United States Health Information Knowledgebase

 

Minnesota



Name:Minnesota
Abbreviation:MN
Title of SystemMinnesota Health Care Claims Reporting System
Websitehttp://www.health.state.mn.us/ Exit Disclaimer [www.health.state.mn.us]
Who Maintains the SystemMinnesota Department of Health
Versions:May 2009

File Specification for Medical Claims File Submission - May 2009

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided Text 2
HD002 Payer Payer Code Text 8
HD004 Type of File Not Provided Text 2
HD005 Period Beginning Date Not Provided Integer CCYYMM 6
HD006 Period Ending Date Not Provided Integer CCYYMM 6
HD007 Record Count Total number of records submitted in the file Integer 10
HD008 Comments Payer comments Text 80
MC001 Payer This field contains the NCDMS assigned submitter code for the data submitter. The first two characters of the submitter code indicate Minnesota and the third character designates the type of submitter. A single data submitter may have multiple submitter codes because the data submitter is submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first 6 characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. Text 8
MC003 Insurance Type / Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. Code all but MC and XX as 2 characters; MC and XX must include a valid subcode. Text 6
MC004 Payer Claim Control Number This field contains the claim number used by the data submitter to internally track the claim. In general the claim number is associated with all service lines of the bill. It must apply to the entire claim and be unique within the data submitter's system. Text 35
MC004A Claim Submitter's Identifier This field is used to track a claim from creation by the health care provider through the payment. This field is used in algorithms to determine the final payment for the service. Text 38
MC005 Line Counter This field contains the line number for this service. The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. This field is used in algorithms to determine the final payment for the service. If the data submitter's processing system assigns an internal line counter for the adjudication process, that number may be submitted in place of the line number submitted by the provider. Integer 4
MC005A Version Number This is a voluntary administrative field and is not required to be reported. This field contains the version number of the claim service line. It begins with 0 and is incremented by 1 for each subsequent version of that service line. This field is used in algorithms to determine the final payment for the service Integer 4
MC008 Plan Specific Contract Number This field contains the data submitter assigned contract number for the subscriber. This field is encrypted using the same algorithm across all data submitters and is not available in the analytical data warehouse. When this field is populated, it forms the core of the unique member identification code. Set as null if unavailable. Text 128
MC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. Integer 2
MC012 Member Gender This field contains the gender of the patient. Text 1
MC013 Member Date of Birth This field contains the member's date of birth with a format of CCYYMMDD. During the encryption process, this field is used to calculate age as of the from date of service (MC059). The field is then encrypted. This data element will not be transmitted in unencrypted form. Date CCYYMMDD 8
MC014 Member City Name This field contains the member's city of residence Text 30
MC015 Member State or Province The member state or province contains the 2 character abbreviation code used by the US Postal Service. Text 2
MC016 Member ZIP Code This field contains the ZIP code associated with the member's residence Text 5
MC017 Check Issue or EFT Effective Date This field contains the date the record was approved for payment. This is generally referred to as the paid date and reported with a CCYYMMDD format. When BPR04 is "NON" for non-payment, include remittance data Date CCYYMMDD 8
MC018 Admission Date This field contains the date of the inpatient admission reported with a CCYYMMDD format. Date CCYYMMDD 8
MC020 Admission Type This field is used to record the type of admission for all inpatient hospital claims. Integer 1
MC021 Admission Source This field is required for inpatient hospital claims. It records the source of admission. For newborns (Admission Type = 4) Text 1
MC023 Discharge Status This field contains the status for the patient discharged from the hospital. Integer 2
MC024 Service Provider Number Data submitter assigned or legacy rendering/attending provider number. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Required if MC026 is not filled. Text 30
MC025 Service Provider Tax ID Number Federal tax payer's identification number for rendering/attending provider. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 10
MC026 National Service Provider ID Record the National Provider Identification (NPI) number for the entity or individual directly providing the service. This field will be used to create a master provider index for Minnesota medical service and prescribing providers. Required if MC024 is not filled. Text 20
