United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Item Name Version State Type Organization
Medical Claims File Submission March 18, 2010 Tennessee File Specification Department of Finance and Administration, Division of Health Planning (DFADHP)
Medical File Submission January 31, 2014 - v1.0 Tennessee File Specification Department of Finance and Administration, Division of Health Planning (DFADHP)
File Specification: Medical Claims File Submission - March 18, 2010 (Tennessee) Medical File Submission - January 31, 2014 - v1.0 (Tennessee)
[Shared] Responsible Organization:
Department of Finance and Administration, Division of Health Planning Department of Finance and Administration, Division of Health Planning
[Unshared] Definition:
"Medical claims file" means a data file composed of service level remittance information for all non-denied adjudicated claims for each billed service including, but not limited to: (a) Member demographics; (b) Provider information; (c) Charge/payment information; and (d) Clinical diagnosis/procedure codes. Not Provided
File Specification: Medical Claims File Submission - March 18, 2010 (Tennessee) Medical File Submission - January 31, 2014 - v1.0 (Tennessee)
HD001
[Unshared] Name: Record Type
[Unshared] Type: Text
[Unshared] Length: 2
Codes:
HD
Header Record
Data Element: HD001
not present in this file submission.
HD002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
Data Element: HD002
not present in this file submission.
HD003
[Unshared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: HD003
not present in this file submission.
HD004
[Unshared] Name: Type of File
[Unshared] Type: Text
[Unshared] Length: 2
Codes:
MC
professional and institutional claims
Data Element: HD004
not present in this file submission.
HD005
[Unshared] Name: Period Beginning Date
[Unshared] Type: Integer
[Unshared] Length: 6
Data Element: HD005
not present in this file submission.
HD006
[Unshared] Name: Period Ending Date
[Unshared] Type: Integer
[Unshared] Length: 6
Data Element: HD006
not present in this file submission.
HD007
[Unshared] Name: Record Count
[Unshared] Type: Integer
[Unshared] Length: 10
Data Element: HD007
not present in this file submission.
HD008
[Unshared] Name: Comments
[Unshared] Type: Text
[Unshared] Length: 80
Data Element: HD008
not present in this file submission.
ADJ_TYP_CD
Data Element: ADJ_TYP_CD
not present in this file submission.
[Unshared] Name: Adjustment Type Code
[Unshared] Type: Char
[Unshared] Length: 1
Codes:
O
Original
R
Replacement
V
Void
ADMDX_POA
Data Element: ADMDX_POA
not present in this file submission.
[Unshared] Name: Admitting Diagnosis Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
ADMIT_DATE
Data Element: ADMIT_DATE
not present in this file submission.
[Unshared] Name: Admission Date
[Unshared] Type: Date
[Unshared] Length: 8
ADMIT_DX
Data Element: ADMIT_DX
not present in this file submission.
[Unshared] Name: Admitting Diagnosis
[Unshared] Type: Char
[Unshared] Length: 8
ADMIT_HOUR
Data Element: ADMIT_HOUR
not present in this file submission.
[Unshared] Name: Admission Hour
[Unshared] Type: Numeric
[Unshared] Length: 4
ADMIT_SOURCE
Data Element: ADMIT_SOURCE
not present in this file submission.
[Unshared] Name: Admission Source
[Unshared] Type: Char
[Unshared] Length: 2
Codes:
1
Non-healthcare Facility Point of Origin
2
Clinic Referral
3
Discontinued
4
Transfer From a Hospital (Different Facility)
5
Born inside this hospital (ADMISSION_TYPE is 4)
6
Born outside this hospital (ADMISSION_TYPE is 4)
7
Emergency Room
8
Court/Law Enforcement
9
Information Not Available
A
Reserved
B
Transfer from Another HHA C:Readmission to Same HHA
D
Transfer from One Distinct Unit of the Hospital to Another Distinct Unit of the Same Hospital Resulting in a Separate Claim to the Payer
E
Transfer from Ambulatory Surgery Center
F
Transfer from Hospice and is Under a Hospice Plan of Care of Enrolled in a Hospice Program
ADMIT_TYPE
Data Element: ADMIT_TYPE
not present in this file submission.
