United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Professional Services Variable Format File Submission February 20, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Professional Services Variable Format File Submission September 13, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Professional Services Variable Format File Submission January 9, 2014 Maryland File Specification Maryland Health Care Commission (MHCC)

Identifying Attributes

File Specification: Professional Services Variable Format File Submission - February 20, 2013 (Maryland) Professional Services Variable Format File Submission - September 13, 2013 (Maryland) Professional Services Variable Format File Submission - January 9, 2014 (Maryland)
[Shared] Responsible Organization:
Maryland Health Care Commission Maryland Health Care Commission Maryland Health Care Commission
[Shared] Definition:
Not provided Not provided Not provided

Data Elements & Codes

File Specification: Professional Services Variable Format File Submission - February 20, 2013 (Maryland) Professional Services Variable Format File Submission - September 13, 2013 (Maryland) Professional Services Variable Format File Submission - January 9, 2014 (Maryland)
1
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Professional Services
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Professional Services
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Professional Services
2
[Unshared] Name: Patient IdentifierP (payer encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Patient IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Patient IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
3
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
4
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
5
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
6
[Shared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
[Shared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
[Shared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
7
[Unshared] Name: Patient Zip Code
[Shared] Type: numeric
[Unshared] Length: 5
[Unshared] Name: Patient Zip Code+4digit add-on code
[Shared] Type: numeric
[Unshared] Length: 10
[Unshared] Name: Patient Zip Code+4digit add-on code
[Shared] Type: numeric
[Unshared] Length: 10
8
[Shared] Name: Patient Covered by Other Insurance Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes, other coverage is primary
2
Yes, other coverage is secondary
9
Unknown
[Shared] Name: Patient Covered by Other Insurance Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes, other coverage is primary
2
Yes, other coverage is secondary
9
Unknown
[Shared] Name: Patient Covered by Other Insurance Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes, other coverage is primary
2
Yes, other coverage is secondary
9
Unknown
9
[Shared] Name: Coverage Type
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
 
 
 
 
Z
Unknown
[Shared] Name: Coverage Type
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
 
 
 
 
Z
Unknown
[Shared] Name: Coverage Type
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP; not sold in MHBE)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan (not sold in MHBE) [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
B
Individual Market sold in MHBE
C
Small Business Options Program (SHOP) sold in MHBE
Z
Unknown
10
[Shared] Name: Source Company
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
[Shared] Name: Source Company
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
[Shared] Name: Source Company
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
11
[Shared] Name: Claim Related Condition
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Non-accident (default)
1
Work
2
Auto Accident
3
Other Accident
9
Unknown
[Shared] Name: Claim Related Condition
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Non-accident (default)
1
Work
2
Auto Accident
3
Other Accident
9
Unknown
[Shared] Name: Claim Related Condition
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Non-accident (default)
1
Work
2
Auto Accident
3
Other Accident
9
Unknown
12
[Shared] Name: Practitioner Federal Tax ID
[Shared] Type: alphanumeric
[Shared] Length: 9
[Shared] Name: Practitioner Federal Tax ID
[Shared] Type: alphanumeric
[Shared] Length: 9
[Shared] Name: Practitioner Federal Tax ID
[Shared] Type: alphanumeric
[Shared] Length: 9
13
[Unshared] Name: Participating Provider Flag
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Participating
2
Non-Participating
3
Unknown/Not Coded
 