MC027 Service Provider Entity Type Qualifier Not Provided Text 1
MC028 Service Provider First Name Report the individual's first name. Set to null if provider is a facility or an organization. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers Text 25
MC029 Service Provider Middle Name Report the individual's middle name or initial. Set to null if provider is a facility or an organization. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 25
MC030 Service Provider Last Name or Organization Name Report the last name of the individual practitioner or the full name if the provider is a facility or an organization. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 100
MC031 Service Provider Suffix The service provider suffix is used to capture any generational identifiers associated with an individual clinician's name (e.g. Jr. Sr., III). Do not code the clinician's credentials (e.g. MD, LCSW) in this field. Set to null if the provider is a facility or an organization. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 10
MC033 Service Provider City Name Report the city name of the provider address, preferably the practice location. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 30
MC034 Service Provider State or Province The provider's state or province contains the 2 character abbreviation code used by the US Postal Service. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 2
MC035 Service Provider ZIP Code Report the ZIP code of the servicing provider's address, preferably the practice location. This field will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 15
MC036 Type of Bill - Institutional This field is required for institutional claims and must be set to null for professional claims. Integer 3
MC037 Site of Service - on NSF/CMS 1500 Claims For professional claims, this field records the type of facility where the service was performed. The field should be set to null for institutional claims. Text 2
MC039 Admitting Diagnosis This field contains the ICD-9 diagnosis code indicating the reason for the inpatient admission. Decimal point is not coded. Text 5
MC040 E-Code This field describes an injury, poisoning or adverse effect using an ICD-9 E-code diagnosis. Decimal point is not coded. Additional E-Codes may be reported in other diagnosis fields MC041-MC053 Text 5
MC041 Principal Diagnosis This field contains the ICD-9 diagnosis code for the principal diagnosis. Decimal point is not coded. Text 5
MC042 Other Diagnosis - 1 This field contains the ICD-9 diagnosis code for the first secondary diagnosis. Decimal point is not coded. Text 5
MC043 Other Diagnosis - 2 This field contains the ICD-9 diagnosis code for the second secondary diagnosis. Decimal point is not coded. Text 5
MC044 Other Diagnosis - 3 This field contains the ICD-9 diagnosis code for the third secondary diagnosis. Decimal point is not coded. Text 5
MC045 Other Diagnosis - 4 This field contains the ICD-9 diagnosis code for the fourth secondary diagnosis. Decimal point is not coded. Text 5
MC046 Other Diagnosis - 5 This field contains the ICD-9 diagnosis code for the fifth secondary diagnosis. Decimal point is not coded. Text 5
MC047 Other Diagnosis - 6 This field contains the ICD-9 diagnosis code for the sixth secondary diagnosis. Decimal point is not coded. Text 5
MC048 Other Diagnosis - 7 This field contains the ICD-9 diagnosis code for the seventh secondary diagnosis. Decimal point is not coded. Text 5
MC049 Other Diagnosis - 8 This field contains the ICD-9 diagnosis code for the eighth secondary diagnosis. Decimal point is not coded. Text 5
MC050 Other Diagnosis - 9 This field contains the ICD-9 diagnosis code for the ninth secondary diagnosis. Decimal point is not coded. Text 5
MC051 Other Diagnosis - 10 This field contains the ICD-9 diagnosis code for the tenth secondary diagnosis. Decimal point is not coded. Text 5
MC052 Other Diagnosis - 11 This field contains the ICD-9 diagnosis code for the eleventh secondary diagnosis. Decimal point is not coded. Text 5
MC053 Other Diagnosis - 12 This field contains the ICD-9 diagnosis code for the twelfth secondary diagnosis. Decimal point is not coded. Text 5
MC054 Revenue Code This field is used to report the revenue code for institutional claims. It is one of three fields used to report type of service. National Uniform Billing Committee Codes are accepted. Code using leading zeroes, left justified and four digits. Text 4
MC055 Procedure Code This field contains the HCPC or CPT code for the procedure performed. It is one of three fields used to report the service. Health Care Common Procedural Coding System (HCPCS), including CPT codes of the American Medical Association, are accepted. Text 5
MC056 Procedure Modifier - 1 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. Text 2
MC057A Procedure Modifier - 2 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. Text 2
MC057B Procedure Modifier - 3 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. Text 2
MC057C Procedure Modifier - 4 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. Text 2
