United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Item Name Version State Type Organization
Medical Claims File Submission 2010-03-16 Maine File Specification Maine Health Data Organization (MHDO)
Medical Claims File Submission v1.2 Maine File Specification Maine Health Data Organization (MHDO)
File Specification: Medical Claims File Submission - 2010-03-16 (Maine) Medical Claims File Submission - v1.2 (Maine)
[Shared] Responsible Organization:
Maine Health Data Organization Maine Health Data Organization
[Unshared] Definition:
Not Provided "Medical claims file" means a data file composed of service level remittance information including, but not limited to, member demographics, provider information, charge/payment information, and clinical diagnosis/procedure codes from all non-denied adjudicated claims for each billed service.
File Specification: Medical Claims File Submission - 2010-03-16 (Maine) Medical Claims File Submission - v1.2 (Maine)
MC001
[Shared] Name: Payer
[Unshared] Type: varchar
[Unshared] Length: 8
Codes:
 
 
 
 
 
 
[Shared] Name: Payer
[Unshared] Type: CHAR
[Unshared] Length: 6
Codes:
C
Commercial carrier
T
Third Party Administrator
U
Unlicensed entity
MC002
[Shared] Name: National Plan ID
[Unshared] Type: varchar
[Shared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: CHAR
[Shared] Length: 30
MC003
[Shared] Name: Insurance Type/Product Code
[Unshared] Type: varchar
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Insurance Type/Product Code
[Unshared] Type: TEXT
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Risk
AM
Automobile Medical
DS
Disability
HM
Health Maintenance Organization
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
OF
Other Federal Program (e.g. Black Lung)
TV
Title V
VA
Veteran Administration Plan
WC
Worker's Compensation
MC004
[Shared] Name: Payer Claim Control Number
[Unshared] Type: varchar
[Shared] Length: 35
[Shared] Name: Payer Claim Control Number
[Unshared] Type: CHAR
[Shared] Length: 35
MC005
[Shared] Name: Line Counter
[Unshared] Type: integer
[Unshared] Length: 4
[Shared] Name: Line Counter
[Unshared] Type: NUMBER
[Unshared] Length: 30
MC005A
[Unshared] Name: Version Number
[Unshared] Type: integer
[Unshared] Length: 4
Data Element: MC005A
not present in this file submission.
MC006
[Unshared] Name: Month
[Unshared] Type: varchar
[Shared] Length: 30
[Unshared] Name: Insured Group or Policy Number
[Unshared] Type: CHAR
[Shared] Length: 30
MC007
[Shared] Name: Encrypted Subscriber Social Security Number
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Encrypted Subscriber Social Security Number
[Unshared] Type: CHAR
[Unshared] Length: 32
MC008
[Shared] Name: Plan Specific Contract Number
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Unshared] Type: CHAR
[Unshared] Length: 64
MC009
[Shared] Name: Member Suffix or Sequence Number
[Unshared] Type: integer
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Unshared] Type: CHAR
[Shared] Length: 20
MC010
[Shared] Name: Member Identification Code
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Member Identification Code
[Unshared] Type: CHAR
[Unshared] Length: 64
MC011
[Shared] Name: Individual Relationship Code
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Individual Relationship Code
[Unshared] 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
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
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
 
 
[Shared] Name: Member Gender
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
MC013
[Shared] Name: Member Date of Birth
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Member Date of Birth
[Unshared] Type: DATE
[Unshared] Length: 8
MC014
[Shared] Name: Member City Name
[Unshared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Unshared] Type: CHAR
[Shared] Length: 30
MC015
[Shared] Name: Member State or Province
[Unshared] Type: varchar
[Shared] Length: 2
[Shared] Name: Member State or Province
[Unshared] Type: CHAR
[Shared] Length: 2
MC016
[Shared] Name: Member ZIP Code
[Unshared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Unshared] Type: CHAR
[Shared] Length: 11
MC017
[Shared] Name: Date Service Approved (AP Date)
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Date Service Approved (AP Date)
[Unshared] Type: DATE
[Unshared] Length: 8
MC018
[Shared] Name: Admission Date
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Admission Date
[Unshared] Type: DATE
[Unshared] Length: 8
MC019
[Shared] Name: Admission Hour
[Unshared] Type: integer
[Unshared] Length: Not Provided
Codes:
 
