United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Medical Claims File Submission August 2011 - v3 Colorado File Specification Center for Improving Value in Health Care (CIVHC)
Medical Claims File Submission March 2013 - v5 Colorado File Specification Center for Improving Value in Health Care (CIVHC)
Medical Claims File Submission March 2014 - v6 Colorado File Specification Center for Improving Value in Health Care (CIVHC)
File Specification: Medical Claims File Submission - August 2011 - v3 (Colorado) Medical Claims File Submission - March 2013 - v5 (Colorado) Medical Claims File Submission - March 2014 - v6 (Colorado)
[Shared] Responsible Organization:
Center for Improving Value in Health Care Center for Improving Value in Health Care Center for Improving Value in Health Care
[Shared] Definition:
Not Provided Not Provided Not Provided
File Specification: Medical Claims File Submission - August 2011 - v3 (Colorado) Medical Claims File Submission - March 2013 - v5 (Colorado) Medical Claims File Submission - March 2014 - v6 (Colorado)
HD001
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
MC
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
MC
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
MC
 
HD002
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
HD003
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
HD004
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
HD005
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
HD006
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
MC001
[Unshared] Name: Payer
[Shared] Type: varchar
[Shared] Length: 8
[Unshared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Unshared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
MC002
[Unshared] Name: National Plan ID
[Shared] Type: varchar
[Shared] Length: 30
[Unshared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 30
[Unshared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 30
MC003
[Shared] Name: Insurance Type/Product Code
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
 
 
99
Other
CI
Commercial Insurance Company
 
 
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Supplemental Policy
TV
Title V
[Shared] Name: Insurance Type/Product Code
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
99
Other
CI
Commercial Insurance Company
DN
Dental
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Medicare Supplemental (Medi-gap) plan
TV
Title V
[Shared] Name: Insurance Type/Product Code
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
99
Other
CI
Commercial Insurance Company
DN
Dental
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Medicare Supplemental (Medi-gap) plan
TV
Title V
MC004
[Shared] Name: Payer Claim Control Number
[Shared] Type: varchar
[Shared] Length: 35
[Shared] Name: Payer Claim Control Number
[Shared] Type: varchar
[Shared] Length: 35
[Shared] Name: Payer Claim Control Number
[Shared] Type: varchar
[Shared] Length: 35
MC005
[Shared] Name: Line Counter
[Unshared] Type: tinyint
[Shared] Length: 4
[Shared] Name: Line Counter
[Unshared] Type: int
[Shared] Length: 4
[Shared] Name: Line Counter
[Unshared] Type: int
[Shared] Length: 4
MC005A
[Shared] Name: Version Number
[Unshared] Type: tinyint
[Shared] Length: 4
[Shared] Name: Version Number
[Unshared] Type: int
[Shared] Length: 4
[Shared] Name: Version Number
[Unshared] Type: int
[Shared] Length: 4
MC006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
MC007
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
MC008
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
MC009
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 20
MC010
[Shared] Name: Member Identification Code (patient)
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Member Identification Code (patient)
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Member Identification Code (patient)
[Shared] Type: varchar
[Shared] Length: 9
MC011
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
MC012
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
MC013
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
MC014
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
MC015
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
MC016
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
MC017
[Unshared] Name: Date Service Approved/Accou nts Payable Date/Actual Paid Date
[Shared] Type: char
[Shared] Length: 8
[Unshared] Name: Date Service Approved/Account s Payable Date/Actual Paid Date
[Shared] Type: char
[Shared] Length: 8
[Unshared] Name: Date Service Approved/Accounts Payable Date/Actual Paid Date
[Shared] Type: char
[Shared] Length: 8
MC018
[Shared] Name: Admission Date
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Admission Date
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Admission Date
[Shared] Type: char
[Shared] Length: 8
MC019
[Shared] Name: Admission Hour
[Shared] Type: char
[Shared] Length: 4
[Shared] Name: Admission Hour
[Shared] Type: char
[Shared] Length: 4
[Shared] Name: Admission Hour
[Shared] Type: char
[Shared] Length: 4
MC020
[Shared] Name: Admission Type
[Unshared] Type: tinyint
[Shared] Length: 1
Codes:
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
9
Information not available
[Shared] Name: Admission Type
[Unshared] Type: int
[Shared] Length: 1
Codes:
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
9
Information not available
[Shared] Name: Admission Type
[Unshared] Type: int
[Shared] Length: 1
Codes:
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
9
Information not available
MC021
[Shared] Name: Admission Source
[Shared] Type: char
[Shared] Length: 1
[Shared] Name: Admission Source
[Shared] Type: char
[Shared] Length: 1
[Shared] Name: Admission Source
[Shared] Type: char
[Shared] Length: 1
MC022
[Shared] Name: Discharge Hour
[Unshared] Type: tinyint
[Shared] Length: 4
[Shared] Name: Discharge Hour
[Unshared] Type: int
[Shared] Length: 4
[Shared] Name: Discharge Hour
[Unshared] Type: int
[Shared] Length: 4
MC023
[Shared] Name: Discharge Status
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Discharged to home or self care
02
Discharged/transferred to another short term general hospital for inpatient care
03
