United States Health Information Knowledgebase

 

Vermont



Name:Vermont
Abbreviation:VT
Title of SystemVermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES)
Websitehttp://gmcboard.vermont.gov/vhcures
Who Maintains the SystemVermont Department of Financial Regulation
Versions:October 2008

File Specification for Medical Claims File Submission - October 2008

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments; Text 8
HD003 National Plan Id CMS National Plan ID; This is not yet available. Code as null 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 the file Integer 10
HD008 Comments Payer comments Text 80
MC001 Payer Payer submitting payments; Text 8
MC002 National Plan ID CMS National Plan ID; This is not yet available. Code as null Text 30
MC003 Insurance Type/Product Code Type of Insurance Product Text 2
MC004 Payer Claim Control Number Unique claim identifier Text 35
MC005 Line Counter Claim line number for service rendered Integer 4
MC005A Version Number Version number of this claim service line Integer 4
MC006 Insured Group or Policy Number Group number or Policy Number Text 30
MC007 Encrypted Subscriber Unique Identification Number Subscriber's social security number; used to create unique member ID Text 128
MC008 Plan Specific Contract Number Do not include values in this field that will distinguish one member of the family from another. If submitted, this should be the contract or certificate number for the subscriber and all of his/her dependents Text 128
MC009 Member Suffix or Sequence Number The unique number of the member within the contract. Integer 20
MC010 Member Identification Code Member's social security number; used to create unique member ID Text 128
MC011 Individual Relationship Code Member's relationship to insured Integer 2
MC012 Member Gender Member's gender Text 1
MC013 Member Date of Birth Not provided Date CCYYMMDD 8
MC014 Member City Name The city location of the 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) Not provided Date CCYYMMDD 8
MC018 Admission Date Not provided Date CCYYMMDD 8
MC019 Admission Hour HHMM: If only the hour is known, code the minutes as 00. 4 PM would be reported as 1600 Integer HHMM 4
MC020 Admission Type Type of Admission Integer 1
MC021 Admission Source Source of Admission Text 1
MC022 Discharge Hour HHMM: If only the hour is known, code the minutes as 00. 4 PM would be reported as 1600 Integer HHMM 4
MC023 Discharge Status Status of Discharge Integer 2
MC024 Service Provider Number Payer assigned number for provider of service Text 30
MC025 Service Provider Tax ID Number Federal tax id for provider of service Text 10
MC026 National Service Provider ID If available NPI for provider of service Text 20
MC027 Service Provider Entity Type Qualifier Person or non-person qualifier of provider of service Text 1
MC028 Service Provider First Name First name of provider of service Text 25
MC029 Service Provider Middle Name Middle name of provider of service Text 25
MC030 Service Provider Last Name or Organization Name Last name of provider of service Text 60
MC031 Service Provider Suffix Any sufficx of provider of service Text 10
MC032 Service Provider Specialty Specialty code of provider of service as defined by payer Text 50
MC033 Service Provider City Name The city location of the provider of service Text 30
MC034 Service Provider State or Province As defined by the US Postal Service state or province of provider of service Text 2
MC035 Service Provider ZIP Code ZIP Code of member - may include non-US codes. Text 11
MC036 Type of Bill - on Facility Claims Institutional claim type of bill Integer 2
MC037 Site of Service - on NSF/CMS 1500 Claims Site of service on professional claim Text 2
MC038 Claim Status Status of claim Integer 2
MC039 Admitting Diagnosis ICD-9-CM Do not code decimal point Text 5
MC040 E-Code Describes an injury, poisoning or adverse effect Text 5
MC041 Principal Diagnosis ICD-9-CM Do not code decimal point 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 Text 4
MC055 Procedure 1 Code This includes the CPT codes of the American Medical Association Text 5
MC056 Procedure 1 Modifier - 1 Procedure modifier required when a modifier clarifies/improves the Text 2
MC057 Procedure 1 Modifier - 2 Procedure modifier required when a modifier clarifies/improves the Text 2
MC058 ICD9-CM Procedure 1 Code Procedure code for this line of service. Do not code decimal point Text 4
MC059 Date of Service - From Not provided Date CCYYMMDD 8
MC060 Date of Service - Thru Not provided Date CCYYMMDD 8
MC061 Quantity Count of services performed Integer 3
MC062 Charge Amount Do not code decimal point Decimal 10
MC063 Paid Amount Includes any withhold amounts Decimal 10
MC064 Prepaid Amount For capitated services, the fee for service equivalent amount Decimal 10
MC065 Copay Amount The preset, fixed dollar amount for which the individual is responsible Decimal 10
MC066 Coinsurance Amount The dollar amount an individual is responsible for not the percentage Decimal 10
MC067 Deductible Amount Do not code decimal point Decimal 10
MC068 Patient Account/Control Number Number assigned by hospital Text 20
MC069 Discharge Date Date patient discharged. Required for all inpatient claims. Date CCYYMMDD 8
MC070 Service Provider Country Name Code US for United States Text 30
MC071 DRG Carriers and health care claims processors shall code using the CMS methodology. Precedence shall be given to DRGs transmitted from the hospital provider. Text 7
MC072 DRG Version Version of DRG (inpatient) grouper used Text 2
MC073 APC Carriers and health care claims processors shall code using the CMS methodology. Precedence shall be given to APCs transmitted from the health care provider. Text 4
MC074 APC Version Version of APC (outpatient) grouper used Text 2
MC075 Drug Code NDC Code Text 11
MC076 Billing Provider Number Payer assigned provider number Text 30
MC077 National Billing Provider ID National Provider ID mandated for use under HIPAA Text 20
MC078 Billing Provider Last Name Full name of billing organization or last name of individual billing or Organization Name Text 60
MC101 Encrypted Subscriber Last Name Encrypted subscriber last name, used to create unique member ID Text 128
MC102 Encrypted Subscriber First Name Encrypted subscriber first name, used to create unique member ID Text 128
MC103 Encrypted Subscriber Middle Initial Encrypted subscriber middle initial, used to create unique member ID Text 1
MC104 Encrypted Member Last Name Encrypted member last name, used to create unique member ID Text 128
MC105 Encrypted Member First Name Encrypted member first name, used to create unique member ID Text 128
MC106 Encrypted Member Middle Initial Encrypted member middle initial, used to create unique member ID Text 1
MC899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer Code Text 8
TR003 National Plan ID CMS National Plan ID; This is not yet available. Code as null 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 YYYYMM 6
TR006 Period Ending Date End of paid period for Claims End of month covered for Eligibility Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

