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 |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | Not Provided | numeric | 1 | |
![]() |
Patient IdentifierP (payor encrypted) | Patient's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
![]() |
Patient IdentifierU (UUID encrypted) | Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
![]() |
Patient Year and Month of Birth | Date of patient's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
![]() |
Patient Sex | Sex of the patient. | numeric | 1 | |
![]() |
Patient Zip Code +4-digit add-on | Zip code of patient's residence. | numeric | 10 | |
![]() |
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 |
![]() |
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 |
![]() |
Hospital/Facility Federal Tax ID | Federal Employer Tax ID of the facility receiving payment for care. | alphanumeric | 9 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Hospital/Facility Participating Provider Flag | Indicates if the service was provided at a hospital/facility that participates in the payor's network. | numeric | 1 | |
![]() |
Claim Control Number | Internal payor claim number used for tracking. | alphanumeric | 23 | |
![]() |
Claim Paid Date | The date a claim was authorized for payment. | numeric | CCYYMMDD | 8 |
![]() |
Record Type | Identifies the type of facility or department in a facility where the service was provided. | numeric | 2 | |
![]() |
Type of Admission | Applies only to hospital inpatient records. All other record types code "0". | numeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 |
![]() |
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 |
![]() |
Diagnosis Code Indicator | Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. | numeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 1 | ICD-9-CM/ICD-10-CM Diagnosis Code 1 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 2 | ICD-9-CM/ICD-10-CM Diagnosis Code 2 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 3 | ICD-9-CM/ICD-10-CM Diagnosis Code 3 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 4 | ICD-9-CM/ICD-10-CM Diagnosis Code 4 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 5 | ICD-9-CM/ICD-10-CM Diagnosis Code 5 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 6 | ICD-9-CM/ICD-10-CM Diagnosis Code 6 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 7 | ICD-9-CM/ICD-10-CM Diagnosis Code 7 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 8 | ICD-9-CM/ICD-10-CM Diagnosis Code 8 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 9 | ICD-9-CM/ICD-10-CM Diagnosis Code 9 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 10 | ICD-9-CM/ICD-10-CM Diagnosis Code 10 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 11 | ICD-9-CM/ICD-10-CM Diagnosis Code 11 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 12 | ICD-9-CM/ICD-10-CM Diagnosis Code 12 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 13 | ICD-9-CM/ICD-10-CM Diagnosis Code 13 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 14 | ICD-9-CM/ICD-10-CM Diagnosis Code 14 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 15 | ICD-9-CM/ICD-10-CM Diagnosis Code 15 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 16 | ICD-9-CM/ICD-10-CM Diagnosis Code 16 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 17 | ICD-9-CM/ICD-10-CM Diagnosis Code 17 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 18 | ICD-9-CM/ICD-10-CM Diagnosis Code 18 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 19 | ICD-9-CM/ICD-10-CM Diagnosis Code 19 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 20 | ICD-9-CM/ICD-10-CM Diagnosis Code 20 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 21 | ICD-9-CM/ICD-10-CM Diagnosis Code 21 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 22 | ICD-9-CM/ICD-10-CM Diagnosis Code 22 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 23 | ICD-9-CM/ICD-10-CM Diagnosis Code 23 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 24 | ICD-9-CM/ICD-10-CM Diagnosis Code 24 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 25 | ICD-9-CM/ICD-10-CM Diagnosis Code 25 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 26 | ICD-9-CM/ICD-10-CM Diagnosis Code 26 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 27 | ICD-9-CM/ICD-10-CM Diagnosis Code 27 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 28 | ICD-9-CM/ICD-10-CM Diagnosis Code 28 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
Other Diagnosis Code 29 | ICD-9-CM/ICD-10-CM Diagnosis Code 29 Remove embedded decimal pt. | alphanumeric | 7 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Procedure Code Indicator | Indicates the classification used in assigning codes to procedures. | numeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Procedure Code1 Modifier II | Specific to Modifier I. | alphanumeric | 2 | |
![]() |
Other Procedure Code 2 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code2 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code2 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 3 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code3 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code3 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 4 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code4 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code4 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 5 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code5 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code5 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 6 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code6 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code6 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 7 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code7 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code7 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 8 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code8 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code8 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 