Maryland

At A Glance

Name:	Maryland
Abbreviation:	MD
Title of System	Maryland Health Care Commission Medical Care Data Base
Website	http://mhcc.dhmh.maryland.gov/SitePages/Home.aspx
Who Maintains the System	Maryland Health Care Commission
Versions:	January 9, 2014 February 20, 2013 September 13, 2013

Dental Services Fixed Format

File Specification for Dental Services Fixed Format File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	The value is 6	numeric		1
2	Patient IdentifierP (payer encrypted)	Patient's unique identification number assigned by payer and encrypted.	alphanumeric		12
3	Patient IdentifierU (UUID encrypted)	Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Patient Year and Month of Birth	Date of patient's birth using 00 instead of day.	numeric	CCYYMM00	8
5	Patient Sex	Sex of the patient.	numeric		1
6	Patient Zip Code+4digit add-on code	Zip code of patient's residence.	numeric		10
7	Patient Covered by Other Insurance Indicator	Indicates whether patient has additional insurance coverage.	numeric		1
8	Coverage Type Modified!	Patient's type of insurance coverage.	alphanumeric		1
9	Source Company	Defines the payer company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law.	numeric		1
10	Claim Related Condition	Describes connection, if any, between patient's condition and employment, automobile accident, or other accident.	numeric		1
11	Practitioner Federal Tax ID (TIN)	Employer Tax ID of the practitioner, practice or office facility receiving payment for services.	alphanumeric		9
12	Participating Provider Flag	Indicates if the service was provided by a provider that participates in the payer's network.	numeric		1
13	Record Status	Describes payment and adjustment status of a claim. Adjustments include paying a claim more than once, paying additional services that may have been denied, or crediting a provider due to overpayment or paying the wrong provider.	alphanumeric		1
14	Claim Control Number	Internal payer claim number used for tracking.	alphanumeric		23
15	Claim Paid Date	The date a claim was authorized for payment.	numeric	CCYYMMDD	8
16	Number of Line Items	If using Variable Format, the # of line items completed in the variable portion must match the value entered for this data element, maximum value for this data and # of line items is 26. If using Fixed Format, the number of line items is always equal to one (1) because only one service is written per row.	numeric		2
17	Service From Date	First date of service for a procedure in this line item.	numeric	CCYYMMDD	8
18	Service Thru Date	Last date of service for this line item.	numeric	CCYYMMDD	8
19	Place of Service	Two-digit numeric code that describes where a service was rendered.	numeric		2
20	Service Location Zip Code	Zip code for location where service described was provided.	alphanumeric		10
21	Procedure Code	Describes the health care service provided (i.e., CDT).	alphanumeric		5
22	Servicing Practitioner ID	Payer-specific identifier for the practitioner rendering health care service(s).	alphanumeric		11
23	Billed Charge	A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS	numeric		9
24	Allowed Amount	Total patient and payer liability. DO NOT USE DECIMALS	numeric		9
25	Reimbursement Amount	Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS	numeric		9
26	Date of Enrollment	The start date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 81)	numeric	CCYYMMDD	8
27	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 81)	numeric	CCYYMMDD	8
28	Patient Deductible	The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS	numeric		9
29	Patient Coinsurance or Patient Co-payment	The specified amount or percentage the patient is required to contribute towards covered medical services after any applicable deductible. DO NOT USE DECIMALS	numeric		9
30	Other Patient Obligations	Any patient obligations other than the deductible or coinsurance/co-payment. This could include obligations for out-of-network care (balance billing net of patient deductible, patient coinsurance/co-payment and payer reimbursement), non-covered services, or penalties. DO NOT USE DECIMALS	numeric		9
31	Servicing Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
32	Practitioner National Provider Identifier (NPI) number used for Billing.	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner or an organization for billing purposes.	alphanumeric		10
33	Product Type	Classifies the benefit plan by key product characteristics (scope of coverage, size of network, coverage for out-of-network benefits). (Please code based on how the product is primarily marketed, and most importantly be consistent from year to year. If not sure, send an e-mail describing the product to Larry Monroe at larry.monroe@maryland.gov)	numeric		1
34	Payer ID Number	Payer assigned submission identification number.	alphanumeric		4
35	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payers with all data coming from one system only, leave the field blank.	alphanumeric		1
36	Encrypted Contract or Group Number (payer encrypted)	Payer assigned contract or group number for the plan sponsor using an encryption algorithm generated by the payer.	alphanumeric		20
37	Relationship to Policyholder	Member's relationship to subscriber/insured.	numeric		1
38	Tooth Number/Letter - 1	Report the tooth identifier(s) when Current Dental Terminology Code is within given range.	alphanumeric		2
39	Tooth - 1 Surface - 1	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
40	Tooth - 1 Surface - 2	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
41	Tooth - 1 Surface - 3	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
42	Tooth - 1 Surface - 4	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
43	Tooth - 1 Surface - 5	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
44	Tooth - 1 Surface - 6	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
45	Tooth Number/Letter - 2	Report the tooth identifier(s) when Current Dental Terminology Code is within given range.	alphanumeric		2
46	Tooth - 2 Surface - 1	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
47	Tooth - 2 Surface - 2	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
48	Tooth - 2 Surface - 3	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
49	Tooth - 2 Surface - 4	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
50	Tooth - 2 Surface - 5	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
51	Tooth - 2 Surface - 6	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
52	Tooth Number/Letter - 3	Report the tooth identifier(s) when Current Dental Terminology Code is within given range.	alphanumeric		2
53	Tooth - 3 Surface - 1	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
54	Tooth - 3 Surface - 2	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
55	Tooth - 3 Surface - 3	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
56	Tooth - 3 Surface - 4	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
57	Tooth - 3 Surface - 5	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
58	Tooth - 3 Surface - 6	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
59	Tooth Number/Letter - 4	Report the tooth identifier(s) when Current Dental Terminology Code is within given range.	alphanumeric		2
60	Tooth - 4 Surface - 1	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
61	Tooth - 4 Surface - 2	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
62	Tooth - 4 Surface - 3	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
63	Tooth - 4 Surface - 4	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
64	Tooth - 4 Surface - 5	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
65	Tooth - 4 Surface - 6	Report the tooth surface(s) that this service relates to. Provides further detail on procedure(s). Required when Tooth Number/Letter is populated.	alphanumeric		5
66	Dental Quadrant - 1	Report the standard quadrant identifier when CDT indicates procedures of 3 or more consecutive teeth. Provides further detail on procedure(s).	alphanumeric		2
67	Dental Quadrant - 2	Report the standard quadrant identifier when CDT indicates procedures of 3 or more consecutive teeth. Provides further detail on procedure(s).	alphanumeric		2
68	Dental Quadrant - 3	Report the standard quadrant identifier when CDT indicates procedures of 3 or more consecutive teeth. Provides further detail on procedure(s).	alphanumeric		2
69	Dental Quadrant - 4	Report the standard quadrant identifier when CDT indicates procedures of 3 or more consecutive teeth. Provides further detail on procedure(s).	alphanumeric		2
70	Orthodontics Treatment	Indicate if the treatment is for Orthodontics.	numeric		1
71	Date Appliance Placed	If treatment is for Orthodontics, then provide the date the appliance was placed.	numeric	CCYYMMDD	8
72	Months of Treatment Remaining	If treatment is for Orthodontics, then provide the number of months of treatment remaining.	numeric		2
73	Prosthesis Replacement	Indicate if the treatment is for the replacement of Prosthesis.	numeric		1
74	Date Prior Placement	If treatment is for replacement of Prosthesis, then provide the prior date of Prosthesis placement.	numeric	CCYYMMDD	8
75	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Institutional Services

