United States Health Information Knowledgebase

 

Medical Claims File Submission

Virginia



Name:Medical Claims File Submission
State:Virginia
Definition:Not Provided
VersionAugust 2013 - v1.2

File Specification for Medical Claims File Submission

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided char 2
HD002 Payer Code NAIC code (example: 12345); leave blank if not applicable varchar 8
HD003 Payer Name Not Provided varchar 75
HD004 Beginning Month Not Provided date CCYYMM 6
HD005 Ending Month Not Provided date CCYYMM 6
HD006 Record count Total number of records submitted in the medical claims file, excluding header and trailer records int 10
MC001 Payer Payer submitting payments varchar 8
MC002 National Plan ID CMS National Plan ID 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. 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. tinyint 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. tinyint 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. varchar 20
MC010 Member Identification Code (patient) Member's social security number; Set as null if contract number = subscriber's social security number or use an alternate unique identifier such as Medicaid ID. Must be an identifier that is unique to the member. varchar 9
MC011 Individual Relationship Code Member's relationship to insured char 2
MC012 Member Gender Not Provided char 1
MC013 Member Date of Birth Not Provided char CCYYMMDD 8
MC014 Member City Name City name of member varchar 30
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 CCYYMMDD 8
MC018 Admission Date Required for all inpatient claims. char CCYYMMDD 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) tinyint 1
MC021 Admission Source Required for all inpatient claims (SOURCE: National Uniform Billing Data Element Specifications) char 1
MC022 Discharge Hour Time expressed in military time tinyint HHMM 4
MC023 Discharge Status Required for all inpatient claims. See Lookup Table B-1.E for codes. char 2
MC024 Service Provider Number Payer assigned service provider number, preferably for the individual provider but alternately for the clinic where the service occurred. 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. Health care claims processors shall code according to: 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 As defined by payer. Dictionary for specialty code values must be supplied during testing. varchar 10
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 Place of Service - 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
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 Procedure Code Health Care Common Procedural Coding System (HCPCS); This includes the CPT codes of the American Medical Association. varchar 10
MC056 Procedure Modifier - 1 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. char 2
MC057 Procedure Modifier - 2 Procedure modifier required when a modifier clarifies/improves the reporting accuracy of the associated procedure code. char 2
MC058 ICD-9/10-CM Principal Procedure Code Primary procedure code for this line of service. Do not code decimal point. char 7
MC059 Date of Service - From First date of service for this service line. date CCYYMMDD 8
MC060 Date of Service - Thru Last date of service for this service line. date CCYYMMDD 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. 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 CCYYMMDD 8
MC070 Service Provider Country Name Code US for United States. 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 LastName 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 Member last name varchar 128
MC105 Member First Name Member first name varchar 128
MC106 Member Middle Initial Member middle intial char 1
MC107 Member Street Address Physical street address of the covered member varchar 50
MC108 Service Provider Street Address Physical practice location street address of the provider administering the services varchar 50
MC200 ICD-9 / ICD-10 Flag The purpose of this field is to identify which code set is being utilized. char 1
MC201 ICD-9/10-CM Other Procedure Code - 1 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC202 ICD-9/10-CM Other Procedure Code - 2 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC203 ICD-9/10-CM Other Procedure Code - 3 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC204 ICD-9/10-CM Other Procedure Code - 4 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC205 ICD-9/10-CM Other Procedure Code - 5 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC206 ICD-9/10-CM Other Procedure Code - 6 Secondary procedure code for this line of service. Do not code decimal point. varchar 7
