United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Item Name Version State Type Organization
Medical Claims File Submission February 2014 - v1.1 Rhode Island File Specification Rhode Island Department of Health (RIDoH)
Medical Claims File Submission June 2014 - v1.3 Rhode Island File Specification Rhode Island Department of Health (RIDoH)
File Specification: Medical Claims File Submission - February 2014 - v1.1 (Rhode Island) Medical Claims File Submission - June 2014 - v1.3 (Rhode Island)
[Shared] Responsible Organization:
Rhode Island Department of Health Rhode Island Department of Health
[Shared] Definition:
Not provided Not provided
File Specification: Medical Claims File Submission - February 2014 - v1.1 (Rhode Island) Medical Claims File Submission - June 2014 - v1.3 (Rhode Island)
HD001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
header record
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
header record
HD002
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
HD003
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
HD004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
MC
medical claims data
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
MC
medical claims data
HD005
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
HD006
[Shared] Name: Period Ending Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Shared] Type: Integer
[Shared] Length: 6
HD007
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
HD008
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
MC001
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
Codes:
RIC
Commercial carrier
RIG
Governmental agency
RIT
Third-party administrator
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
Codes:
RIC
Commercial carrier
RIG
Governmental agency
RIT
Third-party administrator
MC002
[Shared] Name: NAIC
[Shared] Type: Text
[Shared] Length: 5
[Shared] Name: NAIC
[Shared] Type: Text
[Shared] Length: 5
MC003
[Shared] Name: Insurance Type / Product Code
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Insurance Type / Product Code
[Shared] Type: Text
[Shared] Length: 2
MC004
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 50
MC004A
[Shared] Name: Claim Submitter's Identifier
[Shared] Type: Text
[Shared] Length: 38
[Shared] Name: Claim Submitter's Identifier
[Shared] Type: Text
[Shared] Length: 38
MC005
[Shared] Name: Line Counter
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Line Counter
[Shared] Type: Integer
[Shared] Length: 4
MC005A
[Shared] Name: Version Number
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Version Number
[Shared] Type: Integer
[Shared] Length: 4
MC006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 50
MC007
[Shared] Name: Subscriber Social Security Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: Text
[Shared] Length: 9
MC008
[Shared] Name: Plan-Specific Contract Number
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Plan-Specific Contract Number
[Shared] Type: Text
[Shared] Length: 80
MC009
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
MC010
[Shared] Name: Member Social Security Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Member Social Security Number
[Shared] Type: Text
[Shared] Length: 9
MC010A
[Shared] Name: Unique Member Identifier
[Shared] Type: String
[Shared] Length: 32
[Shared] Name: Unique Member Identifier
[Shared] Type: String
[Shared] Length: 32
MC011
[Shared] Name: Member Relationship
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Member Relationship
[Shared] Type: Text
[Shared] Length: 2
MC012
[Shared] Name: Member Gender
[Shared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
[Shared] Name: Member Gender
[Shared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
MC013
[Shared] Name: Member Date of Birth
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: Date
[Shared] Length: 8
MC014
[Shared] Name: Member City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Member City
[Shared] Type: Text
[Shared] Length: 30
MC015
[Shared] Name: Member State or Province
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: Text
[Shared] Length: 2
MC016
[Shared] Name: Member ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Member ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
MC017
[Shared] Name: Payment Date / Settlement Date
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Payment Date / Settlement Date
[Shared] Type: Date
[Shared] Length: 8
MC018
[Shared] Name: Admission Date
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Admission Date
[Shared] Type: Date
[Shared] Length: 8
MC019
[Shared] Name: Admission Hour