 
[Unshared] Name: Participating Provider Status
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Participating
2
Non-Participating
3
Unknown/Not Coded
9
No Network for this Plan
[Unshared] Name: Participating Provider Status
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Participating
2
Non-Participating
3
Unknown/Not Coded
9
No Network for this Plan
14
[Shared] Name: Record Status
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Final Bill
8
Capitated or Global Contract Services
[Shared] Name: Record Status
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Final Bill
8
Capitated or Global Contract Services
[Shared] Name: Record Status
[Shared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Final Bill
8
Capitated or Global Contract Services
15
[Shared] Name: Claim Control Number
[Shared] Type: alphanumeric
[Shared] Length: 23
[Shared] Name: Claim Control Number
[Shared] Type: alphanumeric
[Shared] Length: 23
[Shared] Name: Claim Control Number
[Shared] Type: alphanumeric
[Shared] Length: 23
16
[Shared] Name: Claim Paid Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Claim Paid Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Claim Paid Date
[Shared] Type: numeric
[Shared] Length: 8
17
[Shared] Name: Date of Enrollment
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date of Enrollment
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date of Enrollment
[Shared] Type: numeric
[Shared] Length: 8
18
[Shared] Name: Date of Disenrollment
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date of Disenrollment
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date of Disenrollment
[Shared] Type: numeric
[Shared] Length: 8
19
[Shared] Name: Number of Line Items
[Shared] Type: numeric
[Shared] Length: 2
[Shared] Name: Number of Line Items
[Shared] Type: numeric
[Shared] Length: 2
[Shared] Name: Number of Line Items
[Shared] Type: numeric
[Shared] Length: 2
20
[Shared] Name: Number of Diagnosis Codes
[Shared] Type: numeric
[Shared] Length: 2
[Shared] Name: Number of Diagnosis Codes
[Shared] Type: numeric
[Shared] Length: 2
[Shared] Name: Number of Diagnosis Codes
[Shared] Type: numeric
[Shared] Length: 2
21
[Shared] Name: Diagnosis Field
[Shared] Type: alphanumeric
[Unshared] Length: 5
[Shared] Name: Diagnosis Field
[Shared] Type: alphanumeric
[Unshared] Length: 7
[Shared] Name: Diagnosis Field
[Shared] Type: alphanumeric
[Unshared] Length: 7
22
[Shared] Name: Service From Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Service From Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Service From Date
[Shared] Type: numeric
[Shared] Length: 8
23
[Shared] Name: Service Thru Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Service Thru Date
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Service Thru Date
[Shared] Type: numeric
[Shared] Length: 8
24
[Shared] Name: Place of Service
[Shared] Type: numeric
[Shared] Length: 2
Codes:
11
Provider's Office
12
Patient's Home
13
Assisted Living Facility
17
Walk-in Retail Health Clinic
 
