United States Health Information Knowledgebase

 

Admission Hour

MC019, Colorado

Versions: August 2011 - v3• March 2013 - v5• March 2014 - v6Compare Versions


Name:Admission Hour
Data Element ID:MC019
Description:Required for all inpatient claims. Time is expressed in military time
State:Colorado
Data Type:char
Format:HHMM
Length:4
Required:O (inpatient claims only)
Reference:837/2300/DTP/435/ 03
Downloads
 
Download as an MS Excel™ spreadsheet.
[Download Excel Reader Exit Disclaimer]
 

File Specification for Multiple versionsMedical Claims File Submission - March 2014 - v6

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Not Provided char 2
Multiple versionsHD002 Payer Code Distributed by CIVHC varchar 8
Multiple versionsHD003 Payer Name Distributed by CIVHC varchar 75
Multiple versionsHD004 Beginning Month Not Provided date CCYYMM 6
Multiple versionsHD005 Ending Month Not Provided date CCYYMM 6
Multiple versionsHD006 Record count Total number of records submitted in the medical claims file, excluding header and trailer records int 10
Multiple versionsMC001 Payer Code Distributed by CIVHC varchar 8
Multiple versionsMC002 Payer Name Distributed by CIVHC varchar 30
Multiple versionsMC003 Insurance Type/Product Code Not Provided char 2
Multiple versionsMC004 Payer Claim Control Number Must apply to the entire claim and be unique within the payer's system. No partial claims. Only paid (or partially paid) claims varchar 35
Multiple versionsMC005 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. All claims must contain a line 1. int 4
Multiple versionsMC005A Version Number The version number of this claim service line. The original claim will have a version number of 0, with the next version being assigned a 1, and each subsequent version being incremented by 1 for that service line. Plans that cannot increment this column may opt to use YYMM as the version number. int 4
Multiple versionsMC006 Insured Group or Policy Number Group or policy number - not the number that uniquely identifies the subscriber. varchar 30
Multiple versionsMC007 Subscriber Social Security Number Subscriber's social security number; Set as null if unavailable varchar 9
Multiple versionsMC008 Plan Specific Contract Number Plan assigned subscriber's contract number; Set as null if contract number = subscriber's social security number or use an alternate unique identifier such as Medicaid ID. Must be an identifier that is unique to the subscriber. varchar 128
Multiple versionsMC009 Member Suffix or Sequence Number Unique number of the member within the contract. Must be an identifier that is unique to the member. varchar 20
Multiple versionsMC010 Member Identification Code (patient) Member's social security number; Set as null if contract number = subscriber's social security number or use an alternate unique identifier such as Medicaid ID. Must be an identifier that is unique to the member. varchar 9
Multiple versionsMC011 Individual Relationship Code Member's relationship to insured char 2
Multiple versionsMC012 Member Gender Not Provided char 1
Multiple versionsMC013 Member Date of Birth Not Provided char YYYYMMDD 8
Multiple versionsMC014 Member City Name City name of member varchar 30
Multiple versionsMC107 Member Street Address Physical street address of the covered member Varchar 50
Multiple versionsMC015 Member State or Province As defined by the US Postal Service char 2
Multiple versionsMC016 Member ZIP Code ZIP Code of member - may include non- US codes. Plus 4 optional but desired. varchar 11
Multiple versionsMC017 Date Service Approved/Accounts Payable Date/Actual Paid Date Not Provided char YYYYMMDD 8
Multiple versionsMC018 Admission Date Required for all inpatient claims. char YYYYMMDD 8
Multiple versionsMC019 Admission Hour Required for all inpatient claims. Time is expressed in military time char HHMM 4
Multiple versionsMC020 Admission Type Required for all inpatient claims (SOURCE: National Uniform Billing Data Element Specifications) int 1
Multiple versionsMC021 Admission Source Required for all inpatient claims (SOURCE: National Uniform Billing Data Element Specifications) char 1
Multiple versionsMC022 Discharge Hour Time expressed in military time int HHMM 4
Multiple versionsMC023 Discharge Status Required for all inpatient claims. char 2
Multiple versionsMC024 Service Provider Number Payer assigned service provider number. Submit facility for institutional claims; physician or healthcare professional for professional claims. varchar 30
Multiple versionsMC025 Service Provider Tax ID Number Federal taxpayer's identification number varchar 10
Multiple versionsMC026 Service National Provider ID National Provider ID. This data element pertains to the entity or individual directly providing the service. varchar 20
Multiple versionsMC027 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 a "person", and these shall be coded as a person. char 1
Multiple versionsMC028 Service Provider First Name Individual first name. Set to null if provider is a facility or organization. varchar 25
