United States Health Information Knowledgebase

 

New Hampshire



Name:New Hampshire
Abbreviation:NH
Title of SystemNew Hampshire Comprehensive Health Care Information System
Websitehttps://nhchis.com/ Exit Disclaimer [nhchis.com]
Who Maintains the SystemNHCHIS reflects a partnership between NH Insurance Department and NH Department of Health and Human Services
Versions:September 10, 2012

File Specification for Dental Claims File Submission - September 10, 2012

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments NHID Submitter Code Text 8
HD003 National Plan ID CMS National Plan ID Text 30
HD004 Type of File Not provided Text 2
HD005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
HD006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
HD007 Record Count Total number of records submitted in this file Integer 10
HD008 Comments Submitted may use to document this submission by assigning a filename, system source, etc. Text 80
DC001 Payer Payer submitting payments Text 8
DC002 National Plan ID CMS National Plan ID Text 30
DC003 Insurance Type/Product Code Not provided Text 2
DC004 Payer Claim Control Number Must apply to entire claim and be unique within payer's system Text 35
DC005 Line Counter Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim Integer 4
DC006 Insured Group or Policy Number Group or policy number - not the number that uniquely identifies the subscriber Text 50
DC007 Subscriber Social Security Number subscriber's social security number (this data element will be de-identified by the NHpreprocessor application) Set as null if unavailable Text 32
DC008 Plan Specific Contract Number plan assigned contract number (this data element will be de-identified by the NHpreprocessor application) Set as null if contract number = subscriber's social security number Text 64
DC009 Member Suffix or Sequence Number Uniquely numbers the member within the contract Integer 20
DC010 Member Identification Code member's social security number (this data element will be de-identified by the NHpreprocessor application) Set as null if unavailable Text 30
DC011 Individual Relationship Code Member's relationship to insured Integer 2
DC012 Member Gender Not provided Text 1
DC013 Member Date of Birth Not provided Date CCYYMMDD 8
DC014 Member City Name of Residence City name of member Text 50
DC015 Member State or Province As defined by the U.S. Postal Service Text 2
DC016 Member ZIP Code ZIP Code of member - may include non-US codes Do not include dash Text 11
DC017 Date Service Approved (AP Date) Not provided Date CCYYMMDD 8
DC018 Service Provider Number Payer assigned provider number Text 30
DC019 Service Provider Tax ID Number Federal Taxpayer's identification number Text 10
DC020 National Service Provider ID Required if National Provider ID is mandated for use under HIPAA Text 20
DC021 Service Provider Entity Type Qualifier Not provided Text 1
DC022 Service Provider First Name Individual first name Set as null if provider is a facility or organization Text 25
DC023 Service Provider Middle Name Individual middle name or initial Set as null if provider is a facility or organization Text 25
DC024 Service Provider Last Name or Organization Name Full name of provider organization or last name of individual provider Text 60
DC025 Service Provider Suffix Suffix to individual name Set as null if provider is a facility or organization Text 10
DC026 Service Provider Specialty As defined by payer Dictionary for specialty code values must be supplied during testing Text 10
DC027 Service Provider City Name City name of provider - preferably precise location Text 30
DC028 Service Provider State or Province As defined by the U.S. Postal Service Text 2
DC029 Service Provider ZIP Code ZIP Code of provider - may include non-US codes Do not include dash Text 11
DC030 Facility Type - Professional Not provided Text 2
DC031 Claim Status Not provided Integer 2
DC032 CDT Code Common Dental Terminology code Text 5
DC033 Procedure Modifier - 1 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code Text 2
DC034 Procedure Modifier - 2 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code Text 2
DC035 Date of Service - From First date of service for this service line Date CCYYMMDD 8
DC036 Date of Service - Thru Last date of service for this service line Date CCYYMMDD 8
DC037 Charge Amount Do not code decimal point Decimal 10
DC038 Paid Amount Do not code decimal point Decimal 10
DC039 Copay Amount The present, fixed dollar amount for which the individual is responsible Do not code decimal point Decimal 10
DC040 Coinsurance Amount The dollar amount an individual is responsible for - not the percentage Do not code decimal point Decimal 10
DC041 Deductible Amount Do not code decimal point Decimal 10
DC042 Billing Provider Number Carriers and dental claims processors shall code using the payer assigned billing provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change Text 30
DC043 National Billing Provider Number ID This is the NPI for the billing provider Text 30
DC044 Billing Provider Last Name Full name of provider billing organization or last name of individual billing provider Text 128
DC101 Subscriber Last Name (this data element will be de-identified by the NHpreprocessor application) Text 128
DC102 Subscriber First Name (this data element will be de-identified by the NHpreprocessor application) (this data element will be de-identified by the NHpreprocessor application) Text 128
DC103 Subscriber Middle Initial (this data element will be de-identified by the NHpreprocessor application) (this data element will be de-identified by the NHpreprocessor application) Text 1
DC104 Member Last Name (this data element will be de-identified by the NHpreprocessor application) (this data element will be de-identified by the NHpreprocessor application) Text 128
DC105 Member First Name (this data element will be de-identified by the NHpreprocessor application) (this data element will be de-identified by the NHpreprocessor application) Text 128
DC106 Member Middle Initial (this data element will be de-identified by the NHpreprocessor application) (this data element will be de-identified by the NHpreprocessor application) Text 1
DC899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer submitting payments NHID Submitter Code Text 8
TR003 National Plan ID CMS National Plan ID Text 30
TR004 Type of File Not provided Text 2
TR005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
TR006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
TR007 Date Processed Not provided Date CCYYMMDD 8