File Specification for Institutional Services File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	Not Provided	numeric		1
2	Patient IdentifierP (payor encrypted)	Patient's unique identification number assigned by payor and encrypted.	alphanumeric		12
3	Patient IdentifierU (UUID encrypted)	Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Patient Year and Month of Birth	Date of patient's birth using 00 instead of day.	numeric	CCYYMM00	8
5	Patient Sex	Sex of the patient.	numeric		1
6	Patient Zip Code +4-digit add-on	Zip code of patient's residence.	numeric		10
7	Date of Enrollment	The start date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
8	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
9	Hospital/Facility Federal Tax ID	Federal Employer Tax ID of the facility receiving payment for care.	alphanumeric		9
10	Hospital/Facility National Provider Identifier (NPI) Number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an organization for billing purposes.	alphanumeric		10
11	Hospital/Facility Medicare Provider Number	Federal identifier assigned by the federal government for use in all Medicare transactions to an organization for billing purposes.	alphanumeric		6
12	Hospital/Facility Participating Provider Flag	Indicates if the service was provided at a hospital/facility that participates in the payor's network.	numeric		1
13	Claim Control Number	Internal payor claim number used for tracking.	alphanumeric		23
14	Claim Paid Date	The date a claim was authorized for payment.	numeric	CCYYMMDD	8
15	Record Type	Identifies the type of facility or department in a facility where the service was provided.	numeric		2
16	Type of Admission	Applies only to hospital inpatient records. All other record types code "0".	numeric		1
17	Point of Origin for Admission or Visit	Applies only to hospital inpatient records. All other record types code "0". (Note: Assign the code where the patient originated from before presenting to the health care facility.)	numeric		1
18	Patient Discharge Status	Indicates the disposition of the patient at discharge. Applies only to hospital inpatient records. All other record types code "00".	numeric		2
19	Service from date/Start of Service (if Inpatient, Date of Admission)	First date of service for a procedure in this line item.	numeric	CCYYMMDD	8
20	Service thru date/End of Service (if Inpatient, Date of Discharge)	Last date of service for a procedure in this line item.	numeric	CCYYMMDD	8
21	Diagnosis Code Indicator	Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses.	numeric		1
22	Primary Diagnosis	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 29 codes), if applicable at the time of service. Remove embedded decimal pt.	alphanumeric		7
23	Primary Diagnosis Present on Admission (POA)	Primary Diagnosis present on Admission. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
24	Other Diagnosis Code 1	ICD-9-CM/ICD-10-CM Diagnosis Code 1 Remove embedded decimal pt.	alphanumeric		7
25	Other Diagnosis Code 1 Present on Admission 1 (POA)	Diagnosis Code 1 present on Admission 1. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
26	Other Diagnosis Code 2	ICD-9-CM/ICD-10-CM Diagnosis Code 2 Remove embedded decimal pt.	alphanumeric		7
27	Other Diagnosis Code 2 Present on Admission 2 (POA)	Diagnosis Code 2 present on Admission 2. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
28	Other Diagnosis Code 3	ICD-9-CM/ICD-10-CM Diagnosis Code 3 Remove embedded decimal pt.	alphanumeric		7
29	Other Diagnosis Code 3 Present on Admission 3 (POA)	Diagnosis Code 3 present on Admission 3. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
30	Other Diagnosis Code 4	ICD-9-CM/ICD-10-CM Diagnosis Code 4 Remove embedded decimal pt.	alphanumeric		7
31	Other Diagnosis Code 4 Present on Admission 4 (POA)	Diagnosis Code 4 present on Admission 4. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
32	Other Diagnosis Code 5	ICD-9-CM/ICD-10-CM Diagnosis Code 5 Remove embedded decimal pt.	alphanumeric		7
33	Other Diagnosis Code 5 Present on Admission 5 (POA)	Diagnosis Code 5 present on Admission 5. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
34	Other Diagnosis Code 6	ICD-9-CM/ICD-10-CM Diagnosis Code 6 Remove embedded decimal pt.	alphanumeric		7
35	Other Diagnosis Code 6 Present on Admission 6 (POA)	Diagnosis Code 6 present on Admission 6. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
36	Other Diagnosis Code 7	ICD-9-CM/ICD-10-CM Diagnosis Code 7 Remove embedded decimal pt.	alphanumeric		7
37	Other Diagnosis Code 7 Present on Admission 7 (POA)	Diagnosis Code 7 present on Admission 7. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
38	Other Diagnosis Code 8	ICD-9-CM/ICD-10-CM Diagnosis Code 8 Remove embedded decimal pt.	alphanumeric		7
39	Other Diagnosis Code 8 Present on Admission 8 (POA)	Diagnosis Code 8 present on Admission 8. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
40	Other Diagnosis Code 9	ICD-9-CM/ICD-10-CM Diagnosis Code 9 Remove embedded decimal pt.	alphanumeric		7
41	Other Diagnosis Code 9 Present on Admission 9 (POA)	Diagnosis Code 9 present on Admission 9. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
42	Other Diagnosis Code 10	ICD-9-CM/ICD-10-CM Diagnosis Code 10 Remove embedded decimal pt.	alphanumeric		7
43	Other Diagnosis Code 10 Present on Admission 10 (POA)	Diagnosis Code 10 present on Admission 10. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
44	Other Diagnosis Code 11	ICD-9-CM/ICD-10-CM Diagnosis Code 11 Remove embedded decimal pt.	alphanumeric		7
45	Other Diagnosis Code 11 Present on Admission 11 (POA)	Diagnosis Code 11 present on Admission 11. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
46	Other Diagnosis Code 12	ICD-9-CM/ICD-10-CM Diagnosis Code 12 Remove embedded decimal pt.	alphanumeric		7
47	Other Diagnosis Code 12 Present on Admission 12 (POA)	Diagnosis Code 12 present on Admission 12. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
48	Other Diagnosis Code 13	ICD-9-CM/ICD-10-CM Diagnosis Code 13 Remove embedded decimal pt.	alphanumeric		7
49	Other Diagnosis Code 13 Present on Admission 13 (POA)	Diagnosis Code 13 present on Admission 13. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
50	Other Diagnosis Code 14	ICD-9-CM/ICD-10-CM Diagnosis Code 14 Remove embedded decimal pt.	alphanumeric		7
51	Other Diagnosis Code 14 Present on Admission 14 (POA)	Diagnosis Code 14 present on Admission 14. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
52	Other Diagnosis Code 15	ICD-9-CM/ICD-10-CM Diagnosis Code 15 Remove embedded decimal pt.	alphanumeric		7
53	Other Diagnosis Code 15 Present on Admission 15 (POA)	Diagnosis Code 15 present on Admission 15. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
54	Other Diagnosis Code 16	ICD-9-CM/ICD-10-CM Diagnosis Code 16 Remove embedded decimal pt.	alphanumeric		7
55	Other Diagnosis Code 16 Present on Admission 16 (POA)	Diagnosis Code 16 present on Admission 16. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
56	Other Diagnosis Code 17	ICD-9-CM/ICD-10-CM Diagnosis Code 17 Remove embedded decimal pt.	alphanumeric		7
57	Other Diagnosis Code 17 Present on Admission 17 (POA)	Diagnosis Code 17 present on Admission 17. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
58	Other Diagnosis Code 18	ICD-9-CM/ICD-10-CM Diagnosis Code 18 Remove embedded decimal pt.	alphanumeric		7
59	Other Diagnosis Code 18 Present on Admission 18 (POA)	Diagnosis Code 18 present on Admission 18. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
60	Other Diagnosis Code 19	ICD-9-CM/ICD-10-CM Diagnosis Code 19 Remove embedded decimal pt.	alphanumeric		7
61	Other Diagnosis Code 19 Present on Admission 19 (POA)	Diagnosis Code 19 present on Admission 19. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
62	Other Diagnosis Code 20	ICD-9-CM/ICD-10-CM Diagnosis Code 20 Remove embedded decimal pt.	alphanumeric		7
63	Other Diagnosis Code 20 Present on Admission 20 (POA)	Diagnosis Code 20 present on Admission 20. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
64	Other Diagnosis Code 21	ICD-9-CM/ICD-10-CM Diagnosis Code 21 Remove embedded decimal pt.	alphanumeric		7
65	Other Diagnosis Code 21 Present on Admission 21 (POA)	Diagnosis Code 21 present on Admission 21. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
66	Other Diagnosis Code 22	ICD-9-CM/ICD-10-CM Diagnosis Code 22 Remove embedded decimal pt.	alphanumeric		7
67	Other Diagnosis Code 22 Present on Admission 22 (POA)	Diagnosis Code 22 present on Admission 22. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