Discharged/transferred to skilled nursing facility (SNF)
04
Discharged/transferred to nursing facility (NF)
05
Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution
06
Discharged/transferred to home under 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 provider
09
Admitted as an inpatient to this hospital
20
Expired
30
Still patient or expected to return for outpatient services
40
Expired at home
41
Expired in a medical facility
42
Expired, place unknown
43
Discharged/ transferred to a Federal Hospital
50
Hospice - home
51
Hospice - medical facility
61
Discharged/transferred within this institution to a hospital-based Medicare-approved swing bed
62
Discharged/transferred to an inpatient rehabilitation facility including distinct parts of a hospital
63
Discharged/transferred to a long- term care hospital
64
Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare
[Shared] Name: Discharge Status
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Discharged to home or self-care
02
Discharged/transferred to another short term general hospital for inpatient care
03
Discharged/transferred to skilled nursing facility (SNF)
04
Discharged/transferred to nursing facility (NF)
05
Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution
06
Discharged/transferred to home under 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 provider
09
Admitted as an inpatient to this hospital
20
Expired
30
Still patient or expected to return for outpatient services
40
Expired at home
41
Expired in a medical facility
42
Expired, place unknown
43
Discharged/ transferred to a Federal Hospital
50
Hospice - home
51
Hospice - medical facility
61
Discharged/transferred within this institution to a hospital-based Medicare-approved swing bed
62
Discharged/transferred to an inpatient rehabilitation facility including distinct parts of a hospital
63
Discharged/transferred to a long- term care hospital
64
Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare
[Shared] Name: Discharge Status
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Discharged to home or self-care
02
Discharged/transferred to another short term general hospital for inpatient care
03
Discharged/transferred to skilled nursing facility (SNF)
04
Discharged/transferred to nursing facility (NF)
05
Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution
06
Discharged/transferred to home under 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 provider
09
Admitted as an inpatient to this hospital
20
Expired
30
Still patient or expected to return for outpatient services
40
Expired at home
41
Expired in a medical facility
42
Expired, place unknown
43
Discharged/ transferred to a Federal Hospital
50
Hospice - home
51
Hospice - medical facility
61
Discharged/transferred within this institution to a hospital-based Medicare-approved swing bed
62
Discharged/transferred to an inpatient rehabilitation facility including distinct parts of a hospital
63
Discharged/transferred to a long-term care hospital
64
Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare
MC024
[Shared] Name: Service Provider Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Service Provider Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Service Provider Number
[Shared] Type: varchar
[Shared] Length: 30
MC025
[Shared] Name: Service Provider Tax ID Number
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Tax ID Number
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Tax ID Number
[Shared] Type: varchar
[Shared] Length: 10
MC026
[Shared] Name: Service National Provider ID
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Service National Provider ID
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Service National Provider ID
[Shared] Type: varchar
[Shared] Length: 20
MC027
[Shared] Name: Service Provider Entity Type Qualifier
[Shared] Type: char
[Shared] Length: 1
Codes:
1
Person
2
Non-Person Entity
[Shared] Name: Service Provider Entity Type Qualifier
[Shared] Type: char
[Shared] Length: 1
Codes:
1
Person
2
Non-Person Entity
[Shared] Name: Service Provider Entity Type Qualifier
[Shared] Type: char
[Shared] Length: 1
Codes:
1
Person
2
Non-Person Entity
MC028
[Shared] Name: Service Provider First Name
[Shared] Type: varchar
[Shared] Length: 25
[Shared] Name: Service Provider First Name
[Shared] Type: varchar
[Shared] Length: 25
[Shared] Name: Service Provider First Name
[Shared] Type: varchar
[Shared] Length: 25
MC029
[Shared] Name: Service Provider Middle Name
[Shared] Type: varchar
[Shared] Length: 25
[Shared] Name: Service Provider Middle Name
[Shared] Type: varchar
[Shared] Length: 25
[Shared] Name: Service Provider Middle Name
[Shared] Type: varchar
[Shared] Length: 25
MC030
[Shared] Name: Service Provider Last Name or Organization Name
[Shared] Type: varchar
[Shared] Length: 60
[Shared] Name: Service Provider Last Name or Organization Name
[Shared] Type: varchar
[Shared] Length: 60
[Shared] Name: Service Provider Last Name or Organization Name
[Shared] Type: varchar
[Shared] Length: 60
MC031
[Shared] Name: Service Provider Suffix
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Suffix
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Suffix
[Shared] Type: varchar
[Shared] Length: 10
MC032
[Shared] Name: Service Provider Specialty
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Specialty
[Shared] Type: varchar
[Shared] Length: 10
[Shared] Name: Service Provider Specialty
[Shared] Type: varchar
[Shared] Length: 10
MC033
[Shared] Name: Service Provider City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Service Provider City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Service Provider City Name
[Shared] Type: varchar
[Shared] Length: 30
MC034
[Shared] Name: Service Provider State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Service Provider State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Service Provider State or Province
[Shared] Type: char
[Shared] Length: 2
MC035
[Shared] Name: Service Provider ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Service Provider ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Service Provider ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
MC036
[Shared] Name: Type of Bill - Institutional
