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Data Elements

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Admission Date 18 Pennsylvania Medical Claims File Submission
Admission Hour 19 Pennsylvania Medical Claims File Submission
Admission Source 21 Pennsylvania Medical Claims File Submission
Admission Type 20 Pennsylvania Medical Claims File Submission
Admitting Diagnosis 39 Pennsylvania Medical Claims File Submission
APC 73 Pennsylvania Medical Claims File Submission
APC Version 74 Pennsylvania Medical Claims File Submission
Billing Provider Last Name or Organization Name 78 Pennsylvania Medical Claims File Submission
Billing Provider Number 76 Pennsylvania Medical Claims File Submission
Capitated Services Indicator 85 Pennsylvania Medical Claims File Submission
Charge Amount 62 Pennsylvania Medical Claims File Submission
Claim Status 38 Pennsylvania Medical Claims File Submission
Co-pay Amount 65 Pennsylvania Medical Claims File Submission
Coinsurance Amount 66 Pennsylvania Medical Claims File Submission
Coverage Level Code 7 Pennsylvania Medical Eligibility File Submission
Coverage Type 22 Pennsylvania Medical Eligibility File Submission
Date of Service - From 59 Pennsylvania Medical Claims File Submission
Date of Service - Thru 60 Pennsylvania Medical Claims File Submission
Date Service Approved/Accounts Payable Date/Actual Paid Date 17 Pennsylvania Medical Claims File Submission
Deductible Amount 67 Pennsylvania Medical Claims File Submission
Discharge Date 69 Pennsylvania Medical Claims File Submission
Discharge Hour 22 Pennsylvania Medical Claims File Submission
Discharge Status 23 Pennsylvania Medical Claims File Submission
DRG 71 Pennsylvania Medical Claims File Submission
DRG Version 72 Pennsylvania Medical Claims File Submission
Drug Code 75 Pennsylvania Medical Claims File Submission
E-Code 40 Pennsylvania Medical Claims File Submission
Facility Type - Professional 37 Pennsylvania Medical Claims File Submission
Group Name 25 Pennsylvania Medical Eligibility File Submission
Health Care Home Assigned Flag 26 Pennsylvania Medical Eligibility File Submission
Health Care Home Name 30 Pennsylvania Medical Eligibility File Submission
Health Care Home National Provider ID 29 Pennsylvania Medical Eligibility File Submission
Health Care Home Number 27 Pennsylvania Medical Eligibility File Submission
Health Care Home Tax ID Number 28 Pennsylvania Medical Eligibility File Submission
ICD-9-CM Procedure Code 58 Pennsylvania Medical Claims File Submission
Individual Relationship Code 12 Pennsylvania Medical Eligibility File Submission
Individual Relationship Code 11 Pennsylvania Medical Claims File Submission
Insurance Type/Product Code 3 Pennsylvania Medical Claims File Submission
Insurance Type Code/Product 3 Pennsylvania Medical Eligibility File Submission
Insured Group or Policy Number 6 Pennsylvania Medical Eligibility File Submission
Insured Group or Policy Number 6 Pennsylvania Medical Claims File Submission
Line Counter 5 Pennsylvania Medical Claims File Submission
Market Category Code 23 Pennsylvania Medical Eligibility File Submission
Medical Coverage 18 Pennsylvania Medical Eligibility File Submission
Member City Name 15 Pennsylvania Medical Eligibility File Submission
Member City Name 14 Pennsylvania Medical Claims File Submission
Member Date of Birth 14 Pennsylvania Medical Eligibility File Submission
Member Date of Birth 13 Pennsylvania Medical Claims File Submission
Member First Name 35 Pennsylvania Medical Eligibility File Submission
Member First Name 83 Pennsylvania Medical Claims File Submission
Results 1 - 50 of 125
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