68	Other Diagnosis Code 23	ICD-9-CM/ICD-10-CM Diagnosis Code 23 Remove embedded decimal pt.	alphanumeric		7
69	Other Diagnosis Code 23 Present on Admission 23 (POA)	Diagnosis Code 23 present on Admission 23. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
70	Other Diagnosis Code 24	ICD-9-CM/ICD-10-CM Diagnosis Code 24 Remove embedded decimal pt.	alphanumeric		7
71	Other Diagnosis Code 24 Present on Admission 24 (POA)	Diagnosis Code 24 present on Admission 24. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
72	Other Diagnosis Code 25	ICD-9-CM/ICD-10-CM Diagnosis Code 25 Remove embedded decimal pt.	alphanumeric		7
73	Other Diagnosis Code 25 Present on Admission 25 (POA)	Diagnosis Code 25 present on Admission 25. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
74	Other Diagnosis Code 26	ICD-9-CM/ICD-10-CM Diagnosis Code 26 Remove embedded decimal pt.	alphanumeric		7
75	Other Diagnosis Code 26 Present on Admission 26 (POA)	Diagnosis Code 26 present on Admission 26. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
76	Other Diagnosis Code 27	ICD-9-CM/ICD-10-CM Diagnosis Code 27 Remove embedded decimal pt.	alphanumeric		7
77	Other Diagnosis Code 27 Present on Admission 27 (POA)	Diagnosis Code 27 present on Admission 27. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
78	Other Diagnosis Code 28	ICD-9-CM/ICD-10-CM Diagnosis Code 28 Remove embedded decimal pt.	alphanumeric		7
79	Other Diagnosis Code 28 Present on Admission 28 (POA)	Diagnosis Code 28 present on Admission 28. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
80	Other Diagnosis Code 29	ICD-9-CM/ICD-10-CM Diagnosis Code 29 Remove embedded decimal pt.	alphanumeric		7
81	Other Diagnosis Code 29 Present on Admission 29 (POA)	Diagnosis Code 29 present on Admission 29. Applies only to hospital inpatient records. All other record types code "0".	alphanumeric		1
82	Attending Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
83	Operating Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
84	Procedure Code Indicator	Indicates the classification used in assigning codes to procedures.	numeric		1
85	Principal Procedure Code 1	The principal health care service provided, followed by a secondary procedure (up to 15 codes), if applicable at the time of service. Remove embedded decimal pt.	alphanumeric		6
86	Procedure Code1 Modifier I	Discriminate code used by practitioners to distinguish that a health care service has been altered [by a specific condition] but not changed in definition or code. A modifier is added as a suffix to a procedure code field.	alphanumeric		2
87	Procedure Code1 Modifier II	Specific to Modifier I.	alphanumeric		2
88	Other Procedure Code 2	Remove embedded decimal pt.	alphanumeric		6
89	Procedure Code2 Modifier I	Not Provided	alphanumeric		2
90	Procedure Code2 Modifier II	Not Provided	alphanumeric		2
91	Other Procedure Code 3	Remove embedded decimal pt.	alphanumeric		6
92	Procedure Code3 Modifier I	Not Provided	alphanumeric		2
93	Procedure Code3 Modifier II	Not Provided	alphanumeric		2
94	Other Procedure Code 4	Remove embedded decimal pt.	alphanumeric		6
95	Procedure Code4 Modifier I	Not Provided	alphanumeric		2
96	Procedure Code4 Modifier II	Not Provided	alphanumeric		2
97	Other Procedure Code 5	Remove embedded decimal pt.	alphanumeric		6
98	Procedure Code5 Modifier I	Not Provided	alphanumeric		2
99	Procedure Code5 Modifier II	Not Provided	alphanumeric		2
100	Other Procedure Code 6	Remove embedded decimal pt.	alphanumeric		6
101	Procedure Code6 Modifier I	Not Provided	alphanumeric		2
102	Procedure Code6 Modifier II	Not Provided	alphanumeric		2
103	Other Procedure Code 7	Remove embedded decimal pt.	alphanumeric		6
104	Procedure Code7 Modifier I	Not Provided	alphanumeric		2
105	Procedure Code7 Modifier II	Not Provided	alphanumeric		2
106	Other Procedure Code 8	Remove embedded decimal pt.	alphanumeric		6
107	Procedure Code8 Modifier I	Not Provided	alphanumeric		2
108	Procedure Code8 Modifier II	Not Provided	alphanumeric		2
109	Other Procedure Code 9	Remove embedded decimal pt.	alphanumeric		6
110	Procedure Code9 Modifier I	Not Provided	alphanumeric		2
111	Procedure Code9 Modifier II	Not Provided	alphanumeric		2
112	Other Procedure Code 10	Remove embedded decimal pt.	alphanumeric		6
113	Procedure Code10 Modifier I	Not Provided	alphanumeric		2
114	Procedure Code10 Modifier II	Not Provided	alphanumeric		2
115	Other Procedure Code 11	Remove embedded decimal pt.	alphanumeric		6
116	Procedure Code11 Modifier I	Not Provided	alphanumeric		2
117	Procedure Code11 Modifier II	Not Provided	alphanumeric		2
118	Other Procedure Code 12	Remove embedded decimal pt.	alphanumeric		6
119	Procedure Code12 Modifier I	Not Provided	alphanumeric		2
120	Procedure Code12 Modifier II	Not Provided	alphanumeric		2
121	Other Procedure Code 13	Remove embedded decimal pt.	alphanumeric		6
122	Procedure Code13 Modifier I	Not Provided	alphanumeric		2
123	Procedure Code13 Modifier II	Not Provided	alphanumeric		2
124	Other Procedure Code 14	Remove embedded decimal pt.	alphanumeric		6
125	Procedure Code14 Modifier I	Not Provided	alphanumeric		2
126	Procedure Code14 Modifier II	Not Provided	alphanumeric		2
127	Other Procedure Code 15	Remove embedded decimal pt.	alphanumeric		6
128	Procedure Code15 Modifier I	Not Provided	alphanumeric		2
129	Procedure Code15 Modifier II	Not Provided	alphanumeric		2
130	Diagnosis Related Groups (DRGs) Number	The inpatient classifications based on diagnosis, procedure, age, gender and discharge disposition.	alphanumeric		3
131	DRG Grouper Name	The actual DRG Grouper used to produce the DRGs.	numeric		1
132	DRG Grouper Version	Version of DRG Grouper used.	numeric		2
133	Billed Charge	A provider's billed charges rounded to whole dollars. DO NOT USE DECIMALS	numeric		9
134	Allowed Amount	Total patient and payor liability. DO NOT USE DECIMALS	numeric		9
135	Reimbursement Amount	Amount paid by carrier to Tax ID # of provider as listed on claim. DO NOT USE DECIMALS	numeric		9
136	Total Patient Deductible	The fixed amount that the patient must pay for covered medical services/hospital stay before benefits are payable.	numeric		9
137	Total Patient Coinsurance or Patient Co- payment	The specified amount or percentage the patient is required to contribute towards covered medical services/hospital stay after any applicable deductible.	numeric		9
138	Total Other Patient Obligations	Any patient liability other than the deductible or coinsurance/co-payment. This could include obligations for out-of-network care (balance billing net of patient deductible, patient coinsurance/co-payment and payor reimbursement), non-covered services, or penalties. DO NOT USE DECIMALS	numeric		9
139	Coordination of Benefit Savings or Other Payor Payments	If you are not the primary insurer, report the amount paid by the primary payor.	numeric		9
140	Type of Bill	Not Provided	alphanumeric		3
141	Patient Covered by Other Insurance Indicator	Indicates whether patient has additional insurance coverage.	numeric		1
142	Payor ID Number	Payor assigned submission identification number.	alphanumeric		4
143	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank.	alphanumeric		1
144	Revenue Code 1	Provide the codes used to identify specific accommodation and/or ancillary charges.	numeric		4
145	Other Revenue Code 2	Not Provided	numeric		4
146	Other Revenue Code 3	Not Provided	numeric		4
147	Other Revenue Code 4	Not Provided	numeric		4
148	Other Revenue Code 5	Not Provided	numeric		4
149	Other Revenue Code 6	Not Provided	numeric		4
150	Other Revenue Code 7	Not Provided	numeric		4
151	Other Revenue Code 8	Not Provided	numeric		4
152	Other Revenue Code 9	Not Provided	numeric		4
153	Other Revenue Code 10	Not Provided	numeric		4
154	Other Revenue Code 11	Not Provided	numeric		4
155	Other Revenue Code 12	Not Provided	numeric		4
156	Other Revenue Code 13	Not Provided	numeric		4
157	Other Revenue Code 14	Not Provided	numeric		4
158	Other Revenue Code 15	Not Provided	numeric		4
159	Other Revenue Code 16	Not Provided	numeric		4
160	Other Revenue Code 17	Not Provided	numeric		4
161	Other Revenue Code 18	Not Provided	numeric		4
162	Other Revenue Code 19	Not Provided	numeric		4
163	Other Revenue Code 20	Not Provided	numeric		4
164	Other Revenue Code 21	Not Provided	numeric		4
165	Other Revenue Code 22	Not Provided	numeric		4
166	Other Revenue Code 23	Not Provided	numeric		4
167	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Medical Eligibility

