1 CMS RIF REPORT AS OF: 05/06/2007 SOURCE: CA REPOSITORY NAME LENGTH BEG END CONTENTS ----------------------------------------------------------------------------------------------------------------------- *** Carrier Claim Record (NCH) VAR 1 4863 REC Carrier claim record (other than DMERC) for version I of the NCH. STANDARD ALIAS : CARR_CLM_REC SYSTEM ALIAS : UTLCARRI LIMITATIONS : REFER TO : CARR_LINE_RX_NUM_LIM 1. Carrier Claim Fixed Group 375 1 375 GRP Fixed portion of the carrier claim record for version I of the NCH. 2. Claim Record Identification Group 8 1 8 GRP Effective with Version 'I' the record length, version code, record identification, code and NCH derived claim type code were moved to this group for internal NCH processing. STANDARD ALIAS : CLM_REC_IDENT_GRP 3. Record Length Count 3 1 3 PACK Effective with Version H, the count (in bytes) of the length of the claim record. NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991). DB2 ALIAS : REC_LNGTH_CNT SAS ALIAS : REC_LEN STANDARD ALIAS : REC_LNGTH_CNT LENGTH : 5 SIGNED : Y SOURCE : NCH 4. NCH Near-Line Record Version Code 1 4 4 CHAR The code indicating the record version of the Nearline file where the institutional, carrier or DMERC claims data are stored. DB2 ALIAS : NCH_REC_VRSN_CD SAS ALIAS : REC_LVL STANDARD ALIAS : NCH_NEAR_LINE_REC_VRSN_CD TITLE ALIAS : NCH_VERSION LENGTH : 1 COMMENTS : Prior to Version H this field was named: CLM_NEAR_LINE_REC_VRSN_CD. SOURCE : NCH CODE TABLE : NCH_NEAR_LINE_REC_VRSN_TB 5. NCH Near Line Record Identification Code 1 5 5 CHAR A code defining the type of claim record being processed. COMMON ALIAS : RIC DB2 ALIAS : NEAR_LINE_RIC_CD SAS ALIAS : RIC_CD STANDARD ALIAS : NCH_NEAR_LINE_RIC_CD TITLE ALIAS : RIC LENGTH : 1 COMMENTS : Prior to Version H this field was named: RIC_CD. SOURCE : NCH CODE TABLE : NCH_NEAR_LINE_RIC_TB 6. NCH MQA RIC Code 1 6 6 CHAR Effective with Version H, the code used (for internal editing purposes) to identify the record being processed through CMS' CWFMQA system. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. DB2 ALIAS : NCH_MQA_RIC_CD SAS ALIAS : MQA_RIC STANDARD ALIAS : NCH_MQA_RIC_CD TITLE ALIAS : MQA_RIC LENGTH : 1 SOURCE : NCH QA PROCESS CODE TABLE : NCH_MQA_RIC_TB 7. NCH Claim Type Code 2 7 8 CHAR The code used to identify the type of claim record being processed in NCH. NOTE1: During the Version H conversion this field was populated with data throughout history (back to service year 1991). NOTE2: During the Version I conversion this field was expanded to include inpatient 'full' encounter claims (for service dates after 6/30/97). DB2 ALIAS : NCH_CLM_TYPE_CD SAS ALIAS : CLM_TYPE STANDARD ALIAS : NCH_CLM_TYPE_CD TITLE ALIAS : CLAIM_TYPE LENGTH : 2 DERIVATIONS : FFS CLAIM TYPE CODES DERIVED FROM: NCH CLM_NEAR_LINE_RIC_CD NCH PMT_EDIT_RIC_CD NCH CLM_TRANS_CD NCH PRVDR_NUM INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (Pre-HDC processing -- AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD MCO_PRD_EFCTV_DT MCO_PRD_TRMNTN_DT DERIVATION RULES: SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U' 2. PMT_EDIT_RIC_CD EQUAL 'F' 3. CLM_TRANS_CD EQUAL '5' SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'W' 2. PMT_EDIT_RIC_CD EQUAL 'D' 3. CLM_TRANS_CD EQUAL '6' SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'I' 3. CLM_TRANS_CD EQUAL 'H' SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 - 12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_MCO_PD_SW = '1' 2. CLM_RLT_COND_CD = '04' 3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' 4. FI_NUM = 80881 SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table). SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table). SOURCE : NCH CODE TABLE : NCH_CLM_TYPE_TB 8. Carrier/DMERC Claim Link Group 125 9 133 GRP Effective with Version 'I', this group was added to the carrier and DMERC records to keep fields common across all record types in the same position. Due to OP PPS, several fields on the Institutional record had to be moved to a link group so those same fields had to be moved on the carrier records eventhough OP PPS only affects institutional claims. STANDARD ALIAS : CARR_DMERC_CLM_LINK_GRP 9. Claim Locator Number Group 11 9 19 GRP This number uniquely identifies the beneficiary in the NCH Nearline. COMMON ALIAS : HIC STANDARD ALIAS : CLM_LCTR_NUM_GRP TITLE ALIAS : HICAN 10. Beneficiary Claim Account Number 9 9 17 CHAR The number identifying the primary beneficiary under the SSA or RRB programs submitted. COMMON ALIAS : CAN DB2 ALIAS : BENE_CLM_ACNT_NUM SAS ALIAS : CAN STANDARD ALIAS : BENE_CLM_ACNT_NUM TITLE ALIAS : CAN LENGTH : 9 SOURCE : SSA,RRB LIMITATIONS : RRB-issued numbers contain an overpunch in the first position that may appear as a plus zero or A-G. RRB-formatted numbers may cause matching problems on non-IBM machines. 11. NCH Category Equatable Beneficiary Identification Code 2 18 19 CHAR The code categorizing groups of BICs representing similar relationships between the beneficiary and the primary wage earner. The equatable BIC module electronically matches two records that contain different BICs where it is apparent that both are records for the same beneficiary. It validates the BIC and returns a base BIC under which to house the record in the National Claims History (NCH) databases. (All records for a beneficiary are stored under a single BIC.) COMMON ALIAS : NCH_BASE_CATEGORY_BIC DB2 ALIAS : CTGRY_EQTBL_BIC SAS ALIAS : EQ_BIC STANDARD ALIAS : NCH_CTGRY_EQTBL_BIC_CD TITLE ALIAS : EQUATED_BIC LENGTH : 2 COMMENTS : Prior to Version H this field was named: CTGRY_EQTBL_BENE_IDENT_CD. SOURCE : BIC EQUATE MODULE CODE TABLE : CTGRY_EQTBL_BENE_IDENT_TB 12. Beneficiary Identification Code 2 20 21 