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Record Type

HD001, Massachusetts

Versions: December 1, 2010 - v2.1 • June 7, 2013 - v3.1• October 1, 2014 - v4.0Compare Versions


Name:Record Type
Data Element ID:HD001
Description:Header Record Identifier
State:Massachusetts
Data Type:Text
Data Type Description:ID Record
Format:char[2]
Length:2
Column:1
Threshold:1
File:HD-DC
Element Submission Guideline:Report HD here. Indicates the beginning of the Header Elements of the file
Condition:Mandatory
Cat:HM
Permissible Values: Record Type uses the following permissible values:
Code / Value Meaning
HD
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File Specification for Multiple versionsDental Claims File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsDC001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsDC002 National Plan ID CMS National Plan Identification Number (PlanID) Text int[10] 10
Multiple versionsDC003 Insurance Type Code / Product Type / Product Identification Code Lookup Table - Text char[2] 2
Multiple versionsDC004 Payer Claim Control Number Payer Claim Control Identification Text varchar[35] 35
Multiple versionsDC005 Line Counter Incremental Line Counter Integer varchar[4] 4
Multiple versionsDC005A Version Number Claim Service Line Version Number Integer varchar[4] 4
Multiple versionsDC006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
Multiple versionsDC007 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
Multiple versionsDC008 Plan Specific Contract Number Contract Number Text varchar[30] 30
Multiple versionsDC009 Member Suffix or Sequence Number Member/Patient's Contract Sequence Number Text varchar[20] 20
Multiple versionsDC010 Member SSN Member/Patient's Social Security Number Numeric char[9] 9
Multiple versionsDC011 Individual Relationship Code Patient to Subscriber Relationship Code Lookup Table - Numeric varchar[2] 2
Multiple versionsDC012 Member Gender Patient's Gender Lookup Table - Text char[1] 1
Multiple versionsDC013 Member Date of Birth Member/Patient's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsDC014 Member City Name City name of the Member/Patient Text varchar[50] 50
Multiple versionsDC015 Member State State / Province of the Patient External Code Source 2 - Text char[2] 2
Multiple versionsDC016 Member ZIP Code Zip Code of the Member / Patient External Code Source 2 - Text varchar[9] 9
Multiple versionsDC017 Date Service Approved (AP Date) Date Service Approved by Payer Full Date - Integer int[8] 8
Multiple versionsDC018 Service Provider Number Service Provider Identification Number Text varchar[30] 30
Multiple versionsDC019 Service Provider Tax ID Number Service Provider's Tax ID number Numeric char[9] 9
Multiple versionsDC020 National Provider ID - Service National Provider Identification (NPI) of the Service Provider External Code Source 3 - Integer int[10] 10
Multiple versionsDC021 Service Provider Entity Type Qualifier Service Provider Entity Identifier Code Lookup Table - integer int[1] 1
Multiple versionsDC022 Service Provider First Name First name of Service Provider Text varchar[25] 25
Multiple versionsDC023 Service Provider Middle Name Middle initial of Service Provider Text varchar[25] 25
Multiple versionsDC024 Service Provider Last Name or Organization Name Last name or Organization Name of Service Provider Text varchar[60] 60
Multiple versionsDC025 Delegated Benefit Administrator Organization ID CHIA defined and maintained Org ID for linking across submitters Integer varchar[6] 6
Multiple versionsDC026 Service Provider Taxonomy Taxonomy Code External Code Source 5 - Text varchar[10] 10
Multiple versionsDC027 Service Provider City Name City name of the Provider Text varchar[30] 30
Multiple versionsDC028 Service Provider State State of the Service Provider External Code Source 2 - Text char[2] 2
Multiple versionsDC029 Service Provider ZIP Code Zip Code of the Service Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsDC030 Facility Type - Professional Place of Service Code External Code Source 13 - Numeric char[2] 2
Multiple versionsDC031 Claim Status Claim Line Status Lookup Table - Numeric varchar[2] 2
Multiple versionsDC032 CDT Code HCPCS / CDT Code External Code Source 10 - Text char[5] 5
Multiple versionsDC033 Procedure Modifier - 1 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsDC034 Procedure Modifier - 2 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsDC035 Date of Service - From Date of Service Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsDC036 Date of Service - Thru Last date of service for this service line. Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsDC037 Charge Amount Amount of provider charges for the claim line Integer ±varchar[10] 10
Multiple versionsDC038 Paid Amount Amount paid by the carrier for the claim line Integer ±varchar[10] 10
Multiple versionsDC039 Copay Amount Amount of Copay member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsDC040 Coinsurance Amount Amount of coinsurance member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsDC041 Deductible Amount Amount of deductible member/patient is responsible to pay on the claim line Integer ±varchar[10] 10
Multiple versionsDC042 Product ID Number Product Identification Text varchar[30] 30
Multiple versionsDC043 Member Street Address Street address of the Member/Patient Text varchar[50] 50
Multiple versionsDC044 Billing Provider Tax ID Number The Billing Provider's Federal Tax Identification Number (FTIN) Numeric char[9] 9
Multiple versionsDC045 Paid Date Paid date of the claim line Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsDC046 Allowed Amount Allowed Amount Integer ±varchar[10] 10
Multiple versionsDC047 Tooth Number/Letter Tooth Number or Letter Identification External Code Source 10 - Text varchar[2] 2
Multiple versionsDC048 Dental Quadrant Dental Quadrant External Code Source 10 - Numeric char[2] 2
Multiple versionsDC049 Tooth Surface Tooth Service Identification External Code Source 10 - Text varchar[5] 5
Multiple versionsDC050 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
Multiple versionsDC051 Subscriber First Name First name of Subscriber Text varchar[25] 25
Multiple versionsDC052 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
Multiple versionsDC053 Member Last Name Last name of Member/Patient Text varchar[60] 60
Multiple versionsDC054 Member First Name First name of Member/Patient Text varchar[25] 25
Multiple versionsDC055 Member Middle Initial Middle initial of the Member/Patient Text char[1] 1
Multiple versionsDC056 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
Multiple versionsDC057 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
Multiple versionsDC058 Member Street Address 2 Secondary Street Address of the Member/Patient Text varchar[50] 50
Multiple versionsDC059 Claim Line Type Claim Line Activity Type Code Lookup Table - Text char[1] 1
Multiple versionsDC060 Former Claim Number Previous Claim Number Text varchar[35] 35
Multiple versionsDC061 Diagnosis Code ICD Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsDC062 ICD Indicator International Classification of Diseases version Lookup Table - Integer int[1] 1
Multiple versionsDC063 Denied Flag Denied Claim Line Indicator Lookup Table - Integer int[1] 1
Multiple versionsDC064 Denial Reason Denial Reason Code Carrier Defined Table - OR - External Code Source 16 varchar[20] 20
Multiple versionsDC065 Payment Arrangement Type Payment Arrangement Type Value Lookup Table - Numeric char[2] 2
Multiple versionsDC066 GIC ID GIC Member ID Text varchar[9] 9
Multiple versionsDC067 APCD ID Code Member Enrollment Type Lookup Table - Integer int[1] 1
DC068 Claim Line Paid Flag Claim Line Paid Indicator Lookup Table - Integer int[1] 1
Multiple versionsDC899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

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