 
 
 
 
 
[Shared] Name: Admission Hour
[Unshared] Type: NUMBER
[Unshared] Length: 4
Codes:
0-23
are valid codes
00
Midnight
12
Noon
MC020
[Shared] Name: Admission Type
[Unshared] Type: integer
[Unshared] Length: 1
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Admission Type
[Unshared] Type: NUMBER
[Unshared] Length: 2
Codes:
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
6
Reserved for National Assignment
7
Reserved for National Assignment
8
Reserved for National Assignment
9
Information not Available
MC021
[Shared] Name: Admission Source
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Admission Source
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
1
Physician referral
2
Clinic referral
3
HMO referral
4
Transfer from a hospital
5
Transfer from a skilled nursing facility
6
Transfer from another health care facility
7
Emergency Room
8
Court/Law enforcement
9
Information not available
Admissions other than newborn
 
For newborns (ADMSR = 4)
 
MC022
[Shared] Name: Discharge Hour
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
[Shared] Name: Discharge Hour
[Unshared] Type: NUMBER
[Shared] Length: 2
Codes:
0-23
are valid codes
00
Midnight
12
Noon
MC023
[Unshared] Name: Discharge Status
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Member Status
[Unshared] Type: NUMBER
[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
MC036
[Shared] Name: Type of Bill - Institutional
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Type of Bill - Institutional
[Unshared] Type: NUMBER
[Shared] Length: 2
Codes:
11
Hospital Inpatient (Including Medicare Part A)
12
Hospital Inpatient (Medicare Part B Only)
13
Hospital Outpatient
14
Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
15
Hospital Nursing Facility Level I
16
Hospital Nursing Facility Level II
17
Hospital Intermediate Care Level III Nursing Facility
18
Hospital Swing Beds
21
Skilled Nursing Inpatient (Including Medicare Part A)
22
Skilled Nursing Inpatient (Medicare Part B Only)
23
Skilled Nursing Outpatient
24
Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
25
Skilled Nursing Nursing Facility Level I
26
Skilled Nursing Nursing Facility Level II
27
Skilled Nursing Intermediate Care Level III Nursing Facility
28
Skilled Nursing Swing Beds
31
Home Health Inpatient (Including Medicare Part A)
32
Home Health Inpatient (Medicare Part B Only)
33
Home Health Outpatient
34
Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
35
Home Health Nursing Facility Level I
36
Home Health Nursing Facility Level II
37
Home Health Intermediate Care Level III Nursing Facility
38
Home Health Swing Beds
41
Christian Science Hospital Inpatient (Including Medicare Part A)
42
Christian Science Hospital Inpatient (Medicare Part B Only)
43
Christian Science Hospital Outpatient
44
Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
45
Christian Science Hospital Nursing Facility Level I
46
Christian Science Hospital Nursing Facility Level II
47
Christian Science Hospital Intermediate Care Level III Nursing Facility
48
Christian Science Hospital Swing Beds
51
Nursing Facility Level I Inpatient (Including Medicare Part A)
52
Nursing Facility Level I Inpatient (Medicare Part B Only)
53
Nursing Facility Level I Outpatient
54
Nursing Facility Level I Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
55
Nursing Facility Level I Nursing Facility Level I
56
Nursing Facility Level I Nursing Facility Level II
57
Nursing Facility Level I Intermediate Care Level III Nursing Facility
58
Nursing Facility Level I Swing Beds
61