MC207 Carrier Associated with Claim For each claim, the NAIC code of the carrier when a TPA processes claims on behalf of the carrier. Optional if all medical claims processed by data submitters acting as Third Party Administrators (TPAs) under contract to a data submitter for carved-out services are submitted by the data submitter with unified member IDs in all files. varchar 8
MC208 Carrier Plan Specific Contract Number or Subscriber/Member Social Security Number For each claim, the carrier specific contract number or subscriber/member social security number when a TPA processes claims on behalf of the carrier. Optional if all medical claims processed by data submitters acting as Third Party Administrators (TPAs) under contract to a data submitter for carved-out services are submitted by the data submitter with unified member IDs in all files. varchar 128
MC209 Practitioner Group Practice Name of group practice to which a practitioner is affiliated if different from MC078 varchar 60
MC899 Record Type Not Provided char 2
TR001 Record Type Not Provided char 2
TR002 Payer Code NAIC code (example: 12345); leave blank if not applicable varchar 8
TR003 Payer Name Not Provided varchar 75
TR004 Beginning Month Not Provided date CCYYMM 6
TR005 Ending Month Not Provided date CCYYMM 6
TR006 Extraction Date Not Provided date CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type MC
MC003 Insurance Type/Product Code 12 Preferred Provider Organization (PPO)
13 Point of Service (POS)
15 Indemnity Insurance
16 Health Maintenance Organization (HMO) Medicare Advantage
99 Other
CI Commercial Insurance Company
FE Federal Employees Health Benefits Program
HM Health Maintenance Organization
HN HMO Medicare Risk/ Medicare Part C
MA Medicare Part A
MB Medicare Part B
MC Medicaid
MD Medicare Part D
MP Medicare Primary
QM Qualified Medicare Beneficiary
SP Supplemental Policy
TR Tricare
TV Title V
MC011 Individual Relationship Code 01 Spouse
04 Grandfather or Grandmother
05 Grandson or Granddaughter
07 Nephew or Niece
10 Foster Child
15 Ward
17 Stepson or Stepdaughter
19 Child
20 Employee/Self
21 Unknown
22 Handicapped Dependent
23 Sponsored Dependent
24 Dependent of a Minor Dependent
29 Significant Other
32 Mother
33 Father
36 Emancipated Minor
39 Organ Donor
40 Cadaver Donor
41 Injured Plaintiff
43 Child Where Insured Has No Financial Responsibility
53 Life Partner
76 Dependent
MC012 Member Gender F Female
M Male
U Unknown
MC020 Admission Type 1 Emergency
2 Urgent
3 Elective
4 Newborn
5 Trauma Center
9 Information not available
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 a facility that provides custodial or supportive care
05 Discharged/transferred to a designated cancer center of 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 Reserved for assignment by the NUBC
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 Discharged/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)
69 Discharged/transferred to a designated disaster alternative care site (effective 10/1/13)
70 discharged/transferred to another type of health care institution not defined elsewhere in this code list
81 Discharged to home or self care with a planned acute care hospital inpatient readmission (effective 10/1/13)
82 Discharged / transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission (effective 10/1/13)
83 Discharged / transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission (effective 10/1/13)
84 Discharged / transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission (effective 10/1/13)
85 Discharged / transferred to designated cancer center of children's hospital with a planned acute care hospital inpatient readmission (effective 10/1/13)
86 Discharged / transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (effective 10/1/13)
87 Discharged / transferred to court / law enforcement with a planned acute care hospital inpatient readmission (effective 10/1/13)
88 Discharged / transferred to a federal health care facility with a planned acute care hospital inpatient readmission (effective 10/1/13)
89 Discharged / transferred to a hospital?based Medicare approved swing bed with a planned acute care hospital inpatient readmission (effective 10/1/13)
90 Discharged / transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission (effective 10/1/13)
91 Discharged / transferred to a medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission (effective 10/1/13)
92 Discharged / transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (effective 10/1/13)
93 Discharged / transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission (effective 10/1/13)
94 Discharged / transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission (effective 10/1/13)
95 Discharged / transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (effective 10/1/13)
MC027 Service Provider Entity Type Qualifier 1 Person
2 Non-Person Entity
MC036 Type of Bill - Institutional 110 Hospital Inpatient (Including Medicare Part A) Non-Payment/Zero