[Shared] Type: char
[Shared] Length: 3
Codes:
111
Hospital Inpatient (Including Medicare Part A) Admit Through Discharge
112
Hospital Inpatient (Including Medicare Part A) Interim-First Claim Used for the
113
Hospital Inpatient (Including Medicare Part A) Interim-Continuing Claims
114
Hospital Inpatient (Including Medicare Part A) Interim-Last Claim
115
Hospital Inpatient (Including Medicare Part A) Late Charge Only
117
Hospital Inpatient (Including Medicare Part A) Replacement of Prior Claim
118
Hospital Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
119
Hospital Inpatient (Including Medicare Part A) Final Claim for a Home
121
Hospital Inpatient (Medicare Part B Only) Admit Through Discharge
122
Hospital Inpatient (Medicare Part B Only) Interim-First Claim Used for the
123
Hospital Inpatient (Medicare Part B Only) Interim-Continuing Claims
124
Hospital Inpatient (Medicare Part B Only) Interim-Last Claim
125
Hospital Inpatient (Medicare Part B Only) Late Charge Only
127
Hospital Inpatient (Medicare Part B Only) Replacement of Prior Claim
128
Hospital Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
129
Hospital Inpatient (Medicare Part B Only) Final Claim for a Home
131
Hospital Outpatient Admit Through Discharge
132
Hospital Outpatient Interim-First Claim Used for the
133
Hospital Outpatient Interim-Continuing Claims
134
Hospital Outpatient Interim-Last Claim
135
Hospital Outpatient Late Charge Only
137
Hospital Outpatient Replacement of Prior Claim
138
Hospital Outpatient Void/Cancel of a Prior Claim
139
Hospital Outpatient Final Claim for a Home
141
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
142
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
143
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
144
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
145
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
147
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
148
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
149
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
151
Hospital Nursing Facility Level I Admit Through Discharge
152
Hospital Nursing Facility Level I Interim-First Claim Used for the
153
Hospital Nursing Facility Level I Interim-Continuing Claims
154
Hospital Nursing Facility Level I Interim-Last Claim
155
Hospital Nursing Facility Level I Late Charge Only
157
Hospital Nursing Facility Level I Replacement of Prior Claim
158
Hospital Nursing Facility Level I Void/Cancel of a Prior Claim
159
Hospital Nursing Facility Level I Final Claim for a Home
161
Hospital Nursing Facility Level II Admit Through Discharge
162
Hospital Nursing Facility Level II Interim-First Claim Used for the
163
Hospital Nursing Facility Level II Interim-Continuing Claims
164
Hospital Nursing Facility Level II Interim-Last Claim
165
Hospital Nursing Facility Level II Late Charge Only
167
Hospital Nursing Facility Level II Replacement of Prior Claim
168
Hospital Nursing Facility Level II Void/Cancel of a Prior Claim
169
Hospital Nursing Facility Level II Final Claim for a Home
171
Hospital Intermediate Care Level III Nursing Facility Admit Through Discharge
172
Hospital Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
173
Hospital Intermediate Care Level III Nursing Facility Interim-Continuing Claims
174
Hospital Intermediate Care Level III Nursing Facility Interim-Last Claim
175
Hospital Intermediate Care Level III Nursing Facility Late Charge Only
177
Hospital Intermediate Care Level III Nursing Facility Replacement of Prior Claim
178
Hospital Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
179
Hospital Intermediate Care Level III Nursing Facility Final Claim for a Home
181
Hospital Swing Beds Admit Through Discharge
182
Hospital Swing Beds Interim-First Claim Used for the
183
Hospital Swing Beds Interim-Continuing Claims
184
Hospital Swing Beds Interim-Last Claim
185
Hospital Swing Beds Late Charge Only
187
Hospital Swing Beds Replacement of Prior Claim
188
Hospital Swing Beds Void/Cancel of a Prior Claim
189
Hospital Swing Beds Final Claim for a Home
211
Skilled Nursing Inpatient (Including Medicare Part A) Admit Through Discharge
212
Skilled Nursing Inpatient (Including Medicare Part A) Interim-First Claim Used for the
213
Skilled Nursing Inpatient (Including Medicare Part A) Interim-Continuing Claims
214
Skilled Nursing Inpatient (Including Medicare Part A) Interim-Last Claim
215
Skilled Nursing Inpatient (Including Medicare Part A) Late Charge Only
217
Skilled Nursing Inpatient (Including Medicare Part A) Replacement of Prior Claim
218
Skilled Nursing Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
219
Skilled Nursing Inpatient (Including Medicare Part A) Final Claim for a Home
221
Skilled Nursing Inpatient (Medicare Part B Only) Admit Through Discharge
222
Skilled Nursing Inpatient (Medicare Part B Only) Interim-First Claim Used for the
223
Skilled Nursing Inpatient (Medicare Part B Only) Interim-Continuing Claims
224
Skilled Nursing Inpatient (Medicare Part B Only) Interim-Last Claim
225
Skilled Nursing Inpatient (Medicare Part B Only) Late Charge Only
227
Skilled Nursing Inpatient (Medicare Part B Only) Replacement of Prior Claim
228
Skilled Nursing Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
229
Skilled Nursing Inpatient (Medicare Part B Only) Final Claim for a Home
231
Skilled Nursing Outpatient Admit Through Discharge
232
Skilled Nursing Outpatient Interim-First Claim Used for the
233
Skilled Nursing Outpatient Interim-Continuing Claims
234
Skilled Nursing Outpatient Interim-Last Claim
235
Skilled Nursing Outpatient Late Charge Only
237
Skilled Nursing Outpatient Replacement of Prior Claim
238
Skilled Nursing Outpatient Void/Cancel of a Prior Claim
239
Skilled Nursing Outpatient Final Claim for a Home
241
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
242
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
243
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
244
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
245
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
247
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
248
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
249