File Specification for Medical Eligibility File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	The value is 5	numeric		1
2	Encrypted Enrollee IdentifierP (payor encrypted)	Enrollee's unique identification number assigned by payor and encrypted.	alphanumeric		12
3	Encrypted Enrollee IdentifierU (UUID encrypted)	Enrollee's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Enrollee Year and Month of Birth	Date of enrollee's birth using 00 instead of day.	numeric	CCYYMM00	8
5	Enrollee Sex	Sex of the enrollee.	numeric		1
6	Enrollee Zip Code of Residence +4-digit add-on	Zip code of enrollee's residence.	numeric		10
7	Enrollee County of Residence	County of enrollee's residence. If known, please provide. If not known, MHCC will arbitrarily assign using Zip code of residence.	numeric		3
8	Source of Direct Reporting of Enrollee Race	Indicate the source of direct reporting of enrollee race.	numeric		1
9	Race Category White - Direct	Enter whether the self-defined race of the enrollee is White or Caucasian. White is defined as a person having lineage in any of the original peoples of Europe, the Middle East, or North Africa.	numeric		1
10	Race Category Black or African American - Direct	Enter whether the self-defined race of the enrollee is Black or African American. Black or African American is defined as a person having lineage in any of the Black racial groups of Africa.	numeric		1
11	Race Category American Indian or Alaska Native - Direct	Enter whether the self-defined race of the enrollee is American Indian or Alaska Native. American Indian or Alaska Native is defined as a person having lineage in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.	numeric		1
12	Race Category Asian - Direct	Enter whether the self-defined race of the enrollee is Asian. Asian is defined as a person having lineage in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.	numeric		1
13	Race Category Native Hawaiian or Other Pacific Islander - Direct	Enter whether the self-defined race of the enrollee is Native Hawaiian or Other Pacific Islander. Native Hawaiian or Other Pacific Islander is defined as a person having lineage in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.	numeric		1
14	Race Category Other - Direct	Enter whether the self-defined race of the enrollee is Other.	numeric		1
15	Race Category Declined to Answer - Direct	Enter whether the enrollee declined to disclose their race.	numeric		1
16	Race Category Unknown or Cannot Determined - Direct	Enter whether the race of the enrollee is unknown or cannot be determined.	numeric		1
17	Imputed Race with Highest Probability	Race of enrollee.	numeric		1
18	Probability of Imputed Race Assignment	Specify the probability of race assignment; probability used in race determination.	numeric		3
19	Source of Direct Reporting of Enrollee Ethnicity	Indicate source of reporting enrollee ethnicity.	numeric		1
20	Enrollee OMB Hispanic Ethnicity (Hispanic Indicator)	Ethnicity of enrollee.	numeric		1
21	Imputed Ethnicity with Highest Probability (Hispanic Indicator)	Enter the Ethnicity of the enrollee.	numeric		1
22	Probability of Imputed Ethnicity Assignment	Specify the probability of ethnicity assignment; probability used in ethnicity determination.	numeric		3
23	Enrollee Preferred Spoken Language for a Healthcare Encounter	A locally relevant list of languages has been developed by the Commission.	numeric		2
24	Coverage Type	Enrollee's type of insurance coverage.	alphanumeric		1
25	Source Company	Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law.	alphanumeric		1
26	Product Type	Classifies the benefit plan by key product characteristics (scope of coverage, size of network, coverage for out-of- network benefits). (Please code based on how the product is primarily marketed, and most importantly be consistent from year to year. If not sure, send an e-mail describing the product to Larry Monroe at larry.monroe@maryland.gov)	numeric		1
27	Policy Type	Type of policy.	numeric		1
28	Encrypted Contract or Group Number (payor encrypted)	Payor assigned contract or group number for the plan sponsor using an encryption algorithm generated by the payor.	alphanumeric		20
29	Employer Federal Tax ID Number	Employer Federal Tax ID number will be encrypted by the database contractor in such a way that an employer will have the same encrypted ID across all payor records and the same employer has the same encrypted number from year to year.	alphanumeric		9
30	Medical Services Indicator	Medical Coverage	numeric		1
31	Pharmacy Services Indicator	Prescription Drug Coverage	numeric		1
32	Behavioral Health Services Indicator	Behavioral Health Services Coverage	numeric		1
33	Dental Services Indicator	Dental Coverage	numeric		1
34	Plan Liability	Indicates if insurer is at risk for the patient's service use or the insurer is simply paying claims as an ASO.	numeric		1
35	Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator	Consumer Directed Health Plan (CDHP) with Health Savings Account (HSA) or Health Resources Account (HRA).	numeric		1
36	Start Date of Coverage (in the month)	The start date for benefits in the month (for example, if the enrollee was insured at the start of the month of January in 2014, the start date is 20140101)	numeric	CCYYMMDD	8
37	End Date of Coverage (in the month)	The end date for benefits in the month (for example, if the enrollee was insured for the entire month of January in 2014, the end date is 20140131)	numeric	CCYYMMDD	8
38	Date of FIRST Enrollment	The date of that the patient was initially enrolled in the plan.	numeric	CCYYMMDD	8
39	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 72)	numeric	CCYYMMDD	8
40	Coverage Period End Date	Contract renewal date, after which benefits, such as deductibles and out of pocket maximums reset.	Not Provided	CCYYMMDD	8
41	Relationship to Policyholder	Member's relationship to subscriber/insured.	numeric		1
42	Payor ID Number	Payor assigned submission identification number.	alphanumeric		4
43	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank.	alphanumeric		1
44	Grandfathered Plan Indicator	Indicate if the plan qualifies as a "Grandfathered or Transitional Plan" under the Affordable Care Act (ACA).	numeric		1
45	Plan or Product ID Number	Payor ID number associated with an enrollee's coverage and benefits in the claim adjudication system.	alphanumeric		20
46	Subscriber ID Number	Subscriber ID number associated with individual or family enrollment.	alphanumeric		20
47	Health Insurance Oversight System (HIOS) ID Number	HIOS ID number supplied by the federal government.	alphanumeric		20
48	Master Patient Index	Indicates the unique patient identifier assigned by Maryland's Health Information Exchange, Chesapeake Regional Information System for our Patients (CRISP).	alphanumeric		40
49	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Pharmacy Fixed Format

