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Medical Claims File Submission

Oregon

Versions: September 27, 2011 - v2011.1.1• June 25, 2012 - v2013.0.0• June 27, 2013 - v2014.0.0• 2015.0.1Compare Versions


Name:Medical Claims File Submission
State:Oregon
Definition:Medical claims and pharmacy claims files capture plan payments, member financial responsibility (co-pay, co-insurance, deductible), diagnoses, procedures performed, and numerous other data fields.
Version2015.0.1

File Specification for Medical Claims File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsMC001 Payer type Not Provided Text 1
Multiple versionsMC003 Product code Not Provided Text 3
Multiple versionsMC004 Claim ID Payer's unique claim identifier Text 80
Multiple versionsMC005 Service line counter Increments of 1 for each claim line Numeric 4
Multiple versionsMC010 Member ID Plan-specific unique member identifier Text 30
Multiple versionsMC017 Payment date example: 20090624) Date CCYYMMDD 8
Multiple versionsMC018 Admission date example: 20090603 Date CCYYMMDD 8
Multiple versionsMC023 Discharge status Not Provided Text 2
Multiple versionsMC024 Rendering provider ID Identifier for the rendering provider as assigned by the reporting entity Text 30
Multiple versionsMC036 Type of bill Required only for institutional claims. Numeric 3
Multiple versionsMC037 Place of service Required only for professional claims. Text 2
Multiple versionsMC038 Claim status Was claim paid, denied, CCO encounter, or MCO encounter only? Text 1
Multiple versionsMC038A COB status Was claim a COB claim? Text 1
Multiple versionsMC041 Principal diagnosis ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC041P POA flag 1 Present on admission flag for principal diagnosis. Text 1
Multiple versionsMC042 Diagnosis 2 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC042P POA flag 2 Present on admission flag for diagnosis 2. Required if MC042 is populated. Text 1
Multiple versionsMC043 Diagnosis 3 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC043P POA flag 3 Present on admission flag for diagnosis 3. Required if MC043 is populated. Text 1
Multiple versionsMC044 Diagnosis 4 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC044P POA flag 4 Present on admission flag for diagnosis 4. Required if MC044 is populated. Text 1
Multiple versionsMC045 Diagnosis 5 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC045P POA flag 5 Present on admission flag for diagnosis 5. Required if MC045 is populated. Text 1
Multiple versionsMC046 Diagnosis 6 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC046P POA flag 6 Present on admission flag for diagnosis 6. Required if MC046 is populated. Text 1
Multiple versionsMC047 Diagnosis 7 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC047P POA flag 7 Present on admission flag for diagnosis 7. Required if MC047 is populated. Text 1
Multiple versionsMC048 Diagnosis 8 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC048P POA flag 8 Present on admission flag for diagnosis 8. Required if MC048 is populated. Text 1
Multiple versionsMC049 Diagnosis 9 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC049P POA flag 9 Present on admission flag for diagnosis 9. Required if MC049 is populated. Text 1
Multiple versionsMC050 Diagnosis 10 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC050P POA flag 10 Present on admission flag for diagnosis 10. Required if MC050 is populated. Text 1
Multiple versionsMC051 Diagnosis 11 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC051P POA flag 11 Present on admission flag for diagnosis 11 Required if MC051 is populated. Text 1
Multiple versionsMC052 Diagnosis 12 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC052P POA flag 12 Present on admission flag for diagnosis 12 Required if MC052 is populated. Text 1
Multiple versionsMC053 Diagnosis 13 ICD-10 diagnosis code for dates of service beginning 10/01/2014. Include all characters (example: E10.359). ICD-9 diagnosis code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 01220) Text 7
Multiple versionsMC053P POA flag 13 Present on admission flag for diagnosis 13 Required if MC053 is populated. Text 1
Multiple versionsMC054 Revenue code Include all digits (example: 0320) Text 4
Multiple versionsMC055 CPT/CPT II/HCPCS procedure code CPT, CPT II or HCPCS code. Include all digits (examples: 29870 or G0289) Text 5
Multiple versionsMC056 Procedure modifier 1 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057 Procedure modifier 2 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057A Procedure modifier 3 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC057B Procedure modifier 4 CPT or HCPCS modifier. Include all digits (examples: 50 or AA) Text 2
Multiple versionsMC058 Principal inpatient procedure code ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058A Inpatient procedure code 2 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058B Inpatient procedure code 3 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058C Inpatient procedure code 4 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058D Inpatient procedure code 5 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058E Inpatient procedure code 6 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058F Inpatient procedure code 7 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058G Inpatient procedure code 8 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058H Inpatient procedure code 9 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058J Inpatient procedure code 10 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058K Inpatient procedure code 11 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058L Inpatient procedure code 12 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC058M Inpatient procedure code 13 ICD-10 procedure code for dates of service after 10/01/2014. Include all characters, (example: B245ZZ3). ICD-9 procedure code for dates of service before 10/01/2014. If ICD-9 include all digits and exclude decimal point (example: 0085) Text 7
