Variables : Claim Files

Institutional Claim Types | Non-Institutional Claim Types

Short SAS Name	Long SAS Name	Short Description	Type	Length	Carrier	DME
Claim File
BENE_ID	BENE_ID	Encrypted 723 Beneficiary ID	CHAR	15	1	1
CLM_ID	CLM_ID	Claim ID	CHAR	15	2	2
RIC_CD	NCH_NEAR_LINE_REC_IDENT_CD	NCH Near Line Record Identification Code	CHAR	1	3	3
CLM_TYPE	NCH_CLM_TYPE_CD	NCH Claim Type Code	CHAR	2	4	4
FROM_DT	CLM_FROM_DT	Claim From Date	DATE	8	5	5
THRU_DT	CLM_THRU_DT	Claim Through Date	DATE	8	6	6
WKLY_DT	NCH_WKLY_PROC_DT	NCH Weekly Claim Processing Date	DATE	8	7	7
ENTRY_CD	CARR_CLM_ENTRY_CD	Carrier Claim Entry Code	CHAR	1	8	8
DISP_CD	CLM_DISP_CD	Claim Disposition Code	CHAR	2	9	9
CARR_NUM	CARR_NUM	Carrier Number	CHAR	5	10	10
PMTDNLCD	CARR_CLM_PMT_DNL_CD	Carrier Claim Payment Denial Code	CHAR	1	11	11
PMT_AMT	CLM_PMT_AMT	Claim Payment Amount*	NUM	12	12	12
PRPAYAMT	CARR_CLM_PRMRY_PYR_PD_AMT	Carrier Claim Primary Payer Paid Amount*	NUM	12	13	13
RFR_UPIN	RFR_PHYSN_UPIN	Carrier Claim Referring Physician UPIN Number	CHAR	6	14	-
RFR_NPI	RFR_PHYSN_NPI	Carrier Claim Referring Physician NPI Number	CHAR	10	15	-
ASGMNTCD	CARR_CLM_PRVDR_ASGNMT_IND_SW	Carrier Claim Provider Assignment Indicator Switch	CHAR	1	16	14
PROV_PMT	NCH_CLM_PRVDR_PMT_AMT	NCH Claim Provider Payment Amount*	NUM	12	17	15
BENE _PMT	NCH_CLM_BENE_PMT_AMT	NCH Claim Beneficiary Payment Amount*	NUM	12	18	16
SBMTCHRG	NCH_CARR_CLM_SBMTD_CHRG_AMT	NCH Carrier Claim Submitted Charge Amount*	NUM	12	19	17
ALOWCHRG	NCH_CARR_CLM_ALOWD_AMT	NCH Carrier Claim Allowed Charge Amount*	NUM	12	20	18
DEDAPPLY	CARR_CLM_CASH_DDCTBL_APLD_AMT	Carrier Claim Cash Deductible Applied Amount*	NUM	12	21	19
HCPCS_YR	CARR_CLM_HCPCS_YR_CD	Carrier Claim HCPCS Year Code	CHAR	1	22	20
RFR_PRFL	CARR_CLM_RFRNG_PIN_NUM	Carrier Claim Referring PIN Number	CHAR	14	23	-
DGNS_CD1	ICD9_DGNS_CD1	Primary Claim Diagnosis Code	CHAR	5	24	21
DGNS_CD2	ICD9_DGNS_CD2	Claim Diagnosis Code II	CHAR	5	25	22
DGNS_CD3	ICD9_DGNS_CD3	Claim Diagnosis Code III	CHAR	5	26	23
DGNS_CD4	ICD9_DGNS_CD4	Claim Diagnosis Code IV	CHAR	5	27	24
DGNS_CD5	ICD9_DGNS_CD5	Claim Diagnosis Code V (effective 2007)	CHAR	5	28	25
DGNS_CD6	ICD9_DGNS_CD6	Claim Diagnosis Code VI (effective 2007)	CHAR	5	29	26
DGNS_CD7	ICD9_DGNS_CD7	Claim Diagnosis Code VII (effective 2007)	CHAR	5	30	27
DGNS_CD8	ICD9_DGNS_CD8	Claim Diagnosis Code VIII (effective 2007)	CHAR	5	31	28
RFR_UPIN	RFR_PHYSN_UPIN	DMERC Claim Ordering Physician UPIN Number	CHAR	6	-	29
RFR_NPI	RFR_PHYSN_NPI	DMERC Claim Ordering Physician NPI Number	CHAR	10	-	30
Line File
BENE_ID	BENE_ID	Encrypted 723 Beneficiary ID	CHAR	15	1	1
CLM_ID	CLM_ID	Claim ID	CHAR	15	2	2
LINE_NUM	LINE_NUM	Claim Line Number	NUM	13	3	3
CLM_TYPE	NCH_CLM_TYPE_CD	NCH Claim Type Code	CHAR	2	4	4
THRU_DT	CLM_THRU_DT	Claim Through Date	DATE	8	5	5
PRF_PRFL	CARR_PRFRNG_PIN_NUM	Carrier Line Performing PIN Number	CHAR	15	6	-
PRF_UPIN	PRF_PHYSN_UPIN	Carrier Line Performing UPIN Number	CHAR	6	7	-
PRFNPI	PRF_PHYSN_NPI	Carrier Line Performing NPI Number	CHAR	10	8	-
PRGRPNPI	ORG_NPI_NUM	Carrier Line Performing Group NPI Number	CHAR	10	9	-
PRV_TYPE	CARR_LINE_PRVDR_TYPE_CD	Carrier Line Provider Type Code	CHAR	1	10	-
TAX_NUM	TAX_NUM	Line Provider Tax Number	CHAR	10	11	6
PRVSTATE	PRVDR_STATE_CD	Line NCH Provider State Code	NUM	2	12	-
PROVZIP	PRVDR_ZIP	Carrier Line Performing Provider ZIP Code	CHAR	9	13	-