 
20
Urgent Care Facility
21
Inpatient Hospital
22
Outpatient Hospital
23
Emergency Room - Hospital
24
Ambulatory Surgical 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
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
57
Non-residential Substance Abuse Treatment Facility
60
Mass Immunization Center
61
Comprehensive Inpatient Rehabilitation Facility
62
Comprehensive Outpatient Rehabilitation Facility
65
End-Stage Renal Disease Treatment Facility
71
State or Local Public Health Clinic
72
Rural Health Clinic
81
Independent Laboratory & Imaging
99
Other Place of Service
[Shared] Name: Place of Service
[Shared] Type: numeric
[Shared] Length: 2
Codes:
11
Provider's Office
12
Patient's Home
13
Assisted Living Facility
17
Walk-in Retail Health Clinic
18
Place of Employment - Worksite
20
Urgent Care Facility
21
Inpatient Hospital
22
Outpatient Hospital
23
Emergency Room - Hospital
24
Ambulatory Surgical 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
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
57
Non-residential Substance Abuse Treatment Facility
60
Mass Immunization Center
61
Comprehensive Inpatient Rehabilitation Facility
62
Comprehensive Outpatient Rehabilitation Facility
65
End-Stage Renal Disease Treatment Facility
71
State or Local Public Health Clinic
72
Rural Health Clinic
81
Independent Laboratory & Imaging
99
Other Place of Service
[Shared] Name: Place of Service
[Shared] Type: numeric
[Shared] Length: 2
Codes:
11
Provider's Office
12
Patient's Home
13
Assisted Living Facility
17
Walk-in Retail Health Clinic
18
Place of Employment - Worksite
20
Urgent Care Facility
21
Inpatient Hospital
22
Outpatient Hospital
23
Emergency Room - Hospital
24
Ambulatory Surgical 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
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
57
Non-residential Substance Abuse Treatment Facility
60
Mass Immunization Center
61
Comprehensive Inpatient Rehabilitation Facility
62
Comprehensive Outpatient Rehabilitation Facility
65
End-Stage Renal Disease Treatment Facility
71
State or Local Public Health Clinic
72
Rural Health Clinic
81
Independent Laboratory & Imaging
99
Other Place of Service
25
[Unshared] Name: Service Location Zip Code
[Shared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: Service Location Zip Code +4digit add-on code
[Shared] Type: alphanumeric
[Unshared] Length: 10
[Unshared] Name: Service Location Zip Code +4digit add-on code
[Shared] Type: alphanumeric
[Unshared] Length: 10
26
[Shared] Name: Service Unit Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Values reported as zero (no allowed services)
1
Transportation (ambulance air or ground) Miles
2
Anesthesia Time Units
3
Services
4
Oxygen Units
5
Units of Blood
6
Allergy Tests
7
Lab Tests
8
Minutes of Anesthesia (waiver required)
[Shared] Name: Service Unit Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Values reported as zero (no allowed services)
1
Transportation (ambulance air or ground) Miles
2
Anesthesia Time Units
3
Services
4
Oxygen Units
5
Units of Blood
6
Allergy Tests
7
Lab Tests
8
Minutes of Anesthesia (waiver required)
[Shared] Name: Service Unit Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Values reported as zero (no allowed services)
1
Transportation (ambulance air or ground) Miles
2
Anesthesia Time Units
3
Services
4
Oxygen Units
5
Units of Blood
6
Allergy Tests
7
Lab Tests
8
Minutes of Anesthesia (waiver required)
27
[Shared] Name: Units of Service
[Shared] Type: numeric
[Shared] Length: 3
[Shared] Name: Units of Service
[Shared] Type: numeric
[Shared] Length: 3
[Shared] Name: Units of Service
[Shared] Type: numeric
[Shared] Length: 3
28
[Shared] Name: Procedure Code
[Shared] Type: alphanumeric
[Shared] Length: 6
[Shared] Name: Procedure Code
[Shared] Type: alphanumeric
[Shared] Length: 6
[Shared] Name: Procedure Code
[Shared] Type: alphanumeric
[Shared] Length: 6
29
[Shared] Name: Modifier I
[Shared] Type: alphanumeric
[Shared] Length: 2
Codes:
QX
Nurse Anesthetist service; under supervision of a doctor
QZ
Nurse Anesthetist service; w/o the supervision of a doctor
[Shared] Name: Modifier I
[Shared] Type: alphanumeric
[Shared] Length: 2
Codes:
QX
Nurse Anesthetist service; under supervision of a doctor
QZ
Nurse Anesthetist service; w/o the supervision of a doctor
[Shared] Name: Modifier I
[Shared] Type: alphanumeric
[Shared] Length: 2
Codes:
QX
Nurse Anesthetist service; under supervision of a doctor
QZ
Nurse Anesthetist service; w/o the supervision of a doctor
30
[Shared] Name: Modifier II
[Shared] Type: alphanumeric
[Shared] Length: 2
[Shared] Name: Modifier II
[Shared] Type: alphanumeric
[Shared] Length: 2
[Shared] Name: Modifier II
[Shared] Type: alphanumeric
[Shared] Length: 2
31
[Shared] Name: Servicing Practitioner ID
[Shared] Type: alphanumeric
[Shared] Length: 11
[Shared] Name: Servicing Practitioner ID
[Shared] Type: alphanumeric
[Shared] Length: 11
[Shared] Name: Servicing Practitioner ID
[Shared] Type: alphanumeric
[Shared] Length: 11
32
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
33
[Shared] Name: Allowed Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Allowed Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Allowed Amount
[Shared] Type: numeric
[Shared] Length: 9
34
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
35
[Shared] Name: Patient Deductible
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Patient Deductible
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Patient Deductible
[Shared] Type: numeric
[Shared] Length: 9
36
[Shared] Name: Patient Coinsurance or Co-payment
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Patient Coinsurance or Co-payment
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Patient Coinsurance or Co-payment
[Shared] Type: numeric
[Shared] Length: 9
37
[Shared] Name: Other Patient Obligations
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Other Patient Obligations
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Other Patient Obligations
[Shared] Type: numeric
[Shared] Length: 9
38
[Shared] Name: Plan Liability
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
[Shared] Name: Plan Liability
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
[Shared] Name: Plan Liability
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
39
[Shared] Name: Servicing Practitioner Individual National Provider Identifier (NPI) number
[Shared] Type: alphanumeric
[Shared] Length: 10
[Shared] Name: Servicing Practitioner Individual National Provider Identifier (NPI) number
[Shared] Type: alphanumeric
[Shared] Length: 10
[Shared] Name: Servicing Practitioner Individual National Provider Identifier (NPI) number
[Shared] Type: alphanumeric
[Shared] Length: 10
40
[Shared] Name: Practitioner National Provider Identifier (NPI) number used for Billing
[Shared] Type: alphanumeric
[Shared] Length: 10
[Shared] Name: Practitioner National Provider Identifier (NPI) number used for Billing
[Shared] Type: alphanumeric
[Shared] Length: 10
[Shared] Name: Practitioner National Provider Identifier (NPI) number used for Billing
[Shared] Type: alphanumeric
[Shared] Length: 10
41
[Shared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
[Shared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
[Shared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
42
[Unshared] Name: Payer ID Number
[Shared] Type: alphanumeric
[Shared] Length: 4
Codes:
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
P070
American Republic Insurance Co.
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
CIGNA Healthcare Mid-Atlantic, Inc.
P180
Connecticut General Life Ins. Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Ins. Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life & Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Ins. Co.
P820
United Healthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
[Unshared] Name: Payor ID Number
[Shared] Type: alphanumeric
[Shared] Length: 4
Codes:
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
 