Multiple versionsMC059 Date of service - From example: 20090603 Date CCYYMMDD 8
Multiple versionsMC060 Date of service - Thru example: 20090603 Date CCYYMMDD 8
Multiple versionsMC061 Quantity Count of units sent on claim line. Numeric 5
Multiple versionsMC062 Charges Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC062A Allowed amount Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC063 Payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC064 Prepaid amount Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC065 Co-payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC066 Co-insurance Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC067 Deductible Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC067A Patient pay amount Required if any of MC065, MC066, or MC067 are missing. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC070 Discharge date Required only for institutional claims. Use 99991231 if patient has not discharged. (example: 20090605). Date CCYYMMDD 8
Multiple versionsMC076 Billing provider ID Identifier for the billing provider as assigned by the reporting entity Text 30
Multiple versionsQC05 Prior version claim number Required for participants in Q-Corp initiative. Text 80
Multiple versionsQC06 Claim received date Required for participants in Q-Corp initiative. Date CCYYMMDD 8
Multiple versionsQC22 DRG DRG paid by payer. If not available send billed DRG. Required for participants in Q-Corp initiative. Example: 061 Text 3
Multiple versionsQC23 DRG type Required for participants in Q-Corp initiative. Valid values: C (CMS v.24) or M (MS-DRG) Text 1
Multiple versionsQC37 LOINC code Placeholder for the Q-Corp initiative. Text 8
Multiple versionsQC38 Lab result Placeholder for the Q-Corp initiative. Text 8
Multiple versionsQC39 Micro/macro albumin result Placeholder for the Q-Corp initiative. Text 1
Multiple versionsOHLC1 COB allowed amount Required for participants in OHLC high value medical home initiative. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsOHLC2 Risk withhold amount Required for participants in OHLC high value medical home initiative. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsMC008 Plan specific contract number Plan specific contract number (aka group number) Text 30
Multiple versionsMC201 ICD version code Specifies the claim's ICD version. Text 2
Multiple versionsMC202 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC203 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC204 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC205 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC206 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC207 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC208 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC209 Empty field For future implementation Not Supplied Not Supplied Not Supplied
Multiple versionsMC210 Empty field For future implementation Not Supplied Not Supplied Not Supplied

Downloads
 
Download as an MS Excel™ spreadsheet.
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Data Element ID Data Element Code Value
MC001 Payer type C Carrier
D Medicaid
G Other government agency
P Pharmacy benefits manager
T Third-party administrator
U Unlicensed entity
MC003 Product code CHP Special Childrens Health Insurance Program (SCHIP)
EPO Commercial EPO
HMO Commercial HMO
IN Commercial indemnity
MC Medicare Cost
MD Medicaid disabled HMO
MDE Medicaid dual eligible HMO
MDF Medicaid fee-for-service
MLI Medicaid low income HMO
MP Medicare Advantage PPO
MPD Medicare Part D only
MR Medicare Advantage HMO
MRB Medicaid restricted benefit HMO
PH Pharmacy benefits only
POS Commercial POS
PPO Commercial PPO
SIF Self insured POS
SIH Self insured HMO
SIP Self insured PPO
SL Commercial stop loss
SN1 Special needs plan - chronic condition
SN2 Special needs plan - institutionalized
SN3 Special needs plan - dual eligible
ZZ Unknown
MC023 Discharge status 01 Discharged to home or self care
02 Discharged/transferred to another short term general hospital for inpatient care
03 Discharged/transferred to skilled nursing facility (SNF)
04 Discharged/transferred to nursing facility (NF)
05 Discharged/transferred to a designated cancer center or children's hospital
06 Discharged/transferred to home under care of organized home health service organization
07 Left against medical advice or discontinued care
08 Discharged/transferred to home under care of a Home IV provider
09 Admitted as an inpatient to this hospital
20 Expired
21 Discharged/transferred to court/law enforcement
30 Still patient or expected to return for outpatient services
40 Expired at home
41 Expired in a medical facility
42 Expired, place unknown
43 Discharged/transferred to a Federal hospital
50 Hospice - home
51 Hospice - medical facility
61 Discharged/transferred within this institution to a hospital based Medicare-approved swing bed
62 Discharged/transferred to an inpatient rehabilitation facility including distinct parts of a hospital
63 Discharge/transferred to a long-term care hospital
64 Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare
65 Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital
66 Discharged/transferred to a critical access hospital (CAH)
70 Discharged/transferred to another type of health care institution not defined elsewhere in this code list
MC036 Type of bill 111 Hospital Inpatient (Including Medicare Part A) Admit Through Discharge
112 Hospital Inpatient (Including Medicare Part A) Interim-First Claim
113 Hospital Inpatient (Including Medicare Part A) Interim-Continuing Claims
114 Hospital Inpatient (Including Medicare Part A) Interim-Last Claim
115 Hospital Inpatient (Including Medicare Part A) Late Charge Only
117 Hospital Inpatient (Including Medicare Part A) Replacement of Prior Claim
118 Hospital Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
