1 | BENE_ID | Encrypted CCW Beneficiary ID | |
2 | SAMPLE_GROUP | CCW Beneficiary Random Sample Group | |
3 | ENC_JOIN_KEY | Unique Encounter Join Key | |
4 | CLM_TYPE_CD | Claim Type Code | |
5 | CLM_FROM_DT | Claim From Date (Encounter) | |
6 | CLM_THRU_DT | Claim Through Date (Encounter) | |
7 | SRVC_MONTH | Service Month | |
8 | CLM_CHRT_RVW_SW | Claim Chart Review Switch | |
9 | CLM_CNTL_NUM | Claim Control Number | |
10 | CLM_ORIG_CNTL_NUM | Claim Original Control Number | |
11 | CLM_FINL_ACTN_IND | Claim Final Action Indicator | |
12 | CLM_LTST_CLM_IND | Latest Claim Indicator | |
13 | EDPS_CREATE_DT | Encounter Data Processing System (EDPS) Create Date | |
14 | CLM_RCPT_DT | Claim Receipt Date | |
15 | CLM_FAC_TYPE_CD | Claim Facility Type Code (Encounter) | |
16 | Medicare Advantage Organizations (MAOs) | Claim Service Classification Type Code (Encounter) | |
17 | CLM_FREQ_CD | Claim Frequency Code (Encounter) | |
18 | CNTRCT_NUM | Medicare Part C Contract Number | |
19 | CNTRCT_PBP_NUM | Medicare Part C Plan Benefit Package (PBP) Number | |
20 | CLM_MDCL_REC | Claim Medical Record Number (Encounter) | |
21 | ORG_NPI | Organization NPI Number (Encounter) | |
22 | ORG_TXNMY_CD | Organization Taxonomy Code | |
23 | | Rendering Physician NPI (Encounter) | |
24 | AT_PHYSN_NPI | Claim Attending Physician NPI Number (Encounter) | |
25 | AT_PHYSN_TXNMY_CD | Claim Attending Physician Taxonomy Code | |
26 | OP_PHYSN_NPI | Claim Operating Physician NPI Number (Encounter) | |
27 | OT_PHYSN_NPI | Claim Other Physician NPI Number (Encounter) | |
28 | CLM_ADMSN_DT | Claim Admission Date (Encounter) | |
29 | CLM_IP_ADMSN_TYPE_CD | Claim Inpatient Admission Type Code (Encounter) | |
30 | CLM_SRC_IP_ADMSN_CD | Claim Source Inpatient Admission Code (Encounter) | |
31 | PTNT_DSCHRG_STUS_CD | Patient Discharge Status Code (Encounter) | |
32 | CLM_DAY_CNT | Day Count (Length of Stay) | |
33 | BENE_DSCHRG_DT | Beneficiary Discharge Date | |
34 | CLM_DRG_CD | Claim Diagnosis Related Group Code (or MS-DRG Code) | |
35 | DRVD_DRG_CD | Derived MS-Diagnosis Related Group Code (MS-DRG) | |
36 | ADMTG_DGNS_CD | Claim Admitting Diagnosis Code (Encounter) | |
37 | PRNCPAL_DGNS_CD | Claim Principal Diagnosis Code (Encounter) | |
38 | ICD_DGNS_CD1 | Claim Diagnosis Code I (Encounter) | |
39 | ICD_DGNS_CD2 | Claim Diagnosis Code II (Encounter) | |
40 | ICD_DGNS_CD3 | Claim Diagnosis Code III (Encounter) | |
41 | ICD_DGNS_CD4 | Claim Diagnosis Code IV (Encounter) | |
42 | ICD_DGNS_CD5 | Claim Diagnosis Code V (Encounter) | |
43 | ICD_DGNS_CD6 | Claim Diagnosis Code VI (Encounter) | |
44 | ICD_DGNS_CD7 | Claim Diagnosis Code VII (Encounter) | |
45 | ICD_DGNS_CD8 | Claim Diagnosis Code VIII (Encounter) | |
46 | ICD_DGNS_CD9 | Claim Diagnosis Code IX (Encounter) | |
47 | ICD_DGNS_CD10 | Claim Diagnosis Code X (Encounter) | |
48 | ICD_DGNS_CD11 | Claim Diagnosis Code XI (Encounter) | |
49 | ICD_DGNS_CD12 | Claim Diagnosis Code XII (Encounter) | |
50 | ICD_DGNS_CD13 | Claim Diagnosis Code XIII (Encounter) | |
51 | ICD_DGNS_CD14 | Claim Diagnosis Code XIV (Encounter) | |
52 | ICD_DGNS_CD15 | Claim Diagnosis Code XV (Encounter) | |
53 | ICD_DGNS_CD16 | Claim Diagnosis Code XVI (Encounter) | |
54 | ICD_DGNS_CD17 | Claim Diagnosis Code XVII (Encounter) | |
55 | ICD_DGNS_CD18 | Claim Diagnosis Code XVIII (Encounter) | |
56 | ICD_DGNS_CD19 | Claim Diagnosis Code XIX (Encounter) | |
57 | ICD_DGNS_CD20 | Claim Diagnosis Code XX (Encounter) | |
58 | ICD_DGNS_CD21 | Claim Diagnosis Code XXI (Encounter) | |
59 | ICD_DGNS_CD22 | Claim Diagnosis Code XXII (Encounter) | |