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
251
Skilled Nursing Nursing Facility Level I Admit Through Discharge
252
Skilled Nursing Nursing Facility Level I Interim-First Claim Used for the
253
Skilled Nursing Nursing Facility Level I Interim-Continuing Claims
254
Skilled Nursing Nursing Facility Level I Interim-Last Claim
255
Skilled Nursing Nursing Facility Level I Late Charge Only
257
Skilled Nursing Nursing Facility Level I Replacement of Prior Claim
258
Skilled Nursing Nursing Facility Level I Void/Cancel of a Prior Claim
259
Skilled Nursing Nursing Facility Level I Final Claim for a Home
261
Skilled Nursing Nursing Facility Level II Admit Through Discharge
262
Skilled Nursing Nursing Facility Level II Interim-First Claim Used for the
263
Skilled Nursing Nursing Facility Level II Interim-Continuing Claims
264
Skilled Nursing Nursing Facility Level II Interim-Last Claim
265
Skilled Nursing Nursing Facility Level II Late Charge Only
267
Skilled Nursing Nursing Facility Level II Replacement of Prior Claim
268
Skilled Nursing Nursing Facility Level II Void/Cancel of a Prior Claim
269
Skilled Nursing Nursing Facility Level II Final Claim for a Home
271
Skilled Nursing Intermediate Care Level III Nursing Facility Admit Through Discharge
272
Skilled Nursing Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
273
Skilled Nursing Intermediate Care Level III Nursing Facility Interim-Continuing Claims
274
Skilled Nursing Intermediate Care Level III Nursing Facility Interim-Last Claim
275
Skilled Nursing Intermediate Care Level III Nursing Facility Late Charge Only
277
Skilled Nursing Intermediate Care Level III Nursing Facility Replacement of Prior Claim
278
Skilled Nursing Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
279
Skilled Nursing Intermediate Care Level III Nursing Facility Final Claim for a Home
281
Skilled Nursing Swing Beds Admit Through Discharge
282
Skilled Nursing Swing Beds Interim-First Claim Used for the
283
Skilled Nursing Swing Beds Interim-Continuing Claims
284
Skilled Nursing Swing Beds Interim-Last Claim
285
Skilled Nursing Swing Beds Late Charge Only
287
Skilled Nursing Swing Beds Replacement of Prior Claim
288
Skilled Nursing Swing Beds Void/Cancel of a Prior Claim
289
Skilled Nursing Swing Beds Final Claim for a Home
311
Home Health Inpatient (Including Medicare Part A) Admit Through Discharge
312
Home Health Inpatient (Including Medicare Part A) Interim-First Claim Used for the
313
Home Health Inpatient (Including Medicare Part A) Interim-Continuing Claims
314
Home Health Inpatient (Including Medicare Part A) Interim-Last Claim
315
Home Health Inpatient (Including Medicare Part A) Late Charge Only
317
Home Health Inpatient (Including Medicare Part A) Replacement of Prior Claim
318
Home Health Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
319
Home Health Inpatient (Including Medicare Part A) Final Claim for a Home
321
Home Health Inpatient (Medicare Part B Only) Admit Through Discharge
322
Home Health Inpatient (Medicare Part B Only) Interim-First Claim Used for the
323
Home Health Inpatient (Medicare Part B Only) Interim-Continuing Claims
324
Home Health Inpatient (Medicare Part B Only) Interim-Last Claim
325
Home Health Inpatient (Medicare Part B Only) Late Charge Only
327
Home Health Inpatient (Medicare Part B Only) Replacement of Prior Claim
328
Home Health Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
329
Home Health Inpatient (Medicare Part B Only) Final Claim for a Home
331
Home Health Outpatient Admit Through Discharge
332
Home Health Outpatient Interim-First Claim Used for the
333
Home Health Outpatient Interim-Continuing Claims
334
Home Health Outpatient Interim-Last Claim
335
Home Health Outpatient Late Charge Only
337
Home Health Outpatient Replacement of Prior Claim
338
Home Health Outpatient Void/Cancel of a Prior Claim
339
Home Health Outpatient Final Claim for a Home
341
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
342
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
343
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
344
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
345
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
347
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
348
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
349
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
351
Home Health Nursing Facility Level I Admit Through Discharge
352
Home Health Nursing Facility Level I Interim-First Claim Used for the
353
Home Health Nursing Facility Level I Interim-Continuing Claims
354
Home Health Nursing Facility Level I Interim-Last Claim
355
Home Health Nursing Facility Level I Late Charge Only
357
Home Health Nursing Facility Level I Replacement of Prior Claim
358
Home Health Nursing Facility Level I Void/Cancel of a Prior Claim
359
Home Health Nursing Facility Level I Final Claim for a Home
361
Home Health Nursing Facility Level II Admit Through Discharge
362
Home Health Nursing Facility Level II Interim-First Claim Used for the
363
Home Health Nursing Facility Level II Interim-Continuing Claims
364
Home Health Nursing Facility Level II Interim-Last Claim
365
Home Health Nursing Facility Level II Late Charge Only
367
Home Health Nursing Facility Level II Replacement of Prior Claim
368
Home Health Nursing Facility Level II Void/Cancel of a Prior Claim
369
Home Health Nursing Facility Level II Final Claim for a Home
371
Home Health Intermediate Care Level III Nursing Facility Admit Through Discharge
372
Home Health Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
373
Home Health Intermediate Care Level III Nursing Facility Interim-Continuing Claims
374
Home Health Intermediate Care Level III Nursing Facility Interim-Last Claim
375
Home Health Intermediate Care Level III Nursing Facility Late Charge Only
377
Home Health Intermediate Care Level III Nursing Facility Replacement of Prior Claim
378
Home Health Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
379
Home Health Intermediate Care Level III Nursing Facility Final Claim for a Home
381
Home Health Swing Beds Admit Through Discharge
382
Home Health Swing Beds Interim-First Claim Used for the
383