119 Hospital Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
121 Hospital Inpatient (Medicare Part B Only) Admit Through Discharge
122 Hospital Inpatient (Medicare Part B Only) Interim-First Claim
123 Hospital Inpatient (Medicare Part B Only) Interim-Continuing Claims
124 Hospital Inpatient (Medicare Part B Only) Interim-Last Claim
125 Hospital Inpatient (Medicare Part B Only) Late Charge Only
127 Hospital Inpatient (Medicare Part B Only) Replacement of Prior Claim
128 Hospital Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
129 Hospital Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
131 Hospital Outpatient Admit Through Discharge
132 Hospital Outpatient Interim-First Claim
133 Hospital Outpatient Interim-Continuing Claims
134 Hospital Outpatient Interim-Last Claim
135 Hospital Outpatient Late Charge Only
137 Hospital Outpatient Replacement of Prior Claim
138 Hospital Outpatient Void/Cancel of a Prior Claim
139 Hospital Outpatient Final Claim for a Home Health Encounter
141 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
142 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
143 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
144 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
145 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
147 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
148 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
149 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
151 Hospital Nursing Facility Level I Admit Through Discharge
152 Hospital Nursing Facility Level I Interim-First Claim
153 Hospital Nursing Facility Level I Interim-Continuing Claims
154 Hospital Nursing Facility Level I Interim-Last Claim
155 Hospital Nursing Facility Level I Late Charge Only
157 Hospital Nursing Facility Level I Replacement of Prior Claim
158 Hospital Nursing Facility Level I Void/Cancel of a Prior Claim
159 Hospital Nursing Facility Level I Final Claim for a Home Health Encounter
161 Hospital Nursing Facility Level II Admit Through Discharge
162 Hospital Nursing Facility Level II Interim-First Claim
163 Hospital Nursing Facility Level II Interim-Continuing Claims
164 Hospital Nursing Facility Level II Interim-Last Claim
165 Hospital Nursing Facility Level II Late Charge Only
167 Hospital Nursing Facility Level II Replacement of Prior Claim
168 Hospital Nursing Facility Level II Void/Cancel of a Prior Claim
169 Hospital Nursing Facility Level II Final Claim for a Home Health Encounter
171 Hospital Intermediate Care -Level III Nursing Facility Admit Through Discharge
172 Hospital Intermediate Care -Level III Nursing Facility Interim-First Claim
173 Hospital Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
174 Hospital Intermediate Care -Level III Nursing Facility Interim-Last Claim
175 Hospital Intermediate Care -Level III Nursing Facility Late Charge Only
177 Hospital Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
178 Hospital Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
179 Hospital Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
181 Hospital Swing Beds Admit Through Discharge
182 Hospital Swing Beds Interim-First Claim
183 Hospital Swing Beds Interim-Continuing Claims
184 Hospital Swing Beds Interim-Last Claim
185 Hospital Swing Beds Late Charge Only
187 Hospital Swing Beds Replacement of Prior Claim
188 Hospital Swing Beds Void/Cancel of a Prior Claim
189 Hospital Swing Beds Final Claim for a Home Health Encounter
211 Skilled Nursing Inpatient (Including Medicare Part A) Admit Through Discharge
212 Skilled Nursing Inpatient (Including Medicare Part A) Interim-First Claim
213 Skilled Nursing Inpatient (Including Medicare Part A) Interim-Continuing Claims
214 Skilled Nursing Inpatient (Including Medicare Part A) Interim-Last Claim
215 Skilled Nursing Inpatient (Including Medicare Part A) Late Charge Only
217 Skilled Nursing Inpatient (Including Medicare Part A) Replacement of Prior Claim
218 Skilled Nursing Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
219 Skilled Nursing Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
221 Skilled Nursing Inpatient (Medicare Part B Only) Admit Through Discharge
222 Skilled Nursing Inpatient (Medicare Part B Only) Interim-First Claim
223 Skilled Nursing Inpatient (Medicare Part B Only) Interim-Continuing Claims
224 Skilled Nursing Inpatient (Medicare Part B Only) Interim-Last Claim
225 Skilled Nursing Inpatient (Medicare Part B Only) Late Charge Only
227 Skilled Nursing Inpatient (Medicare Part B Only) Replacement of Prior Claim
228 Skilled Nursing Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
229 Skilled Nursing Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
231 Skilled Nursing Outpatient Admit Through Discharge
232 Skilled Nursing Outpatient Interim-First Claim
233 Skilled Nursing Outpatient Interim-Continuing Claims
234 Skilled Nursing Outpatient Interim-Last Claim
235 Skilled Nursing Outpatient Late Charge Only
237 Skilled Nursing Outpatient Replacement of Prior Claim
238 Skilled Nursing Outpatient Void/Cancel of a Prior Claim
239 Skilled Nursing Outpatient Final Claim for a Home Health Encounter
241 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
242 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
243 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
244 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
245 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
247 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
248 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
249 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
251 Skilled Nursing Nursing Facility Level I Admit Through Discharge
252 Skilled Nursing Nursing Facility Level I Interim-First Claim
253 Skilled Nursing Nursing Facility Level I Interim-Continuing Claims
254 Skilled Nursing Nursing Facility Level I Interim-Last Claim
255 Skilled Nursing Nursing Facility Level I Late Charge Only
257 Skilled Nursing Nursing Facility Level I Replacement of Prior Claim