Multiple versionsMC029 Service Provider Middle Name Individual middle name or initial. Set to null if provider is a facility or organization. varchar 25
Multiple versionsMC030 Service Provider Last Name or Organization Name Full name of provider organization or last name of individual provider varchar 60
Multiple versionsMC031 Service Provider Suffix Suffix to individual name. Set to null if provider is a facility or organization. The service provider suffix shall 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, LCSW). varchar 10
Multiple versionsMC032 Service Provider Specialty As defined by payer. Dictionary for specialty code values must be supplied during testing. varchar 10
Multiple versionsMC108 Service Provider Street Address Physical practice location street address of the provider administering the services Varchar 50
Multiple versionsMC033 Service Provider City Name City name of provider - preferably practice location varchar 30
Multiple versionsMC034 Service Provider State or Province As defined by the US Postal Service char 2
Multiple versionsMC035 Service Provider ZIP Code ZIP Code of provider - may include non- US codes; do not include dash. Plus 4 optional but desired. varchar 11
Multiple versionsMC036 Type of Bill - Institutional Required for institutional claims; Not to be used for professional claims char 3
Multiple versionsMC037 Place of Service Required for professional claims. Not to be used for institutional claims. Map where you can and default to "99" for all others. char 2
Multiple versionsMC038 Claim Status Not Provided char 2
Multiple versionsMC039 Admitting Diagnosis Required on all inpatient admission claims and encounters. ICD-9-CM or ICD-10-CM. Do not code decimal point. varchar 7
Multiple versionsMC898 ICD-9 / ICD-10 Flag The purpose of this field is to identify which code set is being utilized. char 1
Multiple versionsMC040 E-Code Describes an injury, poisoning or adverse effect. ICD-9-CM or ICD-10-CM. Do not code decimal point. varchar 7
Multiple versionsMC041 Principal Diagnosis ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC042 Other Diagnosis - 1 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC043 Other Diagnosis - 2 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC044 Other Diagnosis - 3 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC045 Other Diagnosis - 4 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC046 Other Diagnosis - 5 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC047 Other Diagnosis - 6 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC048 Other Diagnosis - 7 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC049 Other Diagnosis - 8 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC050 Other Diagnosis - 9 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC051 Other Diagnosis - 10 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC052 Other Diagnosis - 11 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC053 Other Diagnosis - 12 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
Multiple versionsMC054 Revenue Code National Uniform Billing Committee Codes. Code using leading zeroes, left justified, and four digits. char 10
Multiple versionsMC055 Outpatient Procedure Code Health Care Common Procedural Coding System (HCPCS); this includes the CPT codes of the American Medical Association. Required for Outpatient and Professional claims only. varchar 10
Multiple versionsMC056 Procedure Modifier - 1 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. Required for Outpatient and Professional claims only. char 2
Multiple versionsMC057 Procedure Modifier - 2 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. Required for Outpatient and Professional claims only. char 2
Multiple versionsMC058 ICD-9-CM or ICD-10 Procedure Code Primary procedure code for this line of service. Do not code decimal point. Default to Blank char 7
Multiple versionsMC059 Date of Service - From First date of service for this service line. Date YYYYMMDD 8
Multiple versionsMC060 Date of Service - Thru Last date of service for this service line. Date YYYYMMDD 8
Multiple versionsMC061 Quantity Count of services performed, which shall be set equal to one on all observation bed service lines and should be set equal to zero on all other room and board service lines, regardless of the length of stay. int 3
Multiple versionsMC062 Charge Amount Do not code decimal point or provide any punctuation where $1,000.00 converted to 100000 Same for all financial data that follows. int 10
Multiple versionsMC063 Paid Amount Includes any withhold amounts. Do not code decimal point. For capitated claims set to zero. int 10
Multiple versionsMC064 Prepaid Amount For capitated services, the fee for service equivalent amount. Do not code decimal point. int 10
Multiple versionsMC065 Co-pay Amount The preset, fixed dollar amount for which the individual is responsible. Do not code decimal point. int 10
Multiple versionsMC066 Coinsurance Amount The dollar amount an individual is responsible for - not the percentage. Do not code decimal point. int 10