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Admission Hour
[Shared] Type: Text
[Shared] Length: 2
MC020
[Shared] Name: Admission Type
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Admission Type
[Shared] Type: Text
[Shared] Length: 1
MC021
[Shared] Name: Admission Source
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Admission Source
[Shared] Type: Text
[Shared] Length: 1
MC022
[Shared] Name: Discharge Hour
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Discharge Hour
[Shared] Type: Text
[Shared] Length: 2
MC023
[Shared] Name: Discharge Status
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Discharge Status
[Shared] Type: Text
[Shared] Length: 2
MC024
[Shared] Name: Rendering Provider Plan ID
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Rendering Provider Plan ID
[Shared] Type: Text
[Shared] Length: 50
MC025
[Shared] Name: Rendering Provider Tax ID Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Rendering Provider Tax ID Number
[Shared] Type: Text
[Shared] Length: 9
MC026
[Shared] Name: Rendering Provider NPI
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: Rendering Provider NPI
[Shared] Type: Text
[Shared] Length: 10
MC027
[Shared] Name: Entity Type Qualifier
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Entity Type Qualifier
[Shared] Type: Text
[Shared] Length: 1
MC027A
[Shared] Name: Network Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
I
In network
 
 
O
Out of network
U
Unknown
[Shared] Name: Network Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
I
In network
N
Not applicable
O
Out of network
U
Unknown
MC028
[Shared] Name: Rendering Provider First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Rendering Provider First Name
[Shared] Type: Text
[Shared] Length: 35
MC029
[Shared] Name: Rendering Provider Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Rendering Provider Middle Initial
[Shared] Type: Text
[Shared] Length: 1
MC030
[Shared] Name: Rendering Provider Last Name or Organization Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Rendering Provider Last Name or Organization Name
[Shared] Type: Text
[Shared] Length: 60
MC031
[Shared] Name: Rendering Provider Suffix
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: Rendering Provider Suffix
[Shared] Type: Text
[Shared] Length: 10
MC032
[Shared] Name: Rendering Provider Taxonomy Code
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: Rendering Provider Taxonomy Code
[Shared] Type: Text
[Shared] Length: 10
MC033
[Shared] Name: Rendered Service Location - City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Rendered Service Location - City
[Shared] Type: Text
[Shared] Length: 30
MC034
[Shared] Name: Rendered Service Location - State or Province
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Rendered Service Location - State or Province
[Shared] Type: Text
[Shared] Length: 2
MC035
[Shared] Name: Rendered Service Location - ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Rendered Service Location - ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
MC036
[Shared] Name: Type of Bill
[Shared] Type: Text
[Shared] Length: 3
[Shared] Name: Type of Bill
[Shared] Type: Text
[Shared] Length: 3
MC037
[Shared] Name: Place of Service
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Place of Service
[Shared] Type: Text
[Shared] Length: 2
MC038
[Shared] Name: Claim Status
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Claim Status
[Shared] Type: Text
[Shared] Length: 2
MC039
[Shared] Name: Admitting Diagnosis
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Admitting Diagnosis
[Shared] Type: Text
[Shared] Length: 7
MC039A
[Shared] Name: ICD Version Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
0
ICD-10
9
ICD-9
[Shared] Name: ICD Version Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
0
ICD-10
9
ICD-9
MC040
[Unshared] Name: External Cause of Injury / E- Code - 1
[Shared] Type: Text
[Shared] Length: 7
[Unshared] Name: External Cause of Injury (ECI) Code - 1
[Shared] Type: Text
[Shared] Length: 7
MC040A
[Unshared] Name: External Cause of Injury / E- Code - 2
[Shared] Type: Text
[Shared] Length: 7
[Unshared] Name: External Cause of Injury (ECI) Code - 2
[Shared] Type: Text
[Shared] Length: 7
MC040B
[Unshared] Name: External Cause of Injury / E- Code - 3
[Shared] Type: Text
[Shared] Length: 7
[Unshared] Name: External Cause of Injury (ECI) Code - 3
[Shared] Type: Text
[Shared] Length: 7
MC041
[Shared] Name: Principal Diagnosis
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Principal Diagnosis
[Shared] Type: Text
[Shared] Length: 7
