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Admission Date

MC018, Utah



Name:Admission Date
Data Element ID:MC018
Description:Required for all inpatient claims.
State:Utah
Data Type:char
Format:YYYYMMDD
Length:8
Required:O (inpatient claims only)
Reference:837/2300/DTP/435/ 03
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File Specification for Medical Claims File Submission - December 5, 2013 - v2.0

Data Element ID Data Element Description Type Format Length
MC001 Payer Code Distributed by OHCS varchar 8
MC002 Payer Name Distributed by OHCS varchar 30
MC003 Insurance Type/Product Code Not Provided char 2
MC004 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
MC005 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
MC005A 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
MC006 Insured Group or Policy Number Group or policy number - not the number that uniquely identifies the subscriber. varchar 30
MC007 Subscriber Social Security Number Subscriber's social security number; Set as null if unavailable varchar 9
MC008 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
MC009 Member Suffix or Sequence Number Unique number of the member within the contract. Must be an identifier that is unique to the member. Must match ME010. varchar 128
MC010 Member Identification Code (patient) Member's social security number; Set as blank if unavailable. varchar 9
MC011 Individual Relationship Code Member's relationship to insured - payers will map their available codes to those listed in Lookup Table B-1.B char 2
MC012 Member Gender Not Provided char 1
MC013 Member Date of Birth Not Provided char YYYYMMDD 8
MC014 Member City Name City name of member varchar 30
MC107 Member Street Address Physical street address of the covered member Varchar 50
MC015 Member State or Province As defined by the US Postal Service char 2
MC016 Member ZIP Code ZIP Code of member - may include non- US codes. Plus 4 optional but desired. varchar 11
MC017 Date Service Approved/Accounts Payable Date/Actual Paid Date Not Provided char YYYYMMDD 8
MC018 Admission Date Required for all inpatient claims. char YYYYMMDD 8
MC019 Admission Hour Required for all inpatient claims. Time is expressed in military time char HHMM 4
MC020 Admission Type Required for all inpatient claims (SOURCE: National Uniform Billing Data Element Specifications) int 1
MC021 Admission Source Required for all inpatient claims (SOURCE: National Uniform Billing Data Element Specifications) Need Values from Treo char 1
MC022 Discharge Hour Time expressed in military time int HHMM 4
MC023 Discharge Status Required for all inpatient claims. char 2
MC024 Service Provider Number Payer assigned service provider number. Submit facility for institutional claims; physician or healthcare professional for professional claims. Must match MP001. varchar 30
MC025 Service Provider Tax ID Number Federal taxpayer's identification number varchar 10
MC026 Service National Provider ID National Provider ID. This data element pertains to the entity or individual directly providing the service. varchar 20
MC027 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
MC028 Service Provider First Name Individual first name. Set to null if provider is a facility or organization. varchar 25
MC029 Service Provider Middle Name Individual middle name or initial. Set to null if provider is a facility or organization. varchar 25
MC030 Service Provider Last Name or Organization Name Full name of provider organization or last name of individual provider varchar 60
MC031 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
MC032 Service Provider Specialty Report the HIPAA-compliant health care provider taxonomy code. Code set is freely available at the National Uniform Claims Committee's web site at http://www.nucc.org/ varchar 50
MC108 Service Provider Street Address Physical practice location street address of the provider administering the services Varchar 50
MC033 Service Provider City Name City name of provider - preferably practice location varchar 30
MC034 Service Provider State or Province As defined by the US Postal Service char 2
MC035 Service Provider ZIP Code ZIP Code of provider - may include non- US codes; do not include dash. Plus 4 optional but desired. varchar 11
MC036 Type of Bill - Institutional Required for institutional claims; Not to be used for professional claims char 3
MC037 Facility Type - Professional Required for professional claims. Not to be used for institutional claims. Map where you can and default to "99" for all others. char 2
MC038 Claim Status Not Provided char 2
MC039 Admitting Diagnosis Required on all inpatient admission claims and encounters. ICD-9-CM or ICD-10-CM. Do not code decimal point. varchar 7
MC898 ICD-9 / ICD-10 Flag The purpose of this field is to identify which code set is being utilized. char 1
MC040 E-Code Describes an injury, poisoning or adverse effect. ICD-9-CM or ICD-10-CM. Do not code decimal point. varchar 7