258 Skilled Nursing Nursing Facility Level I Void/Cancel of a Prior Claim
259 Skilled Nursing Nursing Facility Level I Final Claim for a Home Health Encounter
261 Skilled Nursing Nursing Facility Level II Admit Through Discharge
262 Skilled Nursing Nursing Facility Level II Interim-First Claim
263 Skilled Nursing Nursing Facility Level II Interim-Continuing Claims
264 Skilled Nursing Nursing Facility Level II Interim-Last Claim
265 Skilled Nursing Nursing Facility Level II Late Charge Only
267 Skilled Nursing Nursing Facility Level II Replacement of Prior Claim
268 Skilled Nursing Nursing Facility Level II Void/Cancel of a Prior Claim
269 Skilled Nursing Nursing Facility Level II Final Claim for a Home Health Encounter
271 Skilled Nursing Intermediate Care -Level III Nursing Facility Admit Through Discharge
272 Skilled Nursing Intermediate Care -Level III Nursing Facility Interim-First Claim
273 Skilled Nursing Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
274 Skilled Nursing Intermediate Care -Level III Nursing Facility Interim-Last Claim
275 Skilled Nursing Intermediate Care -Level III Nursing Facility Late Charge Only
277 Skilled Nursing Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
278 Skilled Nursing Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
279 Skilled Nursing Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
281 Skilled Nursing Swing Beds Admit Through Discharge
282 Skilled Nursing Swing Beds Interim-First Claim
283 Skilled Nursing Swing Beds Interim-Continuing Claims
284 Skilled Nursing Swing Beds Interim-Last Claim
285 Skilled Nursing Swing Beds Late Charge Only
287 Skilled Nursing Swing Beds Replacement of Prior Claim
288 Skilled Nursing Swing Beds Void/Cancel of a Prior Claim
289 Skilled Nursing Swing Beds Final Claim for a Home Health Encounter
311 Home Health Inpatient (Including Medicare Part A) Admit Through Discharge
312 Home Health Inpatient (Including Medicare Part A) Interim-First Claim
313 Home Health Inpatient (Including Medicare Part A) Interim-Continuing Claims
314 Home Health Inpatient (Including Medicare Part A) Interim-Last Claim
315 Home Health Inpatient (Including Medicare Part A) Late Charge Only
317 Home Health Inpatient (Including Medicare Part A) Replacement of Prior Claim
318 Home Health Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
319 Home Health Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
321 Home Health Inpatient (Medicare Part B Only) Admit Through Discharge
322 Home Health Inpatient (Medicare Part B Only) Interim-First Claim
323 Home Health Inpatient (Medicare Part B Only) Interim-Continuing Claims
324 Home Health Inpatient (Medicare Part B Only) Interim-Last Claim
325 Home Health Inpatient (Medicare Part B Only) Late Charge Only
327 Home Health Inpatient (Medicare Part B Only) Replacement of Prior Claim
328 Home Health Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
329 Home Health Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
331 Home Health Outpatient Admit Through Discharge
332 Home Health Outpatient Interim-First Claim
333 Home Health Outpatient Interim-Continuing Claims
334 Home Health Outpatient Interim-Last Claim
335 Home Health Outpatient Late Charge Only
337 Home Health Outpatient Replacement of Prior Claim
338 Home Health Outpatient Void/Cancel of a Prior Claim
339 Home Health Outpatient Final Claim for a Home Health Encounter
341 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
342 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
343 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
344 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
345 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
347 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
348 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
349 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
351 Home Health Nursing Facility Level I Admit Through Discharge
352 Home Health Nursing Facility Level I Interim-First Claim
353 Home Health Nursing Facility Level I Interim-Continuing Claims
354 Home Health Nursing Facility Level I Interim-Last Claim
355 Home Health Nursing Facility Level I Late Charge Only
357 Home Health Nursing Facility Level I Replacement of Prior Claim
358 Home Health Nursing Facility Level I Void/Cancel of a Prior Claim
359 Home Health Nursing Facility Level I Final Claim for a Home Health Encounter
361 Home Health Nursing Facility Level II Admit Through Discharge
362 Home Health Nursing Facility Level II Interim-First Claim
363 Home Health Nursing Facility Level II Interim-Continuing Claims
364 Home Health Nursing Facility Level II Interim-Last Claim
365 Home Health Nursing Facility Level II Late Charge Only
367 Home Health Nursing Facility Level II Replacement of Prior Claim
368 Home Health Nursing Facility Level II Void/Cancel of a Prior Claim
369 Home Health Nursing Facility Level II Final Claim for a Home Health Encounter
371 Home Health Intermediate Care -Level III Nursing Facility Admit Through Discharge
372 Home Health Intermediate Care -Level III Nursing Facility Interim-First Claim
373 Home Health Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
374 Home Health Intermediate Care -Level III Nursing Facility Interim-Last Claim
375 Home Health Intermediate Care -Level III Nursing Facility Late Charge Only
377 Home Health Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
378 Home Health Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
379 Home Health Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
381 Home Health Swing Beds Admit Through Discharge
382 Home Health Swing Beds Interim-First Claim
383 Home Health Swing Beds Interim-Continuing Claims
384 Home Health Swing Beds Interim-Last Claim
385 Home Health Swing Beds Late Charge Only
387 Home Health Swing Beds Replacement of Prior Claim
388 Home Health Swing Beds Void/Cancel of a Prior Claim
389 Home Health Swing Beds Final Claim for a Home Health Encounter
