United States Health Information Knowledgebase

 

Maine



Name:Maine
Abbreviation:ME
Title of SystemMaine Health Care Claims Database
Websitehttp://mhdo.maine.gov/imhdo/
Who Maintains the SystemMaine Health Data Organization
Versions:2010-03-16
v1.1
v1.2

File Specification for Multiple versionsDental Claims File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsDC001 Payer This field contains the MHDO submitter code for the payer submitting claims. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by Payer. CHAR 6
Multiple versionsDC002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsDC003 Insurance Type/Product Code - Original The insurance type or product code indicates the type of Insurance coverage the individual has. CHAR 2
Multiple versionsDC004 Payer Claim Control Number Original This field contains the claim number used by the payer to Internally track the claim. CHAR 35
Multiple versionsDC005 Line Counter This field is the line number of the service NUMBER 4
Multiple versionsDC006 Insured Group or Policy Number This field contains the group or policy number associated with the entity which has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 30
Multiple versionsDC007 Encrypted Subscriber Social Security Number Original This field contains the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MEMBERID). CHAR 32
Multiple versionsDC008 Plan Specific Contract Number Original This field contains the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MEMBERID). CHAR 64
Multiple versionsDC009 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or the Contract. CHAR 20
Multiple versionsDC010 Member Identification Code Original This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the ENCRYPTED SOCIAL SECURITY NUMBER. If the member is not the subscriber, this field will not equal the ENCRYPTED SOCIAL SECURITY NUMBER. CHAR 30
Multiple versionsDC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsDC012 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsDC013 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the from date of service. DATE CCYYMMDD 8
Multiple versionsDC014 Member City Name of Residence This field contains the member's city of residence. CHAR 50
Multiple versionsDC015 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service. CHAR 2
Multiple versionsDC016 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsDC017 Date Service Approved (AP Date) This field contains the date the record was approved for payment. This is generally referred to as the Paid Date. In the CCYYMMDD format. DATE 8
Multiple versionsDC030 Facility Type - Professional For professional claims, this field records the type of facility where the service was performed. CHAR 2
Multiple versionsDC031 Claim Status This field contains the status of the claim as reported by the payer. NUMBER 2
Multiple versionsDC032 CDT Code This field is used to report the procedure performed. Common Dental Terminology (CDT) coding is required. CHAR 5
Multiple versionsDC033 Procedure Modifier - 1 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. CHAR 2
Multiple versionsDC034 Procedure Modifier - 2 Procedure modifier required when a modifier clarifies/improves CHAR 2
Multiple versionsDC035 Date of Service From This field contains the first date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsDC036 Date of Service Thru This field contains the thru date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsDC037 Charge Amount This field contains the total charges for the service as reported by the provider. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsDC038 Paid Amount This field includes all health plan payments, including withhold amounts, and excludes all member payments. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsDC039 Copay Amount This field contains the pre-set, fixed dollar amount Payable by a member, often on a per visit/service basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsDC040 Coinsurance Amount This amount is paid by the member and reflects the Percentage a member must pay toward the cost of a covered service. In many health insurance plans the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses have been incurred. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsDC041 Deductible Amount This is an amount that is required to be paid by a member Before health plan benefits will begin to reimburse for Services. It is usually an annual amount of all health care costs that is not covered by the member's insurance plan. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsDC042 Record Type This field indicates the type of record. CHAR 2
Multiple versionsDC901 Member Age This field contains the age of the member in years as of the first day of service. Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsDC902 Record ID # This field contains a Data Processing Center assigned Record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsDC903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsDC904 Unique Member ID The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the MEMBERID is comprised of Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the MEMBERID is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsDC905 Submission Id # This field contains a unique submission number Assigned by the Data Processing Center for tracking Purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsDC906 Double Encrypted Payer Control Claim Number This field contains the encrypted version of the Payer Claim Control Number reported in DC004. The claim number used by the payer to internally track the claim. In general the claim number is associated with all service lines of the bill. Therefore, multiple medical records may share the same claim number. CHAR 100
Multiple versionsDC907 Double Encrypted Subscriber Social Security Number This field contains an encryption of the information Originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsDC908 Double Encrypted Contract Number This field contains an encryption of the information Originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsDC909 Double Encrypted Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the ENCRYPTED SOCIAL SECURITY NUMBER. If the member is not the subscriber, this field will not equal the ENCRYPTED SOCIAL SECURITY NUMBER. CHAR 128
Multiple versionsDC910 Double Encrypted Member ID # The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted Member ID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Double Encrypted Subscriber Social Security Number is blank, the Double Encrypted MEMBERID is comprised of the Encrypted Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 135
Multiple versionsDC911 Provider ID # This is the provider identification number that links to the Dental Service Provider file using DCSPC001. INTEGER 12
Multiple versionsDC912 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsDC913 Year Paid This field is derived from Date Service Approved (DC017) and contains the year of payment (YYYY format). Number 4
Multiple versionsDC914 Month Paid This field is derived from Date Service Approved (DC017) and contains the month of payment (MM format). Number 2
Multiple versionsDC915 Year of Service This field is derived from the From Date of Service (DC035) and contains the year the service was performed (YYYY format). Number YYYY 4
Multiple versionsDC916 Month of Service This field is derived from the From Date of Service (DC035) and contains the month the service was performed (MM format). Number MM 2
Multiple versionsDC917 Payment Quarter This field is derived from Date Service Approved (DC017) and contains the quarter of payment. Number 1
Multiple versionsDC918 Quarter Service Performed This field is derived from the From Date of Service (DC035) and contains the quarter of service. Number 1