MC042
[Shared] Name: Other Diagnosis - 1
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 1
[Shared] Type: Text
[Shared] Length: 7
MC043
[Shared] Name: Other Diagnosis - 2
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 2
[Shared] Type: Text
[Shared] Length: 7
MC044
[Shared] Name: Other Diagnosis - 3
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 3
[Shared] Type: Text
[Shared] Length: 7
MC045
[Shared] Name: Other Diagnosis - 4
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 4
[Shared] Type: Text
[Shared] Length: 7
MC046
[Shared] Name: Other Diagnosis - 5
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 5
[Shared] Type: Text
[Shared] Length: 7
MC047
[Shared] Name: Other Diagnosis - 6
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 6
[Shared] Type: Text
[Shared] Length: 7
MC048
[Shared] Name: Other Diagnosis - 7
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 7
[Shared] Type: Text
[Shared] Length: 7
MC049
[Shared] Name: Other Diagnosis - 8
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 8
[Shared] Type: Text
[Shared] Length: 7
MC050
[Shared] Name: Other Diagnosis - 9
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 9
[Shared] Type: Text
[Shared] Length: 7
MC051
[Shared] Name: Other Diagnosis - 10
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 10
[Shared] Type: Text
[Shared] Length: 7
MC052
[Shared] Name: Other Diagnosis - 11
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 11
[Shared] Type: Text
[Shared] Length: 7
MC053
[Shared] Name: Other Diagnosis - 12
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 12
[Shared] Type: Text
[Shared] Length: 7
MC054
[Shared] Name: Revenue Code
[Shared] Type: Text
[Shared] Length: 4
[Shared] Name: Revenue Code
[Shared] Type: Text
[Shared] Length: 4
MC055
[Shared] Name: Procedure Code
[Shared] Type: Text
[Shared] Length: 5
[Shared] Name: Procedure Code
[Shared] Type: Text
[Shared] Length: 5
MC056
[Shared] Name: Procedure Modifier - 1
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Procedure Modifier - 1
[Shared] Type: Text
[Shared] Length: 2
MC057
[Shared] Name: Procedure Modifier - 2
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Procedure Modifier - 2
[Shared] Type: Text
[Shared] Length: 2
MC057A
[Shared] Name: Procedure Modifier - 3
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Procedure Modifier - 3
[Shared] Type: Text
[Shared] Length: 2
MC057B
[Shared] Name: Procedure Modifier - 4
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Procedure Modifier - 4
[Shared] Type: Text
[Shared] Length: 2
MC058
[Shared] Name: Principal ICD Procedure Code
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Principal ICD Procedure Code
[Shared] Type: Text
[Shared] Length: 7
MC058A
[Shared] Name: Other ICD Procedure Code - 1
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 1
[Shared] Type: Text
[Shared] Length: 7
MC058B
[Shared] Name: Other ICD Procedure Code - 2
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 2
[Shared] Type: Text
[Shared] Length: 7
MC058C
[Shared] Name: Other ICD Procedure Code - 3
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 3
[Shared] Type: Text
[Shared] Length: 7
MC058D
[Shared] Name: Other ICD Procedure Code - 4
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 4
[Shared] Type: Text
[Shared] Length: 7
MC058E
[Shared] Name: Other ICD Procedure Code - 5
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 5
[Shared] Type: Text
[Shared] Length: 7
MC058F
[Shared] Name: Other ICD Procedure Code - 6
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 6
[Shared] Type: Text
[Shared] Length: 7
MC058G
[Shared] Name: Other ICD Procedure Code - 7
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 7
[Shared] Type: Text
[Shared] Length: 7
MC058H
[Shared] Name: Other ICD Procedure Code - 8
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 8
[Shared] Type: Text
[Shared] Length: 7
MC058I
[Shared] Name: Other ICD Procedure Code - 9
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 9
[Shared] Type: Text
[Shared] Length: 7
MC058J
[Shared] Name: Other ICD Procedure Code - 10
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 10
[Shared] Type: Text
[Shared] Length: 7
MC058K
[Shared] Name: Other ICD Procedure Code - 11
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 11
[Shared] Type: Text
[Shared] Length: 7
MC058L
[Shared] Name: Other ICD Procedure Code - 12
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 12
[Shared] Type: Text
[Shared] Length: 7
MC058M
[Shared] Name: Other ICD Procedure Code - 13
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 13
