United States Health Information Knowledgebase

 

Oregon



Name:Oregon
Abbreviation:OR
Title of SystemOregon All Payer All Claims Database
Websitehttp://www.oregon.gov/OHA/OHPR/RSCH/APAC.shtml
Who Maintains the SystemOffice for Oregon Health Policy and Research
Versions:September 27, 2011 - v2011.1.1
June 25, 2012 - v2013.0.0
June 27, 2013 - v2014.0.0
2015.0.1

File Specification for Multiple versionsClaims File Control Totals File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsCFCT1 Payer Payer abbreviation. Text 6
Multiple versionsCFCT2 File Not Provided Text 10
Multiple versionsCFCT3 Data_Rows Count of data rows in the submitted file Numeric 8
Multiple versionsCFCT4 Amt_Billed Sum of MC062 (medical) or PC035 (pharmacy). Two explicit decimal places. Leave blank if File is enrollment or provider Numeric 12
Multiple versionsCFCT5 Amt_Paid Sum of MC063 (medical) or PC036 (pharmacy). Two explicit decimal places. Leave blank if File is enrollment or provider Numeric 12

File Specification for Multiple versionsMedical Claims File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsMC001 Payer type Not Provided Text 1
Multiple versionsMC003 Product code Not Provided Text 3
Multiple versionsMC004 Claim ID Payer's unique claim identifier Text 80
Multiple versionsMC005 Service line counter Increments of 1 for each claim line Numeric 4
Multiple versionsMC010 Member ID Plan-specific unique member identifier Text 30
Multiple versionsMC017 Payment date example: 20090624) Date CCYYMMDD 8
Multiple versionsMC018 Admission date example: 20090603 Date CCYYMMDD 8
Multiple versionsMC023 Discharge status Not Provided Text 2
Multiple versionsMC024 Rendering provider ID Identifier for the rendering provider as assigned by the reporting entity Text 30
Multiple versionsMC036 Type of bill Required only for institutional claims. Numeric 3
Multiple versionsMC037 Place of service Required only for professional claims. Text 2
Multiple versionsMC038 Claim status Was claim paid, denied, CCO encounter, or MCO encounter only? Text 1
Multiple versionsMC038A COB status Was claim a COB claim? Text 1
Multiple versionsMC041 Principal diagnosis ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC041P POA flag 1 Present on admission flag for principal diagnosis. Text 1
Multiple versionsMC042 Diagnosis 2 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC042P POA flag 2 Present on admission flag for diagnosis 2. Required if MC042 is populated. Text 1
Multiple versionsMC043 Diagnosis 3 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC043P POA flag 3 Present on admission flag for diagnosis 3. Required if MC043 is populated. Text 1
Multiple versionsMC044 Diagnosis 4 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC044P POA flag 4 Present on admission flag for diagnosis 4. Required if MC044 is populated. Text 1
Multiple versionsMC045 Diagnosis 5 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC045P POA flag 5 Present on admission flag for diagnosis 5. Required if MC045 is populated. Text 1
Multiple versionsMC046 Diagnosis 6 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC046P POA flag 6 Present on admission flag for diagnosis 6. Required if MC046 is populated. Text 1
Multiple versionsMC047 Diagnosis 7 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC047P POA flag 7 Present on admission flag for diagnosis 7. Required if MC047 is populated. Text 1
Multiple versionsMC048 Diagnosis 8 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC048P POA flag 8 Present on admission flag for diagnosis 8. Required if MC048 is populated. Text 1
Multiple versionsMC049 Diagnosis 9 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC049P POA flag 9 Present on admission flag for diagnosis 9. Required if MC049 is populated. Text 1
Multiple versionsMC050 Diagnosis 10 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC050P POA flag 10 Present on admission flag for diagnosis 10. Required if MC050 is populated. Text 1
Multiple versionsMC051 Diagnosis 11 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC051P POA flag 11 Present on admission flag for diagnosis 11 Required if MC051 is populated. Text 1
Multiple versionsMC052 Diagnosis 12 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC052P POA flag 12 Present on admission flag for diagnosis 12 Required if MC052 is populated. Text 1
Multiple versionsMC053 Diagnosis 13 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC053P POA flag 13 Present on admission flag for diagnosis 13 Required if MC053 is populated. Text 1
Multiple versionsMC054 Revenue code Include all digits (example: 0320) Text 4
Multiple versionsMC055 CPT/CPT II/HCPCS procedure code CPT, CPT II or HCPCS code. Include all digits (examples: 29870 or G0289) Text 5
Multiple versionsMC056 Procedure modifier 1 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057 Procedure modifier 2 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057A Procedure modifier 3 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057B Procedure modifier 4 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC058 Principal inpatient procedure code ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058A Inpatient procedure code 2 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058B Inpatient procedure code 3 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058C Inpatient procedure code 4 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058D Inpatient procedure code 5 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058E Inpatient procedure code 6 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058F Inpatient procedure code 7 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058G Inpatient procedure code 8 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058H Inpatient procedure code 9 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058J Inpatient procedure code 10 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058K Inpatient procedure code 11 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058L Inpatient procedure code 12 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058M Inpatient procedure code 13 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC059 Date of service - From example: 20090603 Date CCYYMMDD 8
Multiple versionsMC060 Date of service - Thru example: 20090603 Date CCYYMMDD 8
Multiple versionsMC061 Quantity Count of units sent on claim line. Numeric 5
Multiple versionsMC062 Charges Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC062A Allowed amount Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC063 Payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC064 Prepaid amount Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC065 Co-payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC066 Co-insurance Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC067 Deductible Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC067A Patient pay amount Required if any of MC065, MC066, or MC067 are missing. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC070 Discharge date Required only for institutional claims. Use 99991231 if patient has not discharged. (example: 20090605). Date CCYYMMDD 8
Multiple versionsMC076 Billing provider ID Identifier for the billing provider as assigned by the reporting entity Text 30
Multiple versionsQC05 Prior version claim number Required for participants in Q-Corp initiative. Text 80
Multiple versionsQC06 Claim received date Required for participants in Q-Corp initiative. Date CCYYMMDD 8
Multiple versionsQC22 DRG DRG paid by payer. If not available send billed DRG. Required for participants in Q-Corp initiative. Example: 061 Text 3
Multiple versionsQC23 DRG type Required for participants in Q-Corp initiative. Valid values: C (CMS v.24) or M (MS-DRG) Text 1
Multiple versionsQC37 LOINC code Placeholder for the Q-Corp initiative. Text 8
Multiple versionsQC38 Lab result Placeholder for the Q-Corp initiative. Text 8
Multiple versionsQC39 Micro/macro albumin result Placeholder for the Q-Corp initiative. Text 1
Multiple versionsOHLC1 COB allowed amount Required for participants in OHLC high value medical home initiative. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsOHLC2 Risk withhold amount Required for participants in OHLC high value medical home initiative. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC008 Plan specific contract number Plan specific contract number (aka group number) Text 30
Multiple versionsMC201 ICD version code Specifies the claim's ICD version. Text 2
Multiple versionsMC202 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC203 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC204 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC205 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC206 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC207 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC208 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC209 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC210 Empty field For future implementation Not Supplied Not Supplied Not Supplied