[Unshared] Name: Admission Type
[Unshared] Type: Numeric
[Unshared] Length: 5
Codes:
-1
Payer supplied no value
-2
Payer supplied incorrect value
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
9
Information Not Available
APC
Data Element: APC
not present in this file submission.
[Unshared] Name: APC Submitted by Payer
[Unshared] Type: Text
[Unshared] Length: 5
APC_VERSION
Data Element: APC_VERSION
not present in this file submission.
[Unshared] Name: Version of APC Grouper Used
[Unshared] Type: Text
[Unshared] Length: 2
BILLING_PRVIDN
Data Element: BILLING_PRVIDN
not present in this file submission.
[Unshared] Name: Billing Provider Number
[Unshared] Type: Numeric
[Unshared] Length: 20
BILL_TYPE
Data Element: BILL_TYPE
not present in this file submission.
[Unshared] Name: Type of Bill - Institutional
[Unshared] Type: Text
[Unshared] Length: 4
CHARGE
Data Element: CHARGE
not present in this file submission.
[Unshared] Name: Charge Amount
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
CLAIM
Data Element: CLAIM
not present in this file submission.
[Unshared] Name: Payer Claim Control Number
[Unshared] Type: Text
[Unshared] Length: 35
CLAIM_STATUS
Data Element: CLAIM_STATUS
not present in this file submission.
[Unshared] Name: Claim Status
[Unshared] Type: Numeric
[Unshared] Length: 2
Codes:
1
Processed as primary
2
Processed as secondary
3
Processed as tertiary
4
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
25
none
CLAIM_TYPE
Data Element: CLAIM_TYPE
not present in this file submission.
[Unshared] Name: Claim Type
[Unshared] Type: Numeric
[Unshared] Length: 2
Codes:
1
Hospital Inpatient
2
Hospital Outpatient
8
Unknown
COINSURANCE
Data Element: COINSURANCE
not present in this file submission.
[Unshared] Name: Coinsurance Amount
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
COPAY
Data Element: COPAY
not present in this file submission.
[Unshared] Name: Copay Amount
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
CPT
Data Element: CPT
not present in this file submission.
[Unshared] Name: CPT Procedure Code
[Unshared] Type: Char
[Unshared] Length: 10
CPT_MOD1
Data Element: CPT_MOD1
not present in this file submission.
[Unshared] Name: Procedure Modifier 1
[Unshared] Type: Char
[Unshared] Length: 2
CPT_MOD2
Data Element: CPT_MOD2
not present in this file submission.
[Unshared] Name: Procedure Modifier 2
[Unshared] Type: Char
[Unshared] Length: 2
DEDUCTIBLE
Data Element: DEDUCTIBLE
not present in this file submission.
[Unshared] Name: Deductible Amount
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
DISCH_HOUR
Data Element: DISCH_HOUR
not present in this file submission.
[Unshared] Name: Discharge Hour
[Unshared] Type: Numeric
[Unshared] Length: 4
DISCH_STATUS
Data Element: DISCH_STATUS
not present in this file submission.
[Unshared] Name: Discharge Status
[Unshared] Type: Numeric
[Unshared] Length: 2
DRG
Data Element: DRG
not present in this file submission.
[Unshared] Name: DRG Submitted by Payer
[Unshared] Type: Text
[Unshared] Length: 10
DRG_VERSION
Data Element: DRG_VERSION
not present in this file submission.
[Unshared] Name: Version of DRG Grouper Used
[Unshared] Type: Text
[Unshared] Length: 2
DX1
Data Element: DX1
not present in this file submission.
[Unshared] Name: Principal Diagnosis
[Unshared] Type: Char
[Unshared] Length: 8
DX1_POA
Data Element: DX1_POA
not present in this file submission.