CHAR The code identifying the type of relationship between an individual and a primary Social Security Administration (SSA) beneficiary or a primary Railroad Board (RRB) beneficiary. COMMON ALIAS : BIC DA3 ALIAS : BENE_IDENT_CODE DB2 ALIAS : BENE_IDENT_CD SAS ALIAS : BIC STANDARD ALIAS : BENE_IDENT_CD TITLE ALIAS : BIC LENGTH : 2 SOURCE : SSA/RRB EDIT RULES : EDB REQUIRED FIELD CODE TABLE : BENE_IDENT_TB 13. NCH State Segment Code 1 22 22 CHAR The code identifying the segment of the NCH Nearline file containing the beneficiary's record for a specific service year. Effective 12/96, segmentation is by CLM_LCTR_NUM, then final action sequence within residence state. (Prior to 12/96, segmentation was by ranges of county codes within the residence state.) DB2 ALIAS : NCH_STATE_SGMT_CD SAS ALIAS : ST_SGMT STANDARD ALIAS : NCH_STATE_SGMT_CD TITLE ALIAS : NEAR_LINE_SEGMENT LENGTH : 1 COMMENTS : Prior to Version H this field was named: BENE_STATE_SGMT_NEAR_LINE_CD. SOURCE : NCH CODE TABLE : NCH_STATE_SGMT_TB 14. Beneficiary Residence SSA Standard State Code 2 23 24 CHAR The SSA standard state code of a beneficiary's residence. DA3 ALIAS : SSA_STANDARD_STATE_CODE DB2 ALIAS : BENE_SSA_STATE_CD SAS ALIAS : STATE_CD STANDARD ALIAS : BENE_RSDNC_SSA_STD_STATE_CD TITLE ALIAS : BENE_STATE_CD LENGTH : 2 COMMENTS : 1. Used in conjunction with a county code, as selection criteria for the determination of payment rates for HMO reimbursement. 2. Concerning individuals directly billable for Part B and/or Part A premiums, this element is used to determine if the beneficiary will receive a bill in English or Spanish. 3. Also used for special studies. SOURCE : SSA/EDB EDIT RULES : OPTIONAL: MAY BE BLANK CODE TABLE : GEO_SSA_STATE_TB 15. Claim From Date 8 25 32 NUM The first day on the billing statement covering services rendered to the bene- ficiary (a.k.a. 'Statement Covers From Date'). NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match. DB2 ALIAS : CLM_FROM_DT SAS ALIAS : FROM_DT STANDARD ALIAS : CLM_FROM_DT TITLE ALIAS : FROM_DATE LENGTH : 8 SIGNED : N SOURCE : CWF EDIT RULES : YYYYMMDD 16. Claim Through Date 8 33 40 NUM The last day on the billing statement covering services rendered to the beneficiary (a.k.a 'Statement Covers Thru Date'). NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match. DB2 ALIAS : CLM_THRU_DT SAS ALIAS : THRU_DT STANDARD ALIAS : CLM_THRU_DT TITLE ALIAS : THRU_DATE LENGTH : 8 SIGNED : N SOURCE : CWF EDIT RULES : YYYYMMDD 17. NCH Weekly Claim Processing Date 8 41 48 NUM The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date will always be a Friday, although the claims will actually be appended to the database subsequent to the date. DB2 ALIAS : NCH_WKLY_PROC_DT SAS ALIAS : WKLY_DT STANDARD ALIAS : NCH_WKLY_PROC_DT TITLE ALIAS : NCH_PROCESS_DT LENGTH : 8 SIGNED : N COMMENTS : Prior to Version H this field was named: HCFA_CLM_PROC_DT. SOURCE : EDIT RULES : YYYYMMDD 18. CWF Claim Accretion Date 8 49 56 NUM The date the claim record is accreted (posted/ processed) to the beneficiary master record at the CWF host site and authorization for payment is returned to the fiscal interme- diary or carrier. DB2 ALIAS : CWF_CLM_ACRTN_DT SAS ALIAS : ACRTN_DT STANDARD ALIAS : CWF_CLM_ACRTN_DT TITLE ALIAS : ACCRETION_DT LENGTH : 8 SIGNED : N SOURCE : CWF EDIT RULES : YYYYMMDD 19. CWF Claim Accretion Number 2 57 58 PACK The sequence number assigned to the claim record when accreted (posted/processed) to the beneficiary master record at the CWF host site on a given date. This element indicates the position of the claim within that day's processing at the CWF host. **(Exception: If the claim record is missing the accretion date CMS' CWFMQA system places a zero in the accretion number. DB2 ALIAS : CWF_CLM_ACRTN_NUM SAS ALIAS : ACRTN_NM STANDARD ALIAS : CWF_CLM_ACRTN_NUM TITLE ALIAS : ACCRETION_NUMBER LENGTH : 3 SIGNED : Y SOURCE : CWF 20. Carrier Claim Control Number 15 59 73 CHAR Unique control number assigned by a carrier to a non-institutional claim. COMMON ALIAS : CCN DB2 ALIAS : CARR_CLM_CNTL_NUM SAS ALIAS : CARRCNTL STANDARD ALIAS : CARR_CLM_CNTL_NUM TITLE ALIAS : CCN LENGTH : 15 COMMENTS : For the physician/supplier or DMERC claim, this field allows CMS to associate each line item with its respective claim. SOURCE : CWF EDIT RULES : LEFT JUSTIFY 21. FILLER CHAR 38 74 111 DB2 ALIAS : FILLER LENGTH : 38 22. NCH Daily Process Date 8 112 119 NUM Effective with Version H, the date the claim record was processed by CMS' CWFMQA system (used for internal editing purposes). Effective with Version I, this date is used in conjunction with the NCH Segment Link Number to keep claims with multiple records/ segments together. NOTE1: With Version 'H' this field was populated with data beginning with NCH weekly process date 10/3/97. Under Version 'I' claims prior to 10/3/97, that were blank under Version 'H', were populated with a date. DB2 ALIAS : NCH_DAILY_PROC_DT SAS ALIAS : DAILY_DT STANDARD ALIAS : NCH_DAILY_PROC_DT TITLE ALIAS : DAILY_PROCESS_DT LENGTH : 8 SIGNED : N SOURCE : NCH EDIT RULES : YYYYMMDD 23. NCH Segment Link Number 5 120 124 PACK Effective with Version 'I', the system gen- erated number used in conjunction with the NCH daily process date to keep records/segments belonging to a specific claim together. This field was added to ensure that records/ segments that come in on the same batch with the same identifying information in the link group are not mixed with each other. NOTE: During the Version I conversion this field was populated with data throughout history (back to service year 1991). DB2 ALIAS : NCH_SGMT_LINK_NUM SAS ALIAS : LINK_NUM STANDARD ALIAS : NCH_SGMT_LINK_NUM TITLE ALIAS : LINK_NUM LENGTH : 9 SIGNED : Y SOURCE : NCH 24. Claim Total Segment Count 2 125 126 NUM Effective with Version I, the count used to identify the total number of segments associated with a given claim. Each claim could have up to 10 segments. NOTE: During the Version I conversion, this field was populated with data throughout history (back to service year 1991). For institutional claims, the count for claims prior to 7/00 will be 1 or 2 (1 if 45 or less revenue center lines on a claim and 2 if more than 45 revenue center lines on a claim). For noninstitutional claims, the count will always be 1. DB2 ALIAS : TOT_SGMT_CNT SAS ALIAS : SGMT_CNT STANDARD ALIAS : CLM_TOT_SGMT_CNT TITLE ALIAS : SEGMENT_COUNT LENGTH : 2 SIGNED : N SOURCE : CWF 25. Claim Segment Number 2 127 128 NUM Effective with Version I, the number used to identify an actual record/segment (1 - 10) associated with a given claim. NOTE: During the Version I conversion this field was populated with data throughout history (back to service year 1991). For institutional claims prior to 7/00, this number will be either 1 or 2. For noninstitutional claims, the number will always be 1. DB2 ALIAS : CLM_SGMT_NUM SAS ALIAS : SGMT_NUM STANDARD ALIAS : CLM_SGMT_NUM TITLE ALIAS : SEGMENT_NUMBER LENGTH : 2 SIGNED : N SOURCE : CWF 26. Claim Total Line Count 3 129 131 NUM Effective with Version I, the count used to identify the total number of revenue center lines associated with the claim. NOTE: During the Version I conversion this field was populated with data throughout history (back to service year 1991). Prior to Version 'I', the maximum line count will be no more than 58. Effective with Version 'I', the maximum line count could be 450. DB2 ALIAS : TOT_LINE_CNT SAS ALIAS : LINECNT STANDARD ALIAS : CLM_TOT_LINE_CNT TITLE ALIAS : TOTAL_LINE_COUNT LENGTH : 3 SIGNED : N SOURCE : CWF 27. Claim Segment Line Count 2 132 133 NUM Effective with Version I, the count used to identify the number of lines on a record/ segment. NOTE: During the Version I conversion this field was populated with data throughout history (back to service year 1991). The maximum line count per record/segment on the revenue center trailer is 45. The maximum number of lines on carrier and DMERC claims are 13. DB2 ALIAS : SGMT_LINE_CNT SAS ALIAS : SGMTLINE STANDARD ALIAS : CLM_SGMT_LINE_CNT TITLE ALIAS : SEGMENT_LINE_COUNT LENGTH : 2 SIGNED : N SOURCE : CWF 28. Carrier/DMERC Claim Common 1 Group 194 134 327 GRP Information common to both carrier and DMERC claims for version I of NCH. 29. FILLER CHAR 5 134 138 DB2 ALIAS : FILLER LENGTH : 5 30. Carrier Claim Entry Code 1 139 139 CHAR Carrier-generated code describing whether the Part B claim is an original debit, full credit, or replacement debit. DB2 ALIAS : CARR_CLM_ENTRY_CD SAS ALIAS : ENTRY_CD STANDARD ALIAS : CARR_CLM_ENTRY_CD TITLE ALIAS : ENTRY_CD LENGTH : 1 COMMENTS : Prior to Version H this field was named: CWFB_CLM_ENTRY_CD. SOURCE : CWF 31. FILLER CHAR 1 140 140 DB2 ALIAS : FILLER LENGTH : 1 32. Claim Disposition Code 2 141 142 CHAR Code indicating the disposition or outcome of the processing of the claim record. DB2 ALIAS : CLM_DISP_CD SAS ALIAS : DISP_CD STANDARD ALIAS : CLM_DISP_CD TITLE ALIAS : DISPOSITION_CD LENGTH : 2 SOURCE : CWF CODE TABLE : CLM_DISP_TB 33. NCH Edit Disposition Code 2 143 144 CHAR Effective with Version H, a code used (for internal editing purposes) to indicate the disposition of the claim after editing in the CWFMQA process. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. DB2 ALIAS : NCH_EDIT_DISP_CD SAS ALIAS : EDITDISP STANDARD ALIAS : NCH_EDIT_DISP_CD TITLE ALIAS : NCH_EDIT_DISP LENGTH : 2 SOURCE : NCH QA Process CODE TABLE : NCH_EDIT_DISP_TB 34. NCH Claim BIC Modify H Code 1 145 145 CHAR Effective with Version H, the code used (for internal editing purposes) to identify a claim record that was submitted with an incorrect HA, HB, or HC BIC. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. DB2 ALIAS : NCH_BIC_MDFY_CD SAS ALIAS : BIC_MDFY STANDARD ALIAS : NCH_CLM_BIC_MDFY_CD TITLE ALIAS : BIC_MODIFY_CD LENGTH : 1 SOURCE : NCH QA Process CODES : H = BIC submitted by CWF = HA, HB or HC blank = No HA, HB or HC BIC present 35. Beneficiary Residence SSA Standard County Code 3 146 148 CHAR The SSA standard county code of a beneficiary's residence. DB2 ALIAS : BENE_SSA_CNTY_CD SAS ALIAS : CNTY_CD STANDARD ALIAS : BENE_RSDNC_SSA_STD_CNTY_CD TITLE ALIAS : BENE_COUNTY_CD LENGTH : 3 SOURCE : SSA/EDB EDIT RULES : OPTIONAL: MAY BE BLANK 36. Carrier Claim Receipt Date 8 149 156 NUM The date the carrier receives the non- institutional claim. DB2 ALIAS : CLM_RCPT_DT SAS ALIAS : RCPT_DT LENGTH : 8 SIGNED : N COMMENTS : Prior to Version 'H' this field was named: FICARR_CLM_RCPT_DT. SOURCE : CWF EDIT RULES : YYYYMMDD 37. Carrier Claim Scheduled Payment Date 8 157 164 NUM The scheduled date of payment to the physician or supplier, as appearing on the original non- institutional claim sent to the CWF host. **Note: This date is considered to be the date paid since no additional information as to the actual payment date is available. DB2 ALIAS : CARR_SCHLD_PMT_DT SAS ALIAS : SCHLD_DT STANDARD ALIAS : CARR_CLM_SCHLD_PMT_DT TITLE ALIAS : SCHLD_PMT_DT LENGTH : 8 SIGNED : N COMMENTS : Prior to Version H this field was named: FICARR_CLM_PMT_DT. SOURCE : CWF EDIT RULES : YYYYMMDD 38. CWF Forwarded Date 8 165 172 NUM Effective with Version H, the date CWF forwarded the claim record to CMS (used for internal editing purposes). NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : CWF_FRWRD_DT SAS ALIAS : FRWRD_DT STANDARD ALIAS : CWF_FRWRD_DT TITLE ALIAS : FORWARD_DT LENGTH : 8 SIGNED : N SOURCE : CWF EDIT RULES : YYYYMMDD 39. Carrier Number 5 173 177 CHAR The identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier. Effective July 2006, the Medicare Administrative Contractors (MACs) began replacing the existing carriers and started processing physician or supplier claim records for states assigned to its jurisdiction. NOTE: The 5-position MAC number will be housed in the existing CARR_NUM field. During the transi- tion from a carrier to a MAC the CARR_NUM field could contain either a Carrier number or a MAC number. See the CARR_NUM table of codes to identify the new MAC numbers and their effective dates. DB2 ALIAS : CARR_NUM SAS ALIAS : CARR_NUM STANDARD ALIAS : CARR_NUM TITLE ALIAS : CARRIER LENGTH : 5 COMMENTS : Prior to Version H this field was named: FICARR_IDENT_NUM. SOURCE : CWF CODE TABLE : CARR_NUM_TB 40. FILLER CHAR 8 178 185 DB2 ALIAS : FILLER LENGTH : 8 41. CWF Transmission Batch Number 4 186 189 CHAR Effective with Version H, the number assigned to each batch of claims transactions sent from CWF(used for internal editing purposes). NOTE: Beginning 11/98, this field will be populated with data. Claims processed prior to 11/98 will contain spaces in this field. DB2 ALIAS : TRNSMSN_BATCH_NUM SAS ALIAS : FIBATCH STANDARD ALIAS : CWF_TRNSMSN_BATCH_NUM TITLE ALIAS : BATCH_NUM LENGTH : 4 SOURCE : CWF 42. Beneficiary Mailing Contact ZIP Code 9 190 198 CHAR The ZIP code of the mailing address where the beneficiary may be contacted. DB2 ALIAS : BENE_MLG_ZIP_CD SAS ALIAS : BENE_ZIP STANDARD ALIAS : BENE_MLG_CNTCT_ZIP_CD TITLE ALIAS : BENE_ZIP LENGTH : 9 SOURCE : 43. Beneficiary Sex Identification Code 1 199 199 CHAR The sex of a beneficiary. COMMON ALIAS : SEX_CD DA3 ALIAS : SEX_CODE DB2 ALIAS : BENE_SEX_IDENT_CD SAS ALIAS : SEX STANDARD ALIAS : BENE_SEX_IDENT_CD TITLE ALIAS : SEX_CD LENGTH : 1 SOURCE : SSA,RRB,EDB EDIT RULES : REQUIRED FIELD CODE TABLE : BENE_SEX_IDENT_TB 44. Beneficiary Race Code 1 200 200 CHAR The race of a beneficiary. DA3 ALIAS : RACE_CODE DB2 ALIAS : BENE_RACE_CD SAS ALIAS : RACE STANDARD ALIAS : BENE_RACE_CD TITLE ALIAS : RACE_CD LENGTH : 1 SOURCE : SSA CODE TABLE : BENE_RACE_TB 45. Beneficiary Birth Date 8 201 208 NUM The beneficiary's date of birth. COMMON ALIAS : DOB DA3 ALIAS : BIRTH_DATE DB2 ALIAS : BENE_BIRTH_DT SAS ALIAS : BENE_DOB STANDARD ALIAS : BENE_BIRTH_DT TITLE ALIAS : BENE_BIRTH_DATE LENGTH : 8 SIGNED : N SOURCE : CWF EDIT RULES : YYYYMMDD 46. CWF Beneficiary Medicare Status Code 2 209 210 CHAR The CWF-derived reason for a beneficiary's entitlement to Medicare benefits, as of the reference date (CLM_THRU_DT). COBOL ALIAS : MSC COMMON ALIAS : MSC DB2 ALIAS : BENE_MDCR_STUS_CD SAS ALIAS : MS_CD STANDARD ALIAS : CWF_BENE_MDCR_STUS_CD TITLE ALIAS : MSC LENGTH : 2 DERIVATIONS : CWF derives MSC from the following: 1. Date of Birth 2. Claim Through Date 3. Original/Current Reasons for entitlement 4. ESRD Indicator 5. Beneficiary Claim Number Items 1,3,4,5 come from the CWF Beneficiary Master Record; item 2 comes from the FI/Carrier claim record. MSC is assigned as follows: MSC OASI DIB ESRD AGE BIC ______ _____ _____ _____ _____ ______ 10 YES N/A NO 65 and over N/A 11 YES N/A YES 65 and over N/A 20 NO YES NO under 65 N/A 21 NO YES YES under 65 N/A 31 NO NO YES any age T. COMMENTS : Prior to Version H this field was named: BENE_MDCR_STUS_CD. The name has been changed to distinguish this CWF-derived field from the EDB-derived MSC (BENE_MDCR_STUS_CD). SOURCE : CWF CODE TABLE : BENE_MDCR_STUS_TB 47. Claim Patient 6 Position Surname 6 211 216 CHAR The first 6 positions of the Medicare patient's surname (last name) as reported by the provider on the claim. NOTE1: Prior to Version H, this field was only present on the IP/SNF claim record. Effective with Version H, this field is present on all claim types. NOTE2: For OP, HHA, Hospice and all Carrier claims, data was populated beginning with NCH weekly process 10/3/97. Claims processed prior to 10/3/97 will contain spaces in this field. COMMON ALIAS : PATIENT_SURNAME DB2 ALIAS : PTNT_6_PSTN_SRNM SAS ALIAS : SURNAME STANDARD ALIAS : CLM_PTNT_6_PSTN_SRNM_NAME TITLE ALIAS : PATIENT_SURNAME LENGTH : 6 SOURCE : CWF 48. Claim Patient 1st Initial Given Name 1 217 217 CHAR The first initial of the Medicare patient's given name (first name) as reported by the provider on the claim. NOTE1: Prior to Version H, this field was only present on the IP/SNF claim record. Effective with Version H, this field is present on all claim types. NOTE2: For OP, HHA, Hospice and all Carrier claims, data was populated beginning with NCH weekly process date 10/3/97. Claims processed prior to 10/3/97 will contain spaces in this field. COMMON ALIAS : PATIENT_GIVEN_NAME DB2 ALIAS : 1ST_INITL_GVN_NAME SAS ALIAS : FRSTINIT STANDARD ALIAS : CLM_PTNT_1ST_INITL_GVN_NAME TITLE ALIAS : PATIENT_FIRST_INITIAL LENGTH : 1 SOURCE : CWF 49. Claim Patient First Initial Middle Name 1 218 218 CHAR The first initial of the Medicare patient's middle name as reported by the provider on the claim. NOTE1: Prior to Version H, this field was only present on the IP/SNF claim record. Effective with Version H, this field is present on all claim types. NOTE2: For OP, HHA, Hospice and all Carrier claims, data was populated beginning with NCH weekly process date 10/3/97. Claims pro- cessed prior to 10/3/97 will contain spaces in this field. COMMON ALIAS : PATIENT_MIDDLE_NAME DB2 ALIAS : 1ST_INITL_MDL_NAME SAS ALIAS : MDL_INIT STANDARD ALIAS : CLM_PTNT_1ST_INITL_MDL_NAME TITLE ALIAS : PATIENT_MIDDLE_INITIAL LENGTH : 1 SOURCE : CWF 50. Beneficiary CWF Location Code 1 219 219 CHAR The code that identifies the Common Working File (CWF) location (the host site) where a beneficiary's Medicare utilization records are maintained. COMMON ALIAS : CWF_HOST DB2 ALIAS : BENE_CWF_LOC_CD SAS ALIAS : CWFLOCCD STANDARD