File Specification for Multiple versionsMedical Eligibility File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsME001 Payer type Not Provided Text 8
Multiple versionsME003 Product code Not Provided Text 3
Multiple versionsME004A Eligibility date example: 20100402. Dates before the submission date range are not valid. See Schedule A for submission data range. Date CCYYMMDD 8
Multiple versionsME005A Termination date example: 20100702. Use 99991231 if termination date is open-ended. Dates over one year past submission due date are not valid (exception: the date of a dependent's 26th birthday is a valid value). Date CCYYMMDD 8
Multiple versionsME007 Subscriber ID Plan-specific unique identifier for subscriber Text 30
Multiple versionsME009 Plan specific contract number Plan-specific contract number (aka group number) Text 30
Multiple versionsME009A PEBB flag Not Provided Numeric 1
Multiple versionsME009B OEBB flag Not Provided Numeric 1
Multiple versionsME009C Medical home flag Not Provided Numeric 1
Multiple versionsME010 Member ID Plan-specific unique identifier for member Text 30
Multiple versionsME012 Relationship code Not Provided Numeric 2
Multiple versionsME013 Member gender Not Provided Text 1
Multiple versionsME014 Member date of birth example: 19570402)\ Date CCYYMMDD 8
Multiple versionsME015A Member's street address Member's primary street address. If member's address is missing then default to subscriber's address. Example: 123 Main Street Text 50
Multiple versionsME015 Member city Example: Grants Pass Text 30
Multiple versionsME016 Member state Example: OR Text 4
Multiple versionsME017 Member ZIP Example: 97209-1234 or 97209 Text 10
Multiple versionsME018 Medical coverage flag Not Provided Text 1
Multiple versionsME019 Prescription drug coverage flag Not Provided Text 1
Multiple versionsME101 Subscriber last name Not Provided Text 35
Multiple versionsME102 Subscriber first name Not Provided Text 25
Multiple versionsME103 Subscriber middle name Not Provided Text 25
Multiple versionsME104 Member last name Not Provided Text 35
Multiple versionsME105 Member first name Not Provided Text 25
Multiple versionsME106 Member middle name Not Provided Text 25
Multiple versionsQC013 ChemDep Benefit - Inpatient Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC014 ChemDep Benefit - Day/Night Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC015 ChemDep Benefit - Ambulatory Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC016 Dental benefit Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC018 Mental Health Benefit - Inpatient Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC019 Mental Health Benefit - Day/ Night Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC020 Mental Health Benefit - Ambulatory Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsRE1 Member race Not Provided Text 1
Multiple versionsRE2 Member ethnicity Not Provided Text 1
Multiple versionsRE3 Primary spoken language This field contains the ANSI/NISO three-character string identifying the member's primary spoken language. Please refer to most recent version of ANSI/NISO Z39.53 (Codes for the Representation of Languages for Information Interchange); the 2001 version is freely available here: http://www.niso.org/topics/ccm/ccmstandards/ Text 3
Multiple versionsOHLC3 Oregon HVMH flag Required for participants in OHLC high value medical home initiative. Text 1
Multiple versionsOHLC4 Oregon HVMH clinic Required for participants in OHLC high value medical home initiative. Text 3
Multiple versionsOHLC5 Oregon HVMH eligibility segment effective date Required for participants in OHLC high value medical home initiative. example: 20090603 Date CCYYMMDD 8
Multiple versionsOHLC6 Oregon HVMH eligibility segment termination date Required for participants in OHLC high value medical home initiative. example: 20090603) Date CCYYMMDD 8
Multiple versionsOHLC7 Prepaid amount/ PMPM Required for participants in OHLC high value medical home initiative. Two explicit decimal places. Example: 402.73 Numeric 12
Multiple versionsME009D OMIP flag Not Provided Numeric 1
Multiple versionsME009E HKC flag Not Provided Numeric 1
Multiple versionsME201 Medicare coverage flag Type of Medicare coverage. Text 2
Multiple versionsME202 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME203 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME204 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME205 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME206 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME207 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME208 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME209 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsME210 Not Provided For future implementation Not Supplied Not Supplied Not Supplied