9 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code9 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code9 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 10 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code10 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code10 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 11 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code11 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code11 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 12 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code12 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code12 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 13 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code13 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code13 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 14 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code14 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code14 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Other Procedure Code 15 | Remove embedded decimal pt. | alphanumeric | 6 | |
![]() |
Procedure Code15 Modifier I | Not Provided | alphanumeric | 2 | |
![]() |
Procedure Code15 Modifier II | Not Provided | alphanumeric | 2 | |
![]() |
Diagnosis Related Groups (DRGs) Number | The inpatient classifications based on diagnosis, procedure, age, gender and discharge disposition. | alphanumeric | 3 | |
![]() |
DRG Grouper Name | The actual DRG Grouper used to produce the DRGs. | numeric | 1 | |
![]() |
DRG Grouper Version | Version of DRG Grouper used. | numeric | 2 | |
![]() |
Billed Charge | A provider's billed charges rounded to whole dollars. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Allowed Amount | Total patient and payor liability. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Reimbursement Amount | Amount paid by carrier to Tax ID # of provider as listed on claim. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Total Patient Deductible | The fixed amount that the patient must pay for covered medical services/hospital stay before benefits are payable. | numeric | 9 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Type of Bill | Not Provided | alphanumeric | 3 | |
![]() |
Patient Covered by Other Insurance Indicator | Indicates whether patient has additional insurance coverage. | numeric | 1 | |
![]() |
Payor ID Number | Payor assigned submission identification number. | alphanumeric | 4 | |
![]() |
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 | |
![]() |
Revenue Code 1 | Provide the codes used to identify specific accommodation and/or ancillary charges. | numeric | 4 | |
![]() |
Other Revenue Code 2 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 3 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 4 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 5 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 6 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 7 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 8 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 9 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 10 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 11 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 12 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 13 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 14 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 15 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 16 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 17 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 18 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 19 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 20 | Not Provided | numeric | 4 | |
![]() |
Other Revenue Code 21 | Not Provided | numeric | 4 | |
![]() |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | The value is 5 | numeric | 1 | |
![]() |
Encrypted Enrollee IdentifierP (payor encrypted) | Enrollee's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
![]() |
Encrypted Enrollee IdentifierU (UUID encrypted) | Enrollee's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
![]() |
Enrollee Year and Month of Birth | Date of enrollee's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
![]() |
Enrollee Sex | Sex of the enrollee. | numeric | 1 | |
![]() |
Enrollee Zip Code of Residence +4-digit add-on | Zip code of enrollee's residence. | numeric | 10 | |
![]() |
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 | |
![]() |
Source of Direct Reporting of Enrollee Race | Indicate the source of direct reporting of enrollee race. | numeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Race Category Other - Direct | Enter whether the self-defined race of the enrollee is Other. | numeric | 1 | |
![]() |
Race Category Declined to Answer - Direct | Enter whether the enrollee declined to disclose their race. | numeric | 1 | |
![]() |
Race Category Unknown or Cannot Determined - Direct | Enter whether the race of the enrollee is unknown or cannot be determined. | numeric | 1 | |
![]() |
Imputed Race with Highest Probability | Race of enrollee. | numeric | 1 | |
![]() |
Probability of Imputed Race Assignment | Specify the probability of race assignment; probability used in race determination. | numeric | 3 | |
![]() |
Source of Direct Reporting of Enrollee Ethnicity | Indicate source of reporting enrollee ethnicity. | numeric | 1 | |
![]() |
Enrollee OMB Hispanic Ethnicity (Hispanic Indicator) | Ethnicity of enrollee. | numeric | 1 | |
![]() |
Imputed Ethnicity with Highest Probability (Hispanic Indicator) | Enter the Ethnicity of the enrollee. | numeric | 1 | |
![]() |
Probability of Imputed Ethnicity Assignment | Specify the probability of ethnicity assignment; probability used in ethnicity determination. | numeric | 3 | |
![]() |
Enrollee Preferred Spoken Language for a Healthcare Encounter | A locally relevant list of languages has been developed by the Commission. | numeric | 2 | |
![]() |
Coverage Type | Enrollee's type of insurance coverage. | alphanumeric | 1 | |