File Specification for Multiple versionsDental Eligibility File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsDE001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. CHAR 6
Multiple versionsDE002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsDE003 Insurance Type/Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsDE004 Year The year during which the member is eligible for services. This field is generally used in conjunction with Month to determine a specific period of eligibility. NUMBER 4
Multiple versionsDE005 Month Month indicates the month during which the member is eligible for services. This field is generally used in conjunction with Year to determine a specific period of eligibility. NUMBER 2
Multiple versionsDE006 Insured Group or Policy Number The group or policy number is associated with the entity that has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 31
Multiple versionsDE007 Coverage Level Code This field indicates the type of coverage or type of contract. CHAR 3
Multiple versionsDE008 Encrypted Subscriber Social Security Number This field contains the encrypted social security number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated.This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(Memberid). CHAR 32
Multiple versionsDE009 Plan Specific Contract Number This field contains the payer assigned contract number for the subscriber. If the Encrypted Social Security Number is null, this field forms the core of the unique member number (Memberid). CHAR 64
Multiple versionsDE010 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or the Contract. CHAR 20
Multiple versionsDE011 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 64
Multiple versionsDE012 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsDE013 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsDE014 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the first day of the membership month. DATE CCYYMMDD 8
Multiple versionsDE015 Member City Name This field contains the member's city of residence and was not required reporting until 2004. CHAR 30
Multiple versionsDE016 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service and was not required reporting until 2004. Since this database has been built for Maine residents the code will generally be ME for Maine. CHAR 2
Multiple versionsDE017 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsDE018 Medical Coverage The medical coverage flag indicates whether this member is covered for medical expenses or not. CHAR 1
Multiple versionsDE019 Prescription Drug Coverage The prescription drug coverage flag indicates whether this member is covered for prescription drug expenses or not. CHAR 1
Multiple versionsDE020 Dental Coverage The dental coverage flag indicates whether this member is covered for dental expenses or not. CHAR 1
Multiple versionsDE021 Record Type This field indicates the type of record. CHAR 2
Multiple versionsDE901 Member Age This field contains the age of the member in years as of the last day of the previous eligibility month. Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsDE902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsDE903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsDE904 Unique Member ID The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsDE905 Medicare Coverage This field is used to flag all Medical Eligibility records associated with supplemental Medicare Coverage. Medicare eligibility does not apply to dental data. CHAR 1
Multiple versionsDE906 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsDE907 Double Encrypted Social Security Number This field contains an encryption of the information originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsDE908 Double Encrypted Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsDE909 Double Encrypted Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Double Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Double Encrypted Social Security Number. CHAR 128
Multiple versionsDE910 Double Encrypted Member ID The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted MemberID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of birth + Gender + Individual Relationship Code. If the Double Encrypted Subscriber Social Security Number is blank, the Double Encrypted Memberid is comprised of the Encrypted Plan Specific Contract Number + Year and Month of birth + Gender + Individual Relationship Code. This field contains the member's relationship to the CHAR 135
Multiple versionsDE911 Standardized Relationship Code Subscriber or the insured. INTEGER 2
Multiple versionsDE912 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsDE913 Duplicate Member Flag This field flags duplicate eligibility records that should not be released. INTEGER 1
Multiple versionsDE914 Eligibility Year and Month This field combines YEAR (DE004) and MONTH (DE005) into a single field with a format of YYYYMM. NUMBER YYYYMM 6

File Specification for Multiple versionsDental Provider File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsDCPM901 Data Processing Center Provider Code This field contains the unique provider identifier that crosses all payers. This field is the link to the Dental Services Provider file (DCSP001). NUMBER 12
Multiple versionsDCPM902 Service Provider Tax ID Number This field should contain the provider's tax identification number. For an individual this code is often the social security number. This field is derived from DC026 in the dental claims data. CHAR 10
Multiple versionsDCPM903 Service Provider Facility Name This field contains the normalized first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from DC024 in the dental claims data. CHAR 60
Multiple versionsDCPM904 Service Provider Facility Code This field is reserved for future use. CHAR 10
Multiple versionsDCPM905 Service Provider First Name This field contains the normalized first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from DC022 in the dental claims data. CHAR 25
Multiple versionsDCPM906 Service Provider Middle Name This field contains the normalized middle name or Initial or initial of the practitioner. This field is derived from DC023 in the dental claims data. CHAR 25
Multiple versionsDCPM907 Service Provider Last Name This field contains the normalized full name of individual practitioner. This field is derived from DC024 in the dental claims data. CHAR 60
Multiple versionsDCPM908 Service Provider Suffix This field contains the normalized generational suffix for the individual. This field is derived from DC025 in the dental claims data. CHAR 10
Multiple versionsDCPM909 Service Provider Title Not Provided CHAR 10
Multiple versionsDCPM910 Service Provider State or Province This is the normalized two character abbreviation for city as defined by the US Postal Service. This field is derived from DC028 in the dental claims data. CHAR 2
Multiple versionsDCPM911 Taxonomy Code This field is used to standardize the specialty coding of the provider records. It is based upon the service provider specialty code (DC026) and the linkage activity. A single DPCID will have only one national TAXONOMY code. CHAR 10
DCPM912 National Provider Identifier This field contains the National Provider ID as established under HIPAA. This field is derived from DC020. CHAR 20