Nursing Facility Level II Inpatient (Including Medicare Part A)
62
Nursing Facility Level II Inpatient (Medicare Part B Only)
63
Nursing Facility Level II Outpatient
64
Nursing Facility Level II Other (for hospital referenced diagnostic services or home health not under a plan of treatment)
65
Nursing Facility Level II Nursing Facility Level I
66
Nursing Facility Level II Nursing Facility Level II
67
Nursing Facility Level II Intermediate Care Level III Nursing Facility
68
Nursing Facility Level II Swing Beds
71
Intermediate Care Level III Nursing Facility Rural Health
72
Intermediate Care Level III Nursing Facility Hospital Based or Independent Renal
73
Intermediate Care Level III Nursing Facility Dialysis Center
74
Intermediate Care Level III Nursing Facility Free Standing
75
Intermediate Care Level III Nursing Facility Outpatient Rehabilitation Facility (ORF)
76
Intermediate Care Level III Nursing Facility Comprehensive Outpatient Rehabilitation
77
Intermediate Care Level III Nursing Facility Facilities (CORFs)
79
Intermediate Care Level III Nursing Facility Other
81
Swing Beds Hospice (Non Hospital Based
82
Swing Beds Hospice (Hospital-Based)
83
Swing Beds Ambulatory Surgery Center
84
Swing Beds Free Standing Birthing Center
89
Swing Beds Other
MC037
[Shared] Name: Facility Type - Professional
[Unshared] Type: varchar
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Facility Type - Professional
[Unshared] Type: CHAR
[Shared] Length: 2
Codes:
11
Office
12
Home
21
Inpatient Hospital
22
Outpatient Hospital
23
Emergency Room Hospital
24
Ambulatory Surgery Center
25
Birthing Center
26
Military Treatment Facility
31
Skilled Nursing Facility
32
Nursing Facility
33
Custodial Care Facility
34
Hospice
41
Ambulance Land
42
Ambulance Air or Water
50
Federally Qualified Center
51
Inpatient Psychiatric Facility
52
Psychiatric Facility Partial Hospitalization
53
Community Mental Health Center
54
Intermediate Care Facility/Mentally Retarded
55
Residential Substance Abuse Treatment Facility
56
Psychiatric Residential Treatment Center
60
Mass Immunization Center
61
Comprehensive Inpatient Rehabilitation Facility
62
Comprehensive Outpatient Rehabilitation Facility
65
End Stage Renal Disease Treatment Facility
71
State of Local Public Health Clinic
72
Rural Health Clinic
81
Independent Laboratory
99
Other Unlisted Facility
MC038
[Shared] Name: Claim Status
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Claim Status
[Unshared] Type: NUMBER
[Shared] Length: 2
Codes:
01
Processed as primary
02
Processed as secondary
03
Processed as tertiary
04
Denied
19
Processed as primary, forwarded to additional payer(s)
20
Processed as secondary, forwarded to additional payer(s)
21
Processed as tertiary, forwarded to additional payer(s)
22
Reversal of previous payment
MC039
[Shared] Name: Admitting Diagnosis
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Admitting Diagnosis
[Unshared] Type: CHAR
[Shared] Length: 5
MC040
[Shared] Name: E-Code
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: E-Code
[Unshared] Type: CHAR
[Shared] Length: 5
MC041
[Shared] Name: Principal Diagnosis
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Principal Diagnosis
[Unshared] Type: CHAR
[Shared] Length: 5
MC042
[Shared] Name: Other Diagnosis 1
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 1
[Unshared] Type: CHAR
[Shared] Length: 5
MC043
[Shared] Name: Other Diagnosis 2
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 2
[Unshared] Type: CHAR
[Shared] Length: 5
MC044
[Shared] Name: Other Diagnosis 3