![]() |
Source Company | Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. | alphanumeric | 1 | |
![]() |
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 | |
![]() |
Policy Type | Type of policy. | numeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Medical Services Indicator | Medical Coverage | numeric | 1 | |
![]() |
Pharmacy Services Indicator | Prescription Drug Coverage | numeric | 1 | |
![]() |
Behavioral Health Services Indicator | Behavioral Health Services Coverage | numeric | 1 | |
![]() |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | The value is 2 | numeric | 1 | |
![]() |
Patient IdentifierP (payor encrypted) | Patient's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
![]() |
Patient IdentifierU (UUID encrypted) | Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
![]() |
Patient Sex | Sex of Patient. | numeric | 1 | |
![]() |
Patient Zip Code+4-digit add-on | Zip code of patient's residence. | numeric | 10 | |
![]() |
Patient Year and Month of Birth | Date of patient's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
![]() |
Pharmacy NCPDP Number | Unique 7 digit number assigned by the National Council for Prescription Drug Program (NCPDP). | numeric | 7 | |
![]() |
Pharmacy Zip Code+4-digit add-on | Zip code of pharmacy where prescription was filled and dispensed. | numeric | 10 | |
![]() |
Practitioner DEA # | Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. | alphanumeric | 11 | |
![]() |
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 | |
![]() |
NDC Number | National Drug Code 11 digit number. | numeric | 11 | |
![]() |
Drug Compound | Indicates a mix of drugs to form a compound medication. | numeric | 1 | |
![]() |
Drug Quantity | Number of units of medication dispensed. | numeric | 5 | |
![]() |
Drug Supply | Estimated number of days of dispensed supply. | numeric | 3 | |
![]() |
Date Filled | Date prescription was filled. | numeric | CCYYMMDD | 8 |
![]() |
Date Prescription Written | Date prescription was written. | numeric | CCYYMMDD | 8 |
![]() |
Billed Charge | Retail amount for drug including dispensing fees and administrative costs. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
![]() |
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 | |
![]() |
Prescription Claim Number | Internal payor claim number used for tracking. | numeric | 15 | |
![]() |
Prescription Claim Paid Date | The date a claim was authorized for payment. | numeric | CCYYMMDD | 8 |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 |
![]() |
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 |
![]() |
Source of Processing | The source processing the pharmacy claim. | alphanumeric | 1 | |
![]() |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | The value is 1 | numeric | 1 | |
![]() |
Patient IdentifierP (payor encrypted) | Patient's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
![]() |
Patient IdentifierU (UUID encrypted) | Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
![]() |
Patient Year and Month of Birth | Date of patient's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
![]() |
Patient Sex | Sex of the patient. | numeric | 1 | |
![]() |
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 | |
![]() |
Patient Zip Code+4digit add-on code | Zip code of patient's residence. | numeric | 10 | |
![]() |
Patient Covered by Other Insurance Indicator | Indicates whether patient has additional insurance coverage. | numeric | 1 | |
![]() |
Coverage Type | Patient's type of insurance coverage. | alphanumeric | 1 | |
![]() |
Source Company | Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. | numeric | 1 | |
![]() |
Claim Related Condition | Describes connection, if any, between patient's condition and employment, automobile accident, or other accident. | numeric | 1 | |
![]() |
Practitioner Federal Tax ID | Employer Tax ID of the practitioner, practice or office facility receiving payment for services. | alphanumeric | 9 | |
![]() |
Participating Provider Status | Indicates if the service was provided by a provider that participates in the payor's network. | numeric | 1 | |
![]() |
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 | |
![]() |
Claim Control Number | Internal payor claim number used for tracking. | alphanumeric | 23 | |
![]() |
Claim Paid Date | The date a claim was authorized for payment. | numeric | CCYYMMDD | 8 |
![]() |
Number of Diagnosis Codes | The number of diagnosis codes, up to ten. | numeric | 2 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Service From Date | First date of service for a procedure in this line item. | numeric | CCYYMMDD | 8 |
![]() |
Service Thru Date | Last date of service for this line item. | numeric | CCYYMMDD | 8 |
![]() |
Place of Service | Two-digit numeric code that describes where a service was rendered. | numeric | 2 | |
![]() |
Service Location Zip Code +4digit add-on code | Zip code for location where service described was provided. | alphanumeric | 10 | |
![]() |
Service Unit Indicator | Category of service as it corresponds to Units data element. | numeric | 1 | |
![]() |
Units of Service | Quantity of services or number of units for a service or minutes of anesthesia. | numeric | 3 | |
![]() |
Procedure Code | Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM) | alphanumeric | 6 | |
![]() |
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 | |
![]() |
Modifier II | Specific to Modifier I. | alphanumeric | 2 | |
![]() |
Servicing Practitioner ID | Payor-specific identifier for the practitioner rendering health care service(s). | alphanumeric | 11 | |
![]() |
Billed Charge | A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Allowed Amount | Total patient and payor liability. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Reimbursement Amount | Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
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 |
![]() |
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 |
![]() |
