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Admission Date

MC018, Tennessee



Name:Admission Date
Data Element ID:MC018
Description:This field contains the date of the inpatient admission reported with a CCYYMMDD format.
State:Tennessee
Data Type:Date
Format:CCYYMMDD
Length:8
Column:19
Threshold:90%
Denominator:INSTITUTIONAL IP
Encrypt:N
Database Fieldname:ADMDAT
File:M
HIPAA REF. STANDARD:Institutional 837/2300/DTP/435/DT/ 03
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File Specification for Multiple versionsMedical Claims File Submission - March 18, 2010

Data Element ID Data Element Description Type Format Length
HD001 Record Type Must be coded HD to indicate Header record. Text 2
HD002 Payer Payer or submitter code assigned by Onpoint CDM Text 8
HD003 National Plan ID Code according to CMS National Plan ID Text 30
HD004 Type of File Must be coded ME to indicate submission of eligibility data. Text 2
HD005 Period Beginning Date Code the earliest payment year/month included in the submission in CCYYMM format. Submissions with records containing a check issue or effective date (MC017) before this date will fail. Integer CCYYMM 6
HD006 Period Ending Date Code the latest payment year/month included in the submission in CCYYMM format. Submissions with records containing a check issue or effective date (MC017) after this date will fail. Integer CCYYMM 6
HD007 Record Count Report the total number of records in the submission, excluding the header and trailer records. If the number of records within the submission does not equal the number reported in this field, the submission will fail. Integer 10
HD008 Comments Submitter comments Text 80
MC001 Payer This field contains the Onpoint CDM-assigned submitter code for the data submitter. The first two characters of the submitter code indicate Tennessee and the third character designates the type of submitter: A single data submitter may have multiple submitter codes because the data submitter is submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first six characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. Text 8
MC002 National Plan ID Code according to CMS National Plan ID Text 30
MC003 Insurance Type/Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has: Text 6
MC004 Payer Claim Control Number This field contains the claim number used by the data submitter to internally track the claim. In general the claim number is associated with all service lines of the bill. It must apply to the entire claim and be unique within the data submitter's system. Text 35
MC005 Line Counter This field contains the line number for this service. The line counter begins with 1 and is incremented by 1 for each additional service line of a claim. This field is used in algorithms to determine the final payment for the service. If the data submitter's processing system assigns an internal line counter for the adjudication process, that number may be submitted in place of the line number submitted by the provider. Integer 4
MC005A Version Number This is a voluntary administrative field and is not required to be reported. This field contains the version number of the claim service line. It begins with 0 and is incremented by 1 for each subsequent version of that service line. This field is used in algorithms to determine the final payment for the service. Integer 4
MC006 Insured Group Or Policy Number Group number or policy number Text 30
MC007 Encrypted Subscriber Index Number Carriers, healthcare claims processors, and pharmacy benefit managers shall input subscriber's Social Security number. During transformation and encryption: o All but one digit of the Social Security number shall be combined with a seed value o This modified subscriber index number then is encrypted by an application on the processors desktop o The original input Social Security number is deleted and replaced with the modified and encrypted output Carriers, healthcare claims processors, and pharmacy benefit managers shall set the input field null if unavailable. This or MC008 must be populated. Text 128
MC008 Encrypted Plan Specific Contract Index Number Carriers and healthcare claims processors shall input a plan-assigned subscriber index number that uniquely identifies members in a contract. This must not be the original contract number, but must be consistent in all fields requiring the plan-specific contract index number and must be consistent in all file submission types (eligibility, medical, and pharmacy claims) submitted by the submitter. This plan-assigned contract index number shall be combined with a seed value and then encrypted. Carriers and healthcare claims processors shall set as null if unavailable. This or MC007 must be populated. Text 128
MC009 Member Suffix Number Code a number to designate a member within the contract. Integer 20
MC010 Encrypted Member Index Number Carriers, healthcare claims processors, and pharmacy benefit managers shall input member's Social Security number. During transformation and encryption: o All but one digit of the Social Security number shall be combined with a seed value o This modified member index number then is encrypted by an application on the processors desktop o The original input Social Security number is deleted and replaced with the modified and encrypted output Carriers, healthcare claims processors, and pharmacy benefit managers shall set the input field null if unavailable. Text 128
