United States Health Information Knowledgebase

 

Maryland



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

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

File Specification for Multiple versionsInstitutional Services File Submission - January 9, 2014

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier Not Provided numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions5 Patient Sex Sex of the patient. numeric 1
Multiple versions6 Patient Zip Code +4-digit add-on Zip code of patient's residence. numeric 10
Multiple versions7 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
Multiple versions8 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
Multiple versions9 Hospital/Facility Federal Tax ID Federal Employer Tax ID of the facility receiving payment for care. alphanumeric 9
Multiple versions10 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
Multiple versions11 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
Multiple versions12 Hospital/Facility Participating Provider Flag Indicates if the service was provided at a hospital/facility that participates in the payor's network. numeric 1
Multiple versions13 Claim Control Number Internal payor claim number used for tracking. alphanumeric 23
Multiple versions14 Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions15 Record Type Identifies the type of facility or department in a facility where the service was provided. numeric 2
Multiple versions16 Type of Admission Applies only to hospital inpatient records. All other record types code "0". numeric 1
Multiple versions17 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
Multiple versions18 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
Multiple versions19 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
Multiple versions20 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
Multiple versions21 Diagnosis Code Indicator Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. numeric 1
Multiple versions22 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
Multiple versions23 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
Multiple versions24 Other Diagnosis Code 1 ICD-9-CM/ICD-10-CM Diagnosis Code 1 Remove embedded decimal pt. alphanumeric 7
Multiple versions25 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
Multiple versions26 Other Diagnosis Code 2 ICD-9-CM/ICD-10-CM Diagnosis Code 2 Remove embedded decimal pt. alphanumeric 7
Multiple versions27 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
Multiple versions28 Other Diagnosis Code 3 ICD-9-CM/ICD-10-CM Diagnosis Code 3 Remove embedded decimal pt. alphanumeric 7
Multiple versions29 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
Multiple versions30 Other Diagnosis Code 4 ICD-9-CM/ICD-10-CM Diagnosis Code 4 Remove embedded decimal pt. alphanumeric 7
Multiple versions31 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
Multiple versions32 Other Diagnosis Code 5 ICD-9-CM/ICD-10-CM Diagnosis Code 5 Remove embedded decimal pt. alphanumeric 7
Multiple versions33 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
Multiple versions34 Other Diagnosis Code 6 ICD-9-CM/ICD-10-CM Diagnosis Code 6 Remove embedded decimal pt. alphanumeric 7
Multiple versions35 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
Multiple versions36 Other Diagnosis Code 7 ICD-9-CM/ICD-10-CM Diagnosis Code 7 Remove embedded decimal pt. alphanumeric 7
Multiple versions37 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
Multiple versions38 Other Diagnosis Code 8 ICD-9-CM/ICD-10-CM Diagnosis Code 8 Remove embedded decimal pt. alphanumeric 7
Multiple versions39 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
Multiple versions40 Other Diagnosis Code 9 ICD-9-CM/ICD-10-CM Diagnosis Code 9 Remove embedded decimal pt. alphanumeric 7
Multiple versions41 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
Multiple versions42 Other Diagnosis Code 10 ICD-9-CM/ICD-10-CM Diagnosis Code 10 Remove embedded decimal pt. alphanumeric 7
Multiple versions43 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
Multiple versions44 Other Diagnosis Code 11 ICD-9-CM/ICD-10-CM Diagnosis Code 11 Remove embedded decimal pt. alphanumeric 7
Multiple versions45 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
Multiple versions46 Other Diagnosis Code 12 ICD-9-CM/ICD-10-CM Diagnosis Code 12 Remove embedded decimal pt. alphanumeric 7
Multiple versions47 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
Multiple versions48 Other Diagnosis Code 13 ICD-9-CM/ICD-10-CM Diagnosis Code 13 Remove embedded decimal pt. alphanumeric 7
Multiple versions49 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
Multiple versions50 Other Diagnosis Code 14 ICD-9-CM/ICD-10-CM Diagnosis Code 14 Remove embedded decimal pt. alphanumeric 7
Multiple versions51 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