File Specification for Medical Claims File Submission - September 10, 2012

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments NHID Submitter Code Text 8
HD003 National Plan ID CMS National Plan ID Text 30
HD004 Type of File Not provided Text 2
HD005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
HD006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
HD007 Record Count Total number of records submitted in this file Integer 10
HD008 Comments Submitted may use to document this submission by assigning a filename, system source, etc. Text 80
MC001 Payer Payer submitting payments NHID Submitter Code Text 8
MC002 National Plan ID CMS National Plan ID Text 30
MC003 Insurance Type/Product Code Not provided Text 2
MC004 Payer Claim Control Number Must apply to the entire claim and be unique within the payer's system Text 35
MC005 Line Counter Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim Integer 4
MC005A Version Number Version number of this claim service line The version number begins with 0 and is incremented by 1 for each subsequent version of that service line Integer 4
MC006 Insured Group or Policy Number Group or policy number (not the number that uniquely identifies the subscriber) Text 50
MC007 Subscriber Social Security Number Subscriber's social security number (this data element will be de-identified by the NHpreprocessor application) Set as null if unavailable Text 128
MC008 Plan Specific Contract Number Plan assigned Set as null if contract number = subscriber's social security number (this data element will be de-identified by the NHpreprocessor application) Text 128
MC009 Member Suffix or Sequence Number Uniquely numbers the member within the contract Integer 20
MC010 Member Identification Code Member's social security number Set as null if unavailable (this data element will be de-identified by the NHpreprocessor application) Text 128
MC011 Individual Relationship Code Member's relationship to insured Integer 2
MC012 Member Gender Not provided Text 1
MC013 Member Date of Birth Not provided Date CCYYMMDD 8
MC014 Member City Name City name of member Text 30
MC015 Member State or Province As defined by the US Postal Service Text 2
MC016 Member ZIP Code ZIP Code of member - may include non-US codes Text 11
MC017 Date Service Approved (AP Date) (Generally the same as the paid date) Date CCYYMMDD 8
MC018 Admission Date Required for all inpatient claims Date CCYYMMDD 8
MC019 Admission Hour Required for all inpatient claims Time is expressed in military time - HHMM Integer HHMM 4
MC020 Admission Type Not provided Integer 1
MC021 Admission Source Not provided Text 1
MC022 Discharge Hour Hour in military time Integer 2
MC023 Discharge Status Not provided Integer 2
MC024 Service Provider Number Payer assigned servicing provider number by the payer for internal identification purposes Text 30
MC025 Service Provider Tax ID Number Federal taxpayer's identification number Text 10
MC026 National Service Provider ID Required if National Provider ID is mandated for use under HIPAA Text 20
MC027 Service Provider Entity Type Qualifier HIPAA provider taxonomy classifies provider groups (clinicians who bill as a group practice or under a corporate name, even if that group is composed of one provider) as "Person". Text 1
MC028 Service Provider First Name Individual first name Set to null if provider is a facility or organization Text 25
MC029 Service Provider Middle Name Individual middle name or initial Set to null if provider is a facility or organization Text 25
MC030 Service Provider Last Name or Organization Name Full name of provider organization or last name of individual provider Text 100
MC031 Service Provider Suffix Suffix to individual name Set to null if provider is a facility or organization. Should be used to capture the generation of the individual clinician (e.g., Jr. Sr., III), if applicable, rather than the clinician's degree [ e.g., 'MD', 'LICSW']. Text 10
MC032 Service Provider Specialty As defined by payer Dictionary for specialty code values must be supplied during testing Text 10
MC033 Service Provider City Name City name of provider - preferably practice location Text 30
MC034 Service Provider State As defined by the US Postal Service Text 2
MC035 Service Provider ZIP Code ZIP Code of provider - may include non-US codes Do not include dash Text 11
MC036 Type of Bill - Institutional Type of Facility - First Digit (Should be coded on facility claims, such as those submitted using on UB04 forms) Integer 2
MC037 Facility Type - Professional (Should be coded on professional claims, such as those submitted using on NSF [CMS 1500 forms]) Text 2
MC038 Claim Status (Actually describes the payment status of the specific service line record) Integer 2
MC039 Admitting Diagnosis Required on all inpatient admission claims and encounters ICD-9-CM Do not code decimal point Text 5