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 3
[Unshared] Type: CHAR
[Shared] Length: 5
MC045
[Shared] Name: Other Diagnosis 4
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 4
[Unshared] Type: CHAR
[Shared] Length: 5
MC046
[Shared] Name: Other Diagnosis 5
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 5
[Unshared] Type: CHAR
[Shared] Length: 5
MC047
[Shared] Name: Other Diagnosis 6
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 6
[Unshared] Type: CHAR
[Shared] Length: 5
MC048
[Shared] Name: Other Diagnosis 7
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 7
[Unshared] Type: CHAR
[Shared] Length: 5
MC049
[Shared] Name: Other Diagnosis 8
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 8
[Unshared] Type: CHAR
[Shared] Length: 5
MC050
[Shared] Name: Other Diagnosis 9
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 9
[Unshared] Type: CHAR
[Shared] Length: 5
MC051
[Shared] Name: Other Diagnosis 10
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 10
[Unshared] Type: CHAR
[Shared] Length: 5
MC052
[Shared] Name: Other Diagnosis 11
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 11
[Unshared] Type: CHAR
[Shared] Length: 5
MC053
[Shared] Name: Other Diagnosis 12
[Unshared] Type: varchar
[Shared] Length: 5
[Shared] Name: Other Diagnosis 12
[Unshared] Type: CHAR
[Shared] Length: 5
MC054
[Shared] Name: Revenue Code
[Unshared] Type: varchar
[Shared] Length: 10
[Shared] Name: Revenue Code
[Unshared] Type: CHAR
[Shared] Length: 10
MC055
[Shared] Name: Procedure Code
[Unshared] Type: varchar
[Shared] Length: 10
[Shared] Name: Procedure Code
[Unshared] Type: CHAR
[Shared] Length: 10
MC056
[Shared] Name: Procedure Modifier 1
[Unshared] Type: varchar
[Shared] Length: 2
[Shared] Name: Procedure Modifier 1
[Unshared] Type: CHAR
[Shared] Length: 2
MC057
[Shared] Name: Procedure Modifier 2
[Unshared] Type: varchar
[Shared] Length: 2
[Shared] Name: Procedure Modifier 2
[Unshared] Type: CHAR
[Shared] Length: 2
MC058
[Shared] Name: ICD-9-CM Procedure Code
[Unshared] Type: varchar
[Shared] Length: 4
[Shared] Name: ICD-9-CM Procedure Code
[Unshared] Type: CHAR
[Shared] Length: 4
MC059
[Shared] Name: Date of Service From
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Date of Service From
[Unshared] Type: DATE
[Unshared] Length: 8
MC060
[Shared] Name: Date of Service Thru
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Date of Service Thru
[Unshared] Type: DATE
[Unshared] Length: 8
MC061
[Shared] Name: Quantity
[Unshared] Type: integer
[Shared] Length: 3
[Shared] Name: Quantity
[Unshared] Type: NUMBER
[Shared] Length: 3
MC062
[Shared] Name: Charge Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Charge Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC063
[Shared] Name: Paid Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Paid Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC064
[Shared] Name: Prepaid Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Prepaid Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC065
[Shared] Name: Copay Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Copay Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC066
[Shared] Name: Coinsurance Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Coinsurance Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC067
[Shared] Name: Deductible Amount
[Unshared] Type: decimal
[Shared] Length: 10
[Shared] Name: Deductible Amount
[Unshared] Type: NUMBER
[Shared] Length: 10
MC068
[Unshared] Name: Patient Account/Control Number
[Unshared] Type: varchar
[Unshared] Length: 20
Codes:
 