111 Hospital Inpatient (Including Medicare Part A) admit through discharge
112 Hospital Inpatient (Including Medicare Part A) interim - first claim used for the...
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) Admission/Election Notice
120 Hospital Inpatient (Medicare Part B Only) Non-Payment/Zero
121 Hospital Inpatient (Medicare Part B Only) admit through discharge
122 Hospital Inpatient (Medicare Part B Only) interim - first claim used for the...
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) Admission/Election Notice
130 Hospital Outpatient Non-Payment/Zero
131 Hospital Outpatient admit through discharge
132 Hospital Outpatient interim - first claim used for the...
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 Admission/Election Notice
140 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
150 Hospital Nursing Facility Level I Non-Payment/Zero
151 Hospital Nursing Facility Level I admit through discharge
152 Hospital Nursing Facility Level I interim - first claim used for the...
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 Admission/Election Notice
160 Hospital Nursing Facility Level II Non-Payment/Zero
161 Hospital Nursing Facility Level II admit through discharge
162 Hospital Nursing Facility Level II interim - first claim used for the...
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 Admission/Election Notice
170 Hospital Intermediate Care - Level III Nursing Facility Non-Payment/Zero
171 Hospital Intermediate Care - Level III Nursing Facility admit through discharge
172 Hospital Intermediate Care - Level III Nursing Facility interim - first claim used for the...
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 Admission/Election Notice
180 Hospital Swing Beds Non-Payment/Zero
181 Hospital Swing Beds admit through discharge
182 Hospital Swing Beds interim - first claim used for the...
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 Admission/Election Notice
210 Skilled Nursing Inpatient (Including Medicare Part A) Non-Payment/Zero
211 Skilled Nursing Inpatient (Including Medicare Part A) admit through discharge
212 Skilled Nursing Inpatient (Including Medicare Part A) interim - first claim used for the...
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) Admission/Election Notice
220 Skilled Nursing Inpatient (Medicare Part B Only) Non-Payment/Zero
221 Skilled Nursing Inpatient (Medicare Part B Only) admit through discharge
222 Skilled Nursing Inpatient (Medicare Part B Only) interim - first claim used for the...
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) Admission/Election Notice
230 Skilled Nursing Outpatient Non-Payment/Zero
231 Skilled Nursing Outpatient admit through discharge
232 Skilled Nursing Outpatient interim - first claim used for the...
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 Admission/Election Notice
240 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
250 Skilled Nursing Nursing Facility Level I Non-Payment/Zero
251 Skilled Nursing Nursing Facility Level I admit through discharge
252 Skilled Nursing Nursing Facility Level I interim - first claim used for the...
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 Admission/Election Notice
260 Skilled Nursing Nursing Facility Level II Non-Payment/Zero
261 Skilled Nursing Nursing Facility Level II admit through discharge
262 Skilled Nursing Nursing Facility Level II interim - first claim used for the...
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 Admission/Election Notice
270 Skilled Nursing Intermediate Care - Level III Nursing Facility Non-Payment/Zero
271 Skilled Nursing Intermediate Care - Level III Nursing Facility admit through discharge
272 Skilled Nursing Intermediate Care - Level III Nursing Facility interim - first claim used for the...
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 Admission/Election Notice
280 Skilled Nursing Swing Beds Non-Payment/Zero
281 Skilled Nursing Swing Beds admit through discharge
282 Skilled Nursing Swing Beds interim - first claim used for the...
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 Admission/Election Notice
310 Home Health Inpatient (Including Medicare Part A) Non-Payment/Zero
311 Home Health Inpatient (Including Medicare Part A) admit through discharge
312 Home Health Inpatient (Including Medicare Part A) interim - first claim used for the...
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) Admission/Election Notice
320 Home Health Inpatient (Medicare Part B Only) Non-Payment/Zero
321 Home Health Inpatient (Medicare Part B Only) admit through discharge
322 Home Health Inpatient (Medicare Part B Only) interim - first claim used for the...
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) Admission/Election Notice
330 Home Health Outpatient Non-Payment/Zero
331 Home Health Outpatient admit through discharge
332 Home Health Outpatient interim - first claim used for the...
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 Admission/Election Notice
340 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
350 Home Health Nursing Facility Level I Non-Payment/Zero
351 Home Health Nursing Facility Level I admit through discharge
352 Home Health Nursing Facility Level I interim - first claim used for the...
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 Admission/Election Notice
360 Home Health Nursing Facility Level II Non-Payment/Zero
361 Home Health Nursing Facility Level II admit through discharge
362 Home Health Nursing Facility Level II interim - first claim used for the...
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 Admission/Election Notice
370 Home Health Intermediate Care - Level III Nursing Facility Non-Payment/Zero