[Unshared] Name: Primary Diagnosis Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX2
Data Element: DX2
not present in this file submission.
[Unshared] Name: Other Diagnosis 1
[Unshared] Type: Char
[Unshared] Length: 8
DX2_POA
Data Element: DX2_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 1 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX3
Data Element: DX3
not present in this file submission.
[Unshared] Name: Other Diagnosis 2
[Unshared] Type: Char
[Unshared] Length: 8
DX3_POA
Data Element: DX3_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 2 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX4
Data Element: DX4
not present in this file submission.
[Unshared] Name: Other Diagnosis 3
[Unshared] Type: Char
[Unshared] Length: 8
DX4_POA
Data Element: DX4_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 3 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX5
Data Element: DX5
not present in this file submission.
[Unshared] Name: Other Diagnosis 4
[Unshared] Type: Char
[Unshared] Length: 8
DX5_POA
Data Element: DX5_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 4 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX6
Data Element: DX6
not present in this file submission.
[Unshared] Name: Other Diagnosis 5
[Unshared] Type: Char
[Unshared] Length: 8
DX6_POA
Data Element: DX6_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 5 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX7
Data Element: DX7
not present in this file submission.
[Unshared] Name: Other Diagnosis 6
[Unshared] Type: Char
[Unshared] Length: 8
DX7_POA
Data Element: DX7_POA
not present in this file submission.
[Unshared] Name: Other Diagnosis 6 Present on Admission Indicator
[Unshared] Type: Char
[Unshared] Length: 1
DX8
Data Element: DX8
not present in this file submission.
[Unshared] Name: Other Diagnosis 7
[Unshared] Type: Char
[Unshared] Length: 8
DX9
Data Element: DX9
not present in this file submission.
[Unshared] Name: Other Diagnosis 8
[Unshared] Type: Char
[Unshared] Length: 8
DX10
Data Element: DX10
not present in this file submission.
[Unshared] Name: Other Diagnosis 9
[Unshared] Type: Char
[Unshared] Length: 8
DX11
Data Element: DX11
not present in this file submission.
[Unshared] Name: Other Diagnosis 10
[Unshared] Type: Char
[Unshared] Length: 8
DX12
Data Element: DX12
not present in this file submission.
[Unshared] Name: Other Diagnosis 11
[Unshared] Type: Char
[Unshared] Length: 8
DX13
Data Element: DX13
not present in this file submission.
[Unshared] Name: Other Diagnosis 12
[Unshared] Type: Char
[Unshared] Length: 8
ECODE_DX
Data Element: ECODE_DX
not present in this file submission.
[Unshared] Name: E-Code
[Unshared] Type: Char
[Unshared] Length: 8
ER_FLAG
Data Element: ER_FLAG
not present in this file submission.
[Unshared] Name: ER Flag
[Unshared] Type: Char
[Unshared] Length: 1
FILLER
Data Element: FILLER
not present in this file submission.
[Unshared] Name: FILLER
[Unshared] Type: Char
[Unshared] Length: 500
FIRST_SVC_DATE
Data Element: FIRST_SVC_DATE
not present in this file submission.
[Unshared] Name: Date of Service - From
[Unshared] Type: Date
[Unshared] Length: 8
ICD9_OP
Data Element: ICD9_OP
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
ICD9_OP1
Data Element: ICD9_OP1
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
ICD9_OP2
Data Element: ICD9_OP2
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
ICD9_OP3
Data Element: ICD9_OP3
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
ICD9_OP4
Data Element: ICD9_OP4
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
ICD9_OP5
Data Element: ICD9_OP5
not present in this file submission.
[Unshared] Name: ICD-9-CM Procedure Code
[Unshared] Type: Char
[Unshared] Length: 8
INPATIENT_CATEGORY
Data Element: INPATIENT_CATEGORY
not present in this file submission.