Home Health Swing Beds Interim-Continuing Claims
384
Home Health Swing Beds Interim-Last Claim
385
Home Health Swing Beds Late Charge Only
387
Home Health Swing Beds Replacement of Prior Claim
388
Home Health Swing Beds Void/Cancel of a Prior Claim
389
Home Health Swing Beds Final Claim for a Home
411
Christian Science Hospital Inpatient (Including Medicare Part A) Admit Through Discharge
412
Christian Science Hospital Inpatient (Including Medicare Part A) Interim-First Claim Used for the
413
Christian Science Hospital Inpatient (Including Medicare Part A) Interim-Continuing Claims
414
Christian Science Hospital Inpatient (Including Medicare Part A) Interim-Last Claim
415
Christian Science Hospital Inpatient (Including Medicare Part A) Late Charge Only
417
Christian Science Hospital Inpatient (Including Medicare Part A) Replacement of Prior Claim
418
Christian Science Hospital Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
419
Christian Science Hospital Inpatient (Including Medicare Part A) Final Claim for a Home
421
Christian Science Hospital Inpatient (Medicare Part B Only) Admit Through Discharge
422
Christian Science Hospital Inpatient (Medicare Part B Only) Interim-First Claim Used for the
423
Christian Science Hospital Inpatient (Medicare Part B Only) Interim-Continuing Claims
424
Christian Science Hospital Inpatient (Medicare Part B Only) Interim-Last Claim
425
Christian Science Hospital Inpatient (Medicare Part B Only) Late Charge Only
427
Christian Science Hospital Inpatient (Medicare Part B Only) Replacement of Prior Claim
428
Christian Science Hospital Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
429
Christian Science Hospital Inpatient (Medicare Part B Only) Final Claim for a Home
431
Christian Science Hospital Outpatient Admit Through Discharge
432
Christian Science Hospital Outpatient Interim-First Claim Used for the
433
Christian Science Hospital Outpatient Interim-Continuing Claims
434
Christian Science Hospital Outpatient Interim-Last Claim
435
Christian Science Hospital Outpatient Late Charge Only
437
Christian Science Hospital Outpatient Replacement of Prior Claim
438
Christian Science Hospital Outpatient Void/Cancel of a Prior Claim
439
Christian Science Hospital Outpatient Final Claim for a Home
441
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
442
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
443
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
444
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
445
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
447
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
448
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
449
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
451
Christian Science Hospital Nursing Facility Level I Admit Through Discharge
452
Christian Science Hospital Nursing Facility Level I Interim-First Claim Used for the
453
Christian Science Hospital Nursing Facility Level I Interim-Continuing Claims
454
Christian Science Hospital Nursing Facility Level I Interim-Last Claim
455
Christian Science Hospital Nursing Facility Level I Late Charge Only
457
Christian Science Hospital Nursing Facility Level I Replacement of Prior Claim
458
Christian Science Hospital Nursing Facility Level I Void/Cancel of a Prior Claim
459
Christian Science Hospital Nursing Facility Level I Final Claim for a Home
461
Christian Science Hospital Nursing Facility Level II Admit Through Discharge
462
Christian Science Hospital Nursing Facility Level II Interim-First Claim Used for the
463
Christian Science Hospital Nursing Facility Level II Interim-Continuing Claims
464
Christian Science Hospital Nursing Facility Level II Interim-Last Claim
465
Christian Science Hospital Nursing Facility Level II Late Charge Only
467
Christian Science Hospital Nursing Facility Level II Replacement of Prior Claim
468
Christian Science Hospital Nursing Facility Level II Void/Cancel of a Prior Claim
469
Christian Science Hospital Nursing Facility Level II Final Claim for a Home
471
Christian Science Hospital Intermediate Care Level III Nursing Facility Admit Through Discharge
472
Christian Science Hospital Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
473
Christian Science Hospital Intermediate Care Level III Nursing Facility Interim-Continuing Claims
474
Christian Science Hospital Intermediate Care Level III Nursing Facility Interim-Last Claim
475
Christian Science Hospital Intermediate Care Level III Nursing Facility Late Charge Only
477
Christian Science Hospital Intermediate Care Level III Nursing Facility Replacement of Prior Claim
478
Christian Science Hospital Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
479
Christian Science Hospital Intermediate Care Level III Nursing Facility Final Claim for a Home
481
Christian Science Hospital Swing Beds Admit Through Discharge
482
Christian Science Hospital Swing Beds Interim-First Claim Used for the
483
Christian Science Hospital Swing Beds Interim-Continuing Claims
484
Christian Science Hospital Swing Beds Interim-Last Claim
485
Christian Science Hospital Swing Beds Late Charge Only
487
Christian Science Hospital Swing Beds Replacement of Prior Claim
488
Christian Science Hospital Swing Beds Void/Cancel of a Prior Claim
489
Christian Science Hospital Swing Beds Final Claim for a Home
511
Christian Science Extended Care Inpatient (Including Medicare Part A) Admit Through Discharge
512
Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-First Claim Used for the
513
Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-Continuing Claims
514
Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-Last Claim
515
Christian Science Extended Care Inpatient (Including Medicare Part A) Late Charge Only
517
Christian Science Extended Care Inpatient (Including Medicare Part A) Replacement of Prior Claim
518
Christian Science Extended Care Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
519
Christian Science Extended Care Inpatient (Including Medicare Part A) Final Claim for a Home
521
Christian Science Extended Care Inpatient (Medicare Part B Only) Admit Through Discharge
522
Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-First Claim Used for the
523
Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-Continuing Claims
524
Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-Last Claim
525
Christian Science Extended Care Inpatient (Medicare Part B Only) Late Charge Only
527
Christian Science Extended Care Inpatient (Medicare Part B Only) Replacement of Prior Claim
528
Christian Science Extended Care Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
529
Christian Science Extended Care Inpatient (Medicare Part B Only) Final Claim for a Home
531
Christian Science Extended Care Outpatient Admit Through Discharge
532
Christian Science Extended Care Outpatient Interim-First Claim Used for the
533
Christian Science Extended Care Outpatient Interim-Continuing Claims
534
Christian Science Extended Care Outpatient Interim-Last Claim
535
Christian Science Extended Care Outpatient Late Charge Only
537
Christian Science Extended Care Outpatient Replacement of Prior Claim
538
Christian Science Extended Care Outpatient Void/Cancel of a Prior Claim
539
Christian Science Extended Care Outpatient Final Claim for a Home
541
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
542
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
543
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
544
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
545
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
547
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
548
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
549
Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
551
Christian Science Extended Care Nursing Facility Level I Admit Through Discharge
552
Christian Science Extended Care Nursing Facility Level I Interim-First Claim Used for the
553
Christian Science Extended Care Nursing Facility Level I Interim-Continuing Claims
554
Christian Science Extended Care Nursing Facility Level I Interim-Last Claim
555
Christian Science Extended Care Nursing Facility Level I Late Charge Only
557
Christian Science Extended Care Nursing Facility Level I Replacement of Prior Claim
558
Christian Science Extended Care Nursing Facility Level I Void/Cancel of a Prior Claim
559
Christian Science Extended Care Nursing Facility Level I Final Claim for a Home
561
Christian Science Extended Care Nursing Facility Level II Admit Through Discharge
562
Christian Science Extended Care Nursing Facility Level II Interim-First Claim Used for the
563
Christian Science Extended Care Nursing Facility Level II Interim-Continuing Claims
564
Christian Science Extended Care Nursing Facility Level II Interim-Last Claim
565
Christian Science Extended Care Nursing Facility Level II Late Charge Only
567
Christian Science Extended Care Nursing Facility Level II Replacement of Prior Claim
568
Christian Science Extended Care Nursing Facility Level II Void/Cancel of a Prior Claim
569
Christian Science Extended Care Nursing Facility Level II Final Claim for a Home
571
Christian Science Extended Care Intermediate Care Level III Nursing Facility Admit Through Discharge
572
Christian Science Extended Care Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
573
Christian Science Extended Care Intermediate Care Level III Nursing Facility Interim-Continuing Claims
574
Christian Science Extended Care Intermediate Care Level III Nursing Facility Interim-Last Claim
575
Christian Science Extended Care Intermediate Care Level III Nursing Facility Late Charge Only
577
Christian Science Extended Care Intermediate Care Level III Nursing Facility Replacement of Prior Claim
578
Christian Science Extended Care Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
579
Christian Science Extended Care Intermediate Care Level III Nursing Facility Final Claim for a Home
581
Christian Science Extended Care Swing Beds Admit Through Discharge
582
Christian Science Extended Care Swing Beds Interim-First Claim Used for the
583
Christian Science Extended Care Swing Beds Interim-Continuing Claims
584
Christian Science Extended Care Swing Beds Interim-Last Claim
585
Christian Science Extended Care Swing Beds Late Charge Only
587
Christian Science Extended Care Swing Beds Replacement of Prior Claim
588
Christian Science Extended Care Swing Beds Void/Cancel of a Prior Claim
589
Christian Science Extended Care Swing Beds Final Claim for a Home
611
Intermediate Care Inpatient (Including Medicare Part A) Admit Through Discharge
612
Intermediate Care Inpatient (Including Medicare Part A) Interim-First Claim Used for the
613
Intermediate Care Inpatient (Including Medicare Part A) Interim-Continuing Claims
614
Intermediate Care Inpatient (Including Medicare Part A) Interim-Last Claim
615
Intermediate Care Inpatient (Including Medicare Part A) Late Charge Only
617
Intermediate Care Inpatient (Including Medicare Part A) Replacement of Prior Claim
618
Intermediate Care Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
619
Intermediate Care Inpatient (Including Medicare Part A) Final Claim for a Home
621
Intermediate Care Inpatient (Medicare Part B Only) Admit Through Discharge
622
Intermediate Care Inpatient (Medicare Part B Only) Interim-First Claim Used for the
623
Intermediate Care Inpatient (Medicare Part B Only) Interim-Continuing Claims
624
Intermediate Care Inpatient (Medicare Part B Only) Interim-Last Claim
625
Intermediate Care Inpatient (Medicare Part B Only) Late Charge Only
627
Intermediate Care Inpatient (Medicare Part B Only) Replacement of Prior Claim
628
Intermediate Care Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
629
Intermediate Care Inpatient (Medicare Part B Only) Final Claim for a Home
631
Intermediate Care Outpatient Admit Through Discharge
632
Intermediate Care Outpatient Interim-First Claim Used for the
633
Intermediate Care Outpatient Interim-Continuing Claims
634
Intermediate Care Outpatient Interim-Last Claim
635
Intermediate Care Outpatient Late Charge Only
637
Intermediate Care Outpatient Replacement of Prior Claim
638
Intermediate Care Outpatient Void/Cancel of a Prior Claim
639
Intermediate Care Outpatient Final Claim for a Home
641
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
642
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
643
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
