United States Health Information Knowledgebase

Health Care Service: Data Reporting Guide

The Health Care Service: Data Reporting Guide (HCSDRG), an ASC X12 specification based on the HIPAA adopted Health Care Claim: Institutional (837), supports state and federal public health reporting requirements. The source of the data content is from the ASC X12 standards, UB-04, the National Committee on Vital and Health Statistics core data set, as well as some state specific public health reporting requirements.

The Gap Assist tool , jointly developed with Washington Publishing Company, with support from the Centers for Disease Control and Prevention/National Center for Health Statistics, provides a metadata perspective on the format and content attributes of each data element supported by the HCSDRG. The Gap Assist tool also provides a view across multiple versions of the ASC X12 standards and a map to the various standards previously named.

Submitter Information
	Submitter Last or Organization Name
	Submitter Identifier
	Communication Number
	Communication Number
	Transaction Set Creation Date
	Claim Transaction Batch Number

Receiver Information
	Data Receiver Name
	Information Receiver Identification Number

Provider Information
	Service Provider Last or Organization Name
	Service Provider Identifier

Patient Information
	Patient Last Name
	Patient First Name
	Patient Middle Name or Initial
	Patient Control Number
	Medical Record Number
	Patient Secondary Identifier
	Marital Status Code
	Race or Ethnicity Code
	Race or Ethnicity Code
	Language Code
	Patient Address Line
	Patient Address Line
	Patient City Name
	Location Identification Code
	Patient State Code
	Patient Postal Zone or ZIP Code
	Patient Gender Code
	Patient Birth Date
	Value Code
	Value Code Amount
	Mother's Medical Record Number
	Patient Responsibility Amount

Claim Information
	Admission Type Code
	Admission Source Code
	Admission Date/Hour or Start of Care Date
	Admission Date/Hour or Start of Care Date
	Original Claim Creation Date
	Statement To and From Date
	Statement From and To Date
	Service Date
	Statement From and To Date
	Discharge Hour
	Patient Status Code
	Facility Type Code
	Claim Frequency Code
	Occurrence Code
	Accident Date
	Auto Accident State or Province Code
	North American Industry Codes
	Occurrence Span Code
	Occurrence Span Code Date
	Occurrence Span Code
	Occurrence Span Code Date
	Condition Code
	Condition Code
	Condition Code
	Condition Code
	Condition Code
	Condition Code
	Condition Code
	Condition Code
	Value Code
	Value Code Amount
	Value Code
	Value Code Amount
	Value Code
	Value Code Amount
	Value Code
	Value Code Amount
	Standard Occupation Classification System Codes

Insurance Information
	Claim Filing Indicator Code
	Payer Identifier
	Policy or Contract Number
	Value Code
	Value Code Amount
	Value Code
	Value Code Amount
	Estimated Claim Due Amount
	Payer Paid Amount
	Source of Payment Typology

Service Line Information
	Service Line Revenue Code
	Service Unit Count
	Service Unit Count
	Line Item Charge Amount
	Line Item Denied Charge or Non-Covered Charge Amount
	Service Line Revenue Code
	Service Unit Count
	Line Item Charge Amount
	Line Item Denied Charge or Non-Covered Charge Amount
	Total Claim Charge Amount
	Procedure Code
	Procedure Modifier
	Procedure Modifier
	Procedure Modifier
	Procedure Modifier

Drug Information - Line Level Detail
	National Drug Code
	National Drug Unit Count
	Prescription Number

Physician Information - Line Level Detail
	Operating Physician Primary Identifier
	Other Operating Physician Identifier

Medical Information
	Principal Diagnosis Code
	Present on Admission Indicator
	Other Diagnosis
	Present on Admission Indicator
	Principal Procedure Code
	Principal Procedure Date
	Procedure Code
	Procedure Date
	Admitting Diagnosis Code
	Patient Reason for Visit
	External Cause of Injury Code
	Present on Admission Indicator
	Diagnosis Related Group (DRG) Code

Physician Information
	Attending Provider Primary Identifier
	Operating Physician Primary Identifier
	Other Operating Physician Identifier
	Rendering Provider Identifier
	Referring Provider Identifier
	Referring Provider Identifier