MC058 Principal ICD-9-CM Procedure Code This is used to report the principal inpatient ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. This is one of three fields used to report type of service. Use fields MC058A- E to report other ICD-9-CM procedure codes. Text 4
MC058A Other ICD- 9-CM Procedure Code - 1 This is used to report the second ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC058B Other ICD- 9-CM Procedure Code - 2 This is used to report the third ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC058C Other ICD- 9-CM Procedure Code - 3 This is used to report the fourth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC058D Other ICD- 9-CM Procedure Code - 4 This is used to report the fifth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC058E Other ICD- 9-CM Procedure Code - 5 This is used to report the sixth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC059 Date of Service - From This field contains the first date of service for this service line in a CCYYMMDD format. Date CCYYMMDD 8
MC060 Date of Service - Thru This field contains the last date of service for this service line in a CCYYMMDD format. Future dates are acceptable. Date CCYYMMDD 8
MC061 Quantity This field contains a count of services performed. This field may be negative. Integer 5
MC062 Charge Amount This field contains the total charges for the service as reported by the provider. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
MC063 Paid Amount This field includes all health plan payments , and excludes all member payments and withholds from providers. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
MC063A Header/ Line Payment Indicator This field is used to indicate whether the payment is reported on the header or line level. Code H for Header or L for Line. If H, populate each line after the first line with "H" and a paid amount of $0. If L, populate each line as necessary. Text 1
MC063C Managed Care Withhold This is an amount withheld from payment to a provider by a managed care organization, which may be paid at a later date. 0$ is acceptable; code "data not available" as 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC064 Prepaid Amount For capitated services, the fee for service equivalent amount. 0$ is acceptable; code "data not available" as 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC065 Copay / Co-insurance Amount This field contains the pre-set, fixed dollar amount of copay and/or ccoinsurance payable by a member, often on a per visit/service basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
MC067 Deductible Amount This is an amount that is required to be paid by a member before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that is not covered by the member's insurance plan. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
MC076 Billing Provider Number Enter the data submitter assigned billing provider number. This should be the identifier used by the data submitter for internal reasons and does not routinely change. Required if MC077 is not filled. Text 30
MC077 National Billing Provider ID National Provider Identification (NPI) number for the billing provider. Required if MC076 is not filled. Text 10
MC078 Billing Provider Last Name Report the full name of the billing organization or the last name of the individual billing provider. Text 60
MC079 Diagnosis Code Pointer -1 A pointer to the claim diagnosis code in the order of importance to this service. Use this pointer for the first diagnosis code pointer (primary diagnosis for this service line). Integer 1
MC080 Diagnosis Code Pointer -2 A pointer to the claim diagnosis code in the order of importance to this service. Use this pointer for the second diagnosis code pointer if applicable. Integer 1
MC081 Diagnosis Code Pointer -3 A pointer to the claim diagnosis code in the order of importance to this service. Use this pointer for the third diagnosis code pointer if applicable. Integer 1
MC082 Diagnosis Code Pointer -4 A pointer to the claim diagnosis code in the order of importance to this service. Use this pointer for the fourth diagnosis code pointer if applicable. Integer 1
MC101 Subscriber Last Name The subscriber last name is used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
MC102 Subscriber First Name Subscriber first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
MC103 Subscriber Middle Initial Subscriber middle initial, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
MC104 Member Last Name Member last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
MC105 Member First Name Member first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
MC106 Member Middle Initial Member middle initial, used to create unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
MC899 Record Type This field indicates the type of record. MC = Institutional & Professional Claims This is an administrative field required by NCDMS and populated with a constant value. Text 2
TR001 Record Type Not Provided Text 2
TR002 Payer Payer Code Text 8
TR004 Type of File Not Provided Text 2
TR005 Period Beginning Date Not Provided Integer YYYYMM 6
TR006 Period Ending Date Not Provided Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