File Specification for Pharmacy Fixed Format File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	The value is 2	numeric		1
2	Patient IdentifierP (payor encrypted)	Patient's unique identification number assigned by payor and encrypted.	alphanumeric		12
3	Patient IdentifierU (UUID encrypted)	Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Patient Sex	Sex of Patient.	numeric		1
5	Patient Zip Code+4-digit add-on	Zip code of patient's residence.	numeric		10
6	Patient Year and Month of Birth	Date of patient's birth using 00 instead of day.	numeric	CCYYMM00	8
7	Pharmacy NCPDP Number	Unique 7 digit number assigned by the National Council for Prescription Drug Program (NCPDP).	numeric		7
8	Pharmacy Zip Code+4-digit add-on	Zip code of pharmacy where prescription was filled and dispensed.	numeric		10
9	Practitioner DEA #	Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act.	alphanumeric		11
10	Fill Number	The code used to indicate if the prescription is an original prescription or a refill. Use '01' for all refills if the specific number of the prescription refill is not available.	numeric		2
11	NDC Number	National Drug Code 11 digit number.	numeric		11
12	Drug Compound	Indicates a mix of drugs to form a compound medication.	numeric		1
13	Drug Quantity	Number of units of medication dispensed.	numeric		5
14	Drug Supply	Estimated number of days of dispensed supply.	numeric		3
15	Date Filled	Date prescription was filled.	numeric	CCYYMMDD	8
16	Date Prescription Written	Date prescription was written.	numeric	CCYYMMDD	8
17	Billed Charge	Retail amount for drug including dispensing fees and administrative costs. MUST INCLUDE 2 IMPLIED DECIMAL PLACES.	numeric		9
18	Reimbursement Amount	Amount paid to the pharmacy by payor. Do not include patient copayment or sales tax. MUST INCLUDE 2 IMPLIED DECIMAL PLACES.	numeric		9
19	Prescription Claim Number	Internal payor claim number used for tracking.	numeric		15
20	Prescription Claim Paid Date	The date a claim was authorized for payment.	numeric	CCYYMMDD	8
21	Prescribing Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
22	Patient Deductible	The fixed amount that the patient must pay for covered pharmacy services before benefits are payable. MUST INCLUDE 2 IMPLIED DECIMAL PLACES.	numeric		9
23	Patient Coinsurance/Patient Co-payment	The specified amount or percentage the patient is required to contribute towards covered pharmacy services after any applicable deductible. MUST INCLUDE 2 IMPLIED DECIMAL PLACES.	numeric		9
24	Other Patient Obligations	Any patient obligations other than the deductible or coinsurance/co-payment. This could include obligations for non-formulary drugs, non-covered pharmacy services, or penalties. MUST INCLUDE 2 IMPLIED DECIMAL PLACES.	numeric		9
25	Date of Enrollment	The first day of the reporting period the patient is in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
26	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
27	Source of Processing	The source processing the pharmacy claim.	alphanumeric		1
28	Payor ID Number	Payor assigned submission identification number.	alphanumeric		4
29	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.)	alphanumeric		1
30	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Professional Services Fixed Format

