Carrier (Fee-for-Service)

File Version: K

Additional Data Documentation:

Variable List:

* = Limitations and/or code table are available for variable.
Short SAS NameVariable NameLimitationCode table
1CCW Encrypted Beneficiary ID Number
2CLM_IDClaim ID*
3RIC_CDNCH Near Line Record Identification Code*
4CLM_TYPENCH Claim Type Code*
5FROM_DTClaim From Date
6THRU_DTClaim Through Date
7WKLY_DTNCH Weekly Claim Processing Date
8ENTRY_CDCarrier Claim Entry Code
9DISP_CDClaim Disposition Code*
10CARR_NUMCarrier Number*
11PMTDNLCDCarrier Claim Payment Denial Code*
12PMT_AMTClaim Payment Amount*
13PRPAYAMTCarrier Claim Primary Payer Paid Amount*
14RFR_UPINCarrier Claim Referring Physician UPIN Number
15RFR_NPICarrier Claim Referring Physician NPI Number
16ASGMNTCDCarrier Claim Provider Assignment Indicator Switch*
17PROV_PMTNCH Claim Provider Payment Amount*
18BENE_PMTNCH Claim Beneficiary Payment Amount*
19SBMTCHRGNCH Carrier Claim Submitted Charge Amount*
20ALOWCHRGNCH Carrier Claim Allowed Charge Amount*
21DEDAPPLYCarrier Claim Cash Deductible Applied Amount*
22HCPCS_YRCarrier Claim HCPCS Year Code
23RFR_PRFLCarrier Claim Referring PIN Number
24PRNCPAL_DGNS_CDClaim Principal Diagnosis Code
25PRNCPAL_DGNS_VRSN_CDPrimary Claim Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)*
26ICD_DGNS_CD1Claim Diagnosis Code I
27ICD_DGNS_VRSN_CD1Claim Diagnosis Code I Diagnosis Version Code (ICD-9 or ICD-10)*
28ICD_DGNS_CD2Claim Diagnosis Code II
29ICD_DGNS_VRSN_CD2Claim Diagnosis Code II Diagnosis Version Code (ICD-9 or ICD-10)*
30ICD_DGNS_CD3Claim Diagnosis Code III
31ICD_DGNS_VRSN_CD3Claim Diagnosis Code III Diagnosis Version Code (ICD-9 or ICD-10)*
32ICD_DGNS_CD4Claim Diagnosis Code IV
33ICD_DGNS_VRSN_CD4Claim Diagnosis Code IV Diagnosis Version Code (ICD-9 or ICD-10)*
34ICD_DGNS_CD5Claim Diagnosis Code V
35ICD_DGNS_VRSN_CD5Claim Diagnosis Code V Diagnosis Version Code (ICD-9 or ICD-10)*
36ICD_DGNS_CD6Claim Diagnosis Code VI
37ICD_DGNS_VRSN_CD6Claim Diagnosis Code VI Diagnosis Version Code (ICD-9 or ICD-10)*
38ICD_DGNS_CD7Claim Diagnosis Code VII
39ICD_DGNS_VRSN_CD7Claim Diagnosis Code VII Diagnosis Version Code (ICD-9 or ICD-10)*
40ICD_DGNS_CD8Claim Diagnosis Code VIII
41ICD_DGNS_VRSN_CD8Claim Diagnosis Code VIII Diagnosis Version Code (ICD-9 or ICD-10)*
42ICD_DGNS_CD9Claim Diagnosis Code IX
43ICD_DGNS_VRSN_CD9Claim Diagnosis Code IX Diagnosis Version Code (ICD-9 or ICD-10)*
44ICD_DGNS_CD10Claim Diagnosis Code X
45ICD_DGNS_VRSN_CD10Claim Diagnosis Code X Diagnosis Version Code (ICD-9 or ICD-10)*
46ICD_DGNS_CD11Claim Diagnosis Code XI
47ICD_DGNS_VRSN_CD11Claim Diagnosis Code XI Diagnosis Version Code (ICD-9 or ICD-10)*
48ICD_DGNS_CD12Claim Diagnosis Code XII
49ICD_DGNS_VRSN_CD12Claim Diagnosis Code XII Diagnosis Version Code (ICD-9 or ICD-10)*
50CCLTRNUMClinical Trial Number
51DOB_DTDate of Birth from Claim (Date)
52GNDR_CDGender Code from Claim*
53RACE_CDRace Code from Claim*
54CNTY_CDCounty Code from Claim (SSA)
55STATE_CDState Code from Claim (SSA)*
56ZIP_CDZip Code of Residence from Claim
57CLM_BENE_PD_AMTCarrier Claim Beneficiary Paid Amount*
58CPO_PRVDR_NUMCare Plan Oversight (CPO) Provider Number
59CPO_ORG_NPI_NUMCPO Organization NPI Number
60CARR_CLM_BLG_NPI_NUMCarrier Claim Billing NPI Number
61ACO_ID_NUMClaim Accountable Care Organization (ACO) Identification Number