File Specification for Multiple versionsDental Service Providers File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsDCSP001 Provider ID # This field is used to link the Dental provider data to the Dental claims data (DC912). It is the primary identification number for each Dental Service Provider record. CHAR 12
Multiple versionsDCSP002 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. It is derived from DC001 in the dental claims data. CHAR 6
Multiple versionsDCSP003 Service Provider Number This is the provider number assigned by the payer. This field is derived from DC018 in the dental claims data. CHAR 30
Multiple versionsDCSP004 Service Provider Tax ID Number This field should contain the provider's tax identification number. For an individual, this code is often the social security number. This field is derived from DC019 in the dental claims data. CHAR 10
Multiple versionsDCSP005 Service Provider Entity Type Qualifier This field is used to distinguish an individual practitioner from a business entity. This field is derived from DC021 in the dental claims data. CHAR 1
Multiple versionsDCSP006 Service Provider First Name This field contains the first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from DC022 in the dental claims data. CHAR 25
Multiple versionsDCSP007 Service Provider Middle Name This field contains the practitioner's middle name or initial. This field is derived from DC023 in the dental claims data. CHAR 25
Multiple versionsDCSP008 Service Provider Last Name or Organization Name This field contains the full name of provider organization or last name of individual provider. This field is derived from DC024 in the dental claims data. CHAR 60
Multiple versionsDCSP009 Service Provider Suffix This field contains the generational suffix for the individual. This field is derived from DC025 in the dental claims data. CHAR 10
Multiple versionsDCSP010 Service Provider Specialty This field contains the specialty code assigned by the payer. Use this field to link to the provider specialty table (SP901). Since specialty codes are not unique across payers, you must also link on Payer. This field is derived from DC026 in the dental claims data. CHAR 10
Multiple versionsDCSP011 Service Provider City Name This field contains the city name of provider - preferably practice location. This field is derived from DC027 in the dental claims data. CHAR 30
Multiple versionsDCSP012 Service Provider State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from DC028in the dental claims data. CHAR 2
Multiple versionsDCSP013 Service Provider ZIP Code This field contains the zip code of provider practice location. It may contain non US codes. This field is derived from DC029 in the dental claims data. CHAR 11
Multiple versionsDCSP014 Data Processing Center Provider Code This field contains the unique provider identifier that crosses all payers. This field is the link to the Dental Provider Master file (DCPM901). NUMBER 12
Multiple versionsDCSP015 Taxonomy Code This field is used to standardize the specialty coding of the provider records. It is based upon the service provider specialty code (DC032) and the linkage activity. A DPCID will have only one national TAXONOMY code. CHAR 10
Multiple versionsDCSP016 Individual Practitioner Flag This field is used to determine if the provider name may be released. Eliminated 04//01/2007 upon the release of practitioner identifiable data elements. NUMBER 1
Multiple versionsDCSP017 National Provider Identifier Not Provided CHAR 20