411 Christian Science Hospital Inpatient (Including Medicare Part A) Admit Through Discharge
412 Christian Science Hospital Inpatient (Including Medicare Part A) Interim-First Claim
413 Christian Science Hospital Inpatient (Including Medicare Part A) Interim-Continuing Claims
414 Christian Science Hospital Inpatient (Including Medicare Part A) Interim-Last Claim
415 Christian Science Hospital Inpatient (Including Medicare Part A) Late Charge Only
417 Christian Science Hospital Inpatient (Including Medicare Part A) Replacement of Prior Claim
418 Christian Science Hospital Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
419 Christian Science Hospital Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
421 Christian Science Hospital Inpatient (Medicare Part B Only) Admit Through Discharge
422 Christian Science Hospital Inpatient (Medicare Part B Only) Interim-First Claim
423 Christian Science Hospital Inpatient (Medicare Part B Only) Interim-Continuing Claims
424 Christian Science Hospital Inpatient (Medicare Part B Only) Interim-Last Claim
425 Christian Science Hospital Inpatient (Medicare Part B Only) Late Charge Only
427 Christian Science Hospital Inpatient (Medicare Part B Only) Replacement of Prior Claim
428 Christian Science Hospital Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
429 Christian Science Hospital Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
431 Christian Science Hospital Outpatient Admit Through Discharge
432 Christian Science Hospital Outpatient Interim-First Claim
433 Christian Science Hospital Outpatient Interim-Continuing Claims
434 Christian Science Hospital Outpatient Interim-Last Claim
435 Christian Science Hospital Outpatient Late Charge Only
437 Christian Science Hospital Outpatient Replacement of Prior Claim
438 Christian Science Hospital Outpatient Void/Cancel of a Prior Claim
439 Christian Science Hospital Outpatient Final Claim for a Home Health Encounter
441 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
442 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
443 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
444 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
445 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
447 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
448 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
449 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
451 Christian Science Hospital Nursing Facility Level I Admit Through Discharge
452 Christian Science Hospital Nursing Facility Level I Interim-First Claim
453 Christian Science Hospital Nursing Facility Level I Interim-Continuing Claims
454 Christian Science Hospital Nursing Facility Level I Interim-Last Claim
455 Christian Science Hospital Nursing Facility Level I Late Charge Only
457 Christian Science Hospital Nursing Facility Level I Replacement of Prior Claim
458 Christian Science Hospital Nursing Facility Level I Void/Cancel of a Prior Claim
459 Christian Science Hospital Nursing Facility Level I Final Claim for a Home Health Encounter
461 Christian Science Hospital Nursing Facility Level II Admit Through Discharge
462 Christian Science Hospital Nursing Facility Level II Interim-First Claim
463 Christian Science Hospital Nursing Facility Level II Interim-Continuing Claims
464 Christian Science Hospital Nursing Facility Level II Interim-Last Claim
465 Christian Science Hospital Nursing Facility Level II Late Charge Only
467 Christian Science Hospital Nursing Facility Level II Replacement of Prior Claim
468 Christian Science Hospital Nursing Facility Level II Void/Cancel of a Prior Claim
469 Christian Science Hospital Nursing Facility Level II Final Claim for a Home Health Encounter
471 Christian Science Hospital Intermediate Care -Level III Nursing Facility Admit Through Discharge
472 Christian Science Hospital Intermediate Care -Level III Nursing Facility Interim-First Claim
473 Christian Science Hospital Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
474 Christian Science Hospital Intermediate Care -Level III Nursing Facility Interim-Last Claim
475 Christian Science Hospital Intermediate Care -Level III Nursing Facility Late Charge Only
477 Christian Science Hospital Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
478 Christian Science Hospital Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
479 Christian Science Hospital Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
481 Christian Science Hospital Swing Beds Admit Through Discharge
482 Christian Science Hospital Swing Beds Interim-First Claim
483 Christian Science Hospital Swing Beds Interim-Continuing Claims
484 Christian Science Hospital Swing Beds Interim-Last Claim
485 Christian Science Hospital Swing Beds Late Charge Only
487 Christian Science Hospital Swing Beds Replacement of Prior Claim
488 Christian Science Hospital Swing Beds Void/Cancel of a Prior Claim
489 Christian Science Hospital Swing Beds Final Claim for a Home Health Encounter
511 Christian Science Extended Care Inpatient (Including Medicare Part A) Admit Through Discharge
512 Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-First Claim
513 Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-Continuing Claims
514 Christian Science Extended Care Inpatient (Including Medicare Part A) Interim-Last Claim
515 Christian Science Extended Care Inpatient (Including Medicare Part A) Late Charge Only
517 Christian Science Extended Care Inpatient (Including Medicare Part A) Replacement of Prior Claim
518 Christian Science Extended Care Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
519 Christian Science Extended Care Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
521 Christian Science Extended Care Inpatient (Medicare Part B Only) Admit Through Discharge
522 Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-First Claim
523 Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-Continuing Claims
524 Christian Science Extended Care Inpatient (Medicare Part B Only) Interim-Last Claim