 
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
Cigna Health and Life Insurance Co., Inc.
P180
Connecticut General Life Insurance Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Insurance Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life and Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Insurance Co.
P820
United Healthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
[Unshared] Name: Payor ID Number
[Shared] Type: alphanumeric
[Shared] Length: 4
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
43
[Shared] Name: Source System
[Shared] Type: alphanumeric
[Shared] Length: 1
[Shared] Name: Source System
[Shared] Type: alphanumeric
[Shared] Length: 1
[Shared] Name: Source System
[Shared] Type: alphanumeric
[Shared] Length: 1
44
Data Element: 44
not present in this file submission.
[Unshared] Name: Assignment of Benefits
[Unshared] Type: alphanumeric
[Unshared] Length: 1
Codes:
0
No, Assignment of Benefits not accepted and Practitioner Not inNetwork
1
Yes, Assignment of Benefits Accepted and Practitioner Not in Network
2
N/A, Practitioner is In Network
9
Unknown
[Unshared] Name: Assignment of Benefits
[Unshared] Type: alphanumeric
[Unshared] Length: 1
Codes:
0
No, Assignment of Benefits not accepted and Practitioner Not in Network
1
Yes, Assignment of Benefits Accepted and Practitioner Not in Network
2
N/A, Practitioner is In Network
9
Unknown
45
Data Element: 45
not present in this file submission.
[Unshared] Name: Diagnosis Code Indicator
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
ICD-9-CM
2
ICD-10-CM
3
Missing/Unknown
[Unshared] Name: Diagnosis Code Indicator
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
ICD-9-CM
2
ICD-10-CM
3
Missing/Unknown
46
Data Element: 46
not present in this file submission.
[Unshared] Name: CPT Category II Code 1
[Unshared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: CPT Category II Code 1
[Unshared] Type: alphanumeric
[Unshared] Length: 5
47
Data Element: 47
not present in this file submission.
[Unshared] Name: Other CPT Category II Code 2
[Unshared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: Other CPT Category II Code 2
[Unshared] Type: alphanumeric
[Unshared] Length: 5
48
Data Element: 48
not present in this file submission.
[Unshared] Name: Other CPT Category II Code 3
[Unshared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: Other CPT Category II Code 3
[Unshared] Type: alphanumeric
[Unshared] Length: 5
49
Data Element: 49
not present in this file submission.
[Unshared] Name: Other CPT Category II Code 4
[Unshared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: Other CPT Category II Code 4
[Unshared] Type: alphanumeric
[Unshared] Length: 5
50
Data Element: 50
not present in this file submission.
[Unshared] Name: Other CPT Category II Code 5
[Unshared] Type: alphanumeric
[Unshared] Length: 5
[Unshared] Name: Other CPT Category II Code 5
[Unshared] Type: alphanumeric
[Unshared] Length: 5
51
Data Element: 51
not present in this file submission.
Data Element: 51
not present in this file submission.
[Unshared] Name: Reporting Quarter
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
First Quarter = January 1 thru March 31
2
Second Quarter = April 1 thru June 30
3
Third Quarter = July 1 thru September 30
4
Fourth Quarter = October 1 thru December 31
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