Multiple versions52 Other Diagnosis Code 15 ICD-9-CM/ICD-10-CM Diagnosis Code 15 Remove embedded decimal pt. alphanumeric 7
Multiple versions53 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
Multiple versions54 Other Diagnosis Code 16 ICD-9-CM/ICD-10-CM Diagnosis Code 16 Remove embedded decimal pt. alphanumeric 7
Multiple versions55 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
Multiple versions56 Other Diagnosis Code 17 ICD-9-CM/ICD-10-CM Diagnosis Code 17 Remove embedded decimal pt. alphanumeric 7
Multiple versions57 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
Multiple versions58 Other Diagnosis Code 18 ICD-9-CM/ICD-10-CM Diagnosis Code 18 Remove embedded decimal pt. alphanumeric 7
Multiple versions59 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
Multiple versions60 Other Diagnosis Code 19 ICD-9-CM/ICD-10-CM Diagnosis Code 19 Remove embedded decimal pt. alphanumeric 7
Multiple versions61 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
Multiple versions62 Other Diagnosis Code 20 ICD-9-CM/ICD-10-CM Diagnosis Code 20 Remove embedded decimal pt. alphanumeric 7
Multiple versions63 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
Multiple versions64 Other Diagnosis Code 21 ICD-9-CM/ICD-10-CM Diagnosis Code 21 Remove embedded decimal pt. alphanumeric 7
Multiple versions65 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
Multiple versions66 Other Diagnosis Code 22 ICD-9-CM/ICD-10-CM Diagnosis Code 22 Remove embedded decimal pt. alphanumeric 7
Multiple versions67 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
Multiple versions68 Other Diagnosis Code 23 ICD-9-CM/ICD-10-CM Diagnosis Code 23 Remove embedded decimal pt. alphanumeric 7
Multiple versions69 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
Multiple versions70 Other Diagnosis Code 24 ICD-9-CM/ICD-10-CM Diagnosis Code 24 Remove embedded decimal pt. alphanumeric 7
Multiple versions71 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
Multiple versions72 Other Diagnosis Code 25 ICD-9-CM/ICD-10-CM Diagnosis Code 25 Remove embedded decimal pt. alphanumeric 7
Multiple versions73 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
Multiple versions74 Other Diagnosis Code 26 ICD-9-CM/ICD-10-CM Diagnosis Code 26 Remove embedded decimal pt. alphanumeric 7
Multiple versions75 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
Multiple versions76 Other Diagnosis Code 27 ICD-9-CM/ICD-10-CM Diagnosis Code 27 Remove embedded decimal pt. alphanumeric 7
Multiple versions77 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
Multiple versions78 Other Diagnosis Code 28 ICD-9-CM/ICD-10-CM Diagnosis Code 28 Remove embedded decimal pt. alphanumeric 7
Multiple versions79 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
Multiple versions80 Other Diagnosis Code 29 ICD-9-CM/ICD-10-CM Diagnosis Code 29 Remove embedded decimal pt. alphanumeric 7
Multiple versions81 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
Multiple versions82 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
Multiple versions83 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
Multiple versions84 Procedure Code Indicator Indicates the classification used in assigning codes to procedures. numeric 1
Multiple versions85 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
Multiple versions86 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
Multiple versions87 Procedure Code1 Modifier II Specific to Modifier I. alphanumeric 2
Multiple versions88 Other Procedure Code 2 Remove embedded decimal pt. alphanumeric 6
Multiple versions89 Procedure Code2 Modifier I Not Provided alphanumeric 2
Multiple versions90 Procedure Code2 Modifier II Not Provided alphanumeric 2
Multiple versions91 Other Procedure Code 3 Remove embedded decimal pt. alphanumeric 6
Multiple versions92 Procedure Code3 Modifier I Not Provided alphanumeric 2
Multiple versions93 Procedure Code3 Modifier II Not Provided alphanumeric 2
Multiple versions94 Other Procedure Code 4 Remove embedded decimal pt. alphanumeric 6
Multiple versions95 Procedure Code4 Modifier I Not Provided alphanumeric 2
Multiple versions96 Procedure Code4 Modifier II Not Provided alphanumeric 2
Multiple versions97 Other Procedure Code 5 Remove embedded decimal pt. alphanumeric 6
Multiple versions98 Procedure Code5 Modifier I Not Provided alphanumeric 2
Multiple versions99 Procedure Code5 Modifier II Not Provided alphanumeric 2
Multiple versions100 Other Procedure Code 6 Remove embedded decimal pt. alphanumeric 6
Multiple versions101 Procedure Code6 Modifier I Not Provided alphanumeric 2
Multiple versions102 Procedure Code6 Modifier II Not Provided alphanumeric 2
Multiple versions103 Other Procedure Code 7 Remove embedded decimal pt. alphanumeric 6
Multiple versions104 Procedure Code7 Modifier I Not Provided alphanumeric 2
Multiple versions105 Procedure Code7 Modifier II Not Provided alphanumeric 2