LINE FILE

Short SAS NameVariable NameLimitationCode table
1CCW Encrypted Beneficiary ID Number
2CLM_IDClaim ID*
3CLM_LNClaim Line Number
4CLM_TYPENCH Claim Type Code*
5THRU_DTClaim Through Date
6PRF_PRFLCarrier Line Performing PIN Number
7PRF_UPINCarrier Line Performing UPIN Number*
8PRFNPICarrier Line Performing NPI Number
9PRGRPNPICarrier Line Performing Group NPI Number
10PRV_TYPECarrier Line Provider Type Code*
11TAX_NUMLine Provider Tax Number
12PRVSTATELine NCH Provider State Code*
13PROVZIPCarrier Line Performing Provider ZIP Code
14HCFASPCLLine CMS Provider Specialty Code*
15PRTCPTGLine Provider Participating Indicator Code*
16ASTNT_CDCarrier Line Reduced Payment Physician Assistant Code*
17SRVC_CNTLine Service Count
18TYPSRVCBLine HCFA Type Service Code*
19PLCSRVCLine Place Of Service Code*
20LCLTY_CDCarrier Line Pricing Locality Code
21EXPNSDT1Line First Expense Date
22EXPNSDT2Line Last Expense Date
23HCPCS_CDHealth Care Common Procedure Coding System
24MDFR_CD1Line HCPCS Initial Modifier Code
25MDFR_CD2Line HCPCS Second Modifier Code
26BETOSLine NCH BETOS Code
27LINEPMTLine NCH Payment Amount
28LBENPMTLine Beneficiary Payment Amount
29LPRVPMTLine Provider Payment Amount
30LDEDAMTLine Beneficiary Part B Deductible Amount
31LPRPAYCDLine Beneficiary Primary Payer Code*
32LPRPDAMTLine Beneficiary Primary Payer Paid Amount
33COINAMTLine Coinsurance Amount
34LSBMTCHGLine Submitted Charge Amount
35LALOWCHGLine Allowed Charge Amount
36PRCNGINDLine Processing Indicator Code*
37PMTINDSWLine Payment 80%/100% Code
38DED_SWLine Service Deductible Indicator Switch*
39MTUS_CNTCarrier Line Miles/Time/Units/Services Count
40MTUS_INDCarrier Line Miles/Time/Units/Services Indicator Code*
41LINE_ICD_DGNS_CDLine Diagnosis Code
42LINE_ICD_DGNS_VRSN_CDLine Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)*
43HPSASCCDCarrier Line HPSA/Scarcity Indicator Code*
44CARRXNUMCarrier Line RX Number*
45HCTHGBRSHematocrit/Hemoglobin Test Results
46HCTHGBTPHematocrit/Hemoglobin Test Type Code*
47LNNDCCDLine National Drug Code
48CARR_LINE_CLIA_LAB_NUMClinical Laboratory Improvement Amendments monitored laboratory number
49CARR_LINE_ANSTHSA_UNIT_CNTCarrier Line Anesthesia Unit Count
50CARR_LINE_CL_CHRG_AMTCarrier Line Clinical Lab Charge Amount
51PHYSN_ZIP_CDLine Place of Service (POS) Physician Zip Code
52LINE_OTHR_APLD_IND_CD1Line Other Applied Indicator 1st Code*
53LINE_OTHR_APLD_IND_CD2Line Other Applied Indicator 2nd Code*
54LINE_OTHR_APLD_IND_CD3Line Other Applied Indicator 3rd Code*
55LINE_OTHR_APLD_IND_CD4Line Other Applied Indicator 4th Code*
56LINE_OTHR_APLD_IND_CD5Line Other Applied Indicator 5th Code*
57LINE_OTHR_APLD_IND_CD6Line Other Applied Indicator 6th Code*
58LINE_OTHR_APLD_IND_CD7Line Other Applied Indicator 7th Code*
59LINE_OTHR_APLD_AMT1Line Other Applied Amount for 1st Code*
60LINE_OTHR_APLD_AMT2Line Other Applied Amount for 2nd Code*
61LINE_OTHR_APLD_AMT3Line Other Applied Amount for 3rd Code*
62LINE_OTHR_APLD_AMT4Line Other Applied Amount for 4th Code*
63LINE_OTHR_APLD_AMT5Line Other Applied Amount for 5th Code*
64LINE_OTHR_APLD_AMT6Line Other Applied Amount for 6th Code*
65LINE_OTHR_APLD_AMT7Line Other Applied Amount for 7th Code*
66THRPY_CAP_IND_CD1Line Therapy cap Indicator 1 Code*
67THRPY_CAP_IND_CD2Line Therapy cap Indicator 2 Code*
68THRPY_CAP_IND_CD3Line Therapy cap Indicator 3 Code*
69THRPY_CAP_IND_CD4Line Therapy cap Indicator 4 Code*
70THRPY_CAP_IND_CD5Line Therapy cap Indicator 5 Code*
71CLM_NEXT_GNRTN_ACO_IND_1_CDClaim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP)*
72CLM_NEXT_GNRTN_ACO_IND_2_CDClaim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth*
73CLM_NEXT_GNRTN_ACO_IND_3_CDClaim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits*
74CLM_NEXT_GNRTN_ACO_IND_4_CDClaim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver*
75CLM_NEXT_GNRTN_ACO_IND_5_CDClaim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation*

Demonstrations/Innovations Code File

Short SAS NameVariable NameLimitationCode table
1CCW Encrypted Beneficiary ID Number
2CLM_IDClaim ID*
3CLM_TYPENCH Claim Type Code*
4DEMO_ID_SQNC_NUMDemonstration sequence number
5DEMO_ID_NUMDemonstration number*
6DEMO_INFO_TXTDemo information text