371 Home Health Intermediate Care - Level III Nursing Facility admit through discharge
372 Home Health Intermediate Care - Level III Nursing Facility interim - first claim used for the...
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 Admission/Election Notice
380 Home Health Swing Beds Non-Payment/Zero
381 Home Health Swing Beds admit through discharge
382 Home Health Swing Beds interim - first claim used for the...
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 Admission/Election Notice
410 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) Non-Payment/Zero
411 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) admit through discharge
412 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) interim - first claim used for the...
413 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) interim - continuing claims
414 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) interim - last claim
415 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) late charge only
417 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) replacement of prior claim
418 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) void/cancel of a prior claim
419 Religious Non-Medical Health Care Institutions Inpatient (Including Medicare Part A) Admission/Election Notice
420 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) Non-Payment/Zero
421 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) admit through discharge
422 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) interim - first claim used for the...
423 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) interim - continuing claims
424 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) interim - last claim
425 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) late charge only
427 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) replacement of prior claim
428 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) void/cancel of a prior claim
429 Religious Non-Medical Health Care Institutions Inpatient (Medicare Part B Only) Admission/Election Notice
430 Religious Non-Medical Health Care Institutions Outpatient Non-Payment/Zero
431 Religious Non-Medical Health Care Institutions Outpatient admit through discharge
432 Religious Non-Medical Health Care Institutions Outpatient interim - first claim used for the...
433 Religious Non-Medical Health Care Institutions Outpatient interim - continuing claims
434 Religious Non-Medical Health Care Institutions Outpatient interim - last claim
435 Religious Non-Medical Health Care Institutions Outpatient late charge only
437 Religious Non-Medical Health Care Institutions Outpatient replacement of prior claim
438 Religious Non-Medical Health Care Institutions Outpatient void/cancel of a prior claim
439 Religious Non-Medical Health Care Institutions Outpatient Admission/Election Notice
440 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
441 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) admit through discharge
442 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) interim - first claim used for the...
443 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) interim - continuing claims
444 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) interim - last claim
445 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) late charge only
447 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) replacement of prior claim
448 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) void/cancel of a prior claim
449 Religious Non-Medical Health Care Institutions Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admission/Election Notice
450 Religious Non-Medical Health Care Institutions Nursing Facility Level I Non-Payment/Zero
451 Religious Non-Medical Health Care Institutions Nursing Facility Level I admit through discharge
452 Religious Non-Medical Health Care Institutions Nursing Facility Level I interim - first claim used for the...
453 Religious Non-Medical Health Care Institutions Nursing Facility Level I interim - continuing claims
454 Religious Non-Medical Health Care Institutions Nursing Facility Level I interim - last claim
455 Religious Non-Medical Health Care Institutions Nursing Facility Level I late charge only
457 Religious Non-Medical Health Care Institutions Nursing Facility Level I replacement of prior claim
458 Religious Non-Medical Health Care Institutions Nursing Facility Level I void/cancel of a prior claim
459 Religious Non-Medical Health Care Institutions Nursing Facility Level I Admission/Election Notice
460 Religious Non-Medical Health Care Institutions Nursing Facility Level II Non-Payment/Zero
461 Religious Non-Medical Health Care Institutions Nursing Facility Level II admit through discharge
462 Religious Non-Medical Health Care Institutions Nursing Facility Level II interim - first claim used for the...
463 Religious Non-Medical Health Care Institutions Nursing Facility Level II interim - continuing claims
464 Religious Non-Medical Health Care Institutions Nursing Facility Level II interim - last claim
465 Religious Non-Medical Health Care Institutions Nursing Facility Level II late charge only
467 Religious Non-Medical Health Care Institutions Nursing Facility Level II replacement of prior claim
468 Religious Non-Medical Health Care Institutions Nursing Facility Level II void/cancel of a prior claim
469 Religious Non-Medical Health Care Institutions Nursing Facility Level II Admission/Election Notice
470 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility Non-Payment/Zero
471 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility admit through discharge
472 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility interim - first claim used for the...