 
[Unshared] Name: Record Type
[Unshared] Type: CHAR
[Unshared] Length: 2
Codes:
MC
Medical Claims
MC069
[Unshared] Name: Discharge Date
[Unshared] Type: date
[Unshared] Length: Not Provided
[Unshared] Name: Patient Account/Control Number
[Unshared] Type: CHAR
[Unshared] Length: 38
MC070
Data Element: MC070
not present in this file submission.
[Unshared] Name: Discharge Date
[Unshared] Type: DATE
[Unshared] Length: 8
MC071
[Unshared] Name: Diagnosis-Related Group (DRG)
[Unshared] Type: varchar
[Unshared] Length: 10
Data Element: MC071
not present in this file submission.
MC072
[Unshared] Name: Version Number Of DRG Grouper Used
[Unshared] Type: varchar
[Unshared] Length: 2
Data Element: MC072
not present in this file submission.
MC073
[Unshared] Name: Ambulatory Payment Classification (APC)
[Unshared] Type: varchar
[Unshared] Length: 4
Data Element: MC073
not present in this file submission.
MC074
[Unshared] Name: Version Number Of APC Grouper Used
[Unshared] Type: varchar
[Unshared] Length: 2
Data Element: MC074
not present in this file submission.
MC075
[Unshared] Name: National Drug Code (NDC)
[Unshared] Type: varchar
[Unshared] Length: 11
Data Element: MC075
not present in this file submission.
MC076
[Unshared] Name: Billing Provider Number
[Unshared] Type: varchar
[Unshared] Length: 30
Data Element: MC076
not present in this file submission.
MC077
[Unshared] Name: National Billing Provider Identifier
[Unshared] Type: varchar
[Unshared] Length: 20
Data Element: MC077
not present in this file submission.
MC078
[Unshared] Name: Billing Provider Last Name or Organization Name
[Unshared] Type: varchar
[Unshared] Length: 60
Data Element: MC078
not present in this file submission.
MC101
[Unshared] Name: Encryped Subscriber Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: MC101
not present in this file submission.
MC102
[Unshared] Name: Encryped Subscriber First Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: MC102
not present in this file submission.
MC103
[Unshared] Name: Encryped Subscriber Middle Initial
[Unshared] Type: varchar
[Unshared] Length: 1
Data Element: MC103
not present in this file submission.
MC104
[Unshared] Name: Encryped Member Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: MC104
not present in this file submission.
MC105
[Unshared] Name: Encryped Member First Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: MC105
not present in this file submission.
MC106
[Unshared] Name: Encryped Member Middle Initial
[Unshared] Type: varchar
[Unshared] Length: 1
Data Element: MC106
not present in this file submission.
MC899
[Unshared] Name: Record Type
[Unshared] Type: varchar
[Unshared] Length: 2
Codes:
MC
 