[Unshared] Name: Inpatient Category Code
[Unshared] Type: Numeric
[Unshared] Length: 1
IPDISCHARGE
Data Element: IPDISCHARGE
not present in this file submission.
[Unshared] Name: Inpatient Discharge Identifier
[Unshared] Type: Numeric
[Unshared] Length: 20
LAST_SVC_DATE
Data Element: LAST_SVC_DATE
not present in this file submission.
[Unshared] Name: Date of Service - Thru
[Unshared] Type: Date
[Unshared] Length: 8
LINE
Data Element: LINE
not present in this file submission.
[Unshared] Name: Line Counter
[Unshared] Type: Numeric
[Unshared] Length: 6
MC001
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
Codes:
TNC
Commercial Carrier
TNG
Governmental Agency
TNT
Third-Party Administrator
TNU
Unlicensed Entity
Data Element: MC001
not present in this file submission.
MC002
[Unshared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: MC002
not present in this file submission.
MC003
[Unshared] Name: Insurance Type/Product Code
[Unshared] Type: Text
[Unshared] Length: 6
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 Advantage
DS
Disability
HM
Health Maintenance Organization
MA
Medicare Part A
MB
Medicare Part B
MCTNCR
Tennessee Medicaid (TennCare)
MD
Medicare Part D
OF
Other Federal Program (eg, Black Lung)
TV
Title V
VA
Veteran Administration Plan
WC
Workers' Compensation
XXTNAC
AccessTN
XXTNCV
CoverTN
XXTNKD
CoverKids
Data Element: MC003
not present in this file submission.
MC004
[Unshared] Name: Payer Claim Control Number
[Unshared] Type: Text
[Unshared] Length: 35
Data Element: MC004
not present in this file submission.
MC005
[Unshared] Name: Line Counter
[Unshared] Type: Integer
[Unshared] Length: 4
Data Element: MC005
not present in this file submission.
MC005A
[Unshared] Name: Version Number
[Unshared] Type: Integer
[Unshared] Length: 4
Data Element: MC005A
not present in this file submission.
MC006
[Unshared] Name: Insured Group Or Policy Number
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: MC006
not present in this file submission.
MC007
[Unshared] Name: Encrypted Subscriber Index Number
[Unshared] Type: Text
[Unshared] Length: 128
Data Element: MC007
not present in this file submission.
MC008
[Unshared] Name: Encrypted Plan Specific Contract Index Number
[Unshared] Type: Text
[Unshared] Length: 128
Data Element: MC008
not present in this file submission.
MC009
[Unshared] Name: Member Suffix Number
[Unshared] Type: Integer
[Unshared] Length: 20
Data Element: MC009
not present in this file submission.
MC010
[Unshared] Name: Encrypted Member Index Number
[Unshared] Type: Text
[Unshared] Length: 128
Data Element: MC010
not present in this file submission.
MC011
[Unshared] Name: Individual Relationship Code
[Unshared] Type: Integer
[Unshared] 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
18
Self
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
34
Other Adult
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
Data Element: MC011
not present in this file submission.
MC012
[Unshared] Name: Member Gender
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
Data Element: MC012
not present in this file submission.
MC013
[Unshared] Name: Member Year of Birth
[Unshared] Type: Date
[Unshared] Length: 4
Data Element: MC013
not present in this file submission.
MC014
[Unshared] Name: Member City Name
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: MC014
not present in this file submission.
MC015
[Unshared] Name: Member State or Province
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC015
not present in this file submission.
MC016
[Unshared] Name: Member ZIP Code
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC016
not present in this file submission.
MC017
[Unshared] Name: Paid Date
[Unshared] Type: Date
[Unshared] Length: 8
Data Element: MC017
not present in this file submission.
MC018
[Unshared] Name: Admission Date
[Unshared] Type: Date
[Unshared] Length: 8
Data Element: MC018
not present in this file submission.
MC019
[Unshared] Name: Admission Hour
[Unshared] Type: Integer
[Unshared] Length: 4
Data Element: MC019
not present in this file submission.