MC011 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured: Integer 2
MC012 Member Gender This field contains the gender of the patient: Text 1
MC013 Member Year of Birth Carriers, healthcare claims processors, and pharmacy benefit managers shall input member's date of birth as CCYYMMDD. During transformation: o Age in months will be calculated for member using first day of the month for the eligibility file o The age in months value will be added to the end of the record by an application on the processor's desktop o The original input date of birth is deleted and replaced with the year of birth only in the output Date CCYYMMDD 4
MC014 Member City Name This field contains the member's city of residence. Text 30
MC015 Member State or Province The member state or province contains the two-character abbreviation code used by the U.S. Postal Service. Text 2
MC016 Member ZIP Code This field contains the ZIP code associated with the member's residence. Text 5
MC017 Paid Date This field contains the date the record was paid. It generally is referred to as the paid date and reported with a CCYYMMDD format. When BPR04 is "NON" for nonpayment, include remittance data. Date CCYYMMDD 8
MC018 Admission Date This field contains the date of the inpatient admission reported with a CCYYMMDD format. Date CCYYMMDD 8
MC019 Admission Hour If only the hour is known, code the minutes as 00. 4 P.M. would be reported as 1600. Integer HHMM 4
MC020 Admission Type This field is used to record the type of admission for all inpatient hospital claims: Integer 1
MC021 Point of Origin for Admission or Visit This field is required for inpatient hospital admissions. It records the source of admission. Reference standard is the National Uniform Billing Committee official UB-04 specifications manual. Currently this data element is form locator 15. Text 1
MC022 Discharge Hour HHMM: If only the hour is known, code the minutes as 00. 4 P.M. would be reported as 1600. Integer HHMM 4
MC023 Discharge Status This field is required for inpatient hospital admissions. It records the status for the patient discharged from the hospital. Reference standard is the National Uniform Billing Committee official UB-04 specifications manual. Currently this data element is form locator 17. Integer 2
MC024 Service Provider Number Data submitter assigned or legacy rendering/attending provider number. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Required if MC026 is not filled. One of the following prefixes must precede the submitted number: Text 30
MC025 Service Provider Tax ID Number Federal taxpayer's identification number for rendering/attending provider. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 10
MC026 National Service Provider ID Record the National Provider Identification (NPI) number for the entity or individual directly providing the service. This field will be used to create a master provider index for Tennessee medical service and prescribing providers. Required if MC024 is not filled. Text 20
MC027 Service Provider Entity Type Qualifier Not Provided Text 1
MC028 Service Provider First Name Report the individual's first name. Set to null if provider is a facility or an organization. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 25
MC029 Service Provider Middle Name Report the individual's middle name or initial. Set to null if provider is a facility or an organization. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 25
MC030 Service Provider Last Name or Organization Name Report the last name of the individual practitioner or the full name if the provider is a facility or an organization. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 100
MC031 Service Provider Suffix The service provider suffix is used to capture any generational identifiers associated with an individual clinician's name (e.g., Jr., Sr., III). Do not code the clinician's credentials (e.g., MD, LCSW) in this field. Set to null if the provider is a facility or an organization. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 10
MC032 Service Provider Specialty Service provider specialty code as defined by payer. Dictionary for specialty code values must be supplied during testing. Text 50
MC033 Service Provider City Name Report the city name of the provider address, preferably the practice location. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 30
MC034 Service Provider State or Province The provider's state or province contains the two- character abbreviation code used by the U.S. Postal Service. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 2
MC035 Service Provider ZIP Code Report the ZIP code of the servicing provider's address, preferably the practice location. This field will be used to create a master provider index for Tennessee providers encompassing both medical service providers and prescribing providers. Text 11
MC036 Type of Bill - Institutional This field is required for all UB-04 submissions. It records the type of bill. Reference standard is the National Uniform Billing Committee official UB-04 specifications manual. Currently this data element is form locator 4. Text 4