MC041 Principal Diagnosis ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC042 Other Diagnosis - 1 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC043 Other Diagnosis - 2 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC044 Other Diagnosis - 3 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC045 Other Diagnosis - 4 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC046 Other Diagnosis - 5 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC047 Other Diagnosis - 6 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC048 Other Diagnosis - 7 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC049 Other Diagnosis - 8 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC050 Other Diagnosis - 9 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC051 Other Diagnosis - 10 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC052 Other Diagnosis - 11 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC053 Other Diagnosis - 12 ICD-9-CM or ICD-10_CM. Do not code decimal point. varchar 7
MC054 Revenue Code National Uniform Billing Committee Codes. Code using leading zeroes, left justified, and four digits. char 10
MC055 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
MC056 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
MC057 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
MC058 ICD-9-CM Procedure Code Primary procedure code for this line of service. Do not code decimal point. char 4
MC059 Date of Service - From First date of service for this service line. Date YYYYMMDD 8
MC060 Date of Service - Thru Last date of service for this service line. Date YYYYMMDD 8
MC061 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
MC062 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
MC063 Paid Amount Includes any withhold amounts. Treo? Do not code decimal point. For capitated claims set to zero. int 10
MC064 Prepaid Amount For capitated services, the fee for service equivalent amount. Do not code decimal point. int 10
MC065 Co-pay Amount The preset, fixed dollar amount for which the individual is responsible. Do not code decimal point. int 10
MC066 Coinsurance Amount The dollar amount an individual is responsible for - not the percentage. Do not code decimal point. int 10
MC067 Deductible Amount Do not code decimal point. int 10
MC068 Patient Account/Control Number Number assigned by hospital varchar 20
MC069 Discharge Date Date patient discharged. Required for all inpatient claims. Date YYYYMMDD 8
MC070 Service Provider Country Name Code US for United States. Non US? varchar 30
MC071 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
MC072 DRG Version Version number of the grouper used char 2
MC073 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
MC074 APC Version Version number of the grouper used char 2
MC075 Drug Code An NDC code used only when a medication is paid for as part of a medical claim. varchar 11
MC076 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
MC077 National Billing Provider ID National Provider ID varchar 20
MC078 Billing Provider Last Name or Organization Name Full name of provider billing organization or last name of individual billing provider. varchar 60
MC101 Subscriber Last Name Subscriber last name varchar 128
MC102 Subscriber First Name Subscriber first name varchar 128
MC103 Subscriber Middle Initial Subscriber middle initial char 1
MC104 Member Last Name Not Provided varchar 128
MC105 Member First Name Not Provided varchar 128
MC106 Member Middle Initial Not Provided char 1
MC201A Present on Admission - PDX Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201B Present on Admission - DX1 Code indicating the presence of diagnosis at the time of admission for MC201. Varchar 1
MC201C Present on Admission - DX2 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201D Present on Admission - DX3 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201E Present on Admission - DX4 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201F Present on Admission - DX5 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201G Present on Admission - DX6 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201H Present on Admission - DX7 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201I Present on Admission - DX8 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201J Present on Admission - DX9 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201K Present on Admission - DX10 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201L Present on Admission - DX11 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC201M Present on Admission - DX12 Code indicating the presence of diagnosis at the time of admission. Varchar 1
MC202 Tooth Number Tooth Number or Letter Identification Char 20
MC203 Dental Quadrant Dental Quandrant Char 1
MC204 Tooth Surface Tooth Surface Identification Char 10
MC205 ICD-9-CM Procedure Date Date MC058 was performed Date 8
MC058A ICD-9-CM Procedure Code Secondary procedure code for this line of service. Do not code decimal point. char 4
MC205A ICD-9-CM Procedure Date Date MC058A was performed Date 8
MC058B ICD-9-CM Procedure Code Secondary procedure code for this line of service. Do not code decimal point. char 4
MC205B ICD-9-CM Procedure Date Date MC058B was performed Date 8
MC058C ICD-9-CM Procedure Code Secondary procedure code for this line of service. Do not code decimal point. char 4
MC205C ICD-9-CM Procedure Date Date MC058C was performed Date 8
MC058D ICD-9-CM Procedure Code Secondary procedure code for this line of service. Do not code decimal point. char 4
MC205D ICD-9-CM Procedure Date Date MC058E was performed Date 8
MC058E ICD-9-CM Procedure Code Secondary procedure code for this line of service. Do not code decimal point. char 4
MC205E ICD-9-CM Procedure Date Date MC058E was performed Date 8
MC206 Capitated Service Indicator Not Provided Char 1
MC899 Record Type Not Provided char 2

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