File Specification for Professional Services Fixed Format File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	The value is 1	numeric		1
2	Patient IdentifierP (payor encrypted)	Patient's unique identification number assigned by payor and encrypted.	alphanumeric		12
3	Patient IdentifierU (UUID encrypted)	Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Patient Year and Month of Birth	Date of patient's birth using 00 instead of day.	numeric	CCYYMM00	8
5	Patient Sex	Sex of the patient.	numeric		1
6	Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator	Consumer Directed Health Plan (CDHP) with Health Savings Account (HSA) or Health Resources Account(HRA)	numeric		1
7	Patient Zip Code+4digit add-on code	Zip code of patient's residence.	numeric		10
8	Patient Covered by Other Insurance Indicator	Indicates whether patient has additional insurance coverage.	numeric		1
9	Coverage Type	Patient's type of insurance coverage.	alphanumeric		1
10	Source Company	Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law.	numeric		1
11	Claim Related Condition	Describes connection, if any, between patient's condition and employment, automobile accident, or other accident.	numeric		1
12	Practitioner Federal Tax ID	Employer Tax ID of the practitioner, practice or office facility receiving payment for services.	alphanumeric		9
13	Participating Provider Status	Indicates if the service was provided by a provider that participates in the payor's network.	numeric		1
14	Record Status	Describes payment and adjustment status of a claim. Adjustments include paying a claim more than once, paying additional services that may have been denied, or crediting a provider due to overpayment or paying the wrong provider.	alphanumeric		1
15	Claim Control Number	Internal payor claim number used for tracking.	alphanumeric		23
16	Claim Paid Date	The date a claim was authorized for payment.	numeric	CCYYMMDD	8
17	Number of Diagnosis Codes	The number of diagnosis codes, up to ten.	numeric		2
18	Number of Line Items	If using Variable Format, the # of line items completed in the variable portion (data elements 20-40, 44-51) must match the value entered for this data element, maximum value for this data and # of line items is 26. If using Fixed Format, the number of line items is always equal to one (1) because only one service is written per row.	numeric		2
19	Diagnosis Code 1	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
20	Diagnosis Code 2	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
21	Diagnosis Code 3	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
22	Diagnosis Code 4	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
23	Diagnosis Code 5	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
24	Diagnosis Code 6	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
25	Diagnosis Code 7	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
26	Diagnosis Code 8	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
27	Diagnosis Code 9	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
28	Diagnosis Code 10	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
29	Service From Date	First date of service for a procedure in this line item.	numeric	CCYYMMDD	8
30	Service Thru Date	Last date of service for this line item.	numeric	CCYYMMDD	8
31	Place of Service	Two-digit numeric code that describes where a service was rendered.	numeric		2
32	Service Location Zip Code +4digit add-on code	Zip code for location where service described was provided.	alphanumeric		10
33	Service Unit Indicator	Category of service as it corresponds to Units data element.	numeric		1
34	Units of Service	Quantity of services or number of units for a service or minutes of anesthesia.	numeric		3
35	Procedure Code	Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM)	alphanumeric		6
36	Modifier I	Discriminate code used by practitioners to distinguish that a health care service has been altered [by a specific condition] but not changed in definition or code. A modifier is added as a suffix to a procedure code field.	alphanumeric		2
37	Modifier II	Specific to Modifier I.	alphanumeric		2
38	Servicing Practitioner ID	Payor-specific identifier for the practitioner rendering health care service(s).	alphanumeric		11
39	Billed Charge	A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS	numeric		9
40	Allowed Amount	Total patient and payor liability. DO NOT USE DECIMALS	numeric		9
41	Reimbursement Amount	Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS	numeric		9
42	Date of Enrollment	The first day of the reporting period the patient is in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
43	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
44	Patient Deductible	The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS	numeric		9
45	Patient Coinsurance or Patient Co-payment	The specified amount or percentage the patient is required to contribute towards covered medical services after any applicable deductible. DO NOT USE DECIMALS	numeric		9
46	Other Patient Obligations	Any patient obligations other than the deductible or coinsurance/co-payment. This could include obligations for out-of-network care (balance billing net of patient deductible, patient coinsurance/co-payment and payor reimbursement), non-covered services, or penalties. DO NOT USE DECIMALS	numeric		9
47	Plan Liability	Indicates if insurer is at risk for the patient's service use or the insurer is simply paying claims as Administrative Services Only (ASO)	numeric		1
48	Servicing Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
49	Practitioner National Provider Identifier (NPI) number used for Billing	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner or an organization for billing purposes.	alphanumeric		10
50	Product Type	Classifies the benefit plan by key product characteristics (scope of coverage, size of network, coverage for out-of- network benefits). (Please code based on how the product is primarily marketed, and most importantly be consistent from year to year. If not sure, send an e-mail describing the product to Larry Monroe at larry.monroe@maryland.gov)	numeric		1
51	Payor ID Number	Payor assigned submission identification number.	alphanumeric		4
52	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank.	alphanumeric		1
53	Assignment of Benefits	For out-of-network services please provide information on whether or not the patient assigned benefits to the servicing physician for an out-of-network service.	alphanumeric		1
54	Diagnosis Code Indicator	Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses.	numeric		1
55	CPT Category II Code 1	Provide any applicable CPT Category II codes.	alphanumeric		5
56	CPT Category II Code 2	Not Provided	alphanumeric		5
57	CPT Category II Code 3	Not Provided	alphanumeric		5
58	CPT Category II Code 4	Not Provided	alphanumeric		5
59	CPT Category II Code 5	Not Provided	alphanumeric		5
60	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Professional Services Variable Format