Multiple versions106 Other Procedure Code 8 Remove embedded decimal pt. alphanumeric 6
Multiple versions107 Procedure Code8 Modifier I Not Provided alphanumeric 2
Multiple versions108 Procedure Code8 Modifier II Not Provided alphanumeric 2
Multiple versions109 Other Procedure Code 9 Remove embedded decimal pt. alphanumeric 6
Multiple versions110 Procedure Code9 Modifier I Not Provided alphanumeric 2
Multiple versions111 Procedure Code9 Modifier II Not Provided alphanumeric 2
Multiple versions112 Other Procedure Code 10 Remove embedded decimal pt. alphanumeric 6
Multiple versions113 Procedure Code10 Modifier I Not Provided alphanumeric 2
Multiple versions114 Procedure Code10 Modifier II Not Provided alphanumeric 2
Multiple versions115 Other Procedure Code 11 Remove embedded decimal pt. alphanumeric 6
Multiple versions116 Procedure Code11 Modifier I Not Provided alphanumeric 2
Multiple versions117 Procedure Code11 Modifier II Not Provided alphanumeric 2
Multiple versions118 Other Procedure Code 12 Remove embedded decimal pt. alphanumeric 6
Multiple versions119 Procedure Code12 Modifier I Not Provided alphanumeric 2
Multiple versions120 Procedure Code12 Modifier II Not Provided alphanumeric 2
Multiple versions121 Other Procedure Code 13 Remove embedded decimal pt. alphanumeric 6
Multiple versions122 Procedure Code13 Modifier I Not Provided alphanumeric 2
Multiple versions123 Procedure Code13 Modifier II Not Provided alphanumeric 2
Multiple versions124 Other Procedure Code 14 Remove embedded decimal pt. alphanumeric 6
Multiple versions125 Procedure Code14 Modifier I Not Provided alphanumeric 2
Multiple versions126 Procedure Code14 Modifier II Not Provided alphanumeric 2
Multiple versions127 Other Procedure Code 15 Remove embedded decimal pt. alphanumeric 6
Multiple versions128 Procedure Code15 Modifier I Not Provided alphanumeric 2
Multiple versions129 Procedure Code15 Modifier II Not Provided alphanumeric 2
Multiple versions130 Diagnosis Related Groups (DRGs) Number The inpatient classifications based on diagnosis, procedure, age, gender and discharge disposition. alphanumeric 3
Multiple versions131 DRG Grouper Name The actual DRG Grouper used to produce the DRGs. numeric 1
Multiple versions132 DRG Grouper Version Version of DRG Grouper used. numeric 2
Multiple versions133 Billed Charge A provider's billed charges rounded to whole dollars. DO NOT USE DECIMALS numeric 9
Multiple versions134 Allowed Amount Total patient and payor liability. DO NOT USE DECIMALS numeric 9
Multiple versions135 Reimbursement Amount Amount paid by carrier to Tax ID # of provider as listed on claim. DO NOT USE DECIMALS numeric 9
Multiple versions136 Total Patient Deductible The fixed amount that the patient must pay for covered medical services/hospital stay before benefits are payable. numeric 9
Multiple versions137 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
Multiple versions138 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
Multiple versions139 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
Multiple versions140 Type of Bill Not Provided alphanumeric 3
Multiple versions141 Patient Covered by Other Insurance Indicator Indicates whether patient has additional insurance coverage. numeric 1
Multiple versions142 Payor ID Number Payor assigned submission identification number. alphanumeric 4
Multiple versions143 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
Multiple versions144 Revenue Code 1 Provide the codes used to identify specific accommodation and/or ancillary charges. numeric 4
Multiple versions145 Other Revenue Code 2 Not Provided numeric 4
Multiple versions146 Other Revenue Code 3 Not Provided numeric 4
Multiple versions147 Other Revenue Code 4 Not Provided numeric 4
Multiple versions148 Other Revenue Code 5 Not Provided numeric 4
Multiple versions149 Other Revenue Code 6 Not Provided numeric 4
Multiple versions150 Other Revenue Code 7 Not Provided numeric 4
Multiple versions151 Other Revenue Code 8 Not Provided numeric 4
Multiple versions152 Other Revenue Code 9 Not Provided numeric 4
Multiple versions153 Other Revenue Code 10 Not Provided numeric 4
Multiple versions154 Other Revenue Code 11 Not Provided numeric 4
Multiple versions155 Other Revenue Code 12 Not Provided numeric 4
Multiple versions156 Other Revenue Code 13 Not Provided numeric 4
Multiple versions157 Other Revenue Code 14 Not Provided numeric 4
Multiple versions158 Other Revenue Code 15 Not Provided numeric 4
Multiple versions159 Other Revenue Code 16 Not Provided numeric 4
Multiple versions160 Other Revenue Code 17 Not Provided numeric 4
Multiple versions161 Other Revenue Code 18 Not Provided numeric 4
Multiple versions162 Other Revenue Code 19 Not Provided numeric 4
Multiple versions163 Other Revenue Code 20 Not Provided numeric 4
Multiple versions164 Other Revenue Code 21 Not Provided numeric 4
Multiple versions165 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

File Specification for Multiple versionsMedical Eligibility File Submission - January 9, 2014

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 5 numeric 1
Multiple versions2 Encrypted Enrollee IdentifierP (payor encrypted) Enrollee's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Encrypted Enrollee IdentifierU (UUID encrypted) Enrollee's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Enrollee Year and Month of Birth Date of enrollee's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions5 Enrollee Sex Sex of the enrollee. numeric 1
Multiple versions6 Enrollee Zip Code of Residence +4-digit add-on Zip code of enrollee's residence. numeric 10
Multiple versions7 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
Multiple versions8 Source of Direct Reporting of Enrollee Race Indicate the source of direct reporting of enrollee race. numeric 1
Multiple versions9 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
Multiple versions10 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
Multiple versions11 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
Multiple versions12 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
Multiple versions13 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
Multiple versions14 Race Category Other - Direct Enter whether the self-defined race of the enrollee is Other. numeric 1
Multiple versions15 Race Category Declined to Answer - Direct Enter whether the enrollee declined to disclose their race. numeric 1
Multiple versions16 Race Category Unknown or Cannot Determined - Direct Enter whether the race of the enrollee is unknown or cannot be determined. numeric 1
Multiple versions17 Imputed Race with Highest Probability Race of enrollee. numeric 1
Multiple versions18 Probability of Imputed Race Assignment Specify the probability of race assignment; probability used in race determination. numeric 3
Multiple versions19 Source of Direct Reporting of Enrollee Ethnicity Indicate source of reporting enrollee ethnicity. numeric 1
Multiple versions20 Enrollee OMB Hispanic Ethnicity (Hispanic Indicator) Ethnicity of enrollee. numeric 1
Multiple versions21 Imputed Ethnicity with Highest Probability (Hispanic Indicator) Enter the Ethnicity of the enrollee. numeric 1
Multiple versions22 Probability of Imputed Ethnicity Assignment Specify the probability of ethnicity assignment; probability used in ethnicity determination. numeric 3
Multiple versions23 Enrollee Preferred Spoken Language for a Healthcare Encounter A locally relevant list of languages has been developed by the Commission. numeric 2
Multiple versions24 Coverage Type Enrollee's type of insurance coverage. alphanumeric 1
Multiple versions25 Source Company Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. alphanumeric 1
Multiple versions26 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
Multiple versions27 Policy Type Type of policy. numeric 1
Multiple versions28 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
Multiple versions29 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
Multiple versions30 Medical Services Indicator Medical Coverage numeric 1
Multiple versions31 Pharmacy Services Indicator Prescription Drug Coverage numeric 1
Multiple versions32 Behavioral Health Services Indicator Behavioral Health Services Coverage numeric 1
Multiple versions33 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

File Specification for Multiple versionsPharmacy Fixed Format File Submission - January 9, 2014

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 2 numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Sex Sex of Patient. numeric 1
Multiple versions5 Patient Zip Code+4-digit add-on Zip code of patient's residence. numeric 10
Multiple versions6 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions7 Pharmacy NCPDP Number Unique 7 digit number assigned by the National Council for Prescription Drug Program (NCPDP). numeric 7
Multiple versions8 Pharmacy Zip Code+4-digit add-on Zip code of pharmacy where prescription was filled and dispensed. numeric 10
Multiple versions9 Practitioner DEA # Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. alphanumeric 11
Multiple versions10 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
Multiple versions11 NDC Number National Drug Code 11 digit number. numeric 11
Multiple versions12 Drug Compound Indicates a mix of drugs to form a compound medication. numeric 1
Multiple versions13 Drug Quantity Number of units of medication dispensed. numeric 5
Multiple versions14 Drug Supply Estimated number of days of dispensed supply. numeric 3
Multiple versions15 Date Filled Date prescription was filled. numeric CCYYMMDD 8
Multiple versions16 Date Prescription Written Date prescription was written. numeric CCYYMMDD 8
Multiple versions17 Billed Charge Retail amount for drug including dispensing fees and administrative costs. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. numeric 9
Multiple versions18 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
Multiple versions19 Prescription Claim Number Internal payor claim number used for tracking. numeric 15
Multiple versions20 Prescription Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions21 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
Multiple versions22 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
Multiple versions23 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
Multiple versions24 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
Multiple versions25 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
Multiple versions26 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
Multiple versions27 Source of Processing The source processing the pharmacy claim. alphanumeric 1
Multiple versions28 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

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

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 1 numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions5 Patient Sex Sex of the patient. numeric 1
Multiple versions6 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
Multiple versions7 Patient Zip Code+4digit add-on code Zip code of patient's residence. numeric 10
Multiple versions8 Patient Covered by Other Insurance Indicator Indicates whether patient has additional insurance coverage. numeric 1
Multiple versions9 Coverage Type Patient's type of insurance coverage. alphanumeric 1
Multiple versions10 Source Company Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. numeric 1
Multiple versions11 Claim Related Condition Describes connection, if any, between patient's condition and employment, automobile accident, or other accident. numeric 1
Multiple versions12 Practitioner Federal Tax ID Employer Tax ID of the practitioner, practice or office facility receiving payment for services. alphanumeric 9
Multiple versions13 Participating Provider Status Indicates if the service was provided by a provider that participates in the payor's network. numeric 1
Multiple versions14 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
Multiple versions15 Claim Control Number Internal payor claim number used for tracking. alphanumeric 23
Multiple versions16 Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions17 Number of Diagnosis Codes The number of diagnosis codes, up to ten. numeric 2
Multiple versions18 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
Multiple versions19 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
Multiple versions20 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
Multiple versions21 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
Multiple versions22 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
Multiple versions23 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
Multiple versions24 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
Multiple versions25 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
Multiple versions26 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
Multiple versions27 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
Multiple versions28 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
Multiple versions29 Service From Date First date of service for a procedure in this line item. numeric CCYYMMDD 8
Multiple versions30 Service Thru Date Last date of service for this line item. numeric CCYYMMDD 8
Multiple versions31 Place of Service Two-digit numeric code that describes where a service was rendered. numeric 2
Multiple versions32 Service Location Zip Code +4digit add-on code Zip code for location where service described was provided. alphanumeric 10
Multiple versions33 Service Unit Indicator Category of service as it corresponds to Units data element. numeric 1
Multiple versions34 Units of Service Quantity of services or number of units for a service or minutes of anesthesia. numeric 3
Multiple versions35 Procedure Code Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM) alphanumeric 6
Multiple versions36 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
Multiple versions37 Modifier II Specific to Modifier I. alphanumeric 2
Multiple versions38 Servicing Practitioner ID Payor-specific identifier for the practitioner rendering health care service(s). alphanumeric 11
Multiple versions39 Billed Charge A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS numeric 9
Multiple versions40 Allowed Amount Total patient and payor liability. DO NOT USE DECIMALS numeric 9
Multiple versions41 Reimbursement Amount Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS numeric 9
Multiple versions42 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
Multiple versions43 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
Multiple versions44 Patient Deductible The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS numeric 9
Multiple versions45 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
Multiple versions46 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
Multiple versions47 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
Multiple versions48 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
Multiple versions49 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
Multiple versions50 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
Multiple versions51 Payor ID Number Payor assigned submission identification number. alphanumeric 4
Multiple versions52 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
Multiple versions53 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
Multiple versions54 Diagnosis Code Indicator Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. numeric 1
Multiple versions55 CPT Category II Code 1 Provide any applicable CPT Category II codes. alphanumeric 5
Multiple versions56 CPT Category II Code 2 Not Provided alphanumeric 5
Multiple versions57 CPT Category II Code 3 Not Provided alphanumeric 5
Multiple versions58 CPT Category II Code 4 Not Provided alphanumeric 5
Multiple versions59 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