ALIAS : BENE_CWF_LOC_CD TITLE ALIAS : CWF_HOST LENGTH : 1 SOURCE : CWF CODE TABLE : BENE_CWF_LOC_TB 51. Claim Principal Diagnosis Code 5 220 224 CHAR The ICD-9-CM diagnosis code identifying the diagnosis, condition, problem or other reason for the admission/encounter/visit shown in the medical record to be chiefly responsible for the services provided. NOTE: Effective with Version H, this data is also redundantly stored as the first occurrence of the diagnosis trailer. DB2 ALIAS : PRNCPAL_DGNS_CD SAS ALIAS : PDGNS_CD STANDARD ALIAS : CLM_PRNCPAL_DGNS_CD TITLE ALIAS : PRINCIPAL_DIAGNOSIS LENGTH : 5 SOURCE : CWF EDIT RULES : ICD-9-CM 52. FILLER CHAR 1 225 225 DB2 ALIAS : FILLER LENGTH : 1 53. Carrier Claim Payment Denial Code 1 226 226 CHAR The code on a noninstitutional claim indicating to whom payment was made or if the claim was denied. NOTE: Effective 4/1/02, this field was expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value. See table of code for the crosswalk. DB2 ALIAS : CARR_PMT_DNL_CD SAS ALIAS : PMTDNLCD STANDARD ALIAS : CARR_CLM_PMT_DNL_CD TITLE ALIAS : PMT_DENIAL_CD LENGTH : 1 COMMENTS : Prior to Version H this field was named: CWFB_CLM_PMT_DNL_CD. SOURCE : CWF CODE TABLE : CARR_CLM_PMT_DNL_TB 54. Claim Excepted/Nonexcepted Medical Treatment Code 1 227 227 CHAR Effective with Version I, the code used to identify whether or not the medical care or treatment received by a beneficiary, who has elected care from a Religious Nonmedical Health Care Institution (RNHCI), is excepted or nonexcepted. Excepted is medical care or treatment that is received involuntarily or is re- quired under Federal, State or local law. Nonexcepted is defined as medical care or treatment other than excepted. DB2 ALIAS : EXCPTD_NEXCPTD_CD SAS ALIAS : TRTMT_CD STANDARD ALIAS : CLM_EXCPTD_NEXCPTD_TRTMT_CD TITLE ALIAS : EXCPTD_NEXCPTD_CD LENGTH : 1 SOURCE : CWF CODES : 0 = No Entry 1 = Excepted 2 = Nonexcepted 55. Claim Payment Amount 6 228 233 PACK Amount of payment made from the Medicare trust fund for the services covered by the claim record. Generally, the amount is calculated by the FI or carrier; and represents what was paid to the institutional provider, physician, or supplier, with the exceptions noted below. **NOTE: In some situations, a negative claim payment amount may be pre- sent; e.g., (1) when a beneficiary is charged the full deductible during a short stay and the deductible exceeded the amount Medicare pays; or (2) when a beneficiary is charged a coinsurance amount during a long stay and the coinsurance amount exceeds the amount Medicare pays (most prevalent situation involves psych hospitals who are paid a daily per diem rate no matter what the charges are.) Under IP PPS, inpatient hospital services are paid based on a predetermined rate per discharge, using the DRG patient classification system and the PRICER program. On the IP PPS claim, the payment amount includes the DRG outlier approved payment amount, disproportionate share (since 5/1/86), indirect medical education (since 10/1/88), total PPS capital (since 10/1/91). After 4/1/03, the payment amount could also include a "new technology" add-on amount. It does NOT include the pass-thru amounts (i.e., capital- related costs, direct medical education costs, kidney acquisition costs, bad debts); or any beneficiary-paid amounts (i.e., deductibles and coinsurance); or any any other payer reimbursement. Under IRFPPS, inpatient rehabilitation services are paid based on a predetermined rate per discharge, using the Case Mix Group (CMG) classification system and the PRICER program. From the CMG on the IRF PPS claim, payment is based on a standard payment amount for operating and capital cost for that facility (including routine and ancillary services). The payment is adjusted for wage, the % of low-income patients (LIP), locality, transfers, interrupted stays, short stay cases, deaths, and high cost outliers. Some or all of these adjustments could apply. The CMG payment does NOT include certain pass- through costs (i.e. bad debts, approved education activities); beneficiary-paid amounts, other payer reim- bursement,and other services outside of the scope of PPS. Under LTCH PPS, long term care hospital services are paid based on a predetermined rate per discharge based on the DRG and the PRICER program. Payments are based on a single standard Federal rate for both inpatient operating and capital-related costs (including routine and ancillary services), but do NOT include certain pass-through costs (i.e. bad debts, direct medical education, new technologies and blood clotting factors). Adjustments to the payment may occur due to short-stay outliers, interrupted stays, high cost outliers, wage index, and cost of living adjust- ments. Under SNF PPS, SNFs will classify beneficiaries using the patient classification system known as RUGS III. For the SNF PPS claim, the SNF PRICER will calculate/return the rate for each revenue center line item with revenue center code = '0022'; multiply the rate times the units count; and then sum the amount payable for all lines with revenue center code '0022' to determine the total claim payment amount. Under Outpatient PPS, the national ambulatory payment classification (APC) rate that is calculated for each APC group is the basis for determining the total claim payment. The payment amount also includes the outlier payment and interest. Under Home Health PPS, beneficiaries will be classified into an appropriate case mix category known as the Home Health Resource Group. A HIPPS code is then generated corresponding to the case mix category (HHRG). For the RAP, the PRICER will determine the payment amount appropriate to the HIPPS code by computing 60% (for