60 | ICD_DGNS_CD23 | Claim Diagnosis Code XXIII (Encounter) | |
61 | ICD_DGNS_CD24 | Claim Diagnosis Code XXIV (Encounter) | |
62 | ICD_DGNS_CD25 | Claim Diagnosis Code XXV (Encounter) | |
63 | CLM_POA_IND_SW1 | Claim Diagnosis Code I Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
64 | CLM_POA_IND_SW2 | Claim Diagnosis Code II Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
65 | CLM_POA_IND_SW3 | Claim Diagnosis Code III Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
66 | CLM_POA_IND_SW4 | Claim Diagnosis Code IV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
67 | CLM_POA_IND_SW5 | Claim Diagnosis Code V Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
68 | CLM_POA_IND_SW6 | Claim Diagnosis Code VI Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
69 | CLM_POA_IND_SW7 | Claim Diagnosis Code VII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
70 | CLM_POA_IND_SW8 | Claim Diagnosis Code VIII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
71 | CLM_POA_IND_SW9 | Claim Diagnosis Code IX Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
72 | CLM_POA_IND_SW10 | Claim Diagnosis Code X Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
73 | CLM_POA_IND_SW11 | Claim Diagnosis Code XI Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
74 | CLM_POA_IND_SW12 | Claim Diagnosis Code XII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
75 | CLM_POA_IND_SW13 | Claim Diagnosis Code XIII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
76 | CLM_POA_IND_SW14 | Claim Diagnosis Code XIV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
77 | CLM_POA_IND_SW15 | Claim Diagnosis Code XV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
78 | CLM_POA_IND_SW16 | Claim Diagnosis Code XVI Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
79 | CLM_POA_IND_SW17 | Claim Diagnosis Code XVII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
80 | CLM_POA_IND_SW18 | Claim Diagnosis Code XVIII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
81 | CLM_POA_IND_SW19 | Claim Diagnosis Code XIX Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
82 | CLM_POA_IND_SW20 | Claim Diagnosis Code XX Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
83 | CLM_POA_IND_SW21 | Claim Diagnosis Code XXI Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
84 | CLM_POA_IND_SW22 | Claim Diagnosis Code XXII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
85 | CLM_POA_IND_SW23 | Claim Diagnosis Code XXIII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
86 | CLM_POA_IND_SW24 | Claim Diagnosis Code XXIV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
87 | CLM_POA_IND_SW25 | Claim Diagnosis Code XXV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
88 | CLM_1ST_DGNS_E_CD | First Claim Diagnosis E Code (Encounter) | |
89 | ICD_DGNS_E_CD1 | Claim Diagnosis E Code I (Encounter) | |
90 | ICD_DGNS_E_CD2 | Claim Diagnosis E Code II (Encounter) | |
91 | ICD_DGNS_E_CD3 | Claim Diagnosis E Code III (Encounter) | |
92 | ICD_DGNS_E_CD4 | Claim Diagnosis E Code IV (Encounter) | |
93 | ICD_DGNS_E_CD5 | Claim Diagnosis E Code V (Encounter) | |
94 | ICD_DGNS_E_CD6 | Claim Diagnosis E Code VI (Encounter) | |
95 | ICD_DGNS_E_CD7 | Claim Diagnosis E Code VII (Encounter) | |
96 | ICD_DGNS_E_CD8 | Claim Diagnosis E Code VIII (Encounter) | |
97 | ICD_DGNS_E_CD9 | Claim Diagnosis E Code IX (Encounter) | |
98 | ICD_DGNS_E_CD10 | Claim Diagnosis E Code X (Encounter) | |
99 | CLM_E_POA_IND_SW1 | Claim Diagnosis E Code I Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