Data Element: MC899
not present in this file submission.
MC901
[Shared] Name: Member Age
[Unshared] Type: integer
[Shared] Length: 3
[Shared] Name: Member Age
[Unshared] Type: NUMBER
[Shared] Length: 3
MC902
[Unshared] Name: Record ID#
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Record ID #
[Unshared] Type: NUMBER
[Unshared] Length: 12
MC903
[Unshared] Name: Date of Transfer to MHDO
[Unshared] Type: date
[Unshared] Length: Not Provided
[Unshared] Name: MHDO Extract Date
[Unshared] Type: DATE
[Unshared] Length: 8
MC904
[Unshared] Name: Encrypted Member ID# (longer of ESSN or Contract) + DOB
[Unshared] Type: varchar
[Shared] Length: 71
[Unshared] Name: Encrypted Member ID #
[Unshared] Type: CHAR
[Shared] Length: 71
MC905
[Shared] Name: Medicare Coverage
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Shared] Name: Medicare Coverage
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
1
Yes
2
No
MC906
[Unshared] Name: Submission ID#
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Submission ID #
[Unshared] Type: NUMBER
[Unshared] Length: 12
MC907
[Shared] Name: Double Encrypted Payer Claim Control Number
[Unshared] Type: varchar
[Shared] Length: 100
[Shared] Name: Double Encrypted Payer Claim Control Number
[Unshared] Type: CHAR
[Shared] Length: 100
MC908
[Shared] Name: Double Encrypted Subscriber Social Security Number
[Unshared] Type: varchar
[Shared] Length: 64
[Shared] Name: Double Encrypted Subscriber Social Security Number
[Unshared] Type: CHAR
[Shared] Length: 64
MC909
[Shared] Name: Double Encrypted Plan Specific Contract Number
[Unshared] Type: varchar
[Shared] Length: 128
[Shared] Name: Double Encrypted Plan Specific Contract Number
[Unshared] Type: CHAR
[Shared] Length: 128
MC910
[Unshared] Name: Double Encrypted Member Identification Code
[Unshared] Type: varchar
[Shared] Length: 128
[Unshared] Name: Double Encrypted Member Social Security Number
[Unshared] Type: CHAR
[Shared] Length: 128
MC911
[Unshared] Name: Double Encrypted Member ID# (longer of MHDO_ESSN or Provider ID#
[Unshared] Type: varchar
[Shared] Length: 135
[Unshared] Name: Double Encrypted Member ID #
[Unshared] Type: CHAR
[Shared] Length: 135
MC912
[Unshared] Name: Provider ID#
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Provider ID #
[Unshared] Type: INTEGER
[Unshared] Length: 12
MC913
[Shared] Name: Standardized Insurance Type/Product Code
[Unshared] Type: varchar
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Standardized Insurance Type/Product Code
[Unshared] Type: CHAR
[Shared] Length: 2
Codes:
11
Other non Federal program
12
Medicare secondary working aged beneficiary or spouse with employer group health plan
13
Medicare secondary end-stage renal disease beneficiary in the 12 month coordination period with an employer's group health plan
14
Medicare secondary, no-fault insurance including auto is primary
15
Medicare secondary public health service (PHS) or other federal agency
41
Medicare secondary black lung
42
Medicare secondary veteran's administration
43
Medicare secondary disabled beneficiary under age 65 with large group health plan (LGHP)
47
Medicare secondary, other liability insurance is primary
AM
Auto insurance policy
CP
Medicare conditionally primary
DB
Disability benefits
DS
Disability
EP
Exclusive Provider Organization (EPO)
HM
Health Maintenance Organization (HMO)
HN
Health Maintenance Organization (HMO) Medicare risk
HS
Special low income Medicare beneficiary
IN
Indemnity Insurance
LC
Long term care
LD
Long term policy
LI
Life insurance
LM
Liability medical
LT
Litigation
MA
Medicare part A
MB
Medicare part B
MC
Medicaid
MH
Medigap part A
MI
Medigap part B
MP
Medicare primary
OF
Other federal program (e.g. black lung)
OT
Other
PE
Property Insurance Personal
PR
Preferred Provider Organization (PPO)
PS
Point of Service (POS)
QM
Qualified Medicare beneficiary
SP
Supplemental policy
TV
Title V
VA
Veteran administration plan
WC
Workers' compensation
MC914
[Unshared] Name: ABORT
[Unshared] Type: integer
[Unshared] Length: Not Provided
Codes:
0
Release(default)
1
Withhold
[Unshared] Name: Abortion Flag
[Unshared] Type: INTEGER
[Unshared] Length: 1
Codes:
0
Release
1
Withhold
MC915
[Unshared] Name: PAID_YR
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Year Paid
[Unshared] Type: Number
[Unshared] Length: 4
MC916
[Unshared] Name: PAID_MON
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Month Paid
[Unshared] Type: Number
[Unshared] Length: 2
MC917
[Unshared] Name: INCURRED_YR
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Year of Service
[Unshared] Type: Number
[Unshared] Length: 4
MC918
[Unshared] Name: INCURRED_MON
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Month of Service
[Unshared] Type: Number
[Unshared] Length: 2
MC919
[Unshared] Name: Quarter
[Unshared] Type: integer
[Unshared] Length: Not Provided
Codes:
 
 
 
 
 
 
 
 
[Unshared] Name: Payment Quarter
[Unshared] Type: Number
[Unshared] Length: 1
Codes:
1
January - March
2
April - June
3
July - September
4
October - December
MC920
[Unshared] Name: Quarter
[Unshared] Type: integer
[Unshared] Length: Not Provided
Codes:
 
 
 
 
 
 
 
 
[Unshared] Name: Quarter Service Performed
[Unshared] Type: Number
[Unshared] Length: 1
Codes:
1
January - March
2
April - June
3
July - September
4
October - December
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