HCFASPCL	PRVDR_SPCLTY	Line HCFA Provider Specialty Code	CHAR	2	14	7
PRTCPTG	PRTCPTNG_IND_CD	Line Provider Participating Indicator Code	CHAR	1	15	8
ASTNT_CD	CARR_LINE_RDCD_PMT_PHYS_ASTN_C	Carrier Line Reduced Payment Physician Assistant Code	CHAR	1	16	-
SRVC_CNT	LINE_SRVC_CNT	Line Service Count	NUM	3	17	9
TYPSRVCB	LINE_CMS_TYPE_SRVC_CD	Line HCFA Type Service Code	CHAR	1	18	10
PLCSRVC	LINE_PLACE_OF_SRVC_CD	Line Place Of Service Code	CHAR	2	19	11
LCLTY_CD	CARR_LINE_PRCNG_LCLTY_CD	Carrier Line Pricing Locality Code	CHAR	2	20	-
EXPNSDT1	LINE_1ST_EXPNS_DT	Line First Expense Date	DATE	8	21	12
EXPNSDT2	LINE_LAST_EXPNS_DT	Line Last Expense Date	DATE	8	22	13
HCPCS_CD	HCPCS_CD	Line HCFA Common Procedure Coding System	CHAR	5	23	14
MDFR_CD1	HCPCS_1ST_MDFR_CD	Line HCPCS Initial Modifier Code	CHAR	2	24	15
MDFR_CD2	HCPCS_2ND_MDFR_CD	Line HCPCS Second Modifier Code	CHAR	2	25	16
BETOS	BETOS_CD	Line NCH BETOS Code	CHAR	3	26	17
LINEPMT	LINE_NCH_PMT_AMT	Line NCH Payment Amount	NUM	12	27	18
LBENPMT	LINE_BENE_PMT_AMT	Line Beneficiary Payment Amount	NUM	12	28	19
LPRVPMT	LINE_PRVDR_PMT_AMT	Line Provider Payment Amount	NUM	12	29	20
LDEDAMT	LINE_BENE_PTB_DDCTBL_AMT	Line Beneficiary Part B Deductible Amount	NUM	12	30	21
LPRPAYCD	LINE_BENE_PRMRY_PYR_CD	Line Beneficiary Primary Payer Code	CHAR	1	31	22
LPRPDAMT	LINE_BENE_PRMRY_PYR_PD_AMT	Line Beneficiary Primary Payer Paid Amount	NUM	12	32	23
COINAMT	LINE_COINSRNC_AMT	Line Coinsurance Amount	NUM	12	33	24
PRPYALOW	LINE_ALOWD_CHRG_AMT	Line Primary Payer Allowed Charge Amount	NUM	12	-	25
LSBMTCHG	LINE_SBMTD_CHRG_AMT	Line Submitted Charge Amount	NUM	12	34	26
LALOWCHG	LINE_ALOWD_CHRG_AMT	Line Allowed Charge Amount	NUM	12	35	27
PRCNGIND	LINE_PRCSG_IND_CD	Line Processing Indicator Code	CHAR	1	36	28
PMTINDSW	LINE_PMT_80_100_CD	Line Payment 80%/100% Code	CHAR	1	37	29
DED_SW	LINE_SERVICE_DEDUCTIBLE	Line Service Deductible Indicator Switch	CHAR	1	38	30
MTUS_CNT	CARR_LINE_MTUS_CNT	Carrier Line Miles/Time/Units/Services Count	NUM	5	39	-
MTUS_IND	CARR_LINE_MTUS_CD	Carrier Line Miles/Time/Units/Services Indicator Code	CHAR	1	40	-
LINEDGNS	LINE_ICD9_DGNS_CD	Line Diagnosis Code	CHAR	5	41	31
DME_PURC	LINE_DME_PRCHS_PRICE_AMT	Line DME Purchase Price Amount	NUM	12	-	32
SUPLRNUM	PRVDR_NUM	DMERC Line Supplier Provider Number	CHAR	10	-	33
SUP_NPI	PRVDR_NPI	DMERC Line Item Supplier NPI Number	CHAR	10	-	34
PRCNG_ST	DMERC_LINE_PRCNG_STATE_CD	DMERC Line Pricing State Code	NUM	2	-	35
PRVSTATE	PRVDR_STATE_CD	DMERC Line Provider State Code	NUM	2	-	36
SUP_TYPE	DMERC_LINE_SUPPLR_TYPE_CD	DMERC Line Supplier Type Code	CHAR	1	-	37
MDFR_CD3	HCPCS_3RD_MDFR_CD	DMERC Line HCPCS Third Modifier Code	CHAR	2	-	38
MDFR_CD4	HCPCS_4TH_MDFR_CD	DMERC Line HCPCS Fourth Modifier Code	CHAR	2	-	39
SCRNSVGS	DMERC_LINE_SCRN_SVGS_AMT	DMERC Line Screen Savings Amount	NUM	12	-	40
DME_UNIT	DMERC_LINE_MTUS_CNT	DMERC Line Miles/Time/Units/Services Count	NUM	7	-	41
UNIT_IND	DMERC_LINE_MTUS_CD	DMERC Line Miles/Time/ Units/Services Indicator Code	CHAR	1	-	42
HPSASCCD	HPSA_SCRCTY_IND_CD	Carrier Line HPSA/Scarcity Indicator Code	CHAR	1	42	-
CARRXNUM	CARR_LINE_RX_NUM	Carrier Line RX Number	CHAR	30	43	-

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.

April 2007 Archived Version of Carrier

April 2007 Archived Version of DME

July 2006 Archived version of Carrier and DME