
4
4
4
RLT_COND CLM_RLT_COND_CD Claim Related Condition Code CHAR
2
5
5
5
5
5

Occurrence Code File
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
3
3
3
3
3
RLTOCRSQ RLT_OCRNC_CD_SEQ Claim Related Occurrence Code Sequence CHAR
2
4
4
4
4
4
OCRNC_CD CLM_RLT_OCRNC_CD Claim Related Occurrence Code CHAR
2
5
5
5
5
5
OCRNCDT CLM_RLT_OCRNC_DT Claim Related Occurrence Date DATE
8
6
6
6
6
6

Span Code File
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
3
3
3
3
3
RLTSPNSQ RLT_SPAN_CD_SEQ Claim Related Span Code Sequence CHAR
2
4
4
4
4
4
SPAN_CD CLM_SPAN_CD Claim Occurrence Span Code CHAR
2
5
5
5
5
5
SPANFROM CLM_SPAN_FROM_DT Claim Occurrence Span From Date DATE
8
6
6
6
6
6
SPANTHRU CLM_SPAN_THRU_DT Claim Occurrence Span Through Date DATE
8
7
7
7
7
7

Value Code File
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
3
3
3
3
3
RLTVALSQ RLT_VAL_CD_SEQ Claim Related Value Code Sequence CHAR
2
4
4
4
4
4
VAL_CD CLM_VAL_CD Claim Value Code CHAR
2
5
5
5
5
5
VAL_AMT CLM_VAL_AMT Claim Value Amount NUM
12
6
6
6
6
6

Revenue Center File
BENE_ID BENE_ID Encrypted 723 Beneficiary ID CHAR
15
1
1
1
1
1
CLM_ID CLM_ID Claim ID CHAR
15
2
2
2
2
2
THRU_DT CLM_THRU_DT Claim Through Date DATE
8
3
3
3
3
3
CLM_LN CLM_LINE_NUM Claim Line Number NUM
13
4
4
4
4
4
CLM_TYPE NCH_CLM_TYPE_CD NCH Claim Type Code CHAR
2
5
5
5
5
5
REV_CNTR REV_CNTR Revenue Center Code CHAR
4
6
6
6
6
6
REV_DT REV_CNTR_DT Revenue Center Date DATE
8
-
7
-
7
7
REVANSI1 REV_CNTR_1ST_ANSI_CD Revenue Center 1st ANSI Code CHAR
5
-
8
-
-
8
REVANSI2 REV_CNTR_2ND_ANSI_CD Revenue Center 2nd ANSI Code CHAR
5
-
9
-
-
-
REVANSI3 REV_CNTR_3RD_ANSI_CD Revenue Center 3rd ANSI Code CHAR
5
-
10
-
-
-
REVANSI4 REV_CNTR_4TH_ANSI_CD Revenue Center 4th ANSI Code CHAR
5
-
11
-
-
-
APCHIPPS REV_CNTR_APC_HIPPS_CD Revenue Center APC/HIPPS CHAR
5
-
12
-
-
9
HCPCS_CD HCPCS_CD Revenue Center HCFA Common Procedure Coding System CHAR
5
7
13
7
8
10
MDFR_CD1 HCPCS_1ST_MDFR_CD Revenue Center HCPCS Initial Modifier Code CHAR
2
-
14
-
9
11
MDFR_CD2 HCPCS_2ND_MDFR_CD Revenue Center HCPCS Second Modifier Code CHAR
2
-
15
-
10
12
PMTMTHD REV_CNTR_PMT_MTHD_IND_CD Revenue Center Payment Method Indicator Code CHAR
2
-
16
-
-
13
DSCNTIND REV_CNTR_DSCNT_IND_CD Revenue Center Discount Indicator Code CHAR
1
-
17
-
-
-
PACKGIND REV_CNTR_PACKG_IND_CD Revenue Center Packaging Indicator Code CHAR
1
-
18
-
-
-
OTAF_1 REV_CNTR_OTAF_PMT_CD Revenue Center Obligation to Accept As Full (OTAF) Payment Code CHAR
1
-
19
-
-
-
IDENDC REV_CNTR_IDE_NDC_UPC_NUM Revenue Center IDE, NDC, UPC Number CHAR
24
-
20
-
-
-
REV_UNIT REV_CNTR_UNIT_CNT Revenue Center Unit Count NUM
8
8
21
8
11
14
REV_RATE REV_CNTR_RATE_AMT Revenue Center Rate Amount NUM
12
9
22
9
12
15
REVBLOOD REV_CNTR_BLOOD_DDCTBL_AMT Revenue Center Blood Deductible Amount NUM
12
-
23
-
-
-
REVDCTBL REV_CNTR_CASH_DDCTBL_AMT Revenue Center Cash Deductible Amount NUM
12
-
24
-
-
-
WAGEADJ REV_CNTR_COINSRNC_WGE_ADJSTD_C Revenue Center Coinsurance/Wage Adjusted Coinsurance Amount NUM
12
-
25
-
-
-
RDCDCOIN REV_CNTR_RDCD_COINSRNC_AMT Revenue Center Reduced Coinsurance Amount NUM
12
-
26
-
-
-
REV_MSP1 REV_CNTR_1ST_MSP_PD_AMT Revenue Center 1st Medicare Secondary Payer Paid Amount NUM
12
-
27
-
-
-
REV_MSP2 REV_CNTR_2ND_MSP_PD_AMT Revenue Center 2nd Medicare Secondary Payer Paid Amount NUM
12
-
28
-
-
-
RPRVDPMT REV_CNTR_PRVDR_PMT_AMT Revenue Center Provider Payment Amount NUM
12
-
29
-
13
-
RBENEPMT REV_CNTR_BENE_PMT_AMT Revenue Center Beneficiary Payment Amount NUM
12
-
30
-
14
-
PTNTRESP REV_CNTR_PTNT_RSPNSBLTY_PMT Revenue Center Patient Responsibility Payment NUM
12
-
31
-
-
-
REVPMT REV_CNTR_PMT_AMT_AMT Revenue Center Payment Amount Amount NUM
12
-
32
-
15
16
REV_CHRG REV_CNTR_TOT_CHRG_AMT Revenue Center Total Charge Amount NUM
12
10
33
10
16
17
REV_NCVR REV_CNTR_NCVRD_CHRG_AMT Revenue Center Non-Covered Charge Amount NUM
12
11
34
11
17
18
REVDEDCD REV_CNTR_DDCTBL_COINSRNC_CD Revenue Center Deductible Coinsurance Code CHAR
1
12
-
12
18
19
REVSTIND REV_CNTR_STUS_IND_CD Revenue Center Status Indicator Code CHAR
2
-
35
-
-
20
Number shown on the matrix indicates the length of the data field.
"-" indicates this variable is not available for this claim type.
* Derived in the CCW using CMS derivation rules.

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