File Specification for Multiple versionsMedical Claims File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsMC001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by Payer. CHAR 6
Multiple versionsMC002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsMC003 Insurance Type/Product Code The insurance type or product code indicates the type of Insurance coverage the individual has. TEXT 2
Multiple versionsMC004 Payer Claim Control Number This field contains the claim number used by the payer to internally track the claim. CHAR 35
Multiple versionsMC005 Line Counter This field contains the line number for this service NUMBER 30
Multiple versionsMC006 Insured Group or Policy Number The group or policy number is associated with the entity that has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 30
Multiple versionsMC007 Encrypted Subscriber Social Security Number This field contains the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code (MEMBERID). CHAR 32
Multiple versionsMC008 Plan Specific Contract Number This field contains the payer assigned contract number for the subscriber. If the Encrypted Social Security Number is null, this field forms the core of the unique member number (MEMBERID). CHAR 64
Multiple versionsMC009 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or Contract. CHAR 20
Multiple versionsMC010 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 64
Multiple versionsMC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsMC012 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsMC013 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the from date of service (MC059). DATE CCYYMMDD 8
Multiple versionsMC014 Member City Name This field contains the member's city of residence and was not required reporting until 2004. CHAR 30
Multiple versionsMC015 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service and was not required reporting until 2004. Since this database has been built for Maine residents the code will generally be ME for Maine. CHAR 2
Multiple versionsMC016 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsMC017 Date Service Approved (AP Date) This field contains the date the record was approved for payment. This is generally referred to as the Paid Date with a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC018 Admission Date This field contains the date of the inpatient admission with a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC019 Admission Hour This field contains the hour the inpatient was admitted to the hospital in military time. NUMBER 4
Multiple versionsMC020 Admission Type This field is used to record the type of admission for all inpatient hospital bills. NUMBER 2
Multiple versionsMC021 Admission Source This field is required for inpatient hospital bills. It records the source of admission. For newborns (ADMSR = 4) CHAR 1
Multiple versionsMC022 Discharge Hour This field contains the hour the inpatient was discharged from the hospital in military time. NUMBER 2
Multiple versionsMC023 Member Status This field contains the status for the patient discharged from the hospital. NUMBER 2
Multiple versionsMC036 Type of Bill - Institutional Not Provided NUMBER 2
Multiple versionsMC037 Facility Type - Professional For professional claims, this field records the type of facility where the service was performed. CHAR 2
Multiple versionsMC038 Claim Status This field contains the status of the claim as reported by the payer. NUMBER 2
Multiple versionsMC039 Admitting Diagnosis This field contains the ICD-9 diagnosis code indicating the reason for the inpatient admission. CHAR 5
Multiple versionsMC040 E-Code This field describes an injury, poisoning or adverse effect using an ICD-9 E-code diagnosis. CHAR 5
Multiple versionsMC041 Principal Diagnosis This field contains the ICD-9 diagnosis code for the principal diagnosis. CHAR 5
Multiple versionsMC042 Other Diagnosis 1 This field contains the ICD-9 diagnosis code for the first secondary diagnosis . This was not required reporting until 2004. CHAR 5
Multiple versionsMC043 Other Diagnosis 2 This field contains the ICD-9 diagnosis code for the second secondary diagnosis and was not required reporting until CHAR 5
Multiple versionsMC044 Other Diagnosis 3 This field contains the ICD-9 diagnosis code for the third secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC045 Other Diagnosis 4 This field contains the ICD-9 diagnosis code for the fourth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC046 Other Diagnosis 5 This field contains the ICD-9 diagnosis code for the fifth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC047 Other Diagnosis 6 This field contains the ICD-9 diagnosis code for the sixth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC048 Other Diagnosis 7 This field contains the ICD-9 diagnosis code for the seventh secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC049 Other Diagnosis 8 This field contains the ICD-9 diagnosis code for the eighth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC050 Other Diagnosis 9 This field contains the ICD-9 diagnosis code for the ninth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC051 Other Diagnosis 10 This field contains the ICD-9 diagnosis code for the tenth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC052 Other Diagnosis 11 This field contains the ICD-9 diagnosis code for the eleventh secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC053 Other Diagnosis 12 This field contains the ICD-9 diagnosis code for the twelfth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC054 Revenue Code This field is used to report the revenue code for hospital claims. It is one of three fields used to report type of service. National Uniform Billing Committee codes are used in this field. CHAR 10
Multiple versionsMC055 Procedure Code This field contains the HCPC or CPT code for the procedure performed. It is one of three fields used to report the service. CHAR 10
Multiple versionsMC056 Procedure Modifier 1 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. CHAR 2
Multiple versionsMC057 Procedure Modifier 2 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. CHAR 2
Multiple versionsMC058 ICD-9-CM Procedure Code This is used to report the ICD-9 procedure code. The decimal point is not coded. This is one of three fields used to report type of service. CHAR 4
Multiple versionsMC059 Date of Service From This field contains the first date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC060 Date of Service Thru This field contains the last date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC061 Quantity This field contains a count of services performed. This field may be negative. NUMBER 3
Multiple versionsMC062 Charge Amount This field contains the total charges for the service as reported by the provider. This is a money field Containing dollars and cents with an implied decimal Point. This field may contain a negative value. NUMBER 10
Multiple versionsMC063 Paid Amount This field includes all health plan payments, including withhold amounts, and excludes all member payments. This is a money field containing dollars and cents with an Implied decimal point. This field may contain a negative Value. NUMBER 10
Multiple versionsMC064 Prepaid Amount This field contains the fee for service equivalent that would have been paid by the health care claims processor for a specific service if the service had not been capitated. "Capitated services" means services rendered by a provider through a contract where payments are based upon a fixed dollar amount for each member on a monthly basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC065 Copay Amount This field contains the pre-set, fixed dollar amount Payable by a member, often on a per visit/service basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC066 Coinsurance Amount This amount is paid by the member and reflects the percent a member must pay toward the cost of a covered service. In many health insurance plans the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses have been incurred. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC067 Deductible Amount This is an amount that is required to be paid by a member before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that is not covered by the member's insurance plan. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC068 Record Type This field indicates the type of record. CHAR 2
Multiple versionsMC069 Patient Account/Control Number This field is used by hospitals to identify a patient. CHAR 38
MC070 Discharge Date This field contains the date the patient was discharged from the hospital. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsMC901 Member Age This field contains the age of the member in years as of the from date of service (MC059). Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsMC902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsMC903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsMC904 Encrypted Member ID # The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsMC905 Medicare Coverage This field indicates whether the claim is for a member who also has Medicare coverage. It is derived from the insurance type/product code field (MC003). CHAR 1
Multiple versionsMC906 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsMC907 Double Encrypted Payer Claim Control Number This field contains the encrypted version of the Payer Claim Control Number reported in DC004. The claim number used by the payer to internally track the claim. In general the claim number is associated with all service lines of the bill. Therefore, multiple medical records may share the same claim number. CHAR 100
Multiple versionsMC908 Double Encrypted Subscriber Social Security Number This field contains an encryption of the information originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsMC909 Double Encrypted Plan Specific Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsMC910 Double Encrypted Member Social Security Number This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 128
Multiple versionsMC911 Double Encrypted Member ID # The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted Memberid is comprised of Double Encrypted Subscriber Social CHAR 135
Multiple versionsMC912 Provider ID # This is the provider identification number that links to the Medical Service Provider file using MCSP001. INTEGER 12
Multiple versionsMC913 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsMC914 Abortion Flag This field flags all records associated with a possible abortion claim. INTEGER 1
Multiple versionsMC915 Year Paid This field is derived from Date Service Approved (MC017) and contains the year of payment (YYYY format). Number YYYY 4
Multiple versionsMC916 Month Paid This field is derived from Date Service Approved (MC017) and contains the month of payment (MM format). Number MM 2
Multiple versionsMC917 Year of Service This field is derived from the From Date of Service (MC059) and contains the year the service was performed (YYYY format). Number YYYY 4
Multiple versionsMC918 Month of Service This field is derived from the From Date of Service (MC059) and contains the month the service was performed (MM format). Number MM 2
Multiple versionsMC919 Payment Quarter This field is derived from Date Service Approved (MC017) and contains the quarter of payment. Number 1
Multiple versionsMC920 Quarter Service Performed This field is derived from the From Date of Service (MC059) and contains the quarter of service. Number 1