MC037 Place of Service - on NSF/CMS 1500 Claims For professional claims, this field records the type of facility where the service was performed. The field should be set to null for institutional claims. Current valid codes are maintained by National Standards Format (NSF) FA0- 07.0 for use on the HCFA 1500 form. Text 2
MC038 Claim Status Claim status: Integer 2
MC039 Admitting Diagnosis This field contains the ICD-9 diagnosis code indicating the reason for the inpatient admission. Decimal point is not coded. Text 5
MC040 E-Code This field describes an injury, poisoning, or adverse effect using an ICD-9 E-code diagnosis. Decimal point is not coded. Additional E-codes may be reported in other diagnosis fields MC041-MC053. Text 5
MC041 Principal Diagnosis This field contains the ICD-9 diagnosis code for the principal diagnosis. Decimal point is not coded. Text 5
MC042 Other Diagnosis - 1 This field contains the ICD-9 diagnosis code for the first secondary diagnosis. Decimal point is not coded. Text 5
MC043 Other Diagnosis - 2 This field contains the ICD-9 diagnosis code for the second secondary diagnosis. Decimal point is not coded. Text 5
MC044 Other Diagnosis - 3 This field contains the ICD-9 diagnosis code for the third secondary diagnosis. Decimal point is not coded. Text 5
MC045 Other Diagnosis - 4 This field contains the ICD-9 diagnosis code for the fourth secondary diagnosis. Decimal point is not coded. Text 5
MC046 Other Diagnosis - 5 This field contains the ICD-9 diagnosis code for the fifth secondary diagnosis. Decimal point is not coded. Text 5
MC047 Other Diagnosis - 6 This field contains the ICD-9 diagnosis code for the sixth secondary diagnosis. Decimal point is not coded. Text 5
MC048 Other Diagnosis - 7 This field contains the ICD-9 diagnosis code for the seventh secondary diagnosis. Decimal point is not coded. Text 5
MC049 Other Diagnosis - 8 This field contains the ICD-9 diagnosis code for the eighth secondary diagnosis. Decimal point is not coded. Text 5
MC050 Other Diagnosis - 9 This field contains the ICD-9 diagnosis code for the ninth secondary diagnosis. Decimal point is not coded. Text 5
MC051 Other Diagnosis - 10 This field contains the ICD-9 diagnosis code for the tenth secondary diagnosis. Decimal point is not coded. Text 5
MC052 Other Diagnosis - 11 This field contains the ICD-9 diagnosis code for the eleventh secondary diagnosis. Decimal point is not coded. Text 5
MC053 Other Diagnosis - 12 This field contains the ICD-9 diagnosis code for the twelfth secondary diagnosis. Decimal point is not coded. Text 5
MC054 Revenue Code This field is used to report the revenue code for institutional claims. It is one of three fields used to report type of service. National Uniform Billing Committee Codes are accepted. Code using leading zeroes, left justified, and four digits. Text 4
MC055 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. Healthcare Common Procedural Coding System (HCPCS), including CPT codes of the American Medical Association, are accepted. Text 5
MC056 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 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. Text 2
MC057 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. Text 2
MC058 Principal ICD- 9-CM Procedure Code This is used to report the principal inpatient ICD-9 procedure code. The decimal point is not coded. The ICD- 9 procedure must be repeated for all lines of the claim if necessary. This is one of three fields used to report type of service. Use fields MC058A-E to report other ICD-9-CM procedure codes. Text 4
MC059 Date of Service - From This field contains the first date of service for this service line in a CCYYMMDD format. Date CCYYMMDD 8
MC060 Date of Service - Thru This field contains the last date of service for this service line in a CCYYMMDD format. Future dates are acceptable. Date CCYYMMDD 8
MC061 Quantity This field contains a count of services performed. This field may be negative. Integer 5
MC062 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. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC063 Paid Amount This field includes all health plan payments and excludes all member payments and withholds from providers. This is a money field containing dollars and cents with an implied decimal point. This field may contain a negative value. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC064 Prepaid Amount For capitated services, the fee for service equivalent amount. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC065 Copay This field contains the pre-set, fixed dollar amount of copay 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. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC066 Coinsurance Amount This field contains the dollar amount of coinsurance 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 is not a percentage. This field may contain a negative value. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC067 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 healthcare 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. 0 is acceptable; code "data not available" as 9999999999. Only 1% of submissions can contain 9999999999. Submissions containing 9999999999 will not factor into the calculation of the threshold. Decimal 10
MC068 Placeholder Placeholder N/A N/A
MC069 Placeholder Placeholder N/A N/A