473 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility interim - continuing claims
474 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility interim - last claim
475 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility late charge only
477 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility replacement of prior claim
478 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility void/cancel of a prior claim
479 Religious Non-Medical Health Care Institutions Intermediate Care - Level III Nursing Facility Admission/Election Notice
480 Religious Non-Medical Health Care Institutions Swing Beds Non-Payment/Zero
481 Religious Non-Medical Health Care Institutions Swing Beds admit through discharge
482 Religious Non-Medical Health Care Institutions Swing Beds interim - first claim used for the...
483 Religious Non-Medical Health Care Institutions Swing Beds interim - continuing claims
484 Religious Non-Medical Health Care Institutions Swing Beds interim - last claim
485 Religious Non-Medical Health Care Institutions Swing Beds late charge only
487 Religious Non-Medical Health Care Institutions Swing Beds replacement of prior claim
488 Religious Non-Medical Health Care Institutions Swing Beds void/cancel of a prior claim
489 Religious Non-Medical Health Care Institutions Swing Beds Admission/Election Notice
510 Christian Science Extended Care Inpatient (Including Medicare Part A) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
520 Christian Science Extended Care Inpatient (Medicare Part B Only) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
530 Christian Science Extended Care Outpatient Non-Payment/Zero
531 Christian Science Extended Care Outpatient admit through discharge
532 Christian Science Extended Care Outpatient interim - first claim used for the...
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 Admission/Election Notice
540 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
550 Christian Science Extended Care Nursing Facility Level I Non-Payment/Zero
551 Christian Science Extended Care Nursing Facility Level I admit through discharge
552 Christian Science Extended Care Nursing Facility Level I interim - first claim used for the...
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 Admission/Election Notice
560 Christian Science Extended Care Nursing Facility Level II Non-Payment/Zero
561 Christian Science Extended Care Nursing Facility Level II admit through discharge
562 Christian Science Extended Care Nursing Facility Level II interim - first claim used for the...
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 Admission/Election Notice
570 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Non-Payment/Zero
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 used for the...
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 Admission/Election Notice
580 Christian Science Extended Care Swing Beds Non-Payment/Zero
581 Christian Science Extended Care Swing Beds admit through discharge
582 Christian Science Extended Care Swing Beds interim - first claim used for the...
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 Admission/Election Notice
610 Intermediate Care Inpatient (Including Medicare Part A) Non-Payment/Zero
611 Intermediate Care Inpatient (Including Medicare Part A) admit through discharge
612 Intermediate Care Inpatient (Including Medicare Part A) interim - first claim used for the...
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) Admission/Election Notice
620 Intermediate Care Inpatient (Medicare Part B Only) Non-Payment/Zero
621 Intermediate Care Inpatient (Medicare Part B Only) admit through discharge
622 Intermediate Care Inpatient (Medicare Part B Only) interim - first claim used for the...
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) Admission/Election Notice
630 Intermediate Care Outpatient Non-Payment/Zero
631 Intermediate Care Outpatient admit through discharge
632 Intermediate Care Outpatient interim - first claim used for the...
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 Admission/Election Notice
640 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Non-Payment/Zero
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 used for the...