File Specification for Multiple versionsMedical Eligibility File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsME001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. CHAR 6
Multiple versionsME002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsME003 Insurance Type/Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsME004 Year The year during which the member is eligible for services. This field is generally used in conjunction with Month to determine a specific period of eligibility. NUMBER 4
Multiple versionsME005 Month Month indicates the month during which the member is eligible for services. This field is generally used in conjunction with Year to determine a specific period of eligibility. NUMBER 2
Multiple versionsME006 Insured Group or Policy Number The group or policy number is associated with the entity that has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 31
Multiple versionsME007 Coverage Level Code This field indicates the type of coverage or type of contract. CHAR 3
Multiple versionsME008 Encrypted Subscriber Social Security Number This field contains the encrypted social security number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated.This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(Memberid). CHAR 32
Multiple versionsME009 Plan Specific Contract Number This field contains the payer assigned contract number for the subscriber. If the Encrypted Social Security Number is null, this field forms the core of the unique member number (Memberid). CHAR 64
Multiple versionsME010 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or the Contract. CHAR 20
Multiple versionsME011 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 64
Multiple versionsME012 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsME013 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsME014 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the first day of the membership month. DATE CCYYMMDD 8
Multiple versionsME015 Member City Name This field contains the member's city of residence and was not required reporting until 2004. CHAR 30
Multiple versionsME016 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service and was not required reporting until 2004. Since this database has been built for Maine residents the code will generally be ME for Maine. CHAR 2
Multiple versionsME017 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsME018 Medical Coverage The medical coverage flag indicates whether this member is covered for medical expenses or not. CHAR 1
Multiple versionsME019 Prescription Drug Coverage The prescription drug coverage flag indicates whether this member is covered for prescription drug expenses or not. CHAR 1
Multiple versionsME020 Dental Coverage The dental coverage flag indicates whether this member is covered for dental expenses or not. CHAR 1
Multiple versionsME021 Record Type This field indicates the type of record. CHAR 2
Multiple versionsME901 Member Age This field contains the age of the member in years as of the last day of the previous eligibility month. Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsME902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsME903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsME904 Unique The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsME905 Medicare Coverage This field is used to flag all Medical Eligibility records associated with supplemental Medicare Coverage. This field is derived from the insurance type/product code field (ME003). CHAR 1
Multiple versionsME906 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsME907 Double Encrypted Social Security Number This field contains an encryption of the information originally submitted by the payer in field DC007 - the encrypted social security number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsME908 Double Encrypted Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsME909 Double Encrypted Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Double Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Double Encrypted Social Security Number. CHAR 128
Multiple versionsME910 Double Encrypted Member ID The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted MemberID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of birth + Gender + Individual Relationship Code. If the Double Encrypted Subscriber Social Security Number is blank, the Double Encrypted Memberid is comprised of the Encrypted Plan Specific Contract Number + Year and Month of birth + Gender + Individual Relationship Code. CHAR 135
Multiple versionsME911 Standardized Relationship Code This field contains the member's relationship to the Subscriber or the insured. INTEGER 2
Multiple versionsME912 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsME913 Duplicate Member Flag This field flags duplicate eligibility records that should not be released. INTEGER 1
Multiple versionsME914 Eligibility Year and Month This field combines YEAR (ME004) and MONTH (ME005) into a single field with a format of YYYYMM. NUMBER YYYYMM 6

File Specification for Multiple versionsMedical Providers File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsMPM901 Data Processing Center Provider Code This field contains the unique provider identifier that crosses all payers. This field is the link to the Medical Service Providers file (MCSP014). NUMBER 12
Multiple versionsMPM902 Service Provider Tax ID Number This field should contain the provider's tax identification number. For an individual this code is often the social security number. This field is derived from MC026 in the medical claims data. CHAR 10
Multiple versionsMPM903 Service Provider Facility Name This field contains the first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from MC030 in the medical claims data and from Medical Service Providers file (MCSP008). CHAR 60
Multiple versionsMPM904 Service Provider Facility Code For Maine hospitals, this field contains the tax id of the facility. All Maine hospital tax identification numbers begin with 2000xx. This is the identification number released in the MHDO Outpatient data. The MHDO Inpatient data reports the last two digits. CHAR 10
Multiple versionsMPM905 Service Provider First Name This field contains the first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from MC028 in the medical claims data and from Medical Service Providers file (MCSP006). CHAR 25
Multiple versionsMPM906 Service Provider Middle Name This field contains the practitioner's middle name or initial. This field is derived from MC029 in the medical claims data and from Medical Service Providers file (MCSP007). CHAR 25
Multiple versionsMPM907 Service Provider Last Name This field contains the full name of provider organization or last name of individual provider. This field is derived from MC030 in the medical claims data and from Medical Service Providers file (MCSP008). CHAR 60
Multiple versionsMPM908 Service Provider Suffix This field contains the generational suffix for the individual. This field is derived from MC031 in the medical claims data and from Medical Service Providers file (MCSP009). CHAR 10
Multiple versionsMPM909 Service Provider Title Not Provided CHAR 10
Multiple versionsMPM910 Service Provider State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from MC034 in the medical claims data and from Medical Service Providers MCSP012. CHAR 2
Multiple versionsMPM911 Taxonomy Code This field is used to standardize the specialty coding of provider records. It is based upon the service provider specialty code (MC032) and the linkage activity. A single DPCID will have only one national TAXONOMY code. CHAR 10
Multiple versionsMPM912 Unique Physician Identifier This field contains the UPIN code used by CMS CHAR 20
Multiple versionsMPM913 National Provider Identifier Not Provided CHAR 20
Multiple versionsMPM914 Prescribing Physician This field contains the prescribing physician's DEA (Drug Enforcement Authority) registration number. This field is derived from PC047. CHAR 9