644
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
645
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
647
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
648
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
649
Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
651
Intermediate Care Nursing Facility Level I Admit Through Discharge
652
Intermediate Care Nursing Facility Level I Interim-First Claim Used for the
653
Intermediate Care Nursing Facility Level I Interim-Continuing Claims
654
Intermediate Care Nursing Facility Level I Interim-Last Claim
655
Intermediate Care Nursing Facility Level I Late Charge Only
657
Intermediate Care Nursing Facility Level I Replacement of Prior Claim
658
Intermediate Care Nursing Facility Level I Void/Cancel of a Prior Claim
659
Intermediate Care Nursing Facility Level I Final Claim for a Home
661
Intermediate Care Nursing Facility Level II Admit Through Discharge
662
Intermediate Care Nursing Facility Level II Interim-First Claim Used for the
663
Intermediate Care Nursing Facility Level II Interim-Continuing Claims
664
Intermediate Care Nursing Facility Level II Interim-Last Claim
665
Intermediate Care Nursing Facility Level II Late Charge Only
667
Intermediate Care Nursing Facility Level II Replacement of Prior Claim
668
Intermediate Care Nursing Facility Level II Void/Cancel of a Prior Claim
669
Intermediate Care Nursing Facility Level II Final Claim for a Home
671
Intermediate Care Intermediate Care Level III Nursing Facility Admit Through Discharge
672
Intermediate Care Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
673
Intermediate Care Intermediate Care Level III Nursing Facility Interim-Continuing Claims
674
Intermediate Care Intermediate Care Level III Nursing Facility Interim-Last Claim
675
Intermediate Care Intermediate Care Level III Nursing Facility Late Charge Only
677
Intermediate Care Intermediate Care Level III Nursing Facility Replacement of Prior Claim
678
Intermediate Care Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
679
Intermediate Care Intermediate Care Level III Nursing Facility Final Claim for a Home
681
Intermediate Care Swing Beds Admit Through Discharge
682
Intermediate Care Swing Beds Interim-First Claim Used for the
683
Intermediate Care Swing Beds Interim-Continuing Claims
684
Intermediate Care Swing Beds Interim-Last Claim
685
Intermediate Care Swing Beds Late Charge Only
687
Intermediate Care Swing Beds Replacement of Prior Claim
688
Intermediate Care Swing Beds Void/Cancel of a Prior Claim
689
Intermediate Care Swing Beds Final Claim for a Home
711
Clinic Rural HealthAdmit Through Discharge
712
Clinic Rural HealthInterim-First Claim Used for the
713
Clinic Rural HealthInterim-Continuing Claims
714
Clinic Rural HealthInterim-Last Claim
715
Clinic Rural HealthLate Charge Only
717
Clinic Rural HealthReplacement of Prior Claim
718
Clinic Rural HealthVoid/Cancel of a Prior Claim
719
Clinic Rural HealthFinal Claim for a Home
721
Clinic Hospital Based or Independent Renal Dialysis CenterAdmit Through Discharge
722
Clinic Hospital Based or Independent Renal Dialysis CenterInterim-First Claim Used for the
723
Clinic Hospital Based or Independent Renal Dialysis CenterInterim-Continuing Claims
724
Clinic Hospital Based or Independent Renal Dialysis CenterInterim-Last Claim
725
Clinic Hospital Based or Independent Renal Dialysis CenterLate Charge Only
727
Clinic Hospital Based or Independent Renal Dialysis CenterReplacement of Prior Claim
728
Clinic Hospital Based or Independent Renal Dialysis CenterVoid/Cancel of a Prior Claim
729
Clinic Hospital Based or Independent Renal Dialysis CenterFinal Claim for a Home
731
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Admit Through Discharge
732
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Interim-First Claim Used for the
733
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Interim-Continuing Claims
734
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Interim-Last Claim
735
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Late Charge Only
737
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Replacement of Prior Claim
738
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Void/Cancel of a Prior Claim
739
Clinic Free Standing Outpatient Rehabilitation Facility (ORF)Final Claim for a Home
751
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Admit Through Discharge
752
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Interim-First Claim Used for the
753
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Interim-Continuing Claims
754
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Interim-Last Claim
755
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Late Charge Only
757
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Replacement of Prior Claim
758
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Void/Cancel of a Prior Claim
759
Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs)Final Claim for a Home
761
Clinic Community Mental Health CenterAdmit Through Discharge
762
Clinic Community Mental Health CenterInterim-First Claim Used for the
763
Clinic Community Mental Health CenterInterim-Continuing Claims
764
Clinic Community Mental Health CenterInterim-Last Claim
765
Clinic Community Mental Health CenterLate Charge Only
767
Clinic Community Mental Health CenterReplacement of Prior Claim
768
Clinic Community Mental Health CenterVoid/Cancel of a Prior Claim
769
Clinic Community Mental Health CenterFinal Claim for a Home
791
Clinic OtherAdmit Through Discharge
792
Clinic OtherInterim-First Claim Used for the
793
Clinic OtherInterim-Continuing Claims
794
Clinic OtherInterim-Last Claim
795
Clinic OtherLate Charge Only
797
Clinic OtherReplacement of Prior Claim
798
Clinic OtherVoid/Cancel of a Prior Claim
799
Clinic OtherFinal Claim for a Home
811
Special Facility Hospice (Non Hospital Based)Admit Through Discharge
812
Special Facility Hospice (Non Hospital Based)Interim-First Claim Used for the
813
Special Facility Hospice (Non Hospital Based)Interim-Continuing Claims
814
Special Facility Hospice (Non Hospital Based)Interim-Last Claim
815
Special Facility Hospice (Non Hospital Based)Late Charge Only