MC040 E-Code Describes an injury, poisoning or adverse effect ICD-9-CM Do not include decimal Text 5
MC041 Principal Diagnosis ICD-9-CM Do not code decimal point This should be the principal diagnosis given on the claim header. Text 5
MC042 Other Diagnosis - 1 ICD-9-CM Do not code decimal point Text 5
MC043 Other Diagnosis - 2 ICD-9-CM Do not code decimal point Text 5
MC044 Other Diagnosis - 3 ICD-9-CM Do not code decimal point Text 5
MC045 Other Diagnosis - 4 ICD-9-CM Do not code decimal point Text 5
MC046 Other Diagnosis - 5 ICD-9-CM Do not code decimal point Text 5
MC047 Other Diagnosis - 6 ICD-9-CM Do not code decimal point Text 5
MC048 Other Diagnosis - 7 ICD-9-CM Do not code decimal point Text 5
MC049 Other Diagnosis - 8 ICD-9-CM Do not code decimal point Text 5
MC050 Other Diagnosis - 9 ICD-9-CM Do not code decimal point Text 5
MC051 Other Diagnosis - 10 ICD-9-CM Do not code decimal point Text 5
MC052 Other Diagnosis - 11 ICD-9-CM Do not code decimal point Text 5
MC053 Other Diagnosis - 12 ICD-9-CM Do not code decimal point Text 5
MC054 Revenue Code National Uniform Billing Committee Codes Code using leading zeroes, left-justified, and four digits. Text 4
MC055 Procedure Code Health Care Common Procedural Coding System (HCPCS) This includes the CPT codes of the American Medical Association Text 5
MC056 Procedure Modifier - 1 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code Text 2
MC057 Procedure Modifier - 2 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code Text 2
MC058 ICD-9-CM Procedure Code Primary ICD-9-CM code given on the claim header. Do not code decimal point Text 4
MC059 Date of Service - From First date of service for this service line Date CCYYMMDD 8
MC060 Date of Service - Thru Last date of service for this service line Date CCYYMMDD 8
MC061 Quantity Count of services performed Should be set equal to 1 on all Observation bed service lines, for consistency. Integer 3
MC062 Charge Amount Do not code decimal point Decimal 10
MC063 Paid Amount Includes any withhold amounts Do not code decimal point Decimal 10
MC064 Prepaid Amount For capitated services, the fee for service equivalent amount Do not code decimal point Decimal 10
MC065 Copay Amount The preset, fixed dollar amount for which the individual is responsible Do not code decimal point Decimal 10
MC066 Coinsurance Amount Do not code decimal point Decimal 10
MC067 Deductible Amount Do not code decimal point Decimal 10
MC068 Patient Account/Control Number Not provided Text 20
MC069 Discharge Date Required for all inpatient(s) Date 8
MC070 Service Provider Country Name Not provided Text 30
MC071 DRG Carriers and health care claims processors shall code using the CMS methodology when available. Precedence shall be given to DRGs transmitted from the hospital provider. When the CMS methodology for DRGs is not available, but the All payer DRG system is available, than that system shall be used. If the All Payer DRG system is used, the carrier shall format the DRG and the complexity level within the same field with an "A" prefix, and with a hyphen separating the DRG and the complexity level (e.g. AXXX-XX) Text 3
MC072 DRG Version This element is the version number of the grouper used. Text 2
MC073 APC Carriers and health care claims processors shall code using CMS methodology. Precedence shall be given to APCs transmitted from the health care provider Text 4
MC074 APC Version This element is the version number of the grouper used Text 2
MC075 Drug Code NDC Code Text 11
MC076 Billing Provider Number Payer assigned billing provider number. This number should be the identifier used by the payer for internal identification purposes and does not routinely change Text 30
MC077 National Billing Provider Number ID This is the NPI for the billing provider Text 30
MC078 Billing Provider Last Name Not provided Text 128
MC101 Subscriber Last Name (this data element will be de-identified by the NH preprocessor application) Text 128
MC102 Subscriber First Name (this data element will be de-identified by the NH preprocessor application) Text 128
MC103 Subscriber Middle Initial (this data element will be de-identified by the NH preprocessor application) Text 1
MC104 Member Last Name (this data element will be de-identified by the NH preprocessor application) Text 128
MC105 Member First Name (this data element will be de-identified by the NH preprocessor application) Text 128
MC106 Member Middle Initial (this data element will be de-identified by the NH preprocessor application) Text 1
MC899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer submitting payments NHID Submitter Code Text 8
TR003 National Plan ID CMS National Plan ID Text 30
TR004 Type of File Not provided Text 2
TR005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
TR006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
TR007 Date Processed Not provided Date CCYYMMDD 8