MC020
[Unshared] Name: Admission Type
[Unshared] Type: Integer
[Unshared] Length: 1
Codes:
1
Emergency
2
Urgent
3
Elective
4
Newborn
5
Trauma Center
9
Information Not Available
Data Element: MC020
not present in this file submission.
MC021
[Unshared] Name: Point of Origin for Admission or Visit
[Unshared] Type: Text
[Unshared] Length: 1
Data Element: MC021
not present in this file submission.
MC022
[Unshared] Name: Discharge Hour
[Unshared] Type: Integer
[Unshared] Length: 4
Data Element: MC022
not present in this file submission.
MC023
[Unshared] Name: Discharge Status
[Unshared] Type: Integer
[Unshared] Length: 2
Data Element: MC023
not present in this file submission.
MC024
[Unshared] Name: Service Provider Number
[Unshared] Type: Text
[Unshared] Length: 30
Codes:
L
Legacy/pre-NPI
O
Other
Data Element: MC024
not present in this file submission.
MC025
[Unshared] Name: Service Provider Tax ID Number
[Unshared] Type: Text
[Unshared] Length: 10
Data Element: MC025
not present in this file submission.
MC026
[Unshared] Name: National Service Provider ID
[Unshared] Type: Text
[Unshared] Length: 20
Data Element: MC026
not present in this file submission.
MC027
[Unshared] Name: Service Provider Entity Type Qualifier
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Person
2
Non-Person Entity
Data Element: MC027
not present in this file submission.
MC028
[Unshared] Name: Service Provider First Name
[Unshared] Type: Text
[Unshared] Length: 25
Data Element: MC028
not present in this file submission.
MC029
[Unshared] Name: Service Provider Middle Name
[Unshared] Type: Text
[Unshared] Length: 25
Data Element: MC029
not present in this file submission.
MC030
[Unshared] Name: Service Provider Last Name or Organization Name
[Unshared] Type: Text
[Unshared] Length: 100
Data Element: MC030
not present in this file submission.
MC031
[Unshared] Name: Service Provider Suffix
[Unshared] Type: Text
[Unshared] Length: 10
Data Element: MC031
not present in this file submission.
MC032
[Unshared] Name: Service Provider Specialty
[Unshared] Type: Text
[Unshared] Length: 50
Data Element: MC032
not present in this file submission.
MC033
[Unshared] Name: Service Provider City Name
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: MC033
not present in this file submission.
MC034
[Unshared] Name: Service Provider State or Province
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC034
not present in this file submission.
MC035
[Unshared] Name: Service Provider ZIP Code
[Unshared] Type: Text
[Unshared] Length: 11
Data Element: MC035
not present in this file submission.
MC036
[Unshared] Name: Type of Bill - Institutional
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC036
not present in this file submission.
MC037
[Unshared] Name: Place of Service - on NSF/CMS 1500 Claims
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC037
not present in this file submission.
MC038
[Unshared] Name: Claim Status
[Unshared] Type: Integer
[Unshared] 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
Data Element: MC038
not present in this file submission.
MC039
[Unshared] Name: Admitting Diagnosis
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC039
not present in this file submission.
MC040
[Unshared] Name: E-Code
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC040
not present in this file submission.
MC041
[Unshared] Name: Principal Diagnosis
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC041
not present in this file submission.
MC042
[Unshared] Name: Other Diagnosis - 1
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC042
not present in this file submission.
MC043
[Unshared] Name: Other Diagnosis - 2
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC043
not present in this file submission.
MC044
[Unshared] Name: Other Diagnosis - 3
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC044
not present in this file submission.
MC045
[Unshared] Name: Other Diagnosis - 4
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC045
not present in this file submission.
MC046
[Unshared] Name: Other Diagnosis - 5
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC046
not present in this file submission.
MC047
[Unshared] Name: Other Diagnosis - 6
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC047
not present in this file submission.