817
Special Facility Hospice (Non Hospital Based)Replacement of Prior Claim
818
Special Facility Hospice (Non Hospital Based)Void/Cancel of a Prior Claim
819
Special Facility Hospice (Non Hospital Based)Final Claim for a Home
821
Special Facility Hospice (Hospital-Based)Admit Through Discharge
822
Special Facility Hospice (Hospital-Based)Interim-First Claim Used for the
823
Special Facility Hospice (Hospital-Based)Interim-Continuing Claims
824
Special Facility Hospice (Hospital-Based)Interim-Last Claim
825
Special Facility Hospice (Hospital-Based)Late Charge Only
827
Special Facility Hospice (Hospital-Based)Replacement of Prior Claim
828
Special Facility Hospice (Hospital-Based)Void/Cancel of a Prior Claim
829
Special Facility Hospice (Hospital-Based)Final Claim for a Home
831
Special Facility Ambulatory Surgery CenterAdmit Through Discharge
832
Special Facility Ambulatory Surgery CenterInterim-First Claim Used for the
833
Special Facility Ambulatory Surgery CenterInterim-Continuing Claims
834
Special Facility Ambulatory Surgery CenterInterim-Last Claim
835
Special Facility Ambulatory Surgery CenterLate Charge Only
837
Special Facility Ambulatory Surgery CenterReplacement of Prior Claim
838
Special Facility Ambulatory Surgery CenterVoid/Cancel of a Prior Claim
839
Special Facility Ambulatory Surgery CenterFinal Claim for a Home
841
Special Facility Free Standing Birthing CenterAdmit Through Discharge
842
Special Facility Free Standing Birthing CenterInterim-First Claim Used for the
843
Special Facility Free Standing Birthing CenterInterim-Continuing Claims
844
Special Facility Free Standing Birthing CenterInterim-Last Claim
845
Special Facility Free Standing Birthing CenterLate Charge Only
847
Special Facility Free Standing Birthing CenterReplacement of Prior Claim
848
Special Facility Free Standing Birthing CenterVoid/Cancel of a Prior Claim
849
Special Facility Free Standing Birthing CenterFinal Claim for a Home
891
Special Facility OtherAdmit Through Discharge
892
Special Facility OtherInterim-First Claim Used for the
893
Special Facility OtherInterim-Continuing Claims
894
Special Facility OtherInterim-Last Claim
895
Special Facility OtherLate Charge Only
897
Special Facility OtherReplacement of Prior Claim
898
Special Facility OtherVoid/Cancel of a Prior Claim
899
Special Facility OtherFinal Claim for a Home
[Shared] Name: Type of Bill - Institutional
[Shared] Type: char
[Shared] Length: 3
Codes:
111
Hospital Inpatient (Including Medicare Part A) Admit Through Discharge
112
Hospital Inpatient (Including Medicare Part A) Interim-First Claim Used for the
113
Hospital Inpatient (Including Medicare Part A) Interim-Continuing Claims
114
Hospital Inpatient (Including Medicare Part A) Interim-Last Claim
115
Hospital Inpatient (Including Medicare Part A) Late Charge Only
117
Hospital Inpatient (Including Medicare Part A) Replacement of Prior Claim
118
Hospital Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
119
Hospital Inpatient (Including Medicare Part A) Final Claim for a Home
121
Hospital Inpatient (Medicare Part B Only) Admit Through Discharge
122
Hospital Inpatient (Medicare Part B Only) Interim-First Claim Used for the
123
Hospital Inpatient (Medicare Part B Only) Interim-Continuing Claims
124
Hospital Inpatient (Medicare Part B Only) Interim-Last Claim
125
Hospital Inpatient (Medicare Part B Only) Late Charge Only
127
Hospital Inpatient (Medicare Part B Only) Replacement of Prior Claim
128
Hospital Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
129
Hospital Inpatient (Medicare Part B Only) Final Claim for a Home
131
Hospital Outpatient Admit Through Discharge
132
Hospital Outpatient Interim-First Claim Used for the
133
Hospital Outpatient Interim-Continuing Claims
134
Hospital Outpatient Interim-Last Claim
135
Hospital Outpatient Late Charge Only
137
Hospital Outpatient Replacement of Prior Claim
138
Hospital Outpatient Void/Cancel of a Prior Claim
139
Hospital Outpatient Final Claim for a Home
141
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
142
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim Used for the
143
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
144
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
145
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
147
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
148
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
149
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home
151
Hospital Nursing Facility Level I Admit Through Discharge
152
Hospital Nursing Facility Level I Interim-First Claim Used for the
153
Hospital Nursing Facility Level I Interim-Continuing Claims
154
Hospital Nursing Facility Level I Interim-Last Claim
155
Hospital Nursing Facility Level I Late Charge Only
157
Hospital Nursing Facility Level I Replacement of Prior Claim
158
Hospital Nursing Facility Level I Void/Cancel of a Prior Claim
159
Hospital Nursing Facility Level I Final Claim for a Home
161
Hospital Nursing Facility Level II Admit Through Discharge
162
Hospital Nursing Facility Level II Interim-First Claim Used for the
163
Hospital Nursing Facility Level II Interim-Continuing Claims
164
Hospital Nursing Facility Level II Interim-Last Claim
165
Hospital Nursing Facility Level II Late Charge Only
167
Hospital Nursing Facility Level II Replacement of Prior Claim
168
Hospital Nursing Facility Level II Void/Cancel of a Prior Claim
169
Hospital Nursing Facility Level II Final Claim for a Home
171
Hospital Intermediate Care Level III Nursing Facility Admit Through Discharge
172
Hospital Intermediate Care Level III Nursing Facility Interim-First Claim Used for the
173
Hospital Intermediate Care Level III Nursing Facility Interim-Continuing Claims
174
Hospital Intermediate Care Level III Nursing Facility Interim-Last Claim
175
Hospital Intermediate Care Level III Nursing Facility Late Charge Only
177
Hospital Intermediate Care Level III Nursing Facility Replacement of Prior Claim
178
Hospital Intermediate Care Level III Nursing Facility Void/Cancel of a Prior Claim
179
Hospital Intermediate Care Level III Nursing Facility Final Claim for a Home
181
Hospital Swing Beds Admit Through Discharge