File Specification for Medical Eligibility File Submission - October 2008

Data Element ID Data Element Description Type Format Length
HD001 Record Type HD Text 2
HD002 Payer Payer submitting payments; Text 8
HD003 National Plan Id CMS National Plan ID; This is not yet available. Code as null Text 30
HD004 Type of File ME 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 the file Integer 10
HD008 Comments Payer comments Text 80
ME001 Payer Payer submitting payments; Text 8
ME002 National Plan ID CMS National Plan ID; This is not yet available. Code as null Text 30
ME003 Insurance Type Code/Product Type of Insurance Product Text 2
ME004 Year Paid year of submission Integer 4
ME005 Month Paid month of submission Integer 2
ME006 Insured Group or Policy Number Group number or Policy Number Text 30
ME007 Coverage Level Code Level of coverage for the benefit Text 3
ME008 Encrypted Subscriber Unique Identification Number Subscriber's social security number; used to create unique member ID Text 128
ME009 Plan Specific Contract Number Do not include values in this field that will distinguish one member of the family from another. If submitted, this should be the contract or certificate number for the subscriber and all of his/her dependents Text 128
ME010 Member Suffix or Sequence Number The unique number of the member within the contract. Integer 20
ME011 Member Identification Code Member's social security number; used to create unique member ID Text 128
ME012 Individual Relationship Code Member's relationship to insured Integer 2
ME013 Member Gender Member's gender Text 1
ME014 Member Date of Birth Not provided Date CCYYMMDD 8
ME015 Member City Name The city location of the 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. Text 11
ME018 Medical Coverage Not provided Text 1
ME019 Prescription Drug Coverage Not provided Text 1
ME020 Dental Coverage Placeholder N/A at this time Text 1
ME021 Race 1 Placeholder N/A at this time Text 6
ME022 Race 2 Placeholder N/A at this time Text 6
ME023 Other Race Placeholder N/A at this time Text 15
ME024 Hispanic Indicator Placeholder N/A at this time Text 1
ME025 Ethnicity 1 Placeholder N/A at this time Text 6
ME026 Ethnicity 2 Placeholder N/A at this time Text 6
ME027 Other Ethnicity Placeholder N/A at this time Text 20
ME028 Primary Insurance Indicator Is insurance policy primary Text 1
ME029 Coverage Type Type of Cov Text 3
ME030 Market Category Code Category of Insurance Policy Text 4
ME031 Special Coverage Special Insurance Coverage (e.g. Catamount) Text 3
ME101 Encrypted Subscriber Last Name Encrypted subscriber last name, used to create unique member ID Text 128
ME102 Encrypted Subscriber First Name Encrypted subscriber first name, used to create unique member ID Text 128
ME103 Encrypted Subscriber Middle Initial Encrypted subscriber middle initial, used to create unique member ID Text 1
ME104 Encrypted Member Last Name Encrypted member last name, used to create unique member ID Text 128
ME105 Encrypted Member First Name Encrypted member first name, used to create unique member ID Text 128
ME106 Encrypted Member Middle Initial Encrypted member middle initial, used to create unique member ID Text 1
ME899 Record Type Value ME Text 2
TR001 Record Type Value TR Text 2
TR002 Payer Payer Code Text 8
TR003 National Plan ID CMS National Plan ID; This is not yet available. Code as null Text 30
TR004 Type of File ME Text 2
TR005 Period Beginning Date Beginning of paid period for Claims Beginning of month covered for Eligibility Integer YYYYMM 6
TR006 Period Ending Date End of paid period for Claims End of month covered for Eligibility Integer YYYYMM 6
TR007 Date Processed Not provided Date 8