Patient Deductible | The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Payor ID Number | Payor assigned submission identification number. | alphanumeric | 4 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Diagnosis Code Indicator | Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. | numeric | 1 | |
![]() |
CPT Category II Code 1 | Provide any applicable CPT Category II codes. | alphanumeric | 5 | |
![]() |
CPT Category II Code 2 | Not Provided | alphanumeric | 5 | |
![]() |
CPT Category II Code 3 | Not Provided | alphanumeric | 5 | |
![]() |
CPT Category II Code 4 | Not Provided | alphanumeric | 5 | |
![]() |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | The value is 1 | numeric | 1 | |
![]() |
Patient IdentifierP (payor encrypted) | Patient's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
![]() |
Patient IdentifierU (UUID encrypted) | Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
![]() |
Patient Year and Month of Birth | Date of patient's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
![]() |
Patient Sex | Sex of the patient. | numeric | 1 | |
![]() |
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 | |
![]() |
Patient Zip Code+4digit add-on code | Zip code of patient's residence. | numeric | 10 | |
![]() |
Patient Covered by Other Insurance Indicator | Indicates whether patient has additional insurance coverage. | numeric | 1 | |
![]() |
Coverage Type | Patient's type of insurance coverage. | alphanumeric | 1 | |
![]() |
Source Company | Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. | numeric | 1 | |
![]() |
Claim Related Condition | Describes connection, if any, between patient's condition and employment, automobile accident, or other accident. | numeric | 1 | |
![]() |
Practitioner Federal Tax ID | Employer Tax ID of the practitioner, practice or office facility receiving payment for services. | alphanumeric | 9 | |
![]() |
Participating Provider Status | Indicates if the service was provided by a provider that participates in the payor's network. | numeric | 1 | |
![]() |
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 | |
![]() |
Claim Control Number | Internal payor claim number used for tracking. | alphanumeric | 23 | |
![]() |
Claim Paid Date | The date a claim was authorized for payment. | numeric | CCYYMMDD | 8 |
![]() |
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 |
![]() |
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 |
![]() |
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 | |
![]() |
Number of Diagnosis Codes | The number of diagnosis codes, up to ten. | numeric | 2 | |
![]() |
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 | |
![]() |
Service From Date | First date of service for a procedure in this line item. | numeric | CCYYMMDD | 8 |
![]() |
Service Thru Date | Last date of service for this line item. | numeric | CCYYMMDD | 8 |
![]() |
Place of Service | Two-digit numeric code that describes where a service was rendered. | numeric | 2 | |
![]() |
Service Location Zip Code +4digit add-on code | Zip code for location where service described was provided. | alphanumeric | 10 | |
![]() |
Service Unit Indicator | Category of service as it corresponds to Units data element. | numeric | 1 | |
![]() |
Units of Service | Quantity of services or number of units for a service or minutes of anesthesia. | numeric | 3 | |
![]() |
Procedure Code | Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM) | alphanumeric | 6 | |
![]() |
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 | |
![]() |
Modifier II | Specific to Modifier I. | alphanumeric | 2 | |
![]() |
Servicing Practitioner ID | Payor-specific identifier for the practitioner rendering health care service(s). | alphanumeric | 11 | |
![]() |
Billed Charge | A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Allowed Amount | Total patient and payor liability. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Reimbursement Amount | Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
Patient Deductible | The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS | numeric | 9 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Payor ID Number | Payor assigned submission identification number. | alphanumeric | 4 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Diagnosis Code Indicator | Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. | numeric | 1 | |
![]() |
CPT Category II Code 1 | Provide any applicable CPT Category II codes. | alphanumeric | 5 | |
![]() |
Other CPT Category II Code 2 | Not Provided | alphanumeric | 5 | |
![]() |
Other CPT Category II Code 3 | Not Provided | alphanumeric | 5 | |
![]() |
Other CPT Category II Code 4 | Not Provided | alphanumeric | 5 | |
![]() |
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 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
![]() |
Record Identifier | The value is 3 | numeric | 1 | |
![]() |
Practitioner/Supplier ID | Payor-specific identifier for a practitioner, practice, or office facility rendering health care service(s). | alphanumeric | 11 | |
![]() |
Practitioner/Supplier Federal Tax ID | Employer Tax ID # of the practitioner, practice or office facility receiving payment for services. | alphanumeric | 9 | |
![]() |
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 | |
![]() |
Practitioner/Supplier First Name | Practitioner's first name. | alphanumeric | 19 | |
![]() |
Practitioner Middle Initial | Not Provided | alphanumeric | 1 | |
![]() |
Practitioner Name Suffix | Not Provided | alphanumeric | 4 | |
![]() |
Practitioner Credential | Not Provided | alphanumeric | 5 | |
![]() |
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 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Practitioner DEA # | Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. | alphanumeric | 11 | |
![]() |
Indicator for Multi-Practitioner Health Care Organization | Not Provided | alphanumeric | 1 | |
![]() |
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 | |
![]() |
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 | |
![]() |
Payor ID Number | Payor assigned submission identification number. | alphanumeric | 4 | |
![]() |
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 |