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Abortion Flag

MC914, Maine

Versions: 2010-03-16• v1.2Compare Versions


Name:Abortion Flag
Data Element ID:MC914
Description:This field flags all records associated with a possible abortion claim.
State:Maine
Data Type:INTEGER
Length:1
Database Fieldname:ABORT
Warnings :This field is not released.
Permissible Values: Abortion Flag uses the following permissible values:
Code / Value Meaning
0 Release
1 Withhold
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File Specification for Multiple versionsMedical Claims File Submission - v1.2

Data Element ID Data Element Description Type Format Length
Multiple versionsMC001 Payer This field contains the MHDO submitter code for the payer submitting payments. The first character of the submitter code indicates the type of submitter. This field is primarily used for tracking compliance by Payer. CHAR 6
Multiple versionsMC002 National Plan ID CMS National Plan ID CHAR 30
Multiple versionsMC003 Insurance Type/Product Code The insurance type or product code indicates the type of Insurance coverage the individual has. TEXT 2
Multiple versionsMC004 Payer Claim Control Number This field contains the claim number used by the payer to internally track the claim. CHAR 35
Multiple versionsMC005 Line Counter This field contains the line number for this service NUMBER 30
Multiple versionsMC006 Insured Group or Policy Number The group or policy number is associated with the entity that has purchased the insurance. For self insured individuals this relates to the purchaser. For the majority of eligibility and claims data the group relates to the employer. CHAR 30
Multiple versionsMC007 Encrypted Subscriber Social Security Number This field contains the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the Contract field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code (MEMBERID). CHAR 32
Multiple versionsMC008 Plan Specific Contract Number This field contains the payer assigned contract number for the subscriber. If the Encrypted Social Security Number is null, this field forms the core of the unique member number (MEMBERID). CHAR 64
Multiple versionsMC009 Member Suffix or Sequence Number This payer supplied code uniquely identifies the member within the context of the subscriber Encrypted Social Security Number or Contract. CHAR 20
Multiple versionsMC010 Member Identification Code This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 64
Multiple versionsMC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. CHAR 2
Multiple versionsMC012 Member Gender This field contains the gender of the member. CHAR 1
Multiple versionsMC013 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. This field is used to calculate age as of the from date of service (MC059). DATE CCYYMMDD 8
Multiple versionsMC014 Member City Name This field contains the member's city of residence and was not required reporting until 2004. CHAR 30
Multiple versionsMC015 Member State or Province The Member State or Province contains the 2 character abbreviation code used by the US Postal Service and was not required reporting until 2004. Since this database has been built for Maine residents the code will generally be ME for Maine. CHAR 2
Multiple versionsMC016 Member ZIP Code This field contains ZIP Code of the member. Payers are encouraged to provide a full 9 character zip code. CHAR 11
Multiple versionsMC017 Date Service Approved (AP Date) This field contains the date the record was approved for payment. This is generally referred to as the Paid Date with a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC018 Admission Date This field contains the date of the inpatient admission with a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC019 Admission Hour This field contains the hour the inpatient was admitted to the hospital in military time. NUMBER 4
Multiple versionsMC020 Admission Type This field is used to record the type of admission for all inpatient hospital bills. NUMBER 2
Multiple versionsMC021 Admission Source This field is required for inpatient hospital bills. It records the source of admission. For newborns (ADMSR = 4) CHAR 1
Multiple versionsMC022 Discharge Hour This field contains the hour the inpatient was discharged from the hospital in military time. NUMBER 2
Multiple versionsMC023 Member Status This field contains the status for the patient discharged from the hospital. NUMBER 2
Multiple versionsMC036 Type of Bill - Institutional Not Provided NUMBER 2
Multiple versionsMC037 Facility Type - Professional For professional claims, this field records the type of facility where the service was performed. CHAR 2
Multiple versionsMC038 Claim Status This field contains the status of the claim as reported by the payer. NUMBER 2
Multiple versionsMC039 Admitting Diagnosis This field contains the ICD-9 diagnosis code indicating the reason for the inpatient admission. CHAR 5
Multiple versionsMC040 E-Code This field describes an injury, poisoning or adverse effect using an ICD-9 E-code diagnosis. CHAR 5
Multiple versionsMC041 Principal Diagnosis This field contains the ICD-9 diagnosis code for the principal diagnosis. CHAR 5