File Specification for Multiple versionsMedical Providers File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsMP003 Provider ID Identifier for the provider as assigned by the reporting entity Text 30
Multiple versionsMP004 Provider Tax ID Tax ID of the provider (example: 1234567890) Text 9
Multiple versionsMP006 Provider first name First name of the provider (example: John); null if provider is an organization entity Text 25
Multiple versionsMP007 Provider middle initial Middle initial of the provider (example: M); null if provider is an organization entity Text 1
Multiple versionsMP008 Provider last name Last name of the provider or organization entity name Text 100
Multiple versionsMP010 Provider specialty Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 12.0 (updated effective April 1, 2012) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP010A Provider second specialty Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 12.0 (updated effective April 1, 2012) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP010B Provider third specialty Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 12.0 (updated effective April 1, 2012) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP011A Provider street address1 First line of physical address of practice. Example: 123 Main Street Text 50
Multiple versionsMP011B Provider street address2 Required if available. Second line of physical address of practice. Example: Bldg A, Suite 100 Text 50
Multiple versionsMP011 Provider city Physical address of practice. Example: Grants Pass Text 30
Multiple versionsMP012 Provider state Physical address of practice. Example: OR Text 2
Multiple versionsMP013 Provider ZIP Physical address of practice. Examples: 97209-1234 or 97209 Text 10
Multiple versionsMP017 Provider DEA number Required if available. Text 12
Multiple versionsMP018 Provider NPI NPI of the provider (example: 1234567890) Text 10
Multiple versionsMP018A Provider state license number Prefix with two-character state of licensure. Example: ORLL12345 Text 15
Multiple versionsQC004 Provider Medicaid number Required (if available) for participants in Q-Corp initiative. Text 12
Multiple versionsQC006 Provider CMS UPIN Required (if available) for participants in Q-Corp initiative. Text 12
Multiple versionsQC011 Provider DOB Required for participants in Q-Corp initiative. Date 8
Multiple versionsQC021 Provider is PCP Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC022 Provider is OBGYN Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC023 Provider is Mental Health Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC024 Provider is Eye Care Provider Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC025 Provider is Dentist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC026 Provider is Nephrologist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC027 Provider is Chem. Dep Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC028 Provider is Nurse Practitioner Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC029 Provider is Phys Assist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC030 Provider can prescribe Rx Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsMP201 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP202 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP203 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP204 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP205 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP206 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP207 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP208 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP209 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMP210 Not Provided For future implementation Not Supplied Not Supplied Not Supplied