MC048
[Unshared] Name: Other Diagnosis - 7
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC048
not present in this file submission.
MC049
[Unshared] Name: Other Diagnosis - 8
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC049
not present in this file submission.
MC050
[Unshared] Name: Other Diagnosis - 9
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC050
not present in this file submission.
MC051
[Unshared] Name: Other Diagnosis - 10
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC051
not present in this file submission.
MC052
[Unshared] Name: Other Diagnosis - 11
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC052
not present in this file submission.
MC053
[Unshared] Name: Other Diagnosis - 12
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC053
not present in this file submission.
MC054
[Unshared] Name: Revenue Code
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC054
not present in this file submission.
MC055
[Unshared] Name: Procedure Code
[Unshared] Type: Text
[Unshared] Length: 5
Data Element: MC055
not present in this file submission.
MC056
[Unshared] Name: Procedure Modifier - 1
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC056
not present in this file submission.
MC057
[Unshared] Name: Procedure Modifier - 2
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC057
not present in this file submission.
MC058
[Unshared] Name: Principal ICD- 9-CM Procedure Code
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC058
not present in this file submission.
MC059
[Unshared] Name: Date of Service - From
[Unshared] Type: Date
[Unshared] Length: 8
Data Element: MC059
not present in this file submission.
MC060
[Unshared] Name: Date of Service - Thru
[Unshared] Type: Date
[Unshared] Length: 8
Data Element: MC060
not present in this file submission.
MC061
[Unshared] Name: Quantity
[Unshared] Type: Integer
[Unshared] Length: 5
Data Element: MC061
not present in this file submission.
MC062
[Unshared] Name: Charge Amount
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC062
not present in this file submission.
MC063
[Unshared] Name: Paid Amount
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC063
not present in this file submission.
MC064
[Unshared] Name: Prepaid Amount
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC064
not present in this file submission.
MC065
[Unshared] Name: Copay
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC065
not present in this file submission.
MC066
[Unshared] Name: Coinsurance Amount
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC066
not present in this file submission.
MC067
[Unshared] Name: Deductible Amount
[Unshared] Type: Decimal
[Unshared] Length: 10
Data Element: MC067
not present in this file submission.
MC068
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC068
not present in this file submission.
MC069
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC069
not present in this file submission.
MC070
[Unshared] Name: Service Provider Country
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: MC070
not present in this file submission.
MC071
[Unshared] Name: DRG
[Unshared] Type: Text
[Unshared] Length: 10
Data Element: MC071
not present in this file submission.
MC072
[Unshared] Name: DRG Version
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC072
not present in this file submission.
MC073
[Unshared] Name: APC
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC073
not present in this file submission.
MC074
[Unshared] Name: APC Version
[Unshared] Type: Text
[Unshared] Length: 2
Data Element: MC074
not present in this file submission.
MC075
[Unshared] Name: Drug Code
[Unshared] Type: Text
[Unshared] Length: 11
Data Element: MC075
not present in this file submission.
MC076
[Unshared] Name: Billing Provider Number
[Unshared] Type: Text
[Unshared] Length: 30
Codes:
L
Legacy/pre-NPI
O
Other
Data Element: MC076
not present in this file submission.
MC077
[Unshared] Name: National Billing Provider ID
[Unshared] Type: Text
[Unshared] Length: 10
Data Element: MC077
not present in this file submission.
MC078
[Unshared] Name: Billing Provider Last Name or Organization Name
[Unshared] Type: Text
[Unshared] Length: 60
Data Element: MC078
not present in this file submission.
MC079
[Unshared] Name: Other ICD-9- CM Procedure Code - 1
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC079
not present in this file submission.
MC080
[Unshared] Name: Other ICD-9- CM Procedure Code - 2
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC080
not present in this file submission.
MC081
[Unshared] Name: Other ICD-9- CM Procedure Code - 3
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC081
not present in this file submission.