File Specification for Medical Eligibility File Submission - May 2009

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided Text 2
HD002 Payer Payer Code Text 8
HD004 Type of File Not Provided Text 2
HD005 Period Beginning Date Not Provided Integer CCYYMM 6
HD006 Period Ending Date Not Provided Integer CCYYMM 6
HD007 Record Count Total number of records submitted in the file Integer 10
HD008 Comments Payer comments Text 80
ME001 Payer This field contains the NCDMS assigned submitter code for the data submitter. The first two characters of the submitter code indicate Minnesota and the third character designates the type of submitter. A single data submitter may have multiple submitter codes because the data submitter is submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first 6 characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. Text 8
ME003 Insurance Type / Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. Code all but MC and XX as 2 characters; MC and XX must include a valid subcode. Text 6
ME004 Year The year during which the member is eligible for services. This field is generally used in conjunction with the month (ME005) to determine a specific period of eligibility. Integer 4
ME005 Month Month indicates the month during which the member is eligible for services. This field is generally used with the year field (ME004) to determine a specific period of eligibility. Integer 2
ME009 Plan Specific Contract Number This field contains the data submitter assigned contract number for the subscriber. This field is encrypted using the same algorithm across all data submitters and is not available in the analytical data warehouse. When this field is populated, it forms the core of the unique member identification code. Set as null if unavailable. Text 128
ME012 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. Integer 2
ME013 Member Gender Member's gender Text 1
ME014 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. During the encryption process, this field is used to calculate age as of the first day of the membership month. The field is then encrypted. This data element will not be transmitted in unencrypted form. Date CCYYMMDD 8
ME015 Member City Name This field contains the member's city of residence. Text 30
ME016 Member State or Province The member state or province contains the 2 character abbreviation code used by the US Postal Service. Text 2
ME017 Member ZIP Code This field contains ZIP code of the member. Text 5
ME018 Medical Coverage The medical coverage flag indicates whether this member is covered for medical expenses. This is an administrative field required by NCDMS and derived from the enrollment data maintained by the data submitter. Text 1
ME019 Prescription Drug Coverage The prescription drug coverage flag indicates whether this member is covered for prescription drug expenses. This is an administrative field required by NCDMS and derived from the enrollment data maintained by the data submitter. Text 1
ME032 Health Care Home Assigned Flag This flags whether the member reported has an approved medical home for this coverage period Text 1
ME033 Health Care Home Number Data submitter assigned medical home number. It is anticipated that this will be the same data submitter number used in reporting servicing provider. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes. Text 30
ME034 Health Care Home Tax ID Number Federal tax payer's identification number for medical home. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes Text 10
ME035 Health Care Home National Provider ID Report the National Provider Identification (NPI) number for the entity or individual serving as the medical home. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes. Text 20
ME036 Health Care Home Name Report the full name of the provider - facility, organization or individual. If the medical home is an individual, report in the format of Last name, first name and middle initial with no punctuation. Text 60
ME101 Subscriber Last Name Subscriber last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME102 Subscriber First Name Subscriber first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME103 Subscriber Middle Initial Subscriber middle initial, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
ME104 Member Last Name Member last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME105 Member First Name Member first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME106 Member Middle Initial Member middle initial, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
ME899 Record Type This field indicates the type of record. ME Eligibility This is an administrative field required by NCDMS and populated with a constant value. Text 2
TR001 Record Type Not Provided Text 2
TR002 Payer Payer Code Text 8
TR004 Type of File Not Provided Text 2
TR005 Period Beginning Date Not Provided Integer YYYYMM 6
TR006 Period Ending Date Not Provided Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