File Specification for Multiple versionsMedical Service Providers File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsMCSP001 Provider ID # This field is used to link to the Medical Claims data (MC912). It is the primary identification number for each Medical Service Provider record. CHAR 12
Multiple versionsMCSP002 Payer This field contains the MHDO submitter code for the payer Submitting payments. The first character of the submitter code indicates the type of submitter. CHAR 6
Multiple versionsMCSP003 Service Provider Number This is the provider number assigned by the payer. This Field is derived from MC024 in the medical claims data. CHAR 30
Multiple versionsMCSP004 Service Provider Tax ID Number This field should contain the provider's tax identification Number. For an individual this code is often the social security number. This field is derived from MC025 in the medical claims data. CHAR 10
Multiple versionsMCSP005 Service Provider Entity Type Qualifier This field is used to distinguish an individual Practitioner from a business entity. This field is derived from MC027 in the medical claims data. CHAR 1
Multiple versionsMCSP006 Service Provider First Name This field contains the first name of the practitioner. If the provider is a facility, this field will be blank. This field is derived from MC028 in the medical claims data or from PC044 in the pharmacy claims data. CHAR 25
Multiple versionsMCSP007 Service Provider Middle Name This field contains the practitioner's middle name or initial. This field is derived from MC029 in the medical claims data or from PC045 in the pharmacy claims data. CHAR 25
Multiple versionsMCSP008 Service Provider Last Name or Organization Name This field contains the full name of provider organization or last name of individual provider. This field is derived from MC030 in the medical claims data or from PC046 in the pharmacy claims data. CHAR 60
Multiple versionsMCSP009 Service Provider Suffix This field contains the generational suffix for the individual. This field is derived from MC031 in the medical claims data. CHAR 10
Multiple versionsMCSP010 Service Provider Specialty This field contains the specialty code assigned by the payer. Use this field to link to the provider specialty table (SP901). Since specialty codes are not unique across payers, you must also link on Payer. This field is derived from MC032 in the medical claims data. CHAR 10
Multiple versionsMCSP011 Service Provider City Name This field contains the city name of provider - preferably practice location. This field is derived from MC033 in the medical claims data. CHAR 30
Multiple versionsMCSP012 Service Provider State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from MC034 in the medical claims data. CHAR 2
Multiple versionsMCSP013 Service Provider ZIP Code This field contains the zip code of provider practice location. It may contain non-US codes. This field is derived from MC035 in the medical claims data. CHAR 11
Multiple versionsMCSP014 Data Processing Center Provider Code This field contains the unique provider identifier that crosses all payers. This field is the link to the Medical Provider Master file (MPM901). NUMBER 12
Multiple versionsMCSP015 Taxonomy Code This field is used to standardize the specialty coding of the provider records. It is based upon the service provider specialty code (MC032) and the linkage activity. A DPCID will have only one national TAXONOMY code. CHAR 10
Multiple versionsMCSP016 Individual Practitioner Flag This field is used to determine if the provider name may be released. Eliminated 04/01/2007 upon the release of practitioner identifiable data elements. NUMBER 1
Multiple versionsMCSP017 Prescribing Physician This field contains the prescribing physician's DEA (Drug Enforcement Authority) registration number. This field is derived from PC047. CHAR 9
Multiple versionsMCSP018 National Provider Identifier This field is reserved for future use. CHAR 20
Multiple versionsMCSP019 File Individual Indicates the source of information as coming from the Medical or Pharmacy files. CHAR 1