File Specification for Pharmacy Claims File Submission - October 2008

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments; Text 8
HD003 National Plan Id CMS National Plan ID; This is not yet available. Code as null 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 the file Integer 10
HD008 Comments Payer comments Text 80
PC001 Payer Payer submitting payments; Text 8
PC002 National CMS National Plan ID; This is not yet available. Code as null Text 30
PC003 Insurance Type/Produ ct Code Type of Insurance Product Text 2
PC004 Payer Claim Control Number Unique claim identifier Text 35
PC005 Line Counter Claim line number for service rendered Integer 4
PC006 Insured Group Number Group number or Policy Number Text 30
PC007 Encrypted Subscriber Unique Identificatio n Number Subscriber's social security number; used to create unique member ID Text 128
PC008 Plan Specific Contract Number Do not include values in this field that will distinguish one member of the family from another. If submitted, this should be the contract or certificate number for the subscriber and all of his/her dependents Text 128
PC009 Member Suffix or Sequence Number The unique number of the member within the contract. Integer 20
PC010 Member Identification Code Member's social security number; used to create unique member ID Text 128
PC011 Individual Relationship Code Member's relationship to insured Integer 2
PC012 Member Gender Member's gender Integer 1
PC013 Member Date of Birth Not provided Date CCYYMMDD 8
PC014 Member City Name of Residence The city location of the member. Text 30
PC015 Member State or Province As defined by the US Postal Service Text 2
PC016 Member ZIP Code ZIP Code of member - may include non-US codes. Text 9
PC017 Date Service Approved (AP Date) Not provided Date CCYYMMDD 8
PC018 Pharmacy Number Payer assigned pharmacy number Text 30
PC019 Pharmacy Tax ID Number Federal taxpayer's identification number 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 Pharmacy City Text 30
PC023 Pharmacy Location State Location of pharmacy state Text 2
PC024 Pharmacy ZIP Code ZIP Code of pharmacy- may include non-US codes Do not include dash Text 10
PC024A Pharmacy Country Name Code US for United States Text 30
PC025 Claim Status Status of claim Integer 2
PC026 Drug Code NDC Code Text 11
PC027 Drug Name Name of drug Text 80
PC028 New Prescription or Refill New prescription or refill number Integer 2
PC029 Generic Drug Indicator Generic indicator Text 1
PC030 Dispense as Written Code Dispense as written Integer 1
PC031 Compound Drug Indicator Compound drug ID Text 1
PC032 Date Prescription Filled Not provided Text CCYYMMDD 8
PC033 Quantity Dispensed Quantity of drug dispensed Integer 5
PC034 Days Supply Days of supply for drug Integer 3
PC035 Charge Amount Do not code decimal point Decimal 10
PC036 Paid Amount Do not code decimal point Decimal 10
PC037 Ingredient Cost/List Price 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 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
PC044 Prescribing Physician First Name Physician first name. Required if PC047 is not filled Text 25
PC045 Prescribing Physician Middle Name Physician middle name or initial. Required if PC047 is not filled Text 25
PC046 Prescribing Physician Last Name Physician last name. Required if PC047 is not filled Text 60
PC047 Prescribing Physician Number DEA number for prescribing physician Text 9
PC101 Encrypted Subscriber Last Name Encrypted subscriber last name, used to create unique member ID Text 128
PC102 Encrypted Subscriber First Name Encrypted subscriber first name, used to create unique member ID Text 128
PC103 Encrypted Subscriber Middle Initial Encrypted subscriber middle initial, used to create unique member ID Text 1
PC104 Encrypted Member Last Name Encrypted member last name, used to create unique member ID Text 128
PC105 Encrypted Member First Name Encrypted member first name, used to create unique member ID Text 128
PC106 Encrypted Member Middle Initial Encrypted member middle initial, used to create unique member ID Text 1
PC899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer Code Text 8
TR003 National Plan ID CMS National Plan ID; This is not yet available. Code as null 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 YYYYMM 6
TR006 Period Ending Date End of paid period for Claims End of month covered for Eligibility Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

Scroll To Top