[Shared] Type: Text
[Shared] Length: 7
MC058N
[Shared] Name: Other ICD Procedure Code - 14
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 14
[Shared] Type: Text
[Shared] Length: 7
MC058O
[Shared] Name: Other ICD Procedure Code - 15
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 15
[Shared] Type: Text
[Shared] Length: 7
MC058P
[Shared] Name: Other ICD Procedure Code - 16
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 16
[Shared] Type: Text
[Shared] Length: 7
MC058Q
[Shared] Name: Other ICD Procedure Code - 17
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 17
[Shared] Type: Text
[Shared] Length: 7
MC058R
[Shared] Name: Other ICD Procedure Code - 18
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 18
[Shared] Type: Text
[Shared] Length: 7
MC058S
[Shared] Name: Other ICD Procedure Code - 19
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 19
[Shared] Type: Text
[Shared] Length: 7
MC058T
[Shared] Name: Other ICD Procedure Code - 20
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 20
[Shared] Type: Text
[Shared] Length: 7
MC058U
[Shared] Name: Other ICD Procedure Code - 21
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 21
[Shared] Type: Text
[Shared] Length: 7
MC058V
[Shared] Name: Other ICD Procedure Code - 22
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 22
[Shared] Type: Text
[Shared] Length: 7
MC058W
[Shared] Name: Other ICD Procedure Code - 23
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 23
[Shared] Type: Text
[Shared] Length: 7
MC058X
[Shared] Name: Other ICD Procedure Code - 24
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other ICD Procedure Code - 24
[Shared] Type: Text
[Shared] Length: 7
MC059
[Shared] Name: Date of Service (From)
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Date of Service (From)
[Shared] Type: Date
[Shared] Length: 8
MC060
[Shared] Name: Date of Service (Through)
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Date of Service (Through)
[Shared] Type: Date
[Shared] Length: 8
MC061
[Shared] Name: Quantity
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Quantity
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC062
[Shared] Name: Charge Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Charge Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC063
[Shared] Name: Paid Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Paid Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC063A
[Shared] Name: Payment Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
H
Header (global payment)
L
Line (fee-for-service)
U
Unavailable information
[Shared] Name: Payment Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
H
Header (global payment)
L
Line (fee-for-service)
U
Unavailable information
MC064A
[Shared] Name: Payment Arrangement Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
B
Bundled payment paid to other provider (eg, ACO)
C
Capitation
M
Managed care withholds
N
Not applicable
V
Virtual bundled payment paid by the submitter directly to each provider who rendered services
[Shared] Name: Payment Arrangement Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
B
Bundled payment paid to other provider (eg, ACO)
C
Capitation
M
Managed care withholds
N
Not applicable / Not available
V
Virtual bundled payment paid by the submitter directly to each provider who rendered services
MC064B
[Shared] Name: Fee-for-Service Equivalent
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Fee-for-Service Equivalent
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC065
[Shared] Name: Copay Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Copay Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC066
[Shared] Name: Coinsurance Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Coinsurance Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC067
[Shared] Name: Deductible Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Deductible Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
MC068
[Shared] Name: Medical Record Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Medical Record Number
[Shared] Type: Text
[Shared] Length: 20
MC069
[Shared] Name: Discharge Date
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Discharge Date
[Shared] Type: Date
[Shared] Length: 8
MC070
[Shared] Name: Rendering Provider Country
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Rendering Provider Country
[Shared] Type: Text
[Shared] Length: 30
MC071
[Shared] Name: DRG
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: DRG
[Shared] Type: Text
[Shared] Length: 7
MC072
[Shared] Name: DRG Version
[Shared] Type: Text
[Shared] Length: 4