File Specification for Multiple versionsPharmacy Claims File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsPC001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by Payer. CHAR 6
Multiple versionsPC002 Plan ID CMS National Plan ID CHAR 30
Multiple versionsPC003 Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsPC004 Payer Claim Control Number This field contains the claim number used by the payer to internally track the claim. In general the claim number is associated with all service lines of the bill. Therefore, multiple medical records may share the same claim number. CHAR 35
Multiple versionsPC005 Line Counter This field contains the line number for this service. CHAR 5
Multiple versionsPC006 Insured Group Number The group or policy number is associated with the entity thaThas purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 31
Multiple versionsPC007 Encrypted Subscriber Social Security Number This field contains the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the contract field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MEMBERID). CHAR 32
Multiple versionsPC008 Plan Specific Contract Number This field contains the payer assigned contract number for The subscriber. If the Encrypted Social Security Number is Null, this field forms the core of the unique member number (MEMBERID). CHAR 64
Multiple versionsPC009 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member Within the context of the subscriber Encrypted Social Security Number or the Contract. CHAR 20
Multiple versionsPC010 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the Subscriber, this field will not equal the Encrypted Social Security Number. CHAR 30
Multiple versionsPC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsPC012 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsPC013 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the from date of service. DATE CCYYMMDD 8
Multiple versionsPC014 Member City Name of Residence This field contains the member's city of residence and was not required reporting until 2004. CHAR 50
Multiple versionsPC015 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service and was not required reporting until 2004. Since this database has been built for Maine residents the code will generally be ME for Maine. CHAR 2
Multiple versionsPC016 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsPC017 Date Service Approved (AP Date) This field contains the date the record was approved for Payment with a CCYYMMDD format. This is generally referred to as the Paid Date. DATE CCYYMMDD 8
Multiple versionsPC025 Claim Status This field contains the status of the claim as reported by the payer. NUMBER 2
Multiple versionsPC026 Drug Code Each drug product listed under Section 510 of the Federal Food, Drug, and Cosmetic Act is assigned a unique 10-digit, 3-segment number. This number, known as the National Drug Code (NDC), identifies the labeler/vendor, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. A labeler is any firm that manufactures, re-packs or distributes a drug product. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code, identifies package sizes. Both the product and package codes are assigned by the firm. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1. CHAR 11
Multiple versionsPC027 Drug Name This field contains the text name of drug as supplied by the payer. CHAR 80
Multiple versionsPC028 New Prescription This field can be used to determine if this is a new prescription. It contains the prescription number. NUMBER 2
Multiple versionsPC029 Generic Drug Indicator This field indicates whether the drug is a branded drug or a generic drug. CHAR 1
Multiple versionsPC030 Dispense as Written Code This field indicates the instructions given to the pharmacist For filling the prescription. For example, a prescription for a brand name drug that also has a generic equivalent may not have the generic equivalent substituted. In this case, the code is 1 - physician requires the script be filled as written. NUMBER 1
Multiple versionsPC031 Compound Drug Indicator This field indicates if this is a compound drug or not. CHAR 1
Multiple versionsPC032 Date Prescription Filled This field contains the date the prescription was filled In a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsPC033 Quantity Dispensed This field contains the total unit dosage in metric units. This field may be negative. NUMBER 5
Multiple versionsPC034 Days Supply This field contains the actual days supply for the Prescription based on the metric quantity dispensed. This field may contain a negative value. NUMBER 3
Multiple versionsPC035 Charge Amount This field contains the total charges for the service as Reported by the provider. This is a money field Containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC036 Paid Amount This field includes all health plan payments and excludes all member payments. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC037 Ingredient Cost/List Price This field contains the cost of the drug that was dispensed as reported by the payer. This is a money field containing Dollars and cents with an implied decimal point. NUMBER 10
Multiple versionsPC038 Postage Amount Claimed This field contains the postage amount included in the charges. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC039 Dispensing Fee This field contains the amount charged for dispensing. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC040 Copay Amount This field contains the pre-set, fixed dollar amount payable by a member, often on a per visit/service basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC041 Coinsurance Amount This amount is paid by the member and reflects the Percentage a member must pay toward the cost of a covered service. In many health insurance plans the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses have been incurred. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC042 Deductible Amount This is an amount that is required to be paid by a member Before health plan benefits will begin to reimburse for Services. It is usually an annual amount of all health care costs that is not covered by the member's insurance plan. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsPC043 Record Type This field indicates the type of record. CHAR 2
Multiple versionsPC901 Member Age This field contains the age of the member in years as of the date the prescription was filled. Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsPC902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. NUMBER CCYYMMDD 12
Multiple versionsPC903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsPC904 Unique Member ID The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsPC905 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsPC906 Double Encrypted Payer Control Claim Number This field contains the encrypted version of the Payer Claim Control Number reported in DC004. The claim number used by the payer to internally track the claim. CHAR 100
Multiple versionsPC907 Double Encrypted Subscriber Social Security Number This field contains an encryption of the information Originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsPC908 Double Encrypted Plan Specific Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Double Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsPC909 Double Encrypted Member Social Security Number The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Double Encrypted Subscriber Social Security Number, the Double Encrypted MemberID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Double Encrypted Subscriber Social Security Number is blank, the Double Encrypted Memberid is comprised of the Double Encrypted Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 128
Multiple versionsPC910 Double Encrypted Member ID The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Social Security Number, the Double Encrypted Member ID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Double Encrypted Social Security Number is blank, the Double Encrypted Memberid is comprised of the Double Encrypted Plan Specific Contract Number + Year and Month of Birth + Gender + Indvidual Relationship Code. CHAR 135
Multiple versionsPC911 Standardized Member Gender This field contains the standardized gender code originally reported in PC012. CHAR 1
Multiple versionsPC912 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsPC913 Pharmacy ID # This is the provider identification number that links to the Pharmacy Name File file using PCSPC001. INTEGER 12
Multiple versionsPC914 Year Paid This field is derived from Data Service Approved (PC017) and contains the year of payment (YYYY format). Number YYYY 4
Multiple versionsPC915 Month Paid This field is derived from Date Service Approved (PC017) and contains the month of payment (MM format). Number MM 2
Multiple versionsPC916 Year of Service This field is derived from the From Date of Service (PC032) and contains the year the service was performed (YYYY format). Number YYYY 4
Multiple versionsPC917 Month of Service This field is derived from the From Date of Service (PC032) and contains the month the service was performed (MM) format). Number MM 2
Multiple versionsPC918 Payment Quarter This field is derived from Date Service Approved (PC017) and contains the quarter of payment. Number 1
Multiple versionsPC919 Quarter Service Performed This field is derived from the From Date of Service (PC032) and contains the quarter of payment. Number 1
Multiple versionsPC920 Prescribing Physician ID This is the prescribing physician identification number that links to the Medical Service Provider file using MCSP001. INTEGER 12