MC070 Service Provider Country Name of the country for the provider of services. Code as US for United States Text 30
MC071 DRG Carriers and healthcare 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, then 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 AXXX- XX 10
MC072 DRG Version This element is the version number of the grouper used. Text 2
MC073 APC Carriers and healthcare claims processors shall code using CMS methodology. Precedence shall be given to APCs transmitted from the healthcare 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 Enter the data submitter-assigned billing provider number. This should be the identifier used by the data submitter for internal reasons and does not routinely change. Required if MC077 is not filled. One of the following prefixes should precede the submitted number: Text 30
MC077 National Billing Provider ID National Provider Identification (NPI) number for the billing provider. Required if MC076 is not filled. Text 10
MC078 Billing Provider Last Name or Organization Name Report the full name of the billing organization or the last name of the individual billing provider. Text 60
MC079 Other ICD-9- CM Procedure Code - 1 This is used to report the second ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC080 Other ICD-9- CM Procedure Code - 2 This is used to report the third ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC081 Other ICD-9- CM Procedure Code - 3 This is used to report the fourth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC082 Other ICD-9- CM Procedure Code - 4 This is used to report the fifth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC083 Other ICD-9- CM Procedure Code - 5 This is used to report the sixth ICD-9 procedure code. The decimal point is not coded. The ICD-9 procedure must be repeated for all lines of the claim if necessary. Text 4
MC084 Present on Admission Present on Admission flag - Admitting Diagnosis. Indicator for MC039 data element. Must equal Onset of Diagnosis Indicator Text 1
MC085 Present on Admission Present on Admission flag - Primary Diagnosis. Indicator for MC041 data element. Must equal Onset of Diagnosis Indicator Text 1
MC086 Present on Admission Present on Admission flag - First Secondary Diagnosis. Indicator for MC042 data element. Must equal Onset of Diagnosis Indicator Text 1
MC087 Present on Admission Present on Admission flag - Second Secondary Diagnosis. Indicator for MC043 data element. Must equal Onset of Diagnosis Indicator Text 1
MC088 Present on Admission Present on Admission flag - Third Secondary Diagnosis. Indicator for MC044 data element. Must equal Onset of Diagnosis Indicator Text 1
MC089 Present on Admission Present on Admission flag - Fourth Secondary Diagnosis. Indicator for MC045 data element. Must equal Onset of Diagnosis Indicator Text 1
MC090 Present on Admission Present on Admission flag - Fifth Secondary Diagnosis. Indicator for MC046 data element. Must equal Onset of Diagnosis Indicator Text 1
MC091 Present on Admission Present on Admission flag - Sixth Secondary Diagnosis. Indicator for MC047 data element. Must equal Onset of Diagnosis Indicator Text 1
MC101 Placeholder Placeholder N/A N/A
MC102 Placeholder Placeholder N/A N/A
MC103 Placeholder Placeholder N/A N/A
MC104 Encrypted Index Number, Member Last Name Carriers, healthcare claims processors, and pharmacy benefit managers shall input member's last name. During transformation and encryption: o The first character of the last name is combined with a numeric name ID o This modified member last name field then is encrypted by an application on the processor's desktop o The original input member last name is deleted and replaced with the modified and encrypted output Text 128
MC105 Encrypted Index Number, Member First Name Carriers, healthcare claims processors, and pharmacy benefit managers shall input member's first initial. During transformation and encryption: o This first character of the first name is combined with a seed value o This modified member first initial then is encrypted by an application on the processor's desktop o The original input member first initial is deleted and replaced with the modified and encrypted output Text 128
MC106 Placeholder Placeholder N/A N/A
MC899 Record Type This field indicates the type of record: This is an administrative field required by Onpoint CDM and populated with a constant value. Text 2
TR001 Record Type Must be coded TR to indicate the Trailer record Text 2
TR002 Payer Payer or submitter code assigned by Onpoint CDM Text 8
TR003 National Plan ID Code according to CMS National Plan ID Text 30
TR004 Type of File Must be coded MC to indicate submission of professional and institutional claims data. Text 2
TR005 Period Beginning Date Code the earliest payment year/month included in the submission in CCYYMM format. Submissions with records containing a check issue or effective date (MC017) before this date will fail. Integer CCYYMM 6
TR006 Period Ending Date Code the latest payment year/month included in the submission in CCYYMM format. Submissions with records containing a check issue or effective date (MC017) after this date will fail. Integer CCYYMM 6
TR007 Date Processed Date that the file was created in CCYYMMDD format Date CCYYMMDD 8

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