Multiple versionsMC042 Other Diagnosis 1 This field contains the ICD-9 diagnosis code for the first secondary diagnosis . This was not required reporting until 2004. CHAR 5
Multiple versionsMC043 Other Diagnosis 2 This field contains the ICD-9 diagnosis code for the second secondary diagnosis and was not required reporting until CHAR 5
Multiple versionsMC044 Other Diagnosis 3 This field contains the ICD-9 diagnosis code for the third secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC045 Other Diagnosis 4 This field contains the ICD-9 diagnosis code for the fourth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC046 Other Diagnosis 5 This field contains the ICD-9 diagnosis code for the fifth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC047 Other Diagnosis 6 This field contains the ICD-9 diagnosis code for the sixth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC048 Other Diagnosis 7 This field contains the ICD-9 diagnosis code for the seventh secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC049 Other Diagnosis 8 This field contains the ICD-9 diagnosis code for the eighth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC050 Other Diagnosis 9 This field contains the ICD-9 diagnosis code for the ninth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC051 Other Diagnosis 10 This field contains the ICD-9 diagnosis code for the tenth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC052 Other Diagnosis 11 This field contains the ICD-9 diagnosis code for the eleventh secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC053 Other Diagnosis 12 This field contains the ICD-9 diagnosis code for the twelfth secondary diagnosis and was not required reporting until 2004. CHAR 5
Multiple versionsMC054 Revenue Code This field is used to report the revenue code for hospital claims. It is one of three fields used to report type of service. National Uniform Billing Committee codes are used in this field. CHAR 10
Multiple versionsMC055 Procedure Code This field contains the HCPC or CPT code for the procedure performed. It is one of three fields used to report the service. CHAR 10
Multiple versionsMC056 Procedure Modifier 1 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. CHAR 2
Multiple versionsMC057 Procedure Modifier 2 A modifier is used to indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate a service or procedure that has both a professional and a technical component, only part of a service was performed, a bilateral procedure was performed, or a service or procedure was provided more than once. CHAR 2
Multiple versionsMC058 ICD-9-CM Procedure Code This is used to report the ICD-9 procedure code. The decimal point is not coded. This is one of three fields used to report type of service. CHAR 4
Multiple versionsMC059 Date of Service From This field contains the first date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC060 Date of Service Thru This field contains the last date of service for this service line in a CCYYMMDD format. DATE CCYYMMDD 8
Multiple versionsMC061 Quantity This field contains a count of services performed. This field may be negative. NUMBER 3
Multiple versionsMC062 Charge Amount This field contains the total charges for the service as reported by the provider. This is a money field Containing dollars and cents with an implied decimal Point. This field may contain a negative value. NUMBER 10
Multiple versionsMC063 Paid Amount This field includes all health plan payments, including withhold amounts, and excludes all member payments. This is a money field containing dollars and cents with an Implied decimal point. This field may contain a negative Value. NUMBER 10
Multiple versionsMC064 Prepaid Amount This field contains the fee for service equivalent that would have been paid by the health care claims processor for a specific service if the service had not been capitated. "Capitated services" means services rendered by a provider through a contract where payments are based upon a fixed dollar amount for each member on a monthly basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC065 Copay Amount This field contains the pre-set, fixed dollar amount Payable by a member, often on a per visit/service basis. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC066 Coinsurance Amount This amount is paid by the member and reflects the percent a member must pay toward the cost of a covered service. In many health insurance plans the coinsurance a member is responsible for is capped after a certain dollar amount of eligible expenses have been incurred. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC067 Deductible Amount This is an amount that is required to be paid by a member before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that is not covered by the member's insurance plan. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. NUMBER 10
Multiple versionsMC068 Record Type This field indicates the type of record. CHAR 2
Multiple versionsMC069 Patient Account/Control Number This field is used by hospitals to identify a patient. CHAR 38