File Specification for Multiple versionsMember Months Control Totals File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsMMCT1 Payer Payer abbreviation. Text 6
Multiple versionsMMCT2 Method Placeholder for future compatibility Text 1
Multiple versionsMMCT3 Month Not Provided Date CCYYMM 6
Multiple versionsMMCT4 Medical_Members Count of members with medical coverage as of first of month. Numeric 8
Multiple versionsMMCT5 Pharmacy_Members Count of members with pharmacy coverage as of first of month Numeric 8

File Specification for Multiple versionsPharmacy Claims File Submission - 2015.0.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPC001 Payer type Not Provided Text 1
Multiple versionsPC008 Plan-specific contract number Plan-specific contract number (aka group number) Text 30
Multiple versionsPC010 Patient ID Unique identifier for member Text 20
Multiple versionsPC003 Insurance type/ product code Not Provided Text 6
Multiple versionsPC021 Pharmacy NPI The pharmacy's National Provider Identifier (NPI) Text 15
Multiple versionsPC021A Pharmacy alternate identifier The pharmacy's alternate identifier as assigned by the payer; required if NPI is not available Text 15
Multiple versionsPC020 Pharmacy Name Not Provided Text 35
Multiple versionsPC022 Pharmacy city Not Provided Text 30
Multiple versionsPC023 Pharmacy state Not Provided Text 2
Multiple versionsPC024 Pharmacy ZIP Not Provided Text 15
Multiple versionsPC048 Prescribing provider NPI Identifier for the provider who prescribed the medication as assigned by the reporting entity Text 15
Multiple versionsPC047 Prescribing provider DEA number Required if available. DEA number of the provider who prescribed the medication. Text 12
Multiple versionsPC025 Claim status Was claim paid, denied, CCO, or encounter only? Text 3
Multiple versionsPC026 NDC National Drug Code (NDC) Text 11
Multiple versionsPC032 Date filled Date the prescription was filled. example: 20090624 Text CCYYMMDD 8
Multiple versionsPC017 Payment date example: 20090624 Date CCYYMMDD 8
Multiple versionsPC033 Quantity dispensed Not Provided Numeric 10
Multiple versionsPC028A Alternate refill number Required if PC028 (calculated refill number) is not available Numeric 2
Multiple versionsPC034 Days supply Days supply of the prescription Numeric 3
Multiple versionsPC030 Dispense as written code Not Provided Text 1
Multiple versionsPC028 Calculated refill number Processor's calculated refill number. If the processor is not able to calculate, the alternate refill number (PC028A) is to be used. Numeric 2
Multiple versionsPC031 Compound drug indicator Indicates if this is a compound drug. Numeric 1
Multiple versionsPC004 Claim ID Payer's unique claim control number Text 30
Multiple versionsPC036 Payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC035 Charges Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC037 Ingredient cost/list price Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC039 Dispensing fee paid Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC040 Co-pay Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC041 Coinsurance Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC042 Deductible Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC043 Patient pay amount Required if any of PC040, PC041, or PC042 are missing. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC201 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC202 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC203 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC204 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC205 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC206 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC207 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC208 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC209 Not Provided For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsPC210 Not Provided For future implementation Not Supplied Not Supplied Not Supplied

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