525 Christian Science Extended Care Inpatient (Medicare Part B Only) Late Charge Only
527 Christian Science Extended Care Inpatient (Medicare Part B Only) Replacement of Prior Claim
528 Christian Science Extended Care Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
529 Christian Science Extended Care Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
531 Christian Science Extended Care Outpatient Admit Through Discharge
532 Christian Science Extended Care Outpatient Interim-First Claim
533 Christian Science Extended Care Outpatient Interim-Continuing Claims
534 Christian Science Extended Care Outpatient Interim-Last Claim
535 Christian Science Extended Care Outpatient Late Charge Only
537 Christian Science Extended Care Outpatient Replacement of Prior Claim
538 Christian Science Extended Care Outpatient Void/Cancel of a Prior Claim
539 Christian Science Extended Care Outpatient Final Claim for a Home Health Encounter
541 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
542 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
543 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
544 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
545 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
547 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
548 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
549 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
551 Christian Science Extended Care Nursing Facility Level I Admit Through Discharge
552 Christian Science Extended Care Nursing Facility Level I Interim-First Claim
553 Christian Science Extended Care Nursing Facility Level I Interim-Continuing Claims
554 Christian Science Extended Care Nursing Facility Level I Interim-Last Claim
555 Christian Science Extended Care Nursing Facility Level I Late Charge Only
557 Christian Science Extended Care Nursing Facility Level I Replacement of Prior Claim
558 Christian Science Extended Care Nursing Facility Level I Void/Cancel of a Prior Claim
559 Christian Science Extended Care Nursing Facility Level I Final Claim for a Home Health Encounter
561 Christian Science Extended Care Nursing Facility Level II Admit Through Discharge
562 Christian Science Extended Care Nursing Facility Level II Interim-First Claim
563 Christian Science Extended Care Nursing Facility Level II Interim-Continuing Claims
564 Christian Science Extended Care Nursing Facility Level II Interim-Last Claim
565 Christian Science Extended Care Nursing Facility Level II Late Charge Only
567 Christian Science Extended Care Nursing Facility Level II Replacement of Prior Claim
568 Christian Science Extended Care Nursing Facility Level II Void/Cancel of a Prior Claim
569 Christian Science Extended Care Nursing Facility Level II Final Claim for a Home Health Encounter
571 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Admit Through Discharge
572 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Interim-First Claim
573 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
574 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Interim-Last Claim
575 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Late Charge Only
577 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
578 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
579 Christian Science Extended Care Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
581 Christian Science Extended Care Swing Beds Admit Through Discharge
582 Christian Science Extended Care Swing Beds Interim-First Claim
583 Christian Science Extended Care Swing Beds Interim-Continuing Claims
584 Christian Science Extended Care Swing Beds Interim-Last Claim
585 Christian Science Extended Care Swing Beds Late Charge Only
587 Christian Science Extended Care Swing Beds Replacement of Prior Claim
588 Christian Science Extended Care Swing Beds Void/Cancel of a Prior Claim
589 Christian Science Extended Care Swing Beds Final Claim for a Home Health Encounter
611 Intermediate Care Inpatient (Including Medicare Part A) Admit Through Discharge
612 Intermediate Care Inpatient (Including Medicare Part A) Interim-First Claim
613 Intermediate Care Inpatient (Including Medicare Part A) Interim-Continuing Claims
614 Intermediate Care Inpatient (Including Medicare Part A) Interim-Last Claim
615 Intermediate Care Inpatient (Including Medicare Part A) Late Charge Only
617 Intermediate Care Inpatient (Including Medicare Part A) Replacement of Prior Claim
618 Intermediate Care Inpatient (Including Medicare Part A) Void/Cancel of a Prior Claim
619 Intermediate Care Inpatient (Including Medicare Part A) Final Claim for a Home Health Encounter
621 Intermediate Care Inpatient (Medicare Part B Only) Admit Through Discharge
622 Intermediate Care Inpatient (Medicare Part B Only) Interim-First Claim
623 Intermediate Care Inpatient (Medicare Part B Only) Interim-Continuing Claims
624 Intermediate Care Inpatient (Medicare Part B Only) Interim-Last Claim
625 Intermediate Care Inpatient (Medicare Part B Only) Late Charge Only
627 Intermediate Care Inpatient (Medicare Part B Only) Replacement of Prior Claim
628 Intermediate Care Inpatient (Medicare Part B Only) Void/Cancel of a Prior Claim
629 Intermediate Care Inpatient (Medicare Part B Only) Final Claim for a Home Health Encounter
631 Intermediate Care Outpatient Admit Through Discharge
632 Intermediate Care Outpatient Interim-First Claim
633 Intermediate Care Outpatient Interim-Continuing Claims
634 Intermediate Care Outpatient Interim-Last Claim
635 Intermediate Care Outpatient Late Charge Only
637 Intermediate Care Outpatient Replacement of Prior Claim
638 Intermediate Care Outpatient Void/Cancel of a Prior Claim
639 Intermediate Care Outpatient Final Claim for a Home Health Encounter
641 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit Through Discharge
642 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-First Claim
643 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Continuing Claims