File Specification for Medical Eligibility File Submission - September 10, 2012

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments NHID Submitter Code Text 8
HD003 National Plan ID CMS National Plan ID Text 30
HD004 Type of File Not provided Text 2
HD005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
HD006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
HD007 Record Count Total number of records submitted in this file Integer 10
HD008 Comments Submitted may use to document this submission by assigning a filename, system source, etc. Text 80
ME001 Payer Payer submitting payments NHID Submitter Code Text 8
ME002 National Plan ID CMS National Plan ID Text 30
ME003 Insurance Type Code/Product Not provided Text 2
ME004 Year Year for which eligibility is reported in this submission Integer 4
ME005 Month Month for which eligibility is reported in this submission Integer 2
ME006 Insured Group or Policy Number Group or policy number (not the number that uniquely identifies the subscriber) Text 50
ME007 Coverage Level Code Benefit Coverage Level Text 3
ME008 Subscriber Social Security Number Subscriber's social security number (set as null if unavailable) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME009 Plan Specific Contract Number Plan assigned contract number (set as null if contract number = subscriber's social security number) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME010 Member Suffice or Sequence Number Uniquely numbers the member within the contract Integer 2
ME011 Member Identification Code Member's social security number (set as null if unavailable) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME012 Individual Relationship Code Member's relationship to insured Integer 2
ME013 Member Gender Not provided Text 1
ME014 Member Date of Birth Not provided Date CCYYMMDD 8
ME015 Member City Name City name of member Text 30
ME016 Member State or Province As defined by the US Postal Service Text 2
ME017 Member ZIP Code ZIP Code of member - may include non-US codes. (Do not include dash) Text 11
ME018 Medical Coverage Not provided Text 1
ME019 Prescription Drug Coverage Not provided Text 1
ME020 Dental Coverage Not provided Text 1
ME021 Race 1 Not provided Text 6
ME022 Race 2 Not provided Text 6
ME023 Placeholder Not provided Not Supplied Not Supplied Not Supplied
ME024 Hispanic Indicator Not provided Text 1
ME025 Ethnicity 1 Not provided Text 6
ME026 Ethnicity 2 Not provided Text 6
ME027 Place holder Not provided 20
ME028 Primary Insurance Indicator Not provided Text 1
ME029 Coverage Type Not provided Text 3
ME030 Market Category Not provided Text 4
ME031 Special Coverage Not provided Text 3
ME032 Group Name Name of the group which the member is covered by. If the member is part of a group of one or non-group then this field shall be set as null Text 128
ME101 Subscriber Last Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME102 Subscriber First Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME103 Subscriber Middle Initial (this data element will be de- identified by the NHpreprocessor application) Not provided Text 1
ME104 Member Last Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME105 Member First Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME106 Member Middle Initial (this data element will be de-identified by the NHpreprocessor application) Not provided Text 1
ME899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer submitting payments NHID Submitter Code Text 8
TR003 National Plan ID CMS National Plan ID Text 30
TR004 Type of File Not provided Text 2
TR005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
TR006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
TR007 Date Processed Not provided Date CCYYMMDD 8