100 | CLM_E_POA_IND_SW2 | Claim Diagnosis E Code II Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
101 | CLM_E_POA_IND_SW3 | Claim Diagnosis E Code III Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
102 | CLM_E_POA_IND_SW4 | Claim Diagnosis E Code IV Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
103 | CLM_E_POA_IND_SW5 | Claim Diagnosis E Code V Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
104 | CLM_E_POA_IND_SW6 | Claim Diagnosis E Code VI Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
105 | CLM_E_POA_IND_SW7 | Claim Diagnosis E Code VII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
106 | CLM_E_POA_IND_SW8 | Claim Diagnosis E Code VIII Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
107 | CLM_E_POA_IND_SW9 | Claim Diagnosis E Code IX Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
108 | CLM_E_POA_IND_SW10 | Claim Diagnosis E Code X Diagnosis Present on Admission (POA) Indicator Code (Encounter) | |
109 | ICD_PRCDR_CD1 | Claim Procedure Code I (Encounter) | |
110 | ICD_PRCDR_CD2 | Claim Procedure Code II (Encounter) | |
111 | ICD_PRCDR_CD3 | Claim Procedure Code III (Encounter) | |
112 | ICD_PRCDR_CD4 | Claim Procedure Code IV (Encounter) | |
113 | ICD_PRCDR_CD5 | Claim Procedure Code V (Encounter) | |
114 | ICD_PRCDR_CD6 | Claim Procedure Code VI (Encounter) | |
115 | ICD_PRCDR_CD7 | Claim Procedure Code VII (Encounter) | |
116 | ICD_PRCDR_CD8 | Claim Procedure Code VIII (Encounter) | |
117 | ICD_PRCDR_CD9 | Claim Procedure Code IX (Encounter) | |
118 | ICD_PRCDR_CD10 | Claim Procedure Code X (Encounter) | |
119 | ICD_PRCDR_CD11 | Claim Procedure Code XI (Encounter) | |
120 | ICD_PRCDR_CD12 | Claim Procedure Code XII (Encounter) | |
121 | ICD_PRCDR_CD13 | Claim Procedure Code XIII (Encounter) | |
122 | PRCDR_DT1 | Claim Procedure Code I Date (Encounter) | |
123 | PRCDR_DT2 | Claim Procedure Code II Date (Encounter) | |
124 | PRCDR_DT3 | Claim Procedure Code III Date (Encounter) | |
125 | PRCDR_DT4 | Claim Procedure Code IV Date (Encounter) | |
126 | PRCDR_DT5 | Claim Procedure Code V Date (Encounter) | |
127 | PRCDR_DT6 | Claim Procedure Code VI Date (Encounter) | |
128 | PRCDR_DT7 | Claim Procedure Code VII Date (Encounter) | |
129 | PRCDR_DT8 | Claim Procedure Code VIII Date (Encounter) | |
130 | PRCDR_DT9 | Claim Procedure Code IX Date (Encounter) | |
131 | PRCDR_DT10 | Claim Procedure Code X Date (Encounter) | |
132 | PRCDR_DT11 | Claim Procedure Code XI Date (Encounter) | |
133 | PRCDR_DT12 | Claim Procedure Code XII Date (Encounter) | |
134 | PRCDR_DT13 | Claim Procedure Code XIII Date (Encounter) | |
135 | CLM_OBSLT_DT | Claim Obsolete Date | |
136 | CLM_BPRVDR_CITY_NAME | Billing Provider Address - City | |
137 | CLM_BPRVDR_USPS_STATE_CD | Billing Provider Address - USPS State Code | |
138 | CLM_BPRVDR_ADR_ZIP_CD | Billing Provider Zip Code | |
139 | CLM_SUBSCR_CITY_NAME | Medicare Subscriber Address - City | |
140 | CLM_SUBSCR_USPS_STATE_CD | Medicare Subscriber Address - USPS State Code | |
141 | CLM_SUBSCR_ADR_ZIP_CD | Medicare Subscriber Address - ZIP Code | |
142 | BENE_CNTY_CD | Beneficiary County Code from Claim (SSA) | |
143 | BENE_STATE_CD | Beneficiary Residence (SSA) State Code (Encounter) | |
144 | BENE_MLG_CNTCT_ZIP_CD | Beneficiary ZIP Code of Residence from Claim | |
145 | GNDR_CD | Gender Code from Encounter record | |
146 | BENE_RACE_CD | Beneficiary Race Code (Encounter) | |
147 | DOB_DT | Date of Birth from Encounter | |
148 | BENE_MDCR_STUS_CD | Beneficiary Medicare Status Code | |
149 | TAX_NUM | Provider Tax Number | |
150 | BENE_STATE | State of beneficiary (postal abbreviation) | |