644 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim-Last Claim
645 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
647 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
648 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of a Prior Claim
649 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Final Claim for a Home Health Encounter
651 Intermediate Care Nursing Facility Level I Admit Through Discharge
652 Intermediate Care Nursing Facility Level I Interim-First Claim
653 Intermediate Care Nursing Facility Level I Interim-Continuing Claims
654 Intermediate Care Nursing Facility Level I Interim-Last Claim
655 Intermediate Care Nursing Facility Level I Late Charge Only
657 Intermediate Care Nursing Facility Level I Replacement of Prior Claim
658 Intermediate Care Nursing Facility Level I Void/Cancel of a Prior Claim
659 Intermediate Care Nursing Facility Level I Final Claim for a Home Health Encounter
661 Intermediate Care Nursing Facility Level II Admit Through Discharge
662 Intermediate Care Nursing Facility Level II Interim-First Claim
663 Intermediate Care Nursing Facility Level II Interim-Continuing Claims
664 Intermediate Care Nursing Facility Level II Interim-Last Claim
665 Intermediate Care Nursing Facility Level II Late Charge Only
667 Intermediate Care Nursing Facility Level II Replacement of Prior Claim
668 Intermediate Care Nursing Facility Level II Void/Cancel of a Prior Claim
669 Intermediate Care Nursing Facility Level II Final Claim for a Home Health Encounter
671 Intermediate Care Intermediate Care -Level III Nursing Facility Admit Through Discharge
672 Intermediate Care Intermediate Care -Level III Nursing Facility Interim-First Claim
673 Intermediate Care Intermediate Care -Level III Nursing Facility Interim-Continuing Claims
674 Intermediate Care Intermediate Care -Level III Nursing Facility Interim-Last Claim
675 Intermediate Care Intermediate Care -Level III Nursing Facility Late Charge Only
677 Intermediate Care Intermediate Care -Level III Nursing Facility Replacement of Prior Claim
678 Intermediate Care Intermediate Care -Level III Nursing Facility Void/Cancel of a Prior Claim
679 Intermediate Care Intermediate Care -Level III Nursing Facility Final Claim for a Home Health Encounter
681 Intermediate Care Swing Beds Admit Through Discharge
682 Intermediate Care Swing Beds Interim-First Claim
683 Intermediate Care Swing Beds Interim-Continuing Claims
684 Intermediate Care Swing Beds Interim-Last Claim
685 Intermediate Care Swing Beds Late Charge Only
687 Intermediate Care Swing Beds Replacement of Prior Claim
688 Intermediate Care Swing Beds Void/Cancel of a Prior Claim
689 Intermediate Care Swing Beds Final Claim for a Home Health Encounter
711 Clinic Rural Health Admit Through Discharge
712 Clinic Rural Health Interim-First Claim
713 Clinic Rural Health Interim-Continuing Claims
714 Clinic Rural Health Interim-Last Claim
715 Clinic Rural Health Late Charge Only
717 Clinic Rural Health Replacement of Prior Claim
718 Clinic Rural Health Void/Cancel of a Prior Claim
719 Clinic Rural Health Final Claim for a Home Health Encounter
721 Clinic Hospital Based or Independent Renal Dialysis Center Admit Through Discharge
722 Clinic Hospital Based or Independent Renal Dialysis Center Interim-First Claim
723 Clinic Hospital Based or Independent Renal Dialysis Center Interim-Continuing Claims
724 Clinic Hospital Based or Independent Renal Dialysis Center Interim-Last Claim
725 Clinic Hospital Based or Independent Renal Dialysis Center Late Charge Only
727 Clinic Hospital Based or Independent Renal Dialysis Center Replacement of Prior Claim
728 Clinic Hospital Based or Independent Renal Dialysis Center Void/Cancel of a Prior Claim
729 Clinic Hospital Based or Independent Renal Dialysis Center Final Claim for a Home Health Encounter
731 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Admit Through Discharge
732 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Interim-First Claim
733 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Interim-Continuing Claims
734 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Interim-Last Claim
735 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Late Charge Only
737 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Replacement of Prior Claim
738 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Void/Cancel of a Prior Claim
739 Clinic Free Standing Outpatient Rehabilitation Facility (ORF) Final Claim for a Home Health Encounter
751 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Admit Through Discharge
752 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim-First Claim
753 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim-Continuing Claims
754 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim-Last Claim
755 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Late Charge Only
757 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Replacement of Prior Claim
758 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Void/Cancel of a Prior Claim
759 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Final Claim for a Home Health Encounter
761 Clinic Nursing Facility Level II Admit Through Discharge
762 Clinic Nursing Facility Level II Interim-First Claim
763 Clinic Nursing Facility Level II Interim-Continuing Claims
764 Clinic Nursing Facility Level II Interim-Last Claim
765 Clinic Nursing Facility Level II Late Charge Only
767 Clinic Nursing Facility Level II Replacement of Prior Claim
768 Clinic Nursing Facility Level II Void/Cancel of a Prior Claim
769 Clinic Nursing Facility Level II Final Claim for a Home Health Encounter
771 Clinic Community Mental Health Center Admit Through Discharge
772 Clinic Community Mental Health Center Interim-First Claim
773 Clinic Community Mental Health Center Interim-Continuing Claims
774 Clinic Community Mental Health Center Interim-Last Claim
775 Clinic Community Mental Health Center Late Charge Only
777 Clinic Community Mental Health Center Replacement of Prior Claim