File Specification for Pharmacy Claims File Submission - September 10, 2012

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments NHID Submitter Code Text 8
HD003 National Plan ID CMS National Plan ID Text 30
HD004 Type of File Not provided Text 2
HD005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
HD006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
HD007 Record Count Total number of records submitted in this file Integer 10
HD008 Comments Submitted may use to document this submission by assigning a filename, system source, etc. Text 80
PC001 Payer Payer submitting payments NHID Submitter Code Text 8
PC002 Plan ID CMS National Plan ID Text 30
PC003 Insurance Type/Product Code Not provided Text 2
PC004 Payer Claim Control Number Must apply to the entire claim and be unique within the payer's system Text 35
PC005 Line Counter Line number for this service The line counter begins with 1 and is incremented by 1 for each additional service line of a claim Integer 4
PC006 Insured Group Number Group or policy number - not the number that uniquely identifies the subscriber Text 30
PC007 Subscriber Social Security Number Subscriber's social security number (this data element will be de-identified by the NHpreprocessor application) Set as null if unavailable Text 30
PC008 Plan Specific Contract Number Plan assigned contract number (this data element will be de-identified by the NHpreprocessor application) Set as null if contract number = subscriber's social security number Text 30
PC009 Member Suffix or Sequence Number Uniquely numbers the member within the contract Integer 2
PC010 Member Identification Code Member's social security number Set as null if unavailable (this data element will be de-identified by the NHpreprocessor application) Text 30
PC011 Individual Relationship Code Member's relationship to insured Integer 2
PC012 Member Gender Not provided Integer 1
PC013 Member Date of Birth Not provided Date CCYYMMDD 8
PC014 Member City Name of Residence City name of member Text 30
PC015 Member State As defined by the US Postal Service Text 2
PC016 Member ZIP Code ZIP Code of member - may include non-US codes Do not include dash Text 9
PC017 Date Service Approved (AP Date) (Generally the same as the paid date or the Pharmacy Benefits Manager's billing date) Date CCYYMMDD 8
PC018 Pharmacy Number Payer assigned pharmacy number AHFS number is acceptable Text 30
PC019 Pharmacy Tax ID Number Federal taxpayer's identification number (Please provide the pharmacy chain's federal tax identification number, if the individual retail pharmacy's tax ID# is not available.) Text 10
PC020 Pharmacy Name Name of pharmacy Text 30
PC021 National Pharmacy ID Number Required if National Provider ID is mandated for use under HIPAA Text 20
PC022 Pharmacy Location City City name of pharmacy - preferably pharmacy location Text 30
PC023 Pharmacy Location State As defined by the US Postal Service Text 2
PC024 Pharmacy ZIP Code ZIP Code of pharmacy - may include non- US codes Do not include dash Text 10
PC024A Pharmacy County Name Not provided Text 30
PC025 Claim Status Not provided Integer 2
PC026 Drug Code NDC Code Text 11
PC027 Drug Name Text name of drug Text 80
PC028 New Prescription 00 New prescription. 01-99 Number of refill(s) ('01' should be used for all refills, if the specific number of the prescription refill is not available) Integer 2
PC029 Generic Drug Indicator Not provided Text 1
PC030 Dispense as Written Code Not provided Integer 1
PC031 Compound Drug Indicator Not provided Text 1
PC032 Date Prescription Filled Not provided Date CCYYMMDD 8
PC033 Quantity Dispensed Number of metric units of medication dispensed Integer 5
PC034 Days Supply Estimated number of days the prescription will last Integer 3
PC035 Charge Amount Do not code decimal point Decimal 10
PC036 Paid Amount Includes all health plan payments and excludes all member payments Do not code decimal point Decimal 10
PC037 Ingredient Cost/List Price Cost of the drug dispensed Do not code decimal point Decimal 10
PC038 Postage Amount Claimed Do not code decimal point Decimal 10
PC039 Dispensing Fee Do not code decimal point Decimal 10
PC040 Copay Amount The preset, fixed dollar amount for which the individual is responsible Do not code decimal point Decimal 10
PC041 Coinsurance Amount Do not code decimal point Decimal 10
PC042 Deductible Amount Do not code decimal point Decimal 10
PC043 Place holder Not provided Not Supplied Not Supplied Not Supplied
PC044 Prescribing Physician First Name Physician first name Text 25
PC045 Prescribing Physician Middle Name Physician middle name Text 25
PC046 Prescribing Physician Last Name Physician last name Text 50
PC047 Prescribing Physician Number Carriers and health claims processors shall code using the payer assigned provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. Text 30
PC101 Subscriber Last Name (this data element will be de-identified by the NH preprocessor application) Text 128
PC102 Subscriber First Name (this data element will be de-identified by the NH preprocessor application) Text 128
TR001 Record Type Not provided Text 2
TR002 Payer Payer submitting payments NHID Submitter Code Text 8
TR003 National Plan ID CMS National Plan ID Text 30
TR004 Type of File Not provided Text 2
TR005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
TR006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
TR007 Date Processed Not provided Date CCYYMMDD 8

Scroll To Top