Multiple versionsMC067 Deductible Amount Do not code decimal point. int 10
Multiple versionsMC068 Patient Account/Control Number Number assigned by hospital varchar 20
Multiple versionsMC069 Discharge Date Date patient discharged. Required for all inpatient claims. Date YYYYMMDD 8
Multiple versionsMC070 Service Provider Country Name Code US for United States. varchar 30
Multiple versionsMC071 DRG Insurers 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 DRG system is used, the insurer 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). varchar 10
Multiple versionsMC072 DRG Version Version number of the grouper used char 2
Multiple versionsMC073 APC Insurers and health care claims processors shall code using the CMS methodology when available. Precedence shall be given to APCs transmitted from the health care provider. char 4
Multiple versionsMC074 APC Version Version number of the grouper used char 2
Multiple versionsMC075 Drug Code An NDC code used only when a medication is paid for as part of a medical claim. varchar 11
Multiple versionsMC076 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. varchar 30
Multiple versionsMC077 National Billing Provider ID National Provider ID varchar 20
Multiple versionsMC078 Billing Provider Last Name or Organization Name Full name of provider billing organization or last name of individual billing provider. varchar 60
Multiple versionsMC101 Subscriber Last Name Subscriber last name varchar 128
Multiple versionsMC102 Subscriber First Name Subscriber first name varchar 128
Multiple versionsMC103 Subscriber Middle Initial Subscriber middle initial char 1
Multiple versionsMC104 Member Last Name Not Provided varchar 128
Multiple versionsMC105 Member First Name Not Provided varchar 128
Multiple versionsMC106 Member Middle Initial Not Provided char 1
Multiple versionsMC201A Present on Admission - PDX Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201B Present on Admission - DX1 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201C Present on Admission - DX2 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201D Present on Admission - DX3 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201E Present on Admission - DX4 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201F Present on Admission - DX5 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201G Present on Admission - DX6 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201H Present on Admission - DX7 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201I Present on Admission - DX8 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201J Present on Admission - DX9 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201K Present on Admission - DX10 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201L Present on Admission - DX11 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC201M Present on Admission - DX12 Code indicating the presence of diagnosis at the time of admission Varchar 1
Multiple versionsMC202 Tooth Number Tooth Number or Letter Identification Char 20
Multiple versionsMC203 Dental Quadrant Dental Quadrant Char 1
Multiple versionsMC204 Tooth Surface Tooth Surface Identification Char 10
Multiple versionsMC205 ICD-9-CM or ICD-10-CM Procedure Date Date MC058 was performed Date 8
Multiple versionsMC058A ICD-9-CM Procedure Code or ICD-10-CM Procedure code Secondary procedure code for this line of service. Do not code decimal point. char 7
Multiple versionsMC205A ICD-9-CM or ICD-10-CM Procedure Date Date MC058A was performed Date 8
Multiple versionsMC058B ICD-9-CM Procedure Code or ICD-10-CM Procedure code Secondary procedure code for this line of service. Do not code decimal point. char 7
Multiple versionsMC205B ICD-9-CM or ICD-10-CM Procedure Date Date MC058B was performed Date 8
Multiple versionsMC058C ICD-9-CM Procedure Code or ICD-10-CM Procedure code Secondary procedure code for this line of service. Do not code decimal point. char 7
Multiple versionsMC205C ICD-9-CM or ICD-10-CM Procedure Date Date MC058C was performed Date 8
Multiple versionsMC058D ICD-9-CM Procedure Code or ICD-10-CM Procedure code Secondary procedure code for this line of service. Do not code decimal point. char 7
Multiple versionsMC205D ICD-9-CM or ICD-10-CM Procedure Date Date MC058E was performed Date 8
Multiple versionsMC058E ICD-9-CM Procedure Code or ICD-10-CM Procedure code Secondary procedure code for this line of service. Do not code decimal point. char 7
Multiple versionsMC205E ICD-9-CM or ICD-10-CM Procedure Date Date MC058E was performed Date 8
Multiple versionsMC206 Capitated Service Indicator Not Provided Char 1
Multiple versionsMC899 Record Type Not Provided char 2
Multiple versionsTR001 Record Type Not Provided char 2
Multiple versionsTR002 Payer Code Distributed by CIVHC varchar 8
Multiple versionsTR003 Payer Name Distributed by CIVHC varchar 75
Multiple versionsTR004 Beginning Month Not Provided date CCYYMM 6
Multiple versionsTR005 Ending Month Not Provided date CCYYMM 6
Multiple versionsTR006 Extraction Date Not Provided date YYYYMMDD 8

Scroll To Top