File Specification for Pharmacy Claims File Submission - May 2009

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided Text 2
HD002 Payer Payer Code Text 8
HD004 Type of File Not Provided Text 2
HD005 Period Beginning Date Not Provided Integer CCYYMM 6
HD006 Period Ending Date Not Provided Integer CCYYMM 6
HD007 Record Count Total number of records submitted in the file Integer 10
HD008 Comments Payer comments Text 80
PC001 Payer This field contains the NCDMS assigned submitter code for the data submitter. The first two characters of the submitter code indicate Minnesota and the third character designates the type of submitter. MNC Commercial carrier MNG Governmental agency MNT Third Party Administrator MNU Unlicensed entity A single data submitter may have multiple submitter codes because the data submitter is submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first 6 characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. Text 8
PC003 Insurance Type/ Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. Text 6
PC004 Payer Claim Control Number This field contains the claim number used by the data submitter to internally track the claim. In general the claim number is associated with all service lines of the bill. It must apply to the entire claim and be unique within the data submitter's system. Text 35
PC005 Line Counter This field contains the line number for this service. The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. This field is used in algorithms to determine the final payment for the service. If the data submitter's processing system assigns an internal line counter for the adjudication process, that number may be submitted in place of the line number submitted by the provider. This should be discussed with NCDMS staff. Integer 4
PC008 Plan Specific Contract Number This field contains the data submitter assigned contract number for the subscriber. This field is encrypted using the same algorithm across all data submitters and is not available in the analytical data warehouse. When this field is populated, it forms the core of the unique member identification code. Set as null if unavailable. Text 128
PC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. Integer 2
PC012 Member Gender This field contains the gender of the member. Integer 1
PC013 Member Date of Birth This field contains the member's date of birth with a format of CCYYMMDD. During the encryption process, this field is used to calculate age as of the date the prescription was filled. The field is then encrypted. This data element will not be transmitted in unencrypted form.. Date CCYYMMDD 8
PC014 Member City Name of Residence This field contains the member's city of residence. Text 30
PC015 Member State or Province The member state or province contains the 2 character abbreviation code used by the US Postal Service. Text 2
PC016 Member ZIP Code This field contains ZIP Code of the member. Text 5
PC017 Date Service Approved (AP Date) This field contains the date the record was approved for payment. This is generally referred to as the paid date and reported with a CCYYMMDD format. May submit batch date. Date CCYYMMDD 8
PC018 Pharmacy Number Payer assigned pharmacy number. Required if PC021 is not filled. Text 30
PC020 Pharmacy Name This field contains the name of the pharmacy. Text 30
PC021 National Pharmacy ID Number The field contains the National Provider Identification (NPI) number and pertains to the entity or individual directly providing the service. Required if PC018 is not filled. Text 20
PC025 Claim Status This field contains the status of the claim as reported by the data submitter. It will be used in the algorithms to determine the final payment for this service. Text 2
PC026 Drug Code Each drug product listed under Section 510 of the Federal Food, Drug, and Cosmetic Act is assigned a unique 10-digit, 3-segment number. This number, known as the National Drug Code (NDC), identifies the labeler/vendor, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. A labeler is any firm that manufactures, re-packs or distributes a drug product. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code, identifies package sizes. Both the product and package codes are assigned by the firm. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1. Text 11
PC027 Drug Name This field contains the text name of drug as supplied by the data submitter. Voluntary - not required Text 80
PC028 New Prescription or Refill This field can be used to determine if this is a new prescription. It contains the prescription number. Integer 2
PC029 Generic Drug Indicator This field indicates whether the drug is a branded drug or a generic drug. Text 1
PC030 Dispense as Written Code This field indicates the instructions given to the pharmacist for filling the prescription. For example, a prescription for a brand name drug that also has a generic equivalent may not have the generic equivalent substituted. In this case, the code is 1 - physician requires the script be filled as written. Integer 1
PC031 Compound Drug Indicator This field indicates if this is a compound drug or not. 0 Not specified 1 No Compound 2 Compound Text 1
PC032 Date Prescription Filled This field contains the date the prescription was filled. Data is reported in a CCYYMMDD format. Text CCYYMMDD 8
PC033 Quantity Dispensed This field contains the total unit dosage in metric units. This field may be negative. Integer 5
PC034 Days Supply This field contains the actual days supply for the prescription based on the metric quantity dispensed. This field may contain a negative value. Integer 3
PC035 Gross Amount Due This field contains the total charges for the service as reported by the provider. This is a money field containing dollars and cents with an implied decimal point and may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC036 Total Amount Paid This field includes all health plan payments and excludes all member payments. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC036A Other Amount Paid This field contains the amount paid for additional costs claimed in "Other Amount Claimed Submitted (480-H9)." This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC036B Other Payer Amount Recognized This field contains the total dollar amount of any payment from another source, including coupons. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC037 Ingredient Cost/List Price This field contains the cost of the drug that was dispensed as reported by the data submitter. This is a money field containing dollars and cents with an implied decimal point. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC039 Dispensing Fee Paid This field contains the amount charged for dispensing. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC040 Copay / Co- insurance Amount This field contains the pre-set, fixed dollar amount payable by a member, often on a per script basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC042 Deductible Amount Do not code decimal point. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC043 Patient Pay Amount Amount that is calculated by the payer and returned to the pharmacy as the total amount to be paid by the patient to the pharmacy. 0$ is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Decimal 10
PC044 Prescribing Physician First Name This is the first name of the prescribing physician. This will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing providers and medical homes. Since there is currently no HIPAA equivalent field for prescribing physician first name, this is a voluntary field. Text 25
PC045 Prescribing Physician Middle Name This is the middle name or initial of the prescribing physician. This will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Since there is currently no HIPAA equivalent field for prescribing physician middle initial, this is a voluntary field. Text 25
PC046 Prescribing Physician Last Name This is the last name of the prescribing physician. This will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Text 60
PC047 Prescribing Physician DEA / Legacy Number This field contains either the DEA number, the data submitter's legacy, pre-NPI number, or the Minnesota Health Care Program ID for the prescribing physician. This will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Required if PC048 is not filled. D DEA ID number L Legacy ID number M MHCP O Other Text 9
PC048 Prescribing Physician National Provider Identification Number This field contains the National Provider Identification (NPI) number for the prescribing physician. This will be used to create a master provider index for Minnesota providers encompassing both medical service providers and prescribing providers. Required if PC047 is not filled. Text 20
PC101 Subscriber Last Name Subscriber last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
PC102 Subscriber First Name Subscriber first name, used to create unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
PC103 Subscriber Middle Initial Subscriber middle initial, used to create unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
PC104 Member Last Name Member last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
PC105 Member First Name Member first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
PC106 Member Middle Initial Member middle initial, used to create unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
PC899 Record Type This field indicates the type of record. PC Pharmacy Claims This is an administrative field required by NCDMS and populated with a constant value. Text 2
TR001 Record Type Value TR Text 2
TR002 Payer Payer Code Text 8
TR004 Type of File PC = Pharmacy Drug Claims Text 2
TR005 Period Beginning Date Not Provided Integer YYYYMM 6
TR006 Period Ending Date Not Provided Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

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