File Specification for Professional Services Variable Format File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Format	Length
1	Record Identifier	The value is 1	numeric		1
2	Patient IdentifierP (payor encrypted)	Patient's unique identification number assigned by payor and encrypted.	alphanumeric		12
3	Patient IdentifierU (UUID encrypted)	Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC.	alphanumeric		12
4	Patient Year and Month of Birth	Date of patient's birth using 00 instead of day.	numeric	CCYYMM00	8
5	Patient Sex	Sex of the patient.	numeric		1
6	Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator	Consumer Directed Health Plan (CDHP) with Health Savings Account (HSA) or Health Resources Account(HRA)	numeric		1
7	Patient Zip Code+4digit add-on code	Zip code of patient's residence.	numeric		10
8	Patient Covered by Other Insurance Indicator	Indicates whether patient has additional insurance coverage.	numeric		1
9	Coverage Type	Patient's type of insurance coverage.	alphanumeric		1
10	Source Company	Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law.	numeric		1
11	Claim Related Condition	Describes connection, if any, between patient's condition and employment, automobile accident, or other accident.	numeric		1
12	Practitioner Federal Tax ID	Employer Tax ID of the practitioner, practice or office facility receiving payment for services.	alphanumeric		9
13	Participating Provider Status	Indicates if the service was provided by a provider that participates in the payor's network.	numeric		1
14	Record Status	Describes payment and adjustment status of a claim. Adjustments include paying a claim more than once, paying additional services that may have been denied, or crediting a provider due to overpayment or paying the wrong provider.	alphanumeric		1
15	Claim Control Number	Internal payor claim number used for tracking.	alphanumeric		23
16	Claim Paid Date	The date a claim was authorized for payment.	numeric	CCYYMMDD	8
17	Date of Enrollment	The first day of the reporting period the patient is in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
18	Date of Disenrollment	The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26)	numeric	CCYYMMDD	8
19	Number of Line Items	If using Variable Format, the # of line items completed in the variable portion (data elements 20-40, 44-51) must match the value entered for this data element, maximum value for this data and # of line items is 26. If using Fixed Format, the number of line items is always equal to one (1) because only one service is written per row.	numeric		2
20	Number of Diagnosis Codes	The number of diagnosis codes, up to ten.	numeric		2
21	Diagnosis Field	The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 9 codes), if applicable at time of service. Remove embedded decimal point.	alphanumeric		7
22	Service From Date	First date of service for a procedure in this line item.	numeric	CCYYMMDD	8
23	Service Thru Date	Last date of service for this line item.	numeric	CCYYMMDD	8
24	Place of Service	Two-digit numeric code that describes where a service was rendered.	numeric		2
25	Service Location Zip Code +4digit add-on code	Zip code for location where service described was provided.	alphanumeric		10
26	Service Unit Indicator	Category of service as it corresponds to Units data element.	numeric		1
27	Units of Service	Quantity of services or number of units for a service or minutes of anesthesia.	numeric		3
28	Procedure Code	Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM)	alphanumeric		6
29	Modifier I	Discriminate code used by practitioners to distinguish that a health care service has been altered [by a specific condition] but not changed in definition or code. A modifier is added as a suffix to a procedure code field.	alphanumeric		2
30	Modifier II	Specific to Modifier I.	alphanumeric		2
31	Servicing Practitioner ID	Payor-specific identifier for the practitioner rendering health care service(s).	alphanumeric		11
32	Billed Charge	A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS	numeric		9
33	Allowed Amount	Total patient and payor liability. DO NOT USE DECIMALS	numeric		9
34	Reimbursement Amount	Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS	numeric		9
35	Patient Deductible	The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS	numeric		9
36	Patient Coinsurance or Co-payment	The specified amount or percentage the patient is required to contribute towards covered medical services after any applicable deductible. DO NOT USE DECIMALS	numeric		9
37	Other Patient Obligations	Any patient obligations other than the deductible or coinsurance/co-payment. This could include obligations for out-of-network care (balance billing net of patient deductible, patient coinsurance/co-payment and payor reimbursement), non-covered services, or penalties. DO NOT USE DECIMALS	numeric		9
38	Plan Liability	Indicates if insurer is at risk for the patient's service use or the insurer is simply paying claims as Administrative Services Only (ASO)	numeric		1
39	Servicing Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric		10
40	Practitioner National Provider Identifier (NPI) number used for Billing	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner or an organization for billing purposes.	alphanumeric		10
41	Product Type	Classifies the benefit plan by key product characteristics (scope of coverage, size of network, coverage for out-of- network benefits). (Please code based on how the product is primarily marketed, and most importantly be consistent from year to year. If not sure, send an e-mail describing the product to Larry Monroe at larry.monroe@maryland.gov)	numeric		1
42	Payor ID Number	Payor assigned submission identification number.	alphanumeric		4
43	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank.	alphanumeric		1
44	Assignment of Benefits	For out-of-network services please provide information on whether or not the patient assigned benefits to the servicing physician for an out-of-network service.	alphanumeric		1
45	Diagnosis Code Indicator	Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses.	numeric		1
46	CPT Category II Code 1	Provide any applicable CPT Category II codes.	alphanumeric		5
47	Other CPT Category II Code 2	Not Provided	alphanumeric		5
48	Other CPT Category II Code 3	Not Provided	alphanumeric		5
49	Other CPT Category II Code 4	Not Provided	alphanumeric		5
50	Other CPT Category II Code 5	Not Provided	alphanumeric		5
51	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric		1