File Specification for Multiple versionsPharmacy Eligibility File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPE001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. CHAR 6
Multiple versionsPE002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsPE003 Insurance Type/Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsPE004 Year The year during which the member is eligible for services. This field is generally used in conjunction with Month to determine a specific period of eligibility. NUMBER 4
Multiple versionsPE005 Month Month indicates the month during which the member is eligible for services. This field is generally used in conjunction with Year to determine a specific period of eligibility. NUMBER 2
Multiple versionsPE006 Insured Group or Policy Number The group or policy number is associated with the entity that has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 31
Multiple versionsPE007 Coverage Level Code This field indicates the type of coverage or type of contract. CHAR 3
Multiple versionsPE008 Encrypted Subscriber Social Security Number This field contains the encrypted social security number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(Memberid). CHAR 32
Multiple versionsPE009 Plan Specific Contract Number This field contains the payer assigned contract number for the subscriber. If the Encrypted Social Security Number is null, this field forms the core of the unique member number (Memberid). CHAR 64
Multiple versionsPE010 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or the Contract. CHAR 20
Multiple versionsPE011 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 64
Multiple versionsPE012 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsPE013 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsPE014 Member Date of Birth This field contains the member's data of birth with a Format of CCYYMMDD. This field is used to calculate age as of the first day of the membership month. DATE CCYYMMDD 8
Multiple versionsPE015 Member City Name This field contains the member's city of residence and was not required reporting until 2004. CHAR 30
Multiple versionsPE016 Member State or Province The Member State or Province contains the 2 character Abbreviation code used by the US Postal Service and was not required reporting until 2004. CHAR 2
Multiple versionsPE017 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsPE018 Medical Coverage The medical coverage flag indicates whether this member is covered for medical expenses or not. CHAR 1
Multiple versionsPE019 Prescription Drug Coverage The prescription drug coverage flag indicates whether this member is covered for prescription drug expenses or not. CHAR 1
Multiple versionsPE020 Dental Coverage The dental coverage flag indicates whether this member is covered for dental expenses or not. CHAR 1
Multiple versionsPE021 Record Type This field indicates the type of record. CHAR 2
Multiple versionsPE901 Member Age This field contains the age of the member in years as of the last day of the previous eligibility month. Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsPE902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsPE903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsPE904 Unique Member ID The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of Birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsPE905 Medicare Coverage This field is used to flag all Eligibility records associated with supplemental Medicare Coverage. This field is derived from the insurance type/product code field (PE003). Medicare eligibility does not apply to pharmacy data. CHAR 1
Multiple versionsPE906 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsPE907 Double Encrypted Social Security Number This field contains an encryption of the information originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsPE908 Double Encrypted Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsPE909 Double Encrypted Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Double Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Double Encrypted Social Security Number. CHAR 128
Multiple versionsPE910 Double Encrypted Member ID The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted MemberID is comprised of Double Encrypted Subscriber Social Security Number + Year and Month of birth + Gender + Individual Relationship Code. If the Double Encrypted Subscriber Social Security Number is blank, the Double Encrypted Memberid is comprised of the Encrypted Plan Specific Contract Number + Year and Month of birth + Gender + Individual Relationship Code. CHAR 135
Multiple versionsPE911 Standardized Relationship Code This field contains the member's relationship to the Subscriber or the insured. INTEGER 2
Multiple versionsPE912 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsPE913 Duplicate Member Flag This field flags duplicate eligibility records that should not be released. INTEGER 1
Multiple versionsPE914 Eligibility Yearand Month This field combines YEAR (PE004) and MONTH (PE005) into a single field with a format of YYYYMM. NUMBER YYYYMM 6

File Specification for Multiple versionsPharmacy Provider File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPM901 Data Processing Center Code This field contains the unique pharmacy identifier that crosses all payers. This field is the link to the Pharmacy Detail file (PCSP902). NUMBER 12
Multiple versionsPM902 Pharmacy Tax ID Number This field should contain the pharmacy's tax identification number. This field is normalized from PC019 in the medical claims data. CHAR 10
Multiple versionsPM903 Pharmacy Name This field contains the name of the pharmacy filling the prescription. This field is derived from normalizingPCSP905 in the Pharmacy Detail file CHAR 100
Multiple versionsPM906 National Pharmacy ID Number This field is derived from PC021 in the pharmacy claims data. CHAR 20
Multiple versionsPM907 Pharmacy City Name This field contains the city name of the pharmacy. This field is derived from PCSP907 in the Pharmacy Detail file. CHAR 30
Multiple versionsPM908 Pharmacy State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from normalizing PCSP908 in the Pharmacy Detail file. CHAR 2
PM909 Pharmacy Zip Code This field contains the zip code of the pharmacy location. It may contain non US codes. This field is derived from normalizing PCSP909 in the Pharmacy Detail file. VARCHAR 11

File Specification for Multiple versionsPharmacy Service Providers File Submission - v1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPCSP901 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by payer. It is derived from PC001 in the pharmacy claims data. CHAR 6
Multiple versionsPCSP902 Data Processing Center Code This field contains the unique pharmacy identifier that crosses all payers. This field is the link to the Pharmacy Master file (PM901). NUMBER 12
Multiple versionsPCSP903 Pharmacy Number This is the pharmacy number assigned by the payer. This field is derived from PC018 in the pharmacy claims data. CHAR 30
Multiple versionsPCSP904 Pharmacy Tax ID Number This field should contain the pharmacy''s tax identification number. This field is derived from PC019 in the pharmacy claims data. CHAR 10
Multiple versionsPCSP905 Pharmacy Name This field contains the name of the pharmacy filling the prescription. This field is derived from PC020 in the pharmacy claims data. CHAR 100
Multiple versionsPCSP906 National Pharmacy ID Number This field is derived from PC021 in the pharmacy claims data. CHAR 20
Multiple versionsPCSP907 Pharmacy City Name This field contains the city name of the pharmacy. This field is derived from PC022 in the pharmacy claims data. CHAR 30
Multiple versionsPCSP908 Pharmacy State or Province This is the two character abbreviation for city as defined by the US Postal Service. This field is derived from PC023 in the pharmacy claims data. CHAR 2
Multiple versionsPCSP909 Pharmacy Zip Code This field contains the zip code of the pharmacy location. It may contain non US codes. This field is derived from PC024 in the pharmacy claims data. VARCHAR 11
Multiple versionsPCSP910 Pharmacy ID # This field is used to link to the pharmacy claims data (PC913). It is the primary identification number for each Pharmacy Detail record. Number 12

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