Codes:
AP0
All Patient DRGs (AP-DRG)
AP9
All Patient DRGs (AP-DRG)
APR0
All Patient Refined DRGs (APR-DRG)
APR9
All Patient Refined DRGs (APR-DRG)
APS0
All Patient, Severity-Adjusted DRGs (APS- DRG)
APS9
All Patient, Severity-Adjusted DRGs (APS- DRG)
IR0
International-Refined DRGs (IR-DRG)
IR9
International-Refined DRGs (IR-DRG)
MS0
Medicare DRG (CMS-DRG & MS-DRG)
MS9
Medicare DRG (CMS-DRG & MS-DRG)
R0
Refined DRGs (R-DRG)
R9
Refined DRGs (R-DRG)
S0
Severity DRGs (S-DRG)
S9
Severity DRGs (S-DRG)
[Shared] Name: DRG Version
[Shared] Type: Text
[Shared] Length: 4
Codes:
AP0
All Patient DRGs (AP-DRG)
AP9
All Patient DRGs (AP-DRG)
APR0
All Patient Refined DRGs (APR-DRG)
APR9
All Patient Refined DRGs (APR-DRG)
APS0
All Patient, Severity-Adjusted DRGs (APS- DRG)
APS9
All Patient, Severity-Adjusted DRGs (APS- DRG)
IR0
International-Refined DRGs (IR-DRG)
IR9
International-Refined DRGs (IR-DRG)
MS0
Medicare DRG (CMS-DRG & MS-DRG)
MS9
Medicare DRG (CMS-DRG & MS-DRG)
R0
Refined DRGs (R-DRG)
R9
Refined DRGs (R-DRG)
S0
Severity DRGs (S-DRG)
S9
Severity DRGs (S-DRG)
MC073
[Shared] Name: APC
[Shared] Type: Text
[Shared] Length: 5
[Shared] Name: APC
[Shared] Type: Text
[Shared] Length: 5
MC074
[Shared] Name: APC Version
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: APC Version
[Shared] Type: Text
[Shared] Length: 2
MC075
[Shared] Name: National Drug Code
[Shared] Type: Text
[Shared] Length: 11
[Shared] Name: National Drug Code
[Shared] Type: Text
[Shared] Length: 11
MC076
[Shared] Name: Billing Provider Plan ID
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Billing Provider Plan ID
[Shared] Type: Text
[Shared] Length: 50
MC077
[Shared] Name: Billing Provider NPI
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: Billing Provider NPI
[Shared] Type: Text
[Shared] Length: 10
MC078
[Shared] Name: Billing Provider Last Name or Organization Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Billing Provider Last Name or Organization Name
[Shared] Type: Text
[Shared] Length: 60
MC080
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
MC081
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
MC082
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
MC083
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
MC084
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
MC101
[Shared] Name: Subscriber Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Subscriber Last Name
[Shared] Type: Text
[Shared] Length: 60
MC102
[Shared] Name: Subscriber First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Subscriber First Name
[Shared] Type: Text
[Shared] Length: 35
MC103
[Shared] Name: Subscriber Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Subscriber Middle Initial
[Shared] Type: Text
[Shared] Length: 1
MC104
[Shared] Name: Member Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Member Last Name
[Shared] Type: Text
[Shared] Length: 60
MC105
[Shared] Name: Member First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Member First Name
[Shared] Type: Text
[Shared] Length: 35
MC106
[Shared] Name: Member Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Member Middle Initial
[Shared] Type: Text
[Shared] Length: 1
MC201
[Shared] Name: Aid Category
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Aid Category
[Shared] Type: Text
[Shared] Length: 2
MC212
[Shared] Name: Category Of Service
[Shared] Type: Text
[Shared] Length: 4
[Shared] Name: Category Of Service
[Shared] Type: Text
[Shared] Length: 4
MC215
[Shared] Name: Fund Source Code
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Fund Source Code
[Shared] Type: Text
[Shared] Length: 2
MC401
[Shared] Name: Other Diagnosis - 13
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 13
[Shared] Type: Text
[Shared] Length: 7
MC402
[Shared] Name: Other Diagnosis - 14
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 14
[Shared] Type: Text
[Shared] Length: 7
MC403
[Shared] Name: Other Diagnosis - 15
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 15
[Shared] Type: Text
[Shared] Length: 7
MC404
[Shared] Name: Other Diagnosis - 16
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 16
[Shared] Type: Text
[Shared] Length: 7
MC405
[Shared] Name: Other Diagnosis - 17
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 17
[Shared] Type: Text
[Shared] Length: 7
MC406
[Shared] Name: Other Diagnosis - 18
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 18
[Shared] Type: Text
[Shared] Length: 7
MC407
[Shared] Name: Other Diagnosis - 19
[Shared] Type: Text
[Shared] Length: 7
[Shared] Name: Other Diagnosis - 19
[Shared] Type: Text
[Shared] Length: