United States Health Information Knowledgebase

 

Massachusetts



Name:Massachusetts
Abbreviation:MA
Title of SystemMassachusetts All-Payer Claims Database
Websitehttp://www.mass.gov/chia/researcher/hcf-data-resources/apcd/
Who Maintains the SystemMassachusetts Center for Health Information and Analysis
Versions:June 20, 2013 - v3.1
October 1, 2014 - v4.0
December 1, 2010 - v2.1
June 7, 2013 - v3.1
October 22, 2010 - v2.0

File Specification for Multiple versionsBenefit Plan Control Total File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 Period Beginning Date Header Period Start Date Date Period -Integer Int[6] CCYYMM 6
Multiple versionsHD004 Period Ending Date Header Period End Date Date Period -Integer Int[6] CCYYMM 6
Multiple versionsHD005 APCD Version Number Submission Guide Version Decimal - Numeric Char[3] 3
Multiple versionsHD006 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsBP001 Benefit Plan Contract ID Benefit Plan ID Text varchar[30] 30
Multiple versionsBP002 Benefit Plan Name Submitter defined benefit plan name Text varchar[70] 70
Multiple versionsBP003 Actuarial Value Actuarial value for the benefit plan Decimal varchar[6] 6
Multiple versionsBP004 Claim Type Qualifier Claim Type Identifier Code Lookup Table - Integer int[1] 1
Multiple versionsBP005 Monthly Claims Paid Number for the Benefit Plan Total Number of Claims Paid Quantity - Integer varchar[15] 15
Multiple versionsBP006 Monthly Net Dollars Paid for the Benefit Plan Total Paid Amount Integer varchar[15] 15
Multiple versionsBP007 Total Monthly Eligible Members by Benefit Plan ID Period Date Total Eligible Members Quantity - Integer varchar[15] 15
BP008 Benefit Plan Start Date Benefit Plan Start Date Full Date-Integer Int[8] CCYYMMDD 8
BP009 Benefit Plan End Date Benefit Plan End Date Full Date - Integer Int[8] CCYYMMDD 8
Multiple versionsTR001 Type of File Validates the file type defined in HD001. Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 Record Count Trailer Record Count Integer varchar[10] 10
Multiple versionsTR004 Date Processed Trailer Processed Date Integer Int[8] CCYYMMDD 8
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period -Integer Int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period End Date Date Period -Integer Int[6] CCYYMM 6

File Specification for Multiple versionsDental Claims File Submission - October 1, 2014 - v4.0

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

File Specification for Multiple versionsMedical Claims File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsMC001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsMC002 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsMC003 Insurance Type Code/Product Type / Product Identification Code Lookup Table - Text char[2] 2
Multiple versionsMC004 Payer Claim Control Number Payer Claim Control Identification Text varchar[35] 35
Multiple versionsMC005 Line Counter Incremental Line Counter Integer varchar[4] 4
Multiple versionsMC005A Version Number Claim Service Line Version Number Integer varchar[4] 4
Multiple versionsMC006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
Multiple versionsMC007 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
Multiple versionsMC008 Plan Specific Contract Number Contract Number Text varchar[30] 30
Multiple versionsMC009 Member Suffix or Sequence Number Member/Patient's Contract Sequence Number Text varchar[20] 20
Multiple versionsMC010 Member SSN Member/Patient's Social Security Number Numeric char[9] 9
Multiple versionsMC011 Individual Relationship Code Patient to Subscriber Relationship Code Lookup Table - Text char[2] 2
Multiple versionsMC012 Member Gender Patient's Gender Lookup Table - Text char[1] 1
Multiple versionsMC013 Member Date of Birth Member/Patient's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC014 Member City Name City name of the Member/Patient Text varchar[30] 30
Multiple versionsMC015 Member State State / Province of the Patient External Code Source 2 - Text char[2] 2
Multiple versionsMC016 Member ZIP Code Zip Code of the Member / Patient External Code Source 2 - Text varchar[9] 9
Multiple versionsMC017 Date Service Approved (AP Date) Date Service Approved by Payer Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC018 Admission Date Inpatient Admit Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC019 Filler Filler Filler char[4] 4
Multiple versionsMC020 Admission Type Admission Type Code External Code Source 14 - Integer int[1] 1
Multiple versionsMC021 Admission Source Admission Source Code External Code Source 14 - Text char[1] 1
Multiple versionsMC022 Filler Filler Filler char[4] 4
Multiple versionsMC023 Discharge Status Inpatient Discharge Status Code External Code Source 14 - Numeric char[2] 2
Multiple versionsMC024 Service Provider Number Service Provider Identification Number Text varchar[30] 30
Multiple versionsMC025 Service Provider Tax ID Number Service Provider's Tax ID number Numeric char[9] 9
Multiple versionsMC026 National Provider ID - Service National Provider Identification (NPI) of the Service Provider External Code Source 3 - Integer int[10] 10
Multiple versionsMC027 Service Provider Entity Type Qualifier Service Provider Entity Identifier Code Lookup Table - integer int[1] 1
Multiple versionsMC028 Service Provider First Name First name of Service Provider Text varchar[25] 25
Multiple versionsMC029 Service Provider Middle Initial Middle initial of Service Provider Text varchar[25] 25
Multiple versionsMC030 Servicing Provider Last Name or Organization Name Last name or Organization Name of Service Provider Text varchar[60] 60
Multiple versionsMC031 Service Provider Suffix Provider Name Suffix Lookup Table - Integer int[1] 1
Multiple versionsMC032 Service Provider Taxonomy Taxonomy Code External Code Source 5 - Text varchar[10] 10
Multiple versionsMC033 Service Provider City Name City Name of the Provider Text varchar[30] 30
Multiple versionsMC034 Service Provider State State of the Service Provider External Code Source 2 - Text char[2] 2
Multiple versionsMC035 Service Provider ZIP Code Zip Code of the Service Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsMC036 Type of Bill - on Facility Claims Type of Bill External Code Source 14 - Integer int[2] 2
Multiple versionsMC037 Site of Service - on NSF/CMS 1500 Claims Place of Service Code External Code Source 13 - Numeric char[2] 2
Multiple versionsMC038 Claim Status Claim Line Status Lookup Table - Numeric varchar[2] 2
Multiple versionsMC039 Admitting Diagnosis Admitting Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC040 E-Code ICD Diagnostic External Injury Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC041 Principal Diagnosis ICD Primary Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC042 Other Diagnosis - 1 ICD Secondary Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC043 Other Diagnosis - 2 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC044 Other Diagnosis - 3 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC045 Other Diagnosis - 4 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC046 Other Diagnosis - 5 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC047 Other Diagnosis - 6 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC048 Other Diagnosis - 7 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC049 Other Diagnosis - 8 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC050 Other Diagnosis - 9 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC051 Other Diagnosis - 10 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC052 Other Diagnosis - 11 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC053 Other Diagnosis - 12 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC054 Revenue Code Revenue Code External Code Source 14 - Numeric char[4] 4
Multiple versionsMC055 Procedure Code HCPCS / CPT Code External Code Source 9 - Text varchar[10] 10
Multiple versionsMC056 Procedure Modifier - 1 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC057 Procedure Modifier - 2 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC058 ICD-CM Primary Procedure Code ICD Primary Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC059 Date of Service - From Date of Service Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC060 Date of Service - To Date of Service Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC061 Quantity Claim line units of service Quantity - Integer ±varchar[15] 15
Multiple versionsMC062 Charge Amount Amount of provider charges for the claim line Integer ±varchar[10] 10
Multiple versionsMC063 Paid Amount Amount paid by the carrier for the claim line Integer ±varchar[10] 10
Multiple versionsMC064 Prepaid Amount Amount carrier has prepaid towards the claim line Integer ±varchar[10] 10
Multiple versionsMC065 Copay Amount Amount of Copay member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsMC066 Coinsurance Amount Amount of coinsurance member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsMC067 Deductible Amount Amount of deductible member/patient is responsible to pay on the claim line Integer ±varchar[10] 10
Multiple versionsMC068 Patient Control Number Patient Control Number Text varchar[20] 20
Multiple versionsMC069 Discharge Date Discharge Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC070 Service Provider Country Code Country name of the Service Provider External Code Source 1 - Text char[3] 3
Multiple versionsMC071 DRG Diagnostic Related Group Code External Code Source 15 - Text varchar[7] 7
Multiple versionsMC072 DRG Version Diagnostic Related Group Version Number External Code Source 15 - Text char[2] 2
Multiple versionsMC073 Filler Filler Filler char[4] 4
Multiple versionsMC074 Filler Filler Filler char[2] 2
Multiple versionsMC075 Drug Code National Drug Code (NDC) External Code Source 12 - Text char[11] 11
Multiple versionsMC076 Billing Provider Number Billing Provider Number Text varchar[30] 30
Multiple versionsMC077 National Provider ID - Billing National Provider Identification (NPI) of the Billing Provider External Code Source 3 - Integer int[10] 10
Multiple versionsMC078 Billing Provider Last Name or Organization Name Last name or Organization Name of Billing Provider Text varchar[60] 60
Multiple versionsMC079 Product ID Number Product Identification Text varchar[30] 30
Multiple versionsMC080 Payment Reason Payment Reason Code Carrier Defined Table - OR - External Code Source 16 - Text varchar[30] 30
Multiple versionsMC081 Capitated Encounter Flag Indicator - Capitation Payment Lookup Table - Integer int[1] 1
Multiple versionsMC082 Member Street Address Street address of the Member/Patient Text varchar[50] 50
Multiple versionsMC083 Other ICD-CM Procedure Code - 1 ICD Secondary Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC084 Other ICD-CM Procedure Code - 2 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC085 Other ICD-CM Procedure Code - 3 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC086 Other ICD-CM Procedure Code - 4 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC087 Other ICD-CM Procedure Code - 5 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC088 Other ICD-CM Procedure Code - 6 ICD Other Procedure Code External Codes Source 8 - Text varchar[7] 7
Multiple versionsMC089 Paid Date Paid date of the claim line Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC090 LOINC Code Logical Observation Identifiers, Names and Codes (LOINC) External Code Source 11 - Text varchar[7] 7
Multiple versionsMC091 Coinsurance Days Covered Coinsurance Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC092 Covered Days Covered Inpatient Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC093 Non Covered Days Noncovered Inpatient Days Quantity - Integer ±varchar[4] 4
Multiple versionsMC094 Type of Claim Type of Claim Indicator Lookup Table - Text char[3] 3
Multiple versionsMC095 Coordination of Benefits/TPL Liability Amount Amount due from a Secondary Carrier when known Integer ±varchar[10] 10
Multiple versionsMC096 Other Insurance Paid Amount Amount paid by a Primary Carrier Integer ±varchar[10] 10
Multiple versionsMC097 Medicare Paid Amount Amount Medicare paid on claim Integer ±varchar[10] 10
Multiple versionsMC098 Allowed amount Allowed Amount Integer ±varchar[10] 10
Multiple versionsMC099 Non-Covered Amount Amount of claim line charge not covered Integer ±varchar[10] 10
Multiple versionsMC100 Delegated Benefit Administrator Organization ID CHIA defined and maintained Org ID for linking across submitters Integer varchar[6] 6
Multiple versionsMC101 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
Multiple versionsMC102 Subscriber First Name First name of Subscriber Text varchar[25] 25
Multiple versionsMC103 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
Multiple versionsMC104 Member Last Name Last name of Member/Patient Text varchar[60] 60
Multiple versionsMC105 Member First Name First name of Member/Patient Text varchar[25] 25
Multiple versionsMC106 Member Middle Initial Middle initial of Member/Patient Text char[1] 1
Multiple versionsMC107 ICD Indicator International Classification of Diseases version Lookup Table - Integer int[1] 1
Multiple versionsMC108 Procedure Modifier - 3 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC109 Procedure Modifier - 4 HCPCS / CPT Code Modifier External Code Source 9 - Text char[2] 2
Multiple versionsMC110 Claim Processed Date Claim Processed Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC111 Diagnostic Pointer Diagnostic Pointer Number Integer varchar[4] 4
Multiple versionsMC112 Referring Provider ID Referring Provider ID Text varchar[30] 30
Multiple versionsMC113 Payment Arrangement Type Payment Arrangement Type Value Lookup Table - Numeric char[2] 2
Multiple versionsMC114 Excluded Expenses Amount not covered at the claim line due to benefit/plan limitation Integer ±varchar[10] 10
Multiple versionsMC115 Medicare Indicator Indicator - Medicare Payment Applied Lookup Table - Integer int[1] 1
Multiple versionsMC116 Withhold Amount Amount to be paid to the provider upon guarantee of performance Integer ±varchar[10] 10
Multiple versionsMC117 Filler Filler Filler int[1] 1
Multiple versionsMC118 Referral Indicator Indicator - Referral Needed Lookup Table - Integer int[1] 1
Multiple versionsMC119 PCP Indicator Indicator - PCP Rendered Service Lookup Table - Integer int[1] 1
Multiple versionsMC120 DRG Level Diagnostic Related Group Code Severity Level External Code Source 15 - Integer int[1] 1
Multiple versionsMC121 Patient Total Out of Pocket Amount Total amount patient/member must pay Integer ±varchar[10] 10
Multiple versionsMC122 Global Payment Flag Indicator - Global Payment Lookup Table - Integer int[1] 1
Multiple versionsMC123 Denied Flag Denied Claim Line Indicator Lookup Table - Integer int[1] 1
Multiple versionsMC124 Denial Reason Denial Reason Code Carrier Defined Table - OR - External Code Source 16 - Text varchar[15] 15
Multiple versionsMC125 Attending Provider Attending Provider ID Text varchar[30] 30
Multiple versionsMC126 Accident Indicator Indicator - Accident Related Lookup Table - Integer int[1] 1
Multiple versionsMC127 Family Planning Indicator Service is related to Family Planning Lookup Table - Integer int[1] 1
Multiple versionsMC128 Employment Related Indicator Indicator - Accident Related Lookup Table - Integer int[1] 1
Multiple versionsMC129 EPSDT Indicator Service related to Early Periodic Screening, Diagnosis and Treatment (EPSDT) Lookup Table - Integer int[1] 1
Multiple versionsMC130 Procedure Code Type Claim line Procedure Code Type Identifier Lookup Table - Integer int[1] 1
Multiple versionsMC131 InNetwork Indicator Indicator - Network Rate Applied Lookup Table - Integer int[1] 1
Multiple versionsMC132 Service Class Service Class Code Carrier Defined Table - Text char[2] 2
Multiple versionsMC133 Bill Frequency Code Bill Frequency External Code Source 14 - Text char[1] 1
Multiple versionsMC134 Plan Rendering Provider Identifier Plan Rendering Number Text varchar[30] 30
Multiple versionsMC135 Provider Location Location of Provider Text varchar[30] 30
Multiple versionsMC136 Discharge Diagnosis ICD Discharge Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC137 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
Multiple versionsMC138 Claim Line Type Claim Line Activity Type Code Lookup Table - Text char[1] 1
Multiple versionsMC139 Former Claim Number Previous Claim Number Text varchar[35] 35
Multiple versionsMC140 Member Street Address 2 Secondary Street Address of the Member/Patient Text varchar[50] 50
Multiple versionsMC141 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
Multiple versionsMC142 Other Diagnosis - 13 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC143 Other Diagnosis - 14 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC144 Other Diagnosis - 15 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC145 Other Diagnosis - 16 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC146 Other Diagnosis - 17 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC147 Other Diagnosis - 18 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC148 Other Diagnosis - 19 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC149 Other Diagnosis - 20 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC150 Other Diagnosis - 21 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC151 Other Diagnosis - 22 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC152 Other Diagnosis - 23 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC153 Other Diagnosis - 24 ICD Other Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsMC154 Present on Admission Code (POA) - 01 POA code for Principal Diagnosis External Code Source 15 - Text char[1] 1
Multiple versionsMC155 Present on Admission Code (POA) - 02 POA code for Other Diagnosis - 1 External Code Source 15 - Text char[1] 1
Multiple versionsMC156 Present on Admission Code (POA) - 03 POA code for Other Diagnosis - 2 External Code Source 15 - Text char[1] 1
Multiple versionsMC157 Present on Admission Code (POA) - 04 POA code for Other Diagnosis - 3 External Code Source 15 - Text char[1] 1
Multiple versionsMC158 Present on Admission Code (POA) - 05 POA code for Other Diagnosis - 4 External Code Source 15 - Text char[1] 1
Multiple versionsMC159 Present on Admission Code (POA) - 06 POA code for Other Diagnosis - 5 External Code Source 15 - Text char[1] 1
Multiple versionsMC160 Present on Admission Code (POA) - 07 POA code for Other Diagnosis - 6 External Code Source 15 - Text char[1] 1
Multiple versionsMC161 Present on Admission Code (POA) - 08 POA code for Other Diagnosis - 7 External Code Source 15 - Text char[1] 1
Multiple versionsMC162 Present on Admission Code (POA) - 09 POA code for Other Diagnosis - 8 External Code Source 15 - Text char[1] 1
Multiple versionsMC163 Present on Admission Code (POA) - 10 POA code for Other Diagnosis - 9 External Code Source 15 - Text char[1] 1
Multiple versionsMC164 Present on Admission Code (POA) - 11 POA code for Other Diagnosis - 10 External Code Source 15 - Text char[1] 1
Multiple versionsMC165 Present on Admission Code (POA) - 12 POA code for Other Diagnosis - 11 External Code Source 15 - Text char[1] 1
Multiple versionsMC166 Present on Admission Code (POA) - 13 POA code for Other Diagnosis - 12 External Code Source 15 - Text char[1] 1
Multiple versionsMC167 Present on Admission Code (POA) - 14 POA code for Other Diagnosis - 13 External Code Source 15 - Text char[1] 1
Multiple versionsMC168 Present on Admission Code (POA) - 15 POA code for Other Diagnosis - 14 External Code Source 15 - Text char[1] 1
Multiple versionsMC169 Present on Admission Code (POA) - 16 POA code for Other Diagnosis - 15 External Code Source 15 - Text char[1] 1
Multiple versionsMC170 Present on Admission Code (POA) - 17 POA code for Other Diagnosis - 16 External Code Source 15 - Text char[1] 1
Multiple versionsMC171 Present on Admission Code (POA) - 18 POA code for Other Diagnosis - 17 External Code Source 15 - Text char[1] 1
Multiple versionsMC172 Present on Admission Code (POA) - 19 POA code for Other Diagnosis - 18 External Code Source 15 - Text char[1] 1
Multiple versionsMC173 Present on Admission Code (POA) - 20 POA code for Other Diagnosis - 19 External Code Source 15 - Text char[1] 1
Multiple versionsMC174 Present on Admission Code (POA) - 21 POA code for Other Diagnosis - 20 External Code Source 15 - Text char[1] 1
Multiple versionsMC175 Present on Admission Code (POA) - 22 POA code for Other Diagnosis - 21 External Code Source 15 - Text char[1] 1
Multiple versionsMC176 Present on Admission Code (POA) - 23 POA code for Other Diagnosis - 22 External Code Source 15 - Text char[1] 1
Multiple versionsMC177 Present on Admission Code (POA) - 24 POA code for Other Diagnosis - 23 External Code Source 15 - Text char[1] 1
Multiple versionsMC178 Present on Admission Code (POA) - 25 POA code for Other Diagnosis - 24 External Code Source 15 - Text char[1] 1
Multiple versionsMC179 Condition Code - 1 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC180 Condition Code - 2 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC181 Condition Code - 3 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC182 Condition Code - 4 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC183 Condition Code - 5 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC184 Condition Code - 6 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC185 Condition Code - 7 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC186 Condition Code - 8 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC187 Condition Code - 9 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC188 Condition Code - 10 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC189 Condition Code - 11 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC190 Condition Code - 12 Condition Code External Code Source 14 - Text char[2] 2
Multiple versionsMC191 Value Code - 1 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC192 Value Amount - 1 Amount that corresponds to Value Code - 1 Integer ±varchar[10] 10
Multiple versionsMC193 Value Code - 2 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC194 Value Amount - 2 Amount that corresponds to Value Code - 2 Integer ±varchar[10] 10
Multiple versionsMC195 Value Code - 3 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC196 Value Amount - 3 Amount that corresponds to Value Code - 3 Integer ±varchar[10] 10
Multiple versionsMC197 Value Code - 4 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC198 Value Amount - 4 Amount that corresponds to Value Code - 4 Integer ±varchar[10] 10
Multiple versionsMC199 Value Code - 5 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC200 Value Amount - 5 Amount that corresponds to Value Code - 5 Integer ±varchar[10] 10
Multiple versionsMC201 Value Code - 6 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC202 Value Amount - 6 Amount that corresponds to Value Code - 6 Integer ±varchar[10] 10
Multiple versionsMC203 Value Code - 7 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC204 Value Amount - 7 Amount that corresponds to Value Code - 7 Integer ±varchar[10] 10
Multiple versionsMC205 Value Code - 8 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC206 Value Amount - 8 Amount that corresponds to Value Code - 8 Integer ±varchar[10] 10
Multiple versionsMC207 Value Code - 9 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC208 Value Amount - 9 Amount that corresponds to Value Code - 9 Integer ±varchar[10] 10
Multiple versionsMC209 Value Code - 10 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC210 Value Amount - 10 Amount that corresponds to Value Code - 10 Integer ±varchar[10] 10
Multiple versionsMC211 Value Code - 11 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC212 Value Amount - 11 Amount that corresponds to Value Code - 11 Integer ±varchar[10] 10
Multiple versionsMC213 Value Code - 12 Value Code External Code Source 14 - Text char[2] 2
Multiple versionsMC214 Value Amount - 12 Amount that corresponds to Value Code - 12 Integer ±varchar[10] 10
Multiple versionsMC215 Occurrence Code - 1 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC216 Occurrence Date - 1 Date that corresponds to Occurrence Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC217 Occurrence Code - 2 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC218 Occurrence Date - 2 Date that corresponds to Occurrence Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC219 Occurrence Code - 3 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC220 Occurrence Date - 3 Date that corresponds to Occurrence Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC221 Occurrence Code - 4 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC222 Occurrence Date - 4 Date that corresponds to Occurrence Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC223 Occurrence Code - 5 Occurrence Code External Code Source 14 - Text char[2] 2
Multiple versionsMC224 Occurrence Date - 5 Date that corresponds to Occurrence Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC225 Occurrence Span Code - 1 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC226 Occurrence Span Start Date - 1 Start Date that corresponds to Occurrence Span Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC227 Occurrence Span End Date - 1 End Date that corresponds to Occurrence Span Code - 1 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC228 Occurrence Span Code - 2 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC229 Occurrence Span Start Date - 2 Start Date that corresponds to Occurrence Span Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC230 Occurrence Span End Date - 2 End Date that corresponds to Occurrence Span Code - 2 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC231 Occurrence Span Code - 3 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC232 Occurrence Span Start Date - 3 Start Date that corresponds to Occurrence Span Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC233 Occurrence Span End Date - 3 End Date that corresponds to Occurrence Span Code - 3 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC234 Occurrence Span Code - 4 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC235 Occurrence Span Start Date - 4 Start Date that corresponds to Occurrence Span Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC236 Occurrence Span End Date - 4 End Date that corresponds to Occurrence Span Code - 4 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC237 Occurrence Span Code - 5 Occurrence Span Code External Code Source 14 - Text char[2] 2
Multiple versionsMC238 Occurrence Span Start Date - 5 Start Date that corresponds to Occurrence Span Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC239 Occurrence Span End Date - 5 End Date that corresponds to Occurrence Span Code - 5 Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsMC240 GIC ID GIC Member ID Text varchar[9] 9
Multiple versionsMC241 APCD ID Code Member Enrollment Type Lookup Table - Integer int[1] 1
MC242 National Provider ID - Plan Rendering National Provider Indentification (NPI) of the Plan Rendering Provider External Code Source 3 - Integer Int[10] 10
MC243 Benefit Plan Contract ID Identifier for the benefit plan the member is enrolled in that covers this claim Text Varchar[30] 30
MC244 Claim Line Paid Flag Claim Line Paid Indicator Lookup Table - Integer int[1] 1
MC245 Type of Facility Type of Facility Indicator Lookup Table - Integer int[2] 2
MC246 MassHealth Claim Type MassHealth Claim Type Indicator MassHealth specific claim type code Char[1] 1
MC247 MassHealth Rate Code MassHealth Rate Code Indicator MassHealth Rate code varchar[3] 3
Multiple versionsMC899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

File Specification for Multiple versionsMember Eligibility File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsME001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsME002 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsME003 Insurance Type Code/Product Type / Product Identification Code Lookup Table - Text char[2] 2
Multiple versionsME004 Year Eligibility year reported in this submission. Date Period - Integer int[4] CCYY 4
Multiple versionsME005 Month Reporting Month of Eligibility Date Period - Numeric char[2] MM 2
Multiple versionsME006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
Multiple versionsME007 Coverage Level Code Benefit Coverage Level Code Lookup Table - Text char[3] 3
Multiple versionsME008 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
Multiple versionsME009 Plan Specific Contract Number Contract Number Text varchar[30] 30
Multiple versionsME010 Member Suffix or Sequence Number Member's Contract Sequence Number Text varchar[20] 20
Multiple versionsME011 Member SSN Member's Social Security Number Numeric char[9] 9
Multiple versionsME012 Individual Relationship Code Member to Subscriber Relationship Code Lookup Table - Numeric varchar[2] 2
Multiple versionsME013 Member Gender Member's Gender Lookup Table - Text char[1] 1
Multiple versionsME014 Member Date of Birth Member's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME015 Member City Name City name of the Member Text varchar[30] 30
Multiple versionsME016 Member State State / Province of the Member External Code Source 2 - Text char[2] 2
Multiple versionsME017 Member ZIP Code Zip Code of the Member External Code Source 2 - Text varchar[9] 9
Multiple versionsME018 Medical Coverage Indicator - Medical Option Lookup Table - Integer int[1] 1
Multiple versionsME019 Prescription Drug Coverage Indicator - Pharmacy Option Lookup Table - Integer int[1] 1
Multiple versionsME020 Dental Coverage Indicator - Dental Option Lookup Table - Integer int[1] 1
Multiple versionsME021 Race 1 Member's self-disclosed Primary Race Lookup Table - Text varchar[6] 6
Multiple versionsME022 Race 2 Member's self-disclosed Secondary Race Lookup Table - Text varchar[6] 6
Multiple versionsME023 Filler Filler Text varchar[15] 15
Multiple versionsME024 Hispanic Indicator Indicator - Hispanic Status Lookup Table - Integer int[1] 1
Multiple versionsME025 Ethnicity 1 Member's Primary Ethnicity Lookup Table - OR - External Code Source 17 - Text char[6] 6
Multiple versionsME026 Ethnicity 2 Member's Secondary Ethnicity Lookup Table - OR - External Code Source 17 - Text char[6] 6
Multiple versionsME027 Other Ethnicity Member's Other Ethnicity Text varchar[20] 20
Multiple versionsME028 Primary Insurance Indicator Indicator - Primary Insurance Coverage Lookup Table - Integer int[1] 1
Multiple versionsME029 Coverage Type Type of Coverage Code Lookup Table - Text char[3] 3
Multiple versionsME030 Market Category Code Market Category Code Lookup Table - Text varchar[4] 4
Multiple versionsME031 Special Coverage Special Coverage Code Lookup Table - Text varchar[3] 3
Multiple versionsME032 Group Name Group name Text varchar[50] 50
Multiple versionsME033 Member language preference Member's self-disclosed verbal language preference External Code Source 7 - Integer int[3] 3
Multiple versionsME034 Member language preference -Other Member's Other Language Preference Text varchar[20] 20
Multiple versionsME035 Health Care Home (PCMH) Assigned Flag Health Care Home Assigned indicator Lookup Table - Integer int[1] 1
Multiple versionsME036 Health Care Home (PCMH) Number Health Care Home ID Text varchar[30] 30
Multiple versionsME037 Health Care Home (PCMH) Tax ID Number Health Care Home EIN Numeric char[9] 9
Multiple versionsME038 National Provider ID - Health Care Home (PCMH) National Provider Identification (NPI) of the Health Care Home Provider External Code Source 3 - Integer int[10] 10
Multiple versionsME039 Health Care Home Name (PCMH) Name of Health Care Home Text varchar[60] 60
Multiple versionsME040 Product ID Number Product Identification Text varchar[30] 30
Multiple versionsME041 Product Enrollment Start Date Member Enrollment Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME042 Product Enrollment End Date Enrollment Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME043 Member Street Address Street address of the Member Text varchar[50] 50
Multiple versionsME044 Member Street Address 2 Secondary Street Address of the Member Text varchar[50] 50
Multiple versionsME045 Purchased through Massachusetts Exchange Flag Indicator - MA Exchange Purchase Lookup Table - Integer int[1] 1
Multiple versionsME046 Member PCP ID Member's PCP ID Text varchar[30] 30
Multiple versionsME047 Member PCP Effective Date PCP Effective Date with Member Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME048 Member PCP Termination Date PCP Termination Date with Member Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME049 Member Deductible Annual maximum out of pocket Member Deductible across all benefit types Integer varchar[10] 10
Multiple versionsME050 Member Deductible Used Member deductible amount incurred Integer varchar[10] 10
Multiple versionsME051 Behavioral Health Benefit Flag Indicator - Behavioral Health Option Lookup Table - Integer int[1] 1
Multiple versionsME052 Laboratory Benefit Flag Indicator - Laboratory Option Lookup Table - Integer int[1] 1
Multiple versionsME053 Disease Management Enrollee Flag Chronic Illness Management indicator Lookup Table - Integer int[1] 1
Multiple versionsME054 Eligibility Determination Date Eligibility date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME055 Business Type Code Business Type Lookup Table - Integer int[1] 1
Multiple versionsME056 Last Activity Date Activity Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME057 Date of Death Member's Date of Death Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME058 Subscriber Street Address Street address of the Subscriber Text varchar[50] 50
Multiple versionsME059 Disability Indicator Flag Indicator - Disability Status Lookup Table - Integer int[1] 1
Multiple versionsME060 Employment Status Employment Status Code Lookup Table - Text char[1] 1
Multiple versionsME061 Student Status Indicator - Student Status Lookup Table - Integer int[1] 1
Multiple versionsME062 Marital Status Marital Status Code Lookup Table - Text char[1] 1
Multiple versionsME063 Benefit Status Benefit Status Code Lookup Table - Text char[1] 1
Multiple versionsME064 Employee Type Employee Type Code Lookup Table - Text char[1] 1
Multiple versionsME065 Date of Retirement Member's date of Retirement Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsME066 COBRA Status COBRA usage indicator Lookup Table - Integer int[1] 1
Multiple versionsME067 Spouse Plan Type Spouse Plan Type Code Carrier Defined Table - Text char[2] 2
Multiple versionsME068 Spouse Plan Spouse Plan Medicare Code Carrier Defined Table - Text char[2] 2
Multiple versionsME069 Spouse Medical Coverage Spouse Medical Medicare Coverage Code Carrier Defined Table - Text char[2] 2
Multiple versionsME070 Spouse Medicare Indicator Spouse Medicare Selected Code Carrier Defined Table - Text char[2] 2
Multiple versionsME071 Pool Indicator Pool Indicator Code Lookup Table - Integer int[1] 1
Multiple versionsME072 Family Size Family Size Contracted Integer varchar[2] 2
Multiple versionsME073 Fully Insured member Fully Insured identifier Lookup Table - Integer int[1] 1
Multiple versionsME074 Interpreter Indicator - Interpreter Need Lookup Table - Integer int[1] 1
Multiple versionsME075 NewMMIS ID MassHealth-assigned Member ID Text char[12] 12
Multiple versionsME076 Member rating category Member Rating Category Code Carrier Defined Table - Text char[5] 5
Multiple versionsME077 Members NAICS Code Member Standard NAICS or SIC Code External Code Source 6 - Numeric varchar[6] 6
Multiple versionsME078 Employer Zip Code (Situs) Zip code of the Employer External Code Source 2 - Text char[5] 5
Multiple versionsME079 Recipient Identification Number (MassHealth only) MassHealth-assigned Member ID Text varchar[15] 15
Multiple versionsME080 Recipient Historical Number (MassHealth only) MassHealth-assigned Member ID Text varchar[15] 15
Multiple versionsME081 Medicare Code Medicare Plan Indicator Code Lookup Table - Integer int[1] 1
Multiple versionsME082 Employer Name Member's Employer Name Text varchar[60] 60
Multiple versionsME083 Employer EIN Member's Employer EIN Numeric char[9] 9
Multiple versionsME101 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
Multiple versionsME102 Subscriber First Name First name of Subscriber Text varchar[25] 25
Multiple versionsME103 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
Multiple versionsME104 Member Last Name Last name of Member Text varchar[60] 60
Multiple versionsME105 Member First Name First name of Member Text varchar[25] 25
Multiple versionsME106 Member Middle Initial Middle initial of Member Text char[1] 1
Multiple versionsME107 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
Multiple versionsME108 Subscriber City Name City name of the Subscriber Text varchar[30] 30
Multiple versionsME109 Subscriber State or Province State of the Subscriber External Code Source 2 - Text char[2] 2
Multiple versionsME110 Subscriber ZIP Code Zip Code of the Subscriber External Code Source 2 - Text varchar[9] 9
Multiple versionsME111 Medical Deductible Maximum out of pocket amount of applied member's deductible Integer varchar[10] 10
Multiple versionsME112 Pharmacy Deductible Maximum out of pocket amount of member's deductible applied to pharmacy Integer varchar[10] 10
Multiple versionsME113 Medical and Pharmacy Deductible Maximum out of pocket amount of member's deductible applied to services Integer varchar[10] 10
Multiple versionsME114 Behavioral Health Deductible Maximum out of pocket amount of member's deductible applied to behavioral health Integer varchar[10] 10
Multiple versionsME115 Dental Deductible Maximum out of pocket amount of member's deductible applied to dental services Integer varchar[10] 10
Multiple versionsME116 Vision Deductible Maximum out of pocket amount of member's deductible applied to vision services Integer varchar[10] 10
Multiple versionsME117 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
Multiple versionsME118 Vision Benefit Indicator - Vision Option Lookup Table - Integer int[1] 1
Multiple versionsME119 Filler Filler Filler char[0] 0
Multiple versionsME120 Actuarial Value The actuarial value of the risk adjustment covered plan the member is enrolled in Decimal - Numeric varchar[6] 6
Multiple versionsME121 Metal Level Standardized plan level in metal reference Lookup Table - Integer int[1] 1
Multiple versionsME122 Coinsurance Maximum % Maximum coinsurance percentage contract of the member Lookup Table - Integer int[1] 1
Multiple versionsME123 Monthly Premium Expected Monthly Premium Integer varchar[10] 10
Multiple versionsME124 Attributed PCP Provider ID PV002 for PCP attributed to the patient for prior year. Text varchar[30] 30
Multiple versionsME125 TME OrgID - Physician Group of the Member's PCP TME Provider OrgID Integer varchar[6] 6
Multiple versionsME126 Risk Adjustment Covered Plan (RACP) Member Enrolled in RACP Indicator Lookup table - Integer Int(1) 1
Multiple versionsME127 Billable Member Billable Member Indicator Lookup table - Integer Int(1) 1
Multiple versionsME128 Benefit Plan Contract ID Identifier for the benefit plan the member is enrolled in as of 15th of the month Text varchar [30] 30
Multiple versionsME129 Member Benefit Plan Contract Enrollment Start Date Date the member is enrolled in the benefit plan Date int[8] CCYYMMDD 8
Multiple versionsME130 Member Benefit Plan Contract Enrollment End Date Date the member's enrollment ends with the benefit plan Date int[8] CCYYMMDD 8
Multiple versionsME131 TME Global Budget/Payment Indicator TME Global Budget/Payment Indicator Integer Int[1] 1
Multiple versionsME132 Total Monthly Premium Employer + Subscriber's total contribution to monthly premium Integer varchar[10] 10
Multiple versionsME133 GIC ID GIC Member ID Text varchar[9] 9
Multiple versionsME134 APCD ID Code Member Enrollment Type Lookup Table - Integer int[1] 1
ME135 Aid Category MassHealth Aid Category Lookup Table - Aid Category Varchar[4] 4
Multiple versionsME899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

File Specification for Multiple versionsPharmacy Claims File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsPC001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsPC002 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsPC003 Insurance Type Code/Product Type / Product Identification Code Lookup Table - Text char[2] 2
Multiple versionsPC004 Payer Claim Control Number Payer Claim Control Identification Text varchar[35] 35
Multiple versionsPC005 Line Counter Incremental Line Counter Integer varchar[4] 4
Multiple versionsPC005A Version Number Claim Service Line Version Number Integer varchar[4] 4
Multiple versionsPC006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
Multiple versionsPC007 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
Multiple versionsPC008 Plan Specific Contract Number Contract Number Text varchar[30] 30
Multiple versionsPC009 Member Suffix or Sequence Number Member/Patient's Contract Sequence Number Text varchar[20] 20
Multiple versionsPC010 Member SSN Member/Patient's Social Security Number Numeric char[9] 9
Multiple versionsPC011 Individual Relationship Code Patient to Subscriber Relationship Code Lookup Table - Text char[2] 2