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) Admission/Election Notice
650 Intermediate Care Nursing Facility Level I Non-Payment/Zero
651 Intermediate Care Nursing Facility Level I admit through discharge
652 Intermediate Care Nursing Facility Level I interim - first claim used for the...
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 Admission/Election Notice
660 Intermediate Care Nursing Facility Level II Non-Payment/Zero
661 Intermediate Care Nursing Facility Level II admit through discharge
662 Intermediate Care Nursing Facility Level II interim - first claim used for the...
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 Admission/Election Notice
670 Intermediate Care Intermediate Care - Level III Nursing Facility Non-Payment/Zero
671 Intermediate Care Intermediate Care - Level III Nursing Facility admit through discharge
672 Intermediate Care Intermediate Care - Level III Nursing Facility interim - first claim used for the...
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 Admission/Election Notice
680 Intermediate Care Swing Beds Non-Payment/Zero
681 Intermediate Care Swing Beds admit through discharge
682 Intermediate Care Swing Beds interim - first claim used for the...
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 Admission/Election Notice
710 Intermediate Care - Level III Nursing Facility Rural Health Non-Payment/Zero
711 Intermediate Care - Level III Nursing Facility Rural Health admit through discharge
712 Intermediate Care - Level III Nursing Facility Rural Health interim - first claim used for the...
713 Intermediate Care - Level III Nursing Facility Rural Health interim - continuing claims
714 Intermediate Care - Level III Nursing Facility Rural Health interim - last claim
715 Intermediate Care - Level III Nursing Facility Rural Health late charge only
717 Intermediate Care - Level III Nursing Facility Rural Health replacement of prior claim
718 Intermediate Care - Level III Nursing Facility Rural Health void/cancel of a prior claim
719 Intermediate Care - Level III Nursing Facility Rural Health Admission/Election Notice
720 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center Non-Payment/Zero
721 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center admit through discharge
722 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center interim - first claim used for the...
723 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center interim - continuing claims
724 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center interim - last claim
725 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center late charge only
727 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center replacement of prior claim
728 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center void/cancel of a prior claim
729 Intermediate Care - Level III Nursing Facility Hospital Based or Independent Renal Dialysis Center Admission/Election Notice
730 Intermediate Care - Level III Nursing Facility Clinic - Freestanding Non-Payment/Zero
731 Intermediate Care - Level III Nursing Facility Clinic - Freestanding admit through discharge
732 Intermediate Care - Level III Nursing Facility Clinic - Freestanding interim - first claim used for the...
733 Intermediate Care - Level III Nursing Facility Clinic - Freestanding interim - continuing claims
734 Intermediate Care - Level III Nursing Facility Clinic - Freestanding interim - last claim
735 Intermediate Care - Level III Nursing Facility Clinic - Freestanding late charge only
737 Intermediate Care - Level III Nursing Facility Clinic - Freestanding replacement of prior claim
738 Intermediate Care - Level III Nursing Facility Clinic - Freestanding void/cancel of a prior claim
739 Intermediate Care - Level III Nursing Facility Clinic - Freestanding Admission/Election Notice
740 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) Non-Payment/Zero
741 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) admit through discharge
742 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) interim - first claim used for the...
743 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) interim - continuing claims
744 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) interim - last claim
745 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) late charge only
747 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) replacement of prior claim
748 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) void/cancel of a prior claim
749 Intermediate Care - Level III Nursing Facility Clinic - Outpatient Rehabilitation Facility (ORF) Admission/Election Notice
750 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) Non-Payment/Zero
751 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) admit through discharge
752 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) interim - first claim used for the...
753 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) interim - continuing claims
754 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) interim - last claim
755 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) late charge only
757 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) replacement of prior claim
758 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) void/cancel of a prior claim
759 Intermediate Care - Level III Nursing Facility Comprehensive Outpatient Rehabilitation Facilities (CORFs) Admission/Election Notice
760 Intermediate Care - Level III Nursing Facility Community Mental Health Center Non-Payment/Zero
761 Intermediate Care - Level III Nursing Facility Community Mental Health Center admit through discharge
762 Intermediate Care - Level III Nursing Facility Community Mental Health Center interim - first claim used for the...
763 Intermediate Care - Level III Nursing Facility Community Mental Health Center interim - continuing claims
764 Intermediate Care - Level III Nursing Facility Community Mental Health Center interim - last claim
765 Intermediate Care - Level III Nursing Facility Community Mental Health Center late charge only
767 Intermediate Care - Level III Nursing Facility Community Mental Health Center replacement of prior claim
768 Intermediate Care - Level III Nursing Facility Community Mental Health Center void/cancel of a prior claim
769 Intermediate Care - Level III Nursing Facility Community Mental Health Center Admission/Election Notice
770 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) Non-Payment/Zero
771 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) admit through discharge
772 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) interim - first claim used for the...