MC070 Discharge Date This field contains the date the patient was discharged from the hospital. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsMC901 Member Age This field contains the age of the member in years as of the from date of service (MC059). Children under the age of 1 have an age of zero. If no date of birth is available, this field is null. NUMBER 3
Multiple versionsMC902 Record ID # This field contains a Data Processing Center assigned record number that is unique across all data types. This field is used for tracking purposes. NUMBER 12
Multiple versionsMC903 MHDO Extract Date This is the date the record was extracted by the Data Processing Center for inclusion in the MHDO Data Warehouse. The format is CCYYMMDD. DATE CCYYMMDD 8
Multiple versionsMC904 Encrypted Member ID # The MEMBERID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Memberid is comprised of Encrypted Subscriber Social Security Number + Year and Month of birth + Gender + Individual Relationship Code. If the Encrypted Subscriber Social Security Number is blank, the Memberid is comprised of the Plan Specific Contract Number + Year and Month of Birth + Gender + Individual Relationship Code. CHAR 71
Multiple versionsMC905 Medicare Coverage This field indicates whether the claim is for a member who also has Medicare coverage. It is derived from the insurance type/product code field (MC003). CHAR 1
Multiple versionsMC906 Submission ID # This field contains a unique submission number assigned by the Data Processing Center for tracking purposes. Each payer submission receives a submission number that is unique across all data types. NUMBER 12
Multiple versionsMC907 Double Encrypted Payer Claim Control Number This field contains the encrypted version of the Payer Claim Control Number reported in DC004. The claim number used by the payer to internally track the claim. In general the claim number is associated with all service lines of the bill. Therefore, multiple medical records may share the same claim number. CHAR 100
Multiple versionsMC908 Double Encrypted Subscriber Social Security Number This field contains an encryption of the information originally submitted by the payer in field DC007 - the Encrypted Social Security Number for the subscriber. If the social security number was not available from the payer this field will be null and the CONTRACT field will be populated. This field has been encrypted using the same algorithm across all payers. If this field is populated, it forms the core of the unique member identification code(MHDO_MEMBERID). CHAR 64
Multiple versionsMC909 Double Encrypted Plan Specific Contract Number This field contains an encryption of the information originally submitted by the payer in field DC008 - the payer assigned contract number for the subscriber. If the Encrypted Subscriber Social Security Number is null, this field forms the core of the unique member number (MHDO_MEMBERID). This field has been encrypted using the same algorithm across all payers. CHAR 128
Multiple versionsMC910 Double Encrypted Member Social Security Number This field is used to record the member's social security number when available. If the member is the subscriber, this field should contain the same value as the Encrypted Social Security Number. If the member is not the subscriber, this field will not equal the Encrypted Social Security Number. CHAR 128
Multiple versionsMC911 Double Encrypted Member ID # The Double Encrypted Member ID is a combination of fields which generally represent a unique individual. For those members with a value in the Encrypted Subscriber Social Security Number, the Double Encrypted Memberid is comprised of Double Encrypted Subscriber Social CHAR 135
Multiple versionsMC912 Provider ID # This is the provider identification number that links to the Medical Service Provider file using MCSP001. INTEGER 12
Multiple versionsMC913 Standardized Insurance Type/Product Code The insurance type or product code indicates the type of insurance coverage the individual has. CHAR 2
Multiple versionsMC914 Abortion Flag This field flags all records associated with a possible abortion claim. INTEGER 1
Multiple versionsMC915 Year Paid This field is derived from Date Service Approved (MC017) and contains the year of payment (YYYY format). Number YYYY 4
Multiple versionsMC916 Month Paid This field is derived from Date Service Approved (MC017) and contains the month of payment (MM format). Number MM 2
Multiple versionsMC917 Year of Service This field is derived from the From Date of Service (MC059) and contains the year the service was performed (YYYY format). Number YYYY 4
Multiple versionsMC918 Month of Service This field is derived from the From Date of Service (MC059) and contains the month the service was performed (MM format). Number MM 2
Multiple versionsMC919 Payment Quarter This field is derived from Date Service Approved (MC017) and contains the quarter of payment. Number 1
Multiple versionsMC920 Quarter Service Performed This field is derived from the From Date of Service (MC059) and contains the quarter of service. Number 1

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