Multiple versionsPC012 Member Gender Patient's Gender Lookup Table - Text char[1] 1
Multiple versionsPC013 Member Date of Birth Member/Patient's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPC014 Member City Name of Residence City name of the Member/Patient Text varchar[50] 50
Multiple versionsPC015 Member State State / Province of the Patient External Code Source 2 - Text char[2] 2
Multiple versionsPC016 Member ZIP Code Zip code of the Member / Patient External Code Source 2 - Text varchar[9] 9
Multiple versionsPC017 Date Service Approved (AP Date) Date Service Approved by Payer Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPC018 Pharmacy Number Pharmacy Number Text varchar[30] 30
Multiple versionsPC019 Pharmacy Tax ID Number Pharmacy Tax Identification Number Numeric char[9] 9
Multiple versionsPC020 Pharmacy Name Name of Pharmacy Text varchar[100] 100
Multiple versionsPC021 National Provider ID - Pharmacy National Provider Identification (NPI) of the Pharmacy External Code Source 3 - Integer int[10] 10
Multiple versionsPC022 Pharmacy Location City City name of the Pharmacy Text varchar[30] 30
Multiple versionsPC023 Pharmacy Location State State of the Pharmacy External Code Source 2 - Text char[2] 2
Multiple versionsPC024 Pharmacy ZIP Code Zip code of the Pharmacy External Code Source 2 - Text varchar[9] 9
Multiple versionsPC024A Pharmacy Country Code Country Code of the Pharmacy External Code Source 1 - Text char[3] 3
Multiple versionsPC025 Claim Status Claim Line Status Lookup Table - Numeric varchar[2] 2
Multiple versionsPC026 Drug Code National Drug Code (NDC) External Code Source 12 - Text char[11] 11
Multiple versionsPC027 Drug Name Name of the drug as supplied External Code Source 12 - Text varchar[80] 80
Multiple versionsPC028 New Prescription or Refill Prescription Status Indicator Numeric char[2] 2
Multiple versionsPC029 Generic Drug Indicator Generic Drug Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC030 Dispense as Written Code Prescription Dispensing Activity Code Lookup Table - Integer int[1] 1
Multiple versionsPC031 Compound Drug Indicator Compound Drug Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC032 Date Prescription Filled Prescription filled date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPC033 Quantity Dispensed Claim line units dispensed Quantity - Integer ±varchar[10] 10
Multiple versionsPC034 Day's Supply Prescription Supply Days Quantity - Integer ±varchar[4] 4
Multiple versionsPC035 Charge Amount Amount of provider charges for the claim line Integer ±varchar[10] 10
Multiple versionsPC036 Paid Amount Amount paid by the carrier for the claim line Integer ±varchar[10] 10
Multiple versionsPC037 Ingredient Cost/List Price Amount defined as the List Price or Ingredient Cost Integer ±varchar[10] 10
Multiple versionsPC038 Postage Amount Claimed Amount of postage claimed on the claim line Integer ±varchar[10] 10
Multiple versionsPC039 Dispensing Fee Amount of dispensing fee for the claim line Integer ±varchar[10] 10
Multiple versionsPC040 Copay Amount Amount of Copay member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsPC041 Coinsurance Amount Amount of coinsurance member/patient is responsible to pay Integer ±varchar[10] 10
Multiple versionsPC042 Deductible Amount Amount of deductible member/patient is responsible to pay on the claim line Integer ±varchar[10] 10
Multiple versionsPC043 Prescribing ProviderID Prescribing Provider Number Text varchar[30] 30
Multiple versionsPC044 Prescribing Physician First Name First name of Prescribing Physician Text varchar[25] 25
Multiple versionsPC045 Prescribing Physician Middle Name Middle initial of Prescribing Physician Text varchar[25] 25
Multiple versionsPC046 Prescribing Physician Last Name Last name of Prescribing Physician Text varchar[60] 60
Multiple versionsPC047 Prescribing Physician DEA Number Prescribing DEA Text char[9] 9
Multiple versionsPC048 National Provider ID - Prescribing National Provider Identification (NPI) of the Prescribing Provider External Code Source 3 - Integer int[10] 10
Multiple versionsPC049 Prescribing Physician Plan Number Carrier-assigned Provider Plan ID Text varchar[30] 30
Multiple versionsPC050 Prescribing Physician License Number Prescribing Physician License Number Text varchar[30] 30
Multiple versionsPC051 Prescribing Physician Street Address Street address of the Prescribing Physician Text varchar[50] 50
Multiple versionsPC052 Prescribing Physician Street Address 2 Secondary Street Address of the Prescribing Physician Text varchar[50] 50
Multiple versionsPC053 Prescribing Physician City City name of the Prescribing Physician Text varchar[30] 30
Multiple versionsPC054 Prescribing Physician State State of the Physician External Code Source 2 - Text char[2] 2
Multiple versionsPC055 Prescribing Physician Zip Zip code of the Prescribing Physician External Code Source 2 - Text varchar[9] 9
Multiple versionsPC056 Product ID Number Product Identification Text varchar[30] 30
Multiple versionsPC057 Mail Order pharmacy Indicator - Mail Order Option Lookup Table - Integer int[1] 1
Multiple versionsPC058 Script number Prescription Number Text varchar[20] 20
Multiple versionsPC059 Recipient PCP ID Patient's PCP ID Number Text varchar[30] 30
Multiple versionsPC060 Single/Multiple Source Indicator Drug Source Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC061 Member Street Address Street address of the Member/Patient Text varchar[50] 50
Multiple versionsPC062 Billing Provider Tax ID Number The Billing Provider's Federal Tax Identification Number (FTIN) Numeric char[9] 9
Multiple versionsPC063 Paid Date Paid date of the claim line Full Date - Integer int[8] 8
Multiple versionsPC064 Date Prescription Written Date prescription was prescribed Full Date - Integer int[8] 8
Multiple versionsPC065 Coordination of Benefits/TPL Liability Amount Amount due from a Secondary Carrier when known Integer ±varchar[10] 10
Multiple versionsPC066 Other Insurance Paid Amount Amount paid by a Primary / Prior Carrier Integer ±varchar[10] 10
Multiple versionsPC067 Medicare Paid Amount Amount Medicare paid on claim Integer ±varchar[10] 10
Multiple versionsPC068 Allowed amount Allowed Amount Integer ±varchar[10] 10
Multiple versionsPC069 Member Self Pay Amount Amount member/patient paid out of pocket on the claim line Integer ±varchar[10] 10
Multiple versionsPC070 Rebate Indicator Drug Rebate Eligibility Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC071 State Sales Tax Amount of applicable sales tax on the claim line Integer ±varchar[10] 10
Multiple versionsPC072 Delegated Benefit Administrator Organization ID CHIA defined and maintained Org ID for linking across submitters Integer varchar[6] 6
Multiple versionsPC073 Formulary Code Formulary inclusion identifier Lookup Table - Integer int[1] 1
Multiple versionsPC074 Route of Administration Route of Administration Lookup Table - Numeric char[2] 2