773 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) interim - continuing claims
774 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) interim - last claim
775 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) late charge only
777 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) replacement of prior claim
778 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) void/cancel of a prior claim
779 Intermediate Care - Level III Nursing Facility Clinic - Federally Qualified Health Center (FQHC) (Effective 4/1/10) Admission/Election Notice
780 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) Non-Payment/Zero
781 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) admit through discharge
782 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) interim - first claim used for the...
783 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) interim - continuing claims
784 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) interim - last claim
785 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) late charge only
787 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) replacement of prior claim
788 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) void/cancel of a prior claim
789 Intermediate Care - Level III Nursing Facility Licensed Freestanding Emergency Medical Facility (Effecitve 7/1/12) Admission/Election Notice
790 Intermediate Care - Level III Nursing Facility Other Non-Payment/Zero
791 Intermediate Care - Level III Nursing Facility Other admit through discharge
792 Intermediate Care - Level III Nursing Facility Other interim - first claim used for the...
793 Intermediate Care - Level III Nursing Facility Other interim - continuing claims
794 Intermediate Care - Level III Nursing Facility Other interim - last claim
795 Intermediate Care - Level III Nursing Facility Other late charge only
797 Intermediate Care - Level III Nursing Facility Other replacement of prior claim
798 Intermediate Care - Level III Nursing Facility Other void/cancel of a prior claim
799 Intermediate Care - Level III Nursing Facility Other Admission/Election Notice
810 Swing Beds Hospice (Non-Hospital Based) Non-Payment/Zero
811 Swing Beds Hospice (Non-Hospital Based) admit through discharge
812 Swing Beds Hospice (Non-Hospital Based) interim - first claim used for the...
813 Swing Beds Hospice (Non-Hospital Based) interim - continuing claims
814 Swing Beds Hospice (Non-Hospital Based) interim - last claim
815 Swing Beds Hospice (Non-Hospital Based) late charge only
817 Swing Beds Hospice (Non-Hospital Based) replacement of prior claim
818 Swing Beds Hospice (Non-Hospital Based) void/cancel of a prior claim
819 Swing Beds Hospice (Non-Hospital Based) Admission/Election Notice
820 Swing Beds Hospice (Hospital-Based) Non-Payment/Zero
821 Swing Beds Hospice (Hospital-Based) admit through discharge
822 Swing Beds Hospice (Hospital-Based) interim - first claim used for the...
823 Swing Beds Hospice (Hospital-Based) interim - continuing claims
824 Swing Beds Hospice (Hospital-Based) interim - last claim
825 Swing Beds Hospice (Hospital-Based) late charge only
827 Swing Beds Hospice (Hospital-Based) replacement of prior claim
828 Swing Beds Hospice (Hospital-Based) void/cancel of a prior claim
829 Swing Beds Hospice (Hospital-Based) Admission/Election Notice
830 Swing Beds Ambulatory Surgery Center Non-Payment/Zero
831 Swing Beds Ambulatory Surgery Center admit through discharge
832 Swing Beds Ambulatory Surgery Center interim - first claim used for the...
833 Swing Beds Ambulatory Surgery Center interim - continuing claims
834 Swing Beds Ambulatory Surgery Center interim - last claim
835 Swing Beds Ambulatory Surgery Center late charge only
837 Swing Beds Ambulatory Surgery Center replacement of prior claim
838 Swing Beds Ambulatory Surgery Center void/cancel of a prior claim
839 Swing Beds Ambulatory Surgery Center Admission/Election Notice