Provider Fixed Format

File Specification for Provider Fixed Format File Submission - January 9, 2014

Data Element ID	Data Element	Description	Type	Length
1	Record Identifier	The value is 3	numeric	1
2	Practitioner/Supplier ID	Payor-specific identifier for a practitioner, practice, or office facility rendering health care service(s).	alphanumeric	11
3	Practitioner/Supplier Federal Tax ID	Employer Tax ID # of the practitioner, practice or office facility receiving payment for services.	alphanumeric	9
4	Practitioner/Supplier Last Name or Multi-practitioner Health Care Organization	Last name of practitioner or complete name of multi- practitioner health care organization.	alphanumeric	31
5	Practitioner/Supplier First Name	Practitioner's first name.	alphanumeric	19
6	Practitioner Middle Initial	Not Provided	alphanumeric	1
7	Practitioner Name Suffix	Not Provided	alphanumeric	4
8	Practitioner Credential	Not Provided	alphanumeric	5
9	Practitioner/Supplier Specialty - 1	The health care field in which a practitioner is licensed, certified, or otherwise authorized under Health Occupations Article, Annotated Code of Maryland, to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program. Up to 3 codes may be listed.	alphanumeric	10
10	Practitioner/Supplier Specialty - 2	The health care field in which a practitioner is licensed, certified, or otherwise authorized under Health Occupations Article, Annotated Code of Maryland, to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program. Up to 3 codes may be listed.	alphanumeric	10
11	Practitioner/Supplier Specialty - 3	The health care field in which a practitioner is licensed, certified, or otherwise authorized under Health Occupations Article, Annotated Code of Maryland, to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program. Up to 3 codes may be listed.	alphanumeric	10
12	Practitioner DEA #	Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act.	alphanumeric	11
13	Indicator for Multi-Practitioner Health Care Organization	Not Provided	alphanumeric	1
14	Practitioner Individual National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner.	alphanumeric	10
15	Practitioner Organizational National Provider Identifier (NPI) number	Federal identifier assigned by the federal government for use in all HIPAA transactions to an organization for billing purposes.	alphanumeric	10
16	Payor ID Number	Payor assigned submission identification number.	alphanumeric	4
17	Source System	Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank.	alphanumeric	1
18	Reporting Quarter	Indicate the quarter number for which the data is being submitted.	numeric	1

United States Health Information Knowledgebase

Maryland

At A Glance

Dental Services Fixed Format

File Specification for Dental Services Fixed Format File Submission - January 9, 2014

Institutional Services

File Specification for Institutional Services File Submission - January 9, 2014

Medical Eligibility

File Specification for Medical Eligibility File Submission - January 9, 2014

Pharmacy Fixed Format

File Specification for Pharmacy Fixed Format File Submission - January 9, 2014

Professional Services Fixed Format

File Specification for Professional Services Fixed Format File Submission - January 9, 2014

Professional Services Variable Format

File Specification for Professional Services Variable Format File Submission - January 9, 2014

Provider Fixed Format

File Specification for Provider Fixed Format File Submission - January 9, 2014