778 Clinic Community Mental Health Center Void/Cancel of a Prior Claim
779 Clinic Community Mental Health Center Final Claim for a Home Health Encounter
791 Clinic Other Admit Through Discharge
792 Clinic Other Interim-First Claim
793 Clinic Other Interim-Continuing Claims
794 Clinic Other Interim-Last Claim
795 Clinic Other Late Charge Only
797 Clinic Other Replacement of Prior Claim
798 Clinic Other Void/Cancel of a Prior Claim
799 Clinic Other Final Claim for a Home Health Encounter
811 Special Facility Hospice (Non Hospital Based) Admit Through Discharge
812 Special Facility Hospice (Non Hospital Based) Interim-First Claim
813 Special Facility Hospice (Non Hospital Based) Interim-Continuing Claims
814 Special Facility Hospice (Non Hospital Based) Interim-Last Claim
815 Special Facility Hospice (Non Hospital Based) Late Charge Only
817 Special Facility Hospice (Non Hospital Based) Replacement of Prior Claim
818 Special Facility Hospice (Non Hospital Based) Void/Cancel of a Prior Claim
819 Special Facility Hospice (Non Hospital Based) Final Claim for a Home Health Encounter
821 Special Facility Hospice (Hospital-Based) Admit Through Discharge
822 Special Facility Hospice (Hospital-Based) Interim-First Claim
823 Special Facility Hospice (Hospital-Based) Interim-Continuing Claims
824 Special Facility Hospice (Hospital-Based) Interim-Last Claim
825 Special Facility Hospice (Hospital-Based) Late Charge Only
827 Special Facility Hospice (Hospital-Based) Replacement of Prior Claim
828 Special Facility Hospice (Hospital-Based) Void/Cancel of a Prior Claim
829 Special Facility Hospice (Hospital-Based) Final Claim for a Home Health Encounter
831 Special Facility Ambulatory Surgery Center Admit Through Discharge
832 Special Facility Ambulatory Surgery Center Interim-First Claim
833 Special Facility Ambulatory Surgery Center Interim-Continuing Claims
834 Special Facility Ambulatory Surgery Center Interim-Last Claim
835 Special Facility Ambulatory Surgery Center Late Charge Only
837 Special Facility Ambulatory Surgery Center Replacement of Prior Claim
838 Special Facility Ambulatory Surgery Center Void/Cancel of a Prior Claim
839 Special Facility Ambulatory Surgery Center Final Claim for a Home Health Encounter
841 Special Facility Free Standing Birthing Center Admit Through Discharge
842 Special Facility Free Standing Birthing Center Interim-First Claim
843 Special Facility Free Standing Birthing Center Interim-Continuing Claims
844 Special Facility Free Standing Birthing Center Interim-Last Claim
845 Special Facility Free Standing Birthing Center Late Charge Only
847 Special Facility Free Standing Birthing Center Replacement of Prior Claim
848 Special Facility Free Standing Birthing Center Void/Cancel of a Prior Claim
849 Special Facility Free Standing Birthing Center Final Claim for a Home Health Encounter
891 Special Facility Other Admit Through Discharge
892 Special Facility Other Interim-First Claim
893 Special Facility Other Interim-Continuing Claims
894 Special Facility Other Interim-Last Claim
895 Special Facility Other Late Charge Only
897 Special Facility Other Replacement of Prior Claim
898 Special Facility Other Void/Cancel of a Prior Claim
899 Special Facility Other Final Claim for a Home Health Encounter
MC037 Place of service 00 Not supplied
01 Pharmacy
03 School
04 Homeless Shelter
05 Indian Health Service Freestanding Facility
06 Indian Health Service Provider-Based Facility
07 Tribal 638 Freestanding Facility
08 Tribal 638 Provider-Based Facility
09 Prison/Correctional Facility
11 Office
12 Home
13 Assisted Living Facility
14 Group Home
15 Mobile Unit
16 Temporary Lodging
17 Walk-in Retail Health Clinic
20 Urgent Care Facility
21 Inpatient Hospital
22 Outpatient Hospital
23 Emergency Room - Hospital
24 Ambulatory Surgical Center
25 Birthing Center
26 Military Treatment Facility
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
34 Hospice
41 Ambulance-Land
42 Ambulance-Air or Water
49 Independent Clinic
50 Federally Qualified Health Center
51 Inpatient Psychiatric Facility
52 Psychiatric Facility-Partial Hospitalization
53 Community Mental Health Center
54 Intermediate Care Facility/Mentally Retarded
55 Residential Substance Abuse Treatment Facility
56 Psychiatric Residential Treatment Center
57 Non-residential Substance Abuse Treatment Facility
60 Mass Immunization Center
61 Comprehensive Inpatient Rehabilitation Facility
62 Comprehensive Outpatient Rehabilitation Facility
65 End-Stage Renal Disease Treatment Facility
71 State or Local Public Health Clinic
72 Rural Health Clinic
81 Independent Laboratory
99 Other Place of Service
MC038 Claim status C CCO encounter
D denied
E other managed care encounter
P paid
MC038A COB status N no
Y yes
MC041P POA flag 1 1 Diagnosis exempt from POA reporting
N No
U Information not in record
W Clinically undetermined
Y Yes
MC042P POA flag 2 1 Diagnosis exempt from POA reporting
N No
N No
U Information not in record
W Clinically undetermined
Y Yes
MC043P POA flag 3 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC044P POA flag 4 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC045P POA flag 5 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC046P POA flag 6 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC047P POA flag 7 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC048P POA flag 8 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC049P POA flag 9 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC050P POA flag 10 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC051P POA flag 11 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC052P POA flag 12 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
MC053P POA flag 13 1 Diagnosis exempt from POA reporting
N no
N No
U Information not in record
W Clinically undetermined
Y Yes
QC23 DRG type C CMS v.24
M MS-DRG
MC201 ICD version code 9 ICD-9
10 ICD-10
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