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

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 1 numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions5 Patient Sex Sex of the patient. numeric 1
Multiple versions6 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
Multiple versions7 Patient Zip Code+4digit add-on code Zip code of patient's residence. numeric 10
Multiple versions8 Patient Covered by Other Insurance Indicator Indicates whether patient has additional insurance coverage. numeric 1
Multiple versions9 Coverage Type Patient's type of insurance coverage. alphanumeric 1
Multiple versions10 Source Company Defines the payor company that holds the beneficiary's contract; for use in characterizing contract requirements under Maryland law. numeric 1
Multiple versions11 Claim Related Condition Describes connection, if any, between patient's condition and employment, automobile accident, or other accident. numeric 1
Multiple versions12 Practitioner Federal Tax ID Employer Tax ID of the practitioner, practice or office facility receiving payment for services. alphanumeric 9
Multiple versions13 Participating Provider Status Indicates if the service was provided by a provider that participates in the payor's network. numeric 1
Multiple versions14 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
Multiple versions15 Claim Control Number Internal payor claim number used for tracking. alphanumeric 23
Multiple versions16 Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions17 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
Multiple versions18 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
Multiple versions19 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
Multiple versions20 Number of Diagnosis Codes The number of diagnosis codes, up to ten. numeric 2
Multiple versions21 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
Multiple versions22 Service From Date First date of service for a procedure in this line item. numeric CCYYMMDD 8
Multiple versions23 Service Thru Date Last date of service for this line item. numeric CCYYMMDD 8
Multiple versions24 Place of Service Two-digit numeric code that describes where a service was rendered. numeric 2
Multiple versions25 Service Location Zip Code +4digit add-on code Zip code for location where service described was provided. alphanumeric 10
Multiple versions26 Service Unit Indicator Category of service as it corresponds to Units data element. numeric 1
Multiple versions27 Units of Service Quantity of services or number of units for a service or minutes of anesthesia. numeric 3
Multiple versions28 Procedure Code Describes the health care service provided (i.e., CPT-4, HCPCS, ICD-9-CM, ICD-10-CM) alphanumeric 6
Multiple versions29 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
Multiple versions30 Modifier II Specific to Modifier I. alphanumeric 2
Multiple versions31 Servicing Practitioner ID Payor-specific identifier for the practitioner rendering health care service(s). alphanumeric 11
Multiple versions32 Billed Charge A practitioner's billed charges rounded to whole dollars. DO NOT USE DECIMALS numeric 9
Multiple versions33 Allowed Amount Total patient and payor liability. DO NOT USE DECIMALS numeric 9
Multiple versions34 Reimbursement Amount Amount paid to Employer Tax ID # of rendering physician as listed on claim. DO NOT USE DECIMALS numeric 9
Multiple versions35 Patient Deductible The fixed amount that the patient must pay for covered medical services before benefits are payable. DO NOT USE DECIMALS numeric 9
Multiple versions36 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
Multiple versions37 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
Multiple versions38 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
Multiple versions39 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
Multiple versions40 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
Multiple versions41 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
Multiple versions42 Payor ID Number Payor assigned submission identification number. alphanumeric 4
Multiple versions43 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
Multiple versions44 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
Multiple versions45 Diagnosis Code Indicator Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. numeric 1
Multiple versions46 CPT Category II Code 1 Provide any applicable CPT Category II codes. alphanumeric 5
Multiple versions47 Other CPT Category II Code 2 Not Provided alphanumeric 5
Multiple versions48 Other CPT Category II Code 3 Not Provided alphanumeric 5
Multiple versions49 Other CPT Category II Code 4 Not Provided alphanumeric 5
Multiple versions50 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

File Specification for Multiple versionsProvider Fixed Format File Submission - January 9, 2014

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 3 numeric 1
Multiple versions2 Practitioner/Supplier ID Payor-specific identifier for a practitioner, practice, or office facility rendering health care service(s). alphanumeric 11
Multiple versions3 Practitioner/Supplier Federal Tax ID Employer Tax ID # of the practitioner, practice or office facility receiving payment for services. alphanumeric 9
Multiple versions4 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
Multiple versions5 Practitioner/Supplier First Name Practitioner's first name. alphanumeric 19
Multiple versions6 Practitioner Middle Initial Not Provided alphanumeric 1
Multiple versions7 Practitioner Name Suffix Not Provided alphanumeric 4
Multiple versions8 Practitioner Credential Not Provided alphanumeric 5
Multiple versions9 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
Multiple versions10 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
Multiple versions11 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
Multiple versions12 Practitioner DEA # Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. alphanumeric 11
Multiple versions13 Indicator for Multi-Practitioner Health Care Organization Not Provided alphanumeric 1
Multiple versions14 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
Multiple versions15 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
Multiple versions16 Payor ID Number Payor assigned submission identification number. alphanumeric 4
Multiple versions17 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

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