MC082
[Unshared] Name: Other ICD-9- CM Procedure Code - 4
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC082
not present in this file submission.
MC083
[Unshared] Name: Other ICD-9- CM Procedure Code - 5
[Unshared] Type: Text
[Unshared] Length: 4
Data Element: MC083
not present in this file submission.
MC084
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC084
not present in this file submission.
MC085
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC085
not present in this file submission.
MC086
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC086
not present in this file submission.
MC087
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC087
not present in this file submission.
MC088
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC088
not present in this file submission.
MC089
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC089
not present in this file submission.
MC090
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC090
not present in this file submission.
MC091
[Unshared] Name: Present on Admission
[Unshared] Type: Text
[Unshared] Length: 1
Codes:
1
Diagnosis code exempt from POA reporting
N
No
U
Unknown/No information on the Record
W
Clinically Undetermined
Y
Yes
Data Element: MC091
not present in this file submission.
MC101
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC101
not present in this file submission.
MC102
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC102
not present in this file submission.
MC103
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC103
not present in this file submission.
MC104
[Unshared] Name: Encrypted Index Number, Member Last Name
[Unshared] Type: Text
[Unshared] Length: 128
Data Element: MC104
not present in this file submission.
MC105
[Unshared] Name: Encrypted Index Number, Member First Name
[Unshared] Type: Text
[Unshared] Length: 128
Data Element: MC105
not present in this file submission.
MC106
[Unshared] Name: Placeholder
[Unshared] Type: N/A
[Unshared] Length: N/A
Data Element: MC106
not present in this file submission.
MC899
[Unshared] Name: Record Type
[Unshared] Type: Text
[Unshared] Length: 2
Codes:
MC
Medical Claims
Data Element: MC899
not present in this file submission.
MEMBERIDN
Data Element: MEMBERIDN
not present in this file submission.
[Unshared] Name: Member ID Number
[Unshared] Type: Numeric
[Unshared] Length: 15
NDC
Data Element: NDC
not present in this file submission.
[Unshared] Name: National Drug Code
[Unshared] Type: Numeric
[Unshared] Length: 11
ORIG_CLM_ID
Data Element: ORIG_CLM_ID
not present in this file submission.
[Unshared] Name: Original Claim ID number
[Unshared] Type: Text
[Unshared] Length: 53
PAID_MEDICAL
Data Element: PAID_MEDICAL
not present in this file submission.
[Unshared] Name: Paid Amount (Medical Paid Amount)
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
PAYER
Data Element: PAYER
not present in this file submission.
[Unshared] Name: PAYER
[Unshared] Type: Numeric
[Unshared] Length: 8
PAYERCODE
Data Element: PAYERCODE
not present in this file submission.
[Unshared] Name: Payer Code
[Unshared] Type: Char
[Unshared] Length: 8
Codes:
TNC
Commercial data reporter
TNG
Governmental payer
TNT
Third-party administrator
PID_MED
Data Element: PID_MED
not present in this file submission.
[Unshared] Name: Provider ID Medical Claims
[Unshared] Type: Text
[Unshared] Length: 40
PLACE_OF_SERVICE
Data Element: PLACE_OF_SERVICE
not present in this file submission.
[Unshared] Name: Service Site (Professional)
[Unshared] Type: Numeric
[Unshared] Length: 2
Codes:
00-10
Unassigned
11
Office
12
Home
13-20
Unassigned
21
Inpatient Hospital
22
Outpatient Hospital
23
Emergency Room - Hospital
24
Ambulatory Surgical Center
25
Birthing Center
26
Military Treatment Facility
27-30
Unassigned
31
Skilled Nursing Facility
32
Nursing Facility
33
Custodial Care Facility
34
Hospice
35-40
Unassigned
41
Ambulance - Land
42
Ambulance - Air or Water
43-49
Unassigned
50
Federally Qualified Health 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
57-59
Unassigned
60
Mass Immunization Center
61
Comprehensive Inpatient Rehabilitation Facility
62
Comprehensive Outpatient Rehabilitation Facility
63-64
Unassigned
65
End-Stage Renal Disease Treatment Facility
66-70
Unassigned
71
State or Local Public Health Clinic
72
Rural Health Clinic
73-80
Unassigned
81
Independent Laboratory
82-98
Unassigned
99
Other Unlisted Facility
PLAN_NPI
Data Element: PLAN_NPI
not present in this file submission.