Multiple versionsPC075 Drug Unit of Measure Units of Measure Lookup Table - Text char[3] 3
Multiple versionsPC101 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
Multiple versionsPC102 Subscriber First Name First name of Subscriber Text varchar[25] 25
Multiple versionsPC103 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
Multiple versionsPC104 Member Last Name Last name of Member/Patient Text varchar[60] 60
Multiple versionsPC105 Member First Name First name of Member/Patient Text varchar[25] 25
Multiple versionsPC106 Member Middle Initial Middle initial of the Member/Patient Text char[1] 1
Multiple versionsPC107 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
Multiple versionsPC108 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
Multiple versionsPC109 Member Street Address 2 Secondary Street Address of the Member/Patient Text varchar[50] 50
Multiple versionsPC110 Claim Line Type Claim Line Activity Type Code Lookup Table - Text char[1] 1
Multiple versionsPC111 Former Claim Number Previous Claim Number Text varchar[35] 35
Multiple versionsPC112 Medicare Indicator Indicator - Medicare Payment Applied Lookup Table - Integer int[1] 1
Multiple versionsPC113 Pregnancy Indicator Indicator - Pregnancy Lookup Table - Integer int[1] 1
Multiple versionsPC114 Diagnosis Code ICD Diagnosis Code External Code Source 8 - Text varchar[7] 7
Multiple versionsPC115 ICD Indicator International Classification of Diseases version Lookup Table - Integer int[1] 1
Multiple versionsPC116 Denied Flag Denied Claim Line Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC117 Denial Reason Denial Reason Code Carrier Defined Table - OR - External Code Source 16 Varchar[30] 30
Multiple versionsPC118 Payment Arrangement Type Payment Arrangement Type Value Lookup Table - Numeric char[2] 2
Multiple versionsPC119 GIC ID GIC Member ID Text varchar[9] 9
Multiple versionsPC120 APCD ID Code Member Enrollment Type Lookup Table - Integer int[1] 1
PC121 Claim Line Paid Flag Claim Line Paid Indicator Lookup Table - Integer int[1] 1
Multiple versionsPC899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

File Specification for Multiple versionsProduct File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsPR001 Product ID number Product Identification Text varchar[30] 30
Multiple versionsPR002 Product Name Submitter defined Product name Text varchar[70] 70
Multiple versionsPR003 Carrier License Type Carrier License Type Lookup Table - Text char[3] 3
Multiple versionsPR004 Product Line of Business Model Line of Business / Insurance Model the Product relates to. Lookup Table - Text char[2] 2
Multiple versionsPR005 Insurance Plan Market Insurance Plan Market Code Lookup Table - Text char[4] 4
Multiple versionsPR006 Product Benefit Type Benefit Options Lookup Table - Integer int[1] 1
Multiple versionsPR007 Other Product Benefit Description Benefit Description Text varchar[80] 80
Multiple versionsPR008 Risk Type Risk Options Lookup Table - Integer int[1] 1
Multiple versionsPR009 Product Start Date Product Start Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPR010 Product End Date Product End Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPR011 Product Active Flag Indicator - Active Product Lookup Table - Integer int[1] 1
Multiple versionsPR012 Annual Per Person Deductible Code Per Person Deductible bandwidth reporting Lookup Table - Text char[3] 3
Multiple versionsPR013 Annual Per Family Deductible Code Per Family Deductible bandwidth reporting Lookup Table - Text char[3] 3
Multiple versionsPR014 Coordinated Care model Indicator - Clinical Coordination Lookup Table - Integer int[1] 1
Multiple versionsPR015 Other Product Line of Business Model Defines Product Line of Business when Other is selected Text varchar[30] 30
Multiple versionsPR016 Other Risk Type Defines Risk Type Other is selected Text varchar[30] 30
Multiple versionsPR017 NAIC Code National Association of Insurance Commissioners' Code Integer int[5] 5
PR018 Situs State / Province of the situs of the Product External Code Source 2 - Text char[2] 2
Multiple versionsPR899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

File Specification for Multiple versionsProvider File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsPV001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsPV002 Plan Provider ID Carrier Unique Provider Code Text varchar[30] 30
Multiple versionsPV003 Tax Id Federal Tax ID of non-individual Provider Numeric char[9] 9
Multiple versionsPV004 UPIN Id Unique Physician ID Text char[6] 6
Multiple versionsPV005 DEA ID Provider DEA Text char[9] 9
Multiple versionsPV006 License Id State practice license ID Text varchar[25] 25
Multiple versionsPV007 Medicaid Id MassHealth-assigned Provider ID Text varchar[25] 25
Multiple versionsPV008 Last Name Last name of the Provider in PV002 Text varchar[50] 50
Multiple versionsPV009 First Name First name of the Provider in PV002 Text varchar[50] 50
Multiple versionsPV010 Middle Initial Middle initial of the Provider in PV002 Text char[1] 1
Multiple versionsPV011 Suffix Suffix of the Provider in PV002 Lookup Table - Integer int[1] 1
Multiple versionsPV012 Entity Name Group / Facility name Text varchar[100] 100
Multiple versionsPV013 Entity Code Provider entity code Lookup Table - Text char[2] 2
Multiple versionsPV014 Gender Code Gender of Provider identified in PV002 Lookup Table - Text char[1] 1
Multiple versionsPV015 DOB Date Provider's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV016 Provider Street Address 1 Street address of the Provider Text varchar[50] 50
Multiple versionsPV017 Provider Street Address 2 Street Address 2 of the Provider Text varchar[50] 50
Multiple versionsPV018 City Name City of the Provider Text varchar[35] 35
Multiple versionsPV019 State Code State of the Provider External Code Source 2 - Text char[2] 2
Multiple versionsPV020 Country Code Country Code of the Provider External Code Source 1 - Text char[3] 3
Multiple versionsPV021 Zip Code Zip code of the Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsPV022 Taxonomy Taxonomy Code External Code Source 5 - Text char[10] 10
Multiple versionsPV023 Mailing Street Address1 Name Street address of the Provider / Entity Text varchar[50] 50
Multiple versionsPV024 Mailing Street Address2 Name Secondary Street address of the Provider / Entity Text varchar[50] 50
Multiple versionsPV025 Mailing City Name City name of the Provider / Entity Text varchar[35] 35
Multiple versionsPV026 Mailing State Code State name of the Provider / Entity External Code Source 2 - Text char[2] 2
Multiple versionsPV027 Mailing Country Code Country name of the Provider / Entity External Code Source 1 - Text char[3] 3
Multiple versionsPV028 Mailing Zip Code Zip code of the Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsPV029 Provider Type Code Provider Type