first episode) or 50% (for subsequent episodes) of the case mix episode payment. The payment is then wage index adjusted. For the final claim, PRICER calculates 100% of the amount due, because the final claim is processed as an adjustment to the RAP, reversing the RAP payment in full. Although final claim will show 100% payment amount, the provider will actually receive the 40% or 50% payment. The payment may also include outlier payments. Exceptions: For claims involving demos and BBA encounter data, the amount reported in this field may not just represent the actual provider payment. For demo Ids '01','02','03','04' -- claims contain amount paid to the provider, except that special 'differentials' paid outside the normal payment system are not included. For demo Ids '05','15' -- encounter data 'claims' contain amount Medicare would have paid under FFS, instead of the actual payment to the MCO. For demo Ids '06','07','08' -- claims contain actual provider payment but represent a special negotiated bundled payment for both Part A and Part B services. To identify what the conventional provider Part A payment would have been, check value code = 'Y4'. The related noninstitutional (physician/supplier) claims contain what would have been paid had there been no demo. For BBA encounter data (non-demo) -- 'claims' contain amount Medicare would have paid under FFS, instead of the actual payment to the BBA plan. COMMON ALIAS : REIMBURSEMENT DB2 ALIAS : CLM_PMT_AMT SAS ALIAS : PMT_AMT STANDARD ALIAS : CLM_PMT_AMT TITLE ALIAS : REIMBURSEMENT LENGTH : 9.2 SIGNED : Y COMMENTS : Prior to Version H the size of this field was S9(7)V99. Also, the noninstitutional claim records carried this field as a line item. Effective with Version H, this element is a claim level field across all claim types (and the line item field has been renamed.) SOURCE : CWF LIMITATIONS : Prior to 4/6/93, on inpatient, outpatient, and physician/supplier claims containing a CLM_DISP_CD of '02', the amount shown as the Medicare reimbursement does not take into consideration any CWF automatic adjustments (involving erroneous deductibles in most cases). In as many as 30% of the claims (30% IP, 15% OP, 5% PART B), the reimbursement reported on the claims may be over or under the actual Medicare payment amount. REFER TO : PMT_AMT_EXCEDG_CHRG_AMT_LIM EDIT RULES : $$$$$$$$$CC 56. Carrier Claim Primary Payer Paid Amount 6 234 239 PACK Effective with Version H, the amount of a payment made on behalf of a Medicare bene- ficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim. NOTE: During the Version H conversion, this field was populated with data throughout history (back to service year 1991) by summing up the line item primary payer amounts. DB2 ALIAS : CARR_PRMRY_PYR_AMT SAS ALIAS : PRPAYAMT STANDARD ALIAS : CARR_CLM_PRMRY_PYR_PD_AMT TITLE ALIAS : PRIMARY_PAYER_AMOUNT LENGTH : 9.2 SIGNED : Y SOURCE : CWF EDIT RULES : $$$$$$$$$CC 57. FILLER CHAR 1 240 240 DB2 ALIAS : FILLER LENGTH : 1 58. Carrier Claim Referring UPIN Number 6 241 246 CHAR The unique physician identification number (UPIN) of the physician who referred the beneficiary to the physician who performed the Part B services. COMMON ALIAS : REFERRING_PHYSICIAN_UPIN DB2 ALIAS : RFRG_UPIN_NUM SAS ALIAS : RFR_UPIN STANDARD ALIAS : CARR_CLM_RFRG_UPIN_NUM TITLE ALIAS : REFERRING_PHYSICIAN_UPIN LENGTH : 6 COMMENTS : Prior to Version H this field was named: CWFB_CLM_RFRG_UPIN_NUM. SOURCE : CWF 59. Carrier Claim Referring Physician NPI Number 10 247 256 CHAR The national provider identifier (NPI) number of the physician who referred the beneficiary to the physician who performed the Part B services. NOTE: Effective May 2007, the NPI will be- come the national standard identifier for covered health care providers. NPIs will replace current OSCAR provider number, UPINs, NSC numbers, and local contractor provider identification numbers (PINs) on standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, PIN, OSCAR provider number, etc.)). NOTE1: CMS has determined that dual provider identifiers (old legacy numbers and new NPI) must be available on the NCH. After the 5/07 NPI implementation, the standard system main- tainers will add the legacy number to the claim when it is adjudicated. We will continue to re- ceive any currently issued UPINs. Effective May 2007, no new UPINs (legacy number) will be generated for new physicians (Part B and Outpatient claims) so there will only be NPIs sent in to the NCH for those physicians. DB2 ALIAS : RFRG_PHYSN_NPI_NUM SAS ALIAS : RFR_NPI LENGTH : 10 SOURCE : CWF 60. Carrier Claim Provider Assignment Indicator Switch 1 257 257 CHAR A switch indicating whether or not the provider accepts assignment for the noninstitutional claim. DB2 ALIAS : PRVDR_ASGNMT_SW SAS ALIAS : ASGMNTCD STANDARD ALIAS : CARR_CLM_PRVDR_ASGNMT_IND_SW TITLE ALIAS : ASSIGNMENT_SW LENGTH : 1 COMMENTS : Prior to Version H this field was named: CWFB_CLM_PRVDR_ASGNMT_IND_SW. SOURCE : CWF CODES : A = Assigned claim N = Non-assigned claim 61. NCH Claim Provider Payment Amount 6 258 263 PACK Effective with Version H, the total payments made to the provider for this claim (sum of line item provider payment amounts.) NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : NCH_PRVDR_PMT_AMT SAS ALIAS : PROV_PMT STANDARD ALIAS : NCH_CLM_PRVDR_PMT_AMT TITLE ALIAS : PRVDR_PMT LENGTH : 9.2 SIGNED : Y SOURCE : NCH QA Process 62. NCH Claim Beneficiary Payment Amount 6 264 269 PACK Effective with Version H, the total payments made to the beneficiary for this claim (sum of line payment amounts to the beneficiary.) NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : NCH_BENE_PMT_AMT SAS ALIAS : BENE_PMT STANDARD ALIAS : NCH_CLM_BENE_PMT_AMT TITLE ALIAS : BENE_PMT LENGTH : 9.2 SIGNED : Y SOURCE : NCH QA Process 63. Carrier Claim Beneficiary Paid Amount 6 270 275 PACK Effective with Version H, the amount paid by the beneficiary for the non-institutional Part B services. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : CARR_BENE_PD_AMT SAS ALIAS : BENEPAID STANDARD ALIAS : CARR_CLM_BENE_PD_AMT TITLE ALIAS : BENE_PD_AMT LENGTH : 9.2 SIGNED : Y SOURCE : CWF 64. NCH Carrier Claim Submitted Charge Amount 6 276 281 PACK Effective with Version H, the total submitted charges on the claim (the sum of line item submitted charges). NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991). DB2 ALIAS : CARR_SBMT_CHRG_AMT SAS ALIAS : SBMTCHRG STANDARD ALIAS : NCH_CARR_SBMT_CHRG_AMT TITLE ALIAS : SBMT_CHRG LENGTH : 9.2 SIGNED : Y SOURCE : NCH QA Process EDIT RULES : $$$$$$$$$CC 65. NCH Carrier Claim Allowed Charge Amount 6 282 287 PACK Effective with Version H, the total allowed charges on the claim (the sum of line item allowed charges). NOTE1: The amount includes beneficiary-paid amounts (i.e., deductible and coinsurance). NOTE2: During the Version H conversion this field was populated with data throughout history (back to service year 1991). DB2 ALIAS : CARR_ALOW_CHRG_AMT SAS ALIAS : ALOWCHRG STANDARD ALIAS : NCH_CARR_ALOW_CHRG_AMT TITLE ALIAS : ALOW_CHRG LENGTH : 9.2 SIGNED : Y SOURCE : NCH QA Process EDIT RULES : $$$$$$$CC 66. Carrier Claim Cash Deductible Applied Amount 6 288 293 PACK Effective with Version H, the amount of the cash deductible as submitted on the claim. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : CASH_DDCTBL_AMT SAS ALIAS : DEDAPPLY STANDARD ALIAS : CARR_CLM_CASH_DDCTBL_APPLY_AMT TITLE ALIAS : CASH_DDCTBL LENGTH : 9.2 SIGNED : Y SOURCE : CWF 67. Carrier Claim HCPCS Year Code 1 294 294 NUM Effective with Version H, the terminal digit of HCPCS version used to code the claim. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : CARR_HCPCS_YR_CD SAS ALIAS : HCPCS_YR STANDARD ALIAS : CARR_CLM_HCPCS_YR_CD TITLE ALIAS : HCPCS_YR LENGTH : 1 SIGNED : N SOURCE : CWF 68. Carrier Claim MCO Override Indicator Code 1 295 295 CHAR Effective with Version H, the code used to indicate whether or not an MCO investigation applies to the claim (used for internal CWFMQA editing purposes). NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. DB2 ALIAS : MCO_OVRRD_IND_CD SAS ALIAS : MCOOVRRD STANDARD ALIAS : CARR_CLM_MCO_OVRRD_IND_CD TITLE ALIAS : MCO_OVERRIDE LENGTH : 1 SOURCE : CWF CODE TABLE : CARR_CLM_MCO_OVRRD_IND_TB 69. Carrier Claim Hospice Override Indicator Code 1 296 296 CHAR Effective with Version H, the code used to indicate whether or not an Hospice investigation applies to the claim (used for internal CWFMQA editing purposes). NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. DB2 ALIAS : HOSPC_OVRRD_IND_CD SAS ALIAS : HOSPOVRD STANDARD ALIAS : CARR_CLM_HOSPC_OVRRD_IND_CD TITLE ALIAS : HOSPC_OVERRIDE LENGTH : 1 SOURCE : CWF CODE TABLE : CARR_CLM_HOSPC_OVRRD_IND_TB 70. Claim Business Segment Identifier Code 4 297 300 CHAR Effective 10/1/2005 with the implementation of NCH/NMUD CR#2, the identifier that captures the 2-byte juris- diction code (represents the USPS state/territory abbreviation (i.e. NY = New York) and the 2-byte modifier that identifies the type of Medicare FFS contract (intermediary, RHHI, carrier or DMERC). This 4-byte identifier along with the 5-byte FI/Carrier number comprises the Contractor Workload Identifier number. The business segment identifier (BSI) is intended to help sort work- loads that may be redistributed with the implemen- tation of contracting reform as required by MMA. DB2 ALIAS : BUSNS_SGMT_ID_CD SAS ALIAS : SGMT_ID STANDARD ALIAS : CLM_BUSNS_SGMT_ID_CD LENGTH : 4 SOURCE : CWF 71. FILLER CHAR 27 301 327 DB2 ALIAS : FILLER LENGTH : 27 72. Carrier Specific Group 34 328 361 GRP This group identifies those fields specific to the carrier claim record. 73. Carrier Claim Referring PIN Number 14 328 341 CHAR Carrier-assigned identification (profiling) number of the physician who referred the beneficiary to the physician that performed the Part B services. COMMON ALIAS : REFERRING_PHYSICIAN_PIN DB2 ALIAS : RFRG_PIN_NUM SAS ALIAS : RFR_PRFL STANDARD ALIAS : CARR_CLM_RFRG_PIN_NUM TITLE ALIAS : RFRG_PIN LENGTH : 14 COMMENTS : Prior to Version H this field was named: CWFB_CLM_RFRG_PHYSN_PRFLG_NUM. SOURCE : CWF 74. Care Plan Oversight (CPO) Provider Number 6 342 347 CHAR Effective with NCH weekly process date 3/7/97, the Medicare provider number of the HHA or Hospice rendering Medicare covered services during period the physician is providing care plan oversight. The purpose of this field is to ensure compliance with the CPO requirement that the beneficiary must be receiving covered HHA or Hospice services during the billing period. There can be only one CPO provider number per claim, and no other services but CPO physician services are to be reported on the claim. This field is only present on the non-DMERC processed carrier claim. NOTE: On the Version G format, this field is stored as a redefinition of the NEAR_LINE_ORGNL_BENE_CAN_NUM (the first 3 positions contain 'CPO', followed by the 6-position provider number). During the Version H conversion the data was moved to this dedicated field. DB2 ALIAS : CPO_PRVDR_NUM SAS ALIAS : CPO_PROV LENGTH : 6 SOURCE : CWF 75. CPO Organization NPI Number 10 348 357 CHAR The National Provider Identifier (NPI) number of the HHA or Hospice rendering Medicare ser- vices during the period the physician is pro- viding care plan oversight. The purpose of this field is to ensure compliance with the CPO requirement that the beneficiary must be receiving covered HHA or Hospice services during the