[Unshared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
PREPAID
Data Element: PREPAID
not present in this file submission.
[Unshared] Name: Prepaid Amount
[Unshared] Type: Decimal (signed)
[Unshared] Length: 14
PRODUCT
Data Element: PRODUCT
not present in this file submission.
[Unshared] Name: Standardized Product Code
[Unshared] Type: Text
[Unshared] Length: 6
Codes:
12
Medicare Secondary Working Aged Beneficiary or Spouse with an Employer's 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 Workers Compensation
16
Medicare Secondary Public Health Service or Other Federal Agency
41
Medicare Secondary Black Lung
42
Medicare Secondary Veterans Administration
43
Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health
47
Medicare Secondary, Other Liability Insurance is Primary
ACA
Affordable Care Act
CP
Medicare Conditionally Primary
D
Disability
DB
Disability Benefits
EP
Exclusive Provider Organization
HM
Health Maintenance Organization (HMO)
HN
Health Maintenance Organization (HMO) Medicare Risk / Medicare Part C
HS
Special Low Income Medicare Beneficiary
IN
Indemnity
MA
Medicare Part A
MB
Medicare Part B
MCTNCR
Tennessee Medicaid (TennCare)
MD
Medicare Part D
MH
Medigap Part A
MI
Medigap Part B
MP
Medicare Primary
PR
Preferred Provider Organization (PPO)
PS
Point of Service (POS)
QM
Qualified Medicare Beneficiary
SP
Supplemental Policy
WC
Worker's Compensation
XXTNAC
AccessTN
XXTNCV
CoverTN
XXTNKD
CoverKids
QTY
Data Element: QTY
not present in this file submission.
[Unshared] Name: Quantity
[Unshared] Type: Numeric (signed)
[Unshared] Length: 14
REV
Data Element: REV
not present in this file submission.
[Unshared] Name: Revenue Code
[Unshared] Type: Char
[Unshared] Length: 4
SVC_PRVIDN
Data Element: SVC_PRVIDN
not present in this file submission.
[Unshared] Name: Service Provider Number
[Unshared] Type: Numeric
[Unshared] Length: 20
TR001
[Unshared] Name: Record Type
[Unshared] Type: Text
[Unshared] Length: 2
Codes:
TR
Trailer Record
Data Element: TR001
not present in this file submission.
TR002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
Data Element: TR002
not present in this file submission.
TR003
[Unshared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
Data Element: TR003
not present in this file submission.
TR004
[Unshared] Name: Type of File
[Unshared] Type: Text
[Unshared] Length: 2
Codes:
MC
Medical Claims
Data Element: TR004
not present in this file submission.
TR005
[Unshared] Name: Period Beginning Date
[Unshared] Type: Integer
[Unshared] Length: 6
Data Element: TR005
not present in this file submission.
TR006
[Unshared] Name: Period Ending Date
[Unshared] Type: Integer
[Unshared] Length: 6
Data Element: TR006
not present in this file submission.
TR007
[Unshared] Name: Date Processed
[Unshared] Type: Date
[Unshared] Length: 8
Data Element: TR007
not present in this file submission.
TYP_OF_SVC
Data Element: TYP_OF_SVC
not present in this file submission.
[Unshared] Name: Type of Service
[Unshared] Type: Text
[Unshared] Length: 2
VERSION_NUM
Data Element: VERSION_NUM
not present in this file submission.
[Unshared] Name: Claim Version
[Unshared] Type: Numeric
[Unshared] Length: 4
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