840 Swing Beds Free Standing Birthing Center Non-Payment/Zero
841 Swing Beds Free Standing Birthing Center admit through discharge
842 Swing Beds Free Standing Birthing Center interim - first claim used for the...
843 Swing Beds Free Standing Birthing Center interim - continuing claims
844 Swing Beds Free Standing Birthing Center interim - last claim
845 Swing Beds Free Standing Birthing Center late charge only
847 Swing Beds Free Standing Birthing Center replacement of prior claim
848 Swing Beds Free Standing Birthing Center void/cancel of a prior claim
849 Swing Beds Free Standing Birthing Center Admission/Election Notice
850 Swing Beds Critial Access Hospital Non-Payment/Zero
851 Swing Beds Critial Access Hospital admit through discharge
852 Swing Beds Critial Access Hospital interim - first claim used for the...
853 Swing Beds Critial Access Hospital interim - continuing claims
854 Swing Beds Critial Access Hospital interim - last claim
855 Swing Beds Critial Access Hospital late charge only
857 Swing Beds Critial Access Hospital replacement of prior claim
858 Swing Beds Critial Access Hospital void/cancel of a prior claim
859 Swing Beds Critial Access Hospital Admission/Election Notice
860 Swing Beds Residential Facility Non-Payment/Zero
861 Swing Beds Residential Facility admit through discharge
862 Swing Beds Residential Facility interim - first claim used for the...
863 Swing Beds Residential Facility interim - continuing claims
864 Swing Beds Residential Facility interim - last claim
865 Swing Beds Residential Facility late charge only
867 Swing Beds Residential Facility replacement of prior claim
868 Swing Beds Residential Facility void/cancel of a prior claim
869 Swing Beds Residential Facility Admission/Election Notice
890 Swing Beds Other Non-Payment/Zero
891 Swing Beds Other admit through discharge
892 Swing Beds Other interim - first claim used for the...
893 Swing Beds Other interim - continuing claims
894 Swing Beds Other interim - last claim
895 Swing Beds Other late charge only
897 Swing Beds Other replacement of prior claim
898 Swing Beds Other void/cancel of a prior claim
899 Swing Beds Other Admission/Election Notice
MC037 Place of Service - Professional 01 Pharmacy
02 Unassigned
03 School
04 Homeless Shelter
05 Indian Health Service Free-standing Facility
06 Indian Health Service Provider-based Facility
07 Tribal 638 Free-standing Facility
08 Tribal 638 Provider-based Facility
09 Prison/Correctional Facility
10 Unassigned
11 Office
12 Home
13 Assisted Living Facility Congregate
14 Group Home
15 Mobile Unit
16 Temporary Lodging
17 Walk-in Retail Health Clinic
18 Place of Employment-Worksite
19 Unassigned
20 Urgent Care Facility
21 Inpatient Hospital
22 Outpatient Hospital
23 Emergency Room - Hospital
24 Ambulatory Surgery Center
25 Birthing Center
26 Military Treatment Facility
27-30 Unassigned
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
34 Hospice
35-40 Unassigned
41 Ambulance - Land
42 Ambulance - Air or Water
43-48 Unassigned
50 Federally Qualified 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
58-59 Unassigned
60 Mass Immunization Center
61 Comprehensive Inpatient Rehabilitation Facility
62 Comprehensive Outpatient Rehabilitation Facility
63-64 Unassigned
65 End Stage Renal Disease Treatment Facility
66-70 Unassigned
71 State or Local Public Health Clinic
72 Rural Health Clinic
73-80 Unassigned
81 Independent Laboratory
82-98 Unassigned
99 Other Unlisted Facility
MC038 Claim Status 01 Processed as primary
02 Processed as secondary
03 Processed as tertiary
19 Processed as primary, forwarded to additional payer(s)
20 Processed as secondary, forwarded to additional payer(s)
21 Processed as tertiary, forwarded to additional payer(s)
22 Reversal of previous payment
MC200 ICD-9 / ICD-10 Flag 0 This claim contains ICD-9-CM codes
1 This claim contains ICD-10-CM codes
MC899 Record Type MC
TR001 Record Type MC
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