billing period. There can be only one CPO provider number per claim, and no other services but CPO physician services are to be reported on the claim. This field is only present on the non-DMERC processed carrier claim. NOTE: Effective May 2007, the NPI will become the national standard identifier for covered health care providers. NPIs will replace the current legacy provider numbers (UPINs, PINs, OSCAR provider numbers, etc.) on the standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, NPIs, OSCAR provider numbers, etc.)). NOTE1: CMS has determined that dual provider iden- tifiers (legacy numbers and NPIs) must be avail- able on the NCH. After the 5/07 NPI implementation, the standard system maintainers will add the legacy number to the claim when it is adjudicated. Effect- tive May 2007, no NEW UPINs (legacy number) will be generated for NEW physicians (Part B and Outpatient claims) so there will only be NPIs sent in to the NCH for those physicians. DB2 ALIAS : CPO_ORG_NPI_NUM SAS ALIAS : CPO_NPI LENGTH : 10 SOURCE : CWF 76. Claim Blood Pints Furnished Quantity 2 358 359 PACK Number of whole pints of blood furnished to the beneficiary, as reported on the carrier claim (non-DMERC). DB2 ALIAS : BLOOD_PT_FRNSH_QTY SAS ALIAS : BLDFRNSH STANDARD ALIAS : CLM_BLOOD_PT_FRNSH_QTY TITLE ALIAS : BLOOD_PINTS_FURNISHED LENGTH : 3 SIGNED : Y COMMENTS : Prior to Version H this field was stored in a blood trailer. Version H eliminated the blood trailer. SOURCE : CWF EDIT RULES : NUMERIC 77. Claim Blood Deductible Pints Quantity 2 360 361 PACK The quantity of blood pints applied (blood deductible) as reported on the carrier claim (non-DMERC). DB2 ALIAS : BLOOD_DDCTBL_PT SAS ALIAS : BLD_DED STANDARD ALIAS : CLM_BLOOD_DDCTBL_PT_QTY TITLE ALIAS : BLOOD_PINTS_DEDUCTIBLE LENGTH : 3 SIGNED : Y COMMENTS : Prior to Version H this field was stored in a blood trailer. Version H eliminated the blood trailer. SOURCE : CWF EDIT RULES : NUMERIC 78. Carrier NCH Edit Code Count 2 362 363 NUM The count of the number of edit codes annotated to the carrier claim during HCFA's CWFMQA process. The purpose of this count is to indicate how many claim edit trailers are present. DB2 ALIAS : EDIT_TRLR_CNT SAS ALIAS : CEDCNT STANDARD ALIAS : CARR_NCH_EDIT_CD_CNT LENGTH : 2 SIGNED : N COMMENTS : Prior to Version H this field was named: CLM_EDIT_CD_CNT. SOURCE : NCH 79. Carrier NCH Patch Code Count 2 364 365 NUM Effective with Version H, the count of the number of HCFA patch codes annotated to the carrier claim during the Nearline maintenance process. The purpose of this count is to indicate how many NCH patch trailers are present. NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991). DB2 ALIAS : PATCH_TRLR_CNT SAS ALIAS : CPATCNT STANDARD ALIAS : CARR_NCH_PATCH_CD_I_CNT LENGTH : 2 SIGNED : N SOURCE : NCH 80. Carrier MCO Period Count 1 366 366 NUM Effective with Version H, the count of the number of Managed Care Organization (MCO) periods reported on a carrier claim. The purpose of this count is to indicate how many MCO period trailers are present. NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field. DB2 ALIAS : CARR_MCO_PRD_CNT SAS ALIAS : CMCOCNT STANDARD ALIAS : CARR_MCO_PRD_CNT LENGTH : 1 SIGNED : N SOURCE : NCH EDIT RULES : RANGE: 0 TO 2 81. Carrier Claim Health PlanID Count 1 367 367 NUM A placeholder field (effective with Version H) for storing the count of the number of Health PlanIDs reported on the carrier claim. The purpose of this count is to indicate how many Health PlanID trailers are present. NOTE: Prior to Version 'I' this field was named: CARR_CLM_PAYERID_CNT. DB2 ALIAS : PAYERID_TRLR_CNT SAS ALIAS : CPLNCNT STANDARD ALIAS : CARR_CLM_HLTH_PLANID_CNT LENGTH : 1 SIGNED : N SOURCE : NCH EDIT RULES : RANGE: 0 TO 3 82. Carrier Claim Demonstration ID Count 1 368 368 NUM Effective with Version H, the count of the number of claim demonstration IDs reported on an carrier claim. The purpose of this count is to indicate how many claim demonstration trailers are present. NOTE: During the Version H conversion this field was populated with data where a demo was identifiable. DB2 ALIAS : DEMO_TRLR_CNT SAS ALIAS : CDEMCNT STANDARD ALIAS : CARR_CLM_DEMO_ID_CNT LENGTH : 1 SIGNED : N SOURCE : NCH EDIT RULES : RANGE: 0 TO 5 83. Carrier Claim Diagnosis Code Count 1 369 369 NUM The count of the number of diagnosis codes (both principal and other) reported on an carrier claim. The purpose of this count is to indicate how many claim diagnosis trailers are present. DB2 ALIAS : DGNS_TRLR_CNT SAS ALIAS : CDGNCNT STANDARD ALIAS : CARR_CLM_DGNS_CD_CNT LENGTH : 1 SIGNED : N COMMENTS : Prior to Version H this field was named: CLM_DGNS_CD_CNT. SOURCE : NCH EDIT RULES : RANGE: 0 TO 4 84. Carrier Claim Line Count 2 370 371 NUM The count of the number of line items reported on the carrier claim. The purpose of this count is to indicate how many line item trailers are present. DB2 ALIAS : LINE_ITM_TRLR_CNT SAS ALIAS : CLINECNT STANDARD ALIAS : CARR_CLM_LINE_CNT LENGTH : 2 SIGNED : N COMMENTS : Prior to Version H this field was named: CWFB_CLM_NUM_LINE_ITM_CNT. SOURCE : CWFB CLAIMS EDIT RULES : RANGE: 1 TO 13 85. FILLER CHAR 4 372 375 DB2 ALIAS : FILLER LENGTH : 4 86. Carrier Claim Variable Group VAR 376 4863 GRP Variable portion of the Carrier Claim Record for version I of the NCH. 87. NCH Edit Group 5 376 380 GRP The number of claim edit trailers is determined by the claim edit code count. STANDARD ALIAS : NCH_EDIT_GRP OCCURS MIN: 0 OCCURS MAX: 13 DEPENDING ON : CARR_NCH_EDIT_CD_CNT 88. NCH Edit Trailer Indicator Code 1 376 376 CHAR Effective with Version H